Exposure assessment and cytogenetic biomonitoring study of workers occupationally exposed to extremely low-frequency magnetic fields.

Human cytogenetic biomonitoring (HCB) has long been used to evaluate the potential effects of work environments on the DNA integrity of workers. However, HCB studies on the genotoxic effects of occupational exposure to extremely low-frequency electromagnetic fields (ELF-MFs) were limited by the quality of the exposure assessment. More specifically, concerns were raised regarding the method of exposure assessment, the selection of exposure metrics, and the definition of exposure group. In this study, genotoxic effects of occupational exposure to ELF-MFs were assessed on peripheral blood lymphocytes of 88 workers from the electrical sector using the comet and cytokinesis-block micronucleus assay, considering workers' actual exposure over three consecutive days. Different methods were applied to define exposure groups. Overall, the summarized ELF-MF data indicated a low exposure level in the whole study population. It also showed that relying solely on job titles might misclassify 12 workers into exposure groups. We proposed combining hierarchical agglomerative clustering on personal exposure data and job titles to define exposure groups. The final results showed that occupational MF exposure did not significantly induce more genetic damage. Other factors such as age or past smoking rather than ELF-MF exposure could affect the cytogenetic test outcomes.

International collaboration to improve physiotherapists' training, Viet Nam.

Problem: Like most low- and middle-income countries, Viet Nam has a scarcity of rehabilitation professionals and lacks training programmes that meet international standards. Approach: In 2018, four Vietnamese medical universities, the Université Catholique de Louvain, the Université Libre de Bruxelles, the Humanity & Inclusion charity and World Physiotherapy agreed to collaborate on strengthening pre-service education for physiotherapists in the country. Local setting: Viet Nam has a favourable environment for nurturing rehabilitation services and education: development funds have been available; government investment is increasing; and rehabilitation education has existed for many decades. Relevant changes: The collaboration resulted in the establishment of: (i) a 4-year, competency-based, entry-level curriculum for physiotherapists (bachelor's degree); (ii) opportunities for continuing professional development; (iii) a 2-year master's programme for physiotherapy lecturers and clinical supervisors; and (iv) a national physiotherapy association. In addition, four students were supported in studying for PhD degrees. Strong collaboration and comprehensive and complementary interventions have laid the foundations for sustainable, high-quality, educational programmes for physiotherapists, which will improve access to, and the standard of, rehabilitation services in Viet Nam, thereby leading to better patient outcomes. Lessons learnt: Curricula for entry-level physiotherapy programmes should be competency-based, be actively managed by national educators and meet international standards while being responsive to local priorities. To strengthen the rehabilitation workforce, educators involved in teaching and supervising training programmes should have the skills and knowledge required. A national professional physiotherapy association should be established to provide continuing professional development for physiotherapists and to take part in international collaborations.

Anatomical study of paratenons and fascia lata connections in the posteromedial knee region.

INTRODUCTION: In the last decade, fascia research increased significantly in various aspects such as anatomical and biomechanical features related to epimuscular force transmission. METHODS: The present anatomic study focuses on macroscopic observations of the potential gracilis and semitendinosus paratenons, as well as fascial surroundings connections in the posteromedial knee region on 17 lower-limbs dissections. RESULTS: The gracilis and semitendinosus expansions and paratenons were observed in all specimen and further connections with the fascia lata and crural fascia were demonstrated. Contrary to the previously described expansions connected to the tendons, we observed that the expansions were the edges of the paratenon tunnel and that the paratenon structure surrounded the overall muscle. Both paratenons of gracilis and semitendinosus were connected to the crural fascia and, respectively, to the sartorius fascia (part of the fascia lata), to the semimembranosus and the fascia lata. Furthermore, numerous connections between the fascia lata and the neighboring structures in the posteromedial knee region are described. DISCUSSION-CONCLUSION: The present study describes for the first time gracilis and semitendinosus paratenons and other surrounding fascial connections. Such macroscopic observations may represent a new basis for further characterization of the myofascial pathway of epimuscular force transmission in the knee region.

Consequences of Female Genital Mutilation on Women's Sexual Health - Systematic Review and Meta-Analysis.

BACKGROUND: Female genital mutilation (FGM) can leave a lasting mark on the lives and minds of those affected. AIM: To assess the consequences of FGM on women's sexual function in women who have undergone FGM compared to women who have not undergone FGM. METHODS: A systematic review and meta-analysis were conducted from 3 databases; inclusion and exclusion criterions were determined. Studies included adult women having undergone FGM and presenting sexual disorders assessed by the Female Sexual Function Index (FSFI). RESULTS: Of 129 studies, 5 that met the criteria were selected. The sexual function of mutilated women, based on the FSFI total score and its different domains, was compared to the sexual function of non-mutilated women. There was a significant decrease in the total FSFI scores of mutilated women compared to non-mutilated women. However, the results obtained for the different domains were not the same for all authors. The meta-analysis highlighted a high heterogeneity with inconsistency and true variance in effect size between-studies. CONCLUSION: Analysis of studies showed that there is a significant decrease in the total FSFI score, indicating that FGM of any type may cause impaired sexual functioning. But a firm conclusion on this topic is not yet achievable because the results of this analysis do not allow to conclude a cause and effect relationship of FGM on sexual function. Nzinga A-M, De Andrade Castanheira S, Herklmann J, et al. Consequences of Female Genital Mutilation on Women's Sexual Health - Systematic Review and Meta-Analysis. J Sex Med 2021;18:750-760.

The biomechanical role of the lacertus fibrosus of the biceps brachii Muscle.

PURPOSE: The lacertus fibrosus (LF) is involved in various surgeries. However, the biomechanical contribution of the LF remains unclear. The aim of this study was to determine the role of the lacertus fibrosus on the elbow and forearm kinematics and on the biceps brachii muscle lever arms. METHODS: This biomechanical study was performed on seven fresh-frozen upper limbs of cadavers. Elbow flexion, forearm supination, and biceps brachii muscle lever arms were analyzed in the intact conditions (I) and after superficial (R) and deep part (R2) of the lacertus fibrosus release, respectively. RESULTS: Elbow flexion shows a significant difference (p < 0.0001) between I, R, R2. Abduction/adduction shows a significant difference between I-R (p < 0.0001) and I-R2 (p < 0.0001). Supination does not show a significant difference in mean maximum amplitude, but between 40 and 70%, there are significant differences. There is a significant mean decrease of lever arm in flexion (28%) and supination (50%) after superficial and deep part of the lacertus fibrosus release. CONCLUSION: The results of this study show that the lacertus fibrosus increases the lever arm during flexion and supination. It limits the flexion and abduction of the elbow and supination of the forearm. Lacertus fibrosus maintains the rhythmicity between the elbow flexion and supination of the forearm. LEVEL OF EVIDENCE: Basic science study, biomechanics.

Reaction Force Magnitude and Orientation During Supine Thoracic Spine Thrust Manipulation: An Exploratory Analysis and Reliability of Preload and Impulse Phase.

OBJECTIVE: The main purpose of this study was to explore specific kinetic parameters during supine thoracic thrust manipulation and to analyze task reliability and differences between various practitioners METHODS: Kinetic parameters were assessed by examining ground reaction force magnitude and orientation (on the basis of the zenithal angle) using force platforms. The manipulative procedure (consisting of the application of 3 preloads followed by 1 single thrust adjustment) was performed by different practitioners at 3 sessions. Application of thrust was allowed for trained practitioners only. Preload force, peak force, and vector force orientation were compared between sessions and practitioners. RESULTS: Reliability analysis showed that practitioners achieved similar preload and peak force independent of the session, with comparable force orientation data. Differences between practitioners were observed for preload and peak force but not regarding the zenithal angle during the thrust phase. CONCLUSION: This study is the first that explores kinetic parameters for supine thoracic thrust manipulation. Task repeatability was confirmed and several differences were observed between practitioners. Certainly, there is a need for further investigation examining both dynamic parameters (ie, velocity and accelerations) and the potential neurologic effect of such manipulative technique.

Three-Corner Arthrodesis (lunate - hamate - capitate) : clinical and kinematical evaluation.

In the absence of prosthetic arthroplasty offering good results for the treatment of wrist osteoarthritis, we studied the arthrodesis of three carpal bones (lunate - hamate - capitate) completed by triquetrum and scaphoid excision in the presence of Scapholunate Advanced Collapse (SLAC) or Scaphoid Nonunion Advanced Collapse (SNAC) stage II or III. Clinical data on eight patients between the ages of 32 and 61 years at an average of 29 months after surgery was analyzed. Seven patients reached fusion with a carpal height ratio of 0.39. These arc of dorsal-palmar flexion (DPF) attended 54° and the arc of radio-ulnar deviation (RUD) 29° using the optoelectronic stereophotogrammetry system. The mean polar radius (R) was 14.5° and the envelope shape coefficient (K) was 1.66. This operation could be considered as an alternative for the treatment of patients suffering of SNAC or SLAC stage II and III. Type of study/level of evidence : Therapeutic IV.

Joint contact areas after radial head arthroplasty: a comparative study of 3 prostheses.

BACKGROUND: Contact stresses of radial head prostheses remain a concern, potentially leading to early capitellar cartilage wear and erosion. In particular, point contact or edge loading could have a detrimental effect. The purpose of this study was to compare 3 different types of radial head prostheses in terms of joint contact areas with each other and with the native situation. The hypothesis was that the joint contact areas would be lower after monopolar arthroplasty. METHODS: Seven fresh-frozen cadaveric upper limbs were used. Radiocapitellar contact areas of a monopolar design, a straight-neck bipolar design, and an angled-neck bipolar design were compared with each other and with the native joint. After standardized preparation, polysiloxane was injected into the loaded radiocapitellar joint to create a cast from which the joint contact area was measured. Measurements were performed at 3 angles of elbow flexion and in 3 different forearm positions. RESULTS: In the native elbow, contact areas were highest in supination. Elbow flexion had no significant effect on native and prosthetic joint contact areas. Contact areas were decreased for all types of arthroplasties compared with the native joint (from 11% to 53%). No significant contact area difference was found between the 3 designs. However, bipolar prostheses showed lateral subluxation in neutral forearm rotation, resulting in a significant decrease in the contact areas from pronation to the neutral position. CONCLUSIONS: All types of radial head prostheses tested showed a significant decrease in radiocapitellar contact area compared with the native joint. Bipolar designs led to subluxation of the radial head, further decreasing radiocapitellar contact.

Automated functional upper limb evaluation of patients with Friedreich ataxia using serious games rehabilitation exercises.

BACKGROUND: Friedreich ataxia (FRDA) is a disease with neurological and systemic involvement. Clinical assessment tools commonly used for FRDA become less effective in evaluating decay in patients with advanced FRDA, particularly when they are in a wheelchair. Further motor worsening mainly impairs upper limb function. In this study, we tested if serious games (SG) developed for rehabilitation can be used as an assessment tool for upper limb function even in patients with advanced FRDA. METHODS: A specific SG has been developed for physical rehabilitation of patients suffering from neurologic diseases. The use of this SG, coupled with Kinect sensor, has been validated to perform functional evaluation of the upper limbs with healthy subjects across lifespan. Twenty-seven FRDA patients were included in the study. Patients were invited to perform upper limb rehabilitation exercises embedded in SG. Motions were recorded by the Kinect and clinically relevant parameters were extracted from the collected motions. We tested if the existence of correlations between the scores from the serious games and the severity of the disease using clinical assessment tools commonly used for FRDA. Results of patients were compared with a group a healthy subjects of similar age. RESULTS: Very highly significant differences were found for time required to perform the exercise (increase of 76%, t(68) = 7.22, P < 0.001) and for accuracy (decrease of 6%, t(68) = - 3.69, P < 0.001) between patients and healthy subjects. Concerning the patients significant correlations were found between age and time (R = 0.65, p = 0.015), accuracy (R = - 0.75, p = 0.004) and the total displacement of upper limbs. (R = 0.55, p = 0.031). Statistically significant correlations were found between the age of diagnosis and speed related parameters. CONCLUSIONS: The results of this study indicate that SG reliably captures motor impairment of FRDA patients due to cerebellar and pyramidal involvement. Results also show that functional evaluation of FRDA patients can be performed during rehabilitation therapy embedded in games with the patient seated in a wheelchair. TRIAL REGISTRATION: The study was approved as a component of the EFACTS study ( Clinicaltrials.gov identifier NCT02069509 , registered May 2010) by the local institutional Ethics Committee (ref. P2010/132).

Pregnancy and pelvic girdle pain: Analysis of pelvic belt on pain.

AIMS AND OBJECTIVES: To analyse pain and functional capacity in women with pelvic girdle pain and to evaluate the effect of pelvic belt on these parameters. Two types of belts were to compare. BACKGROUND: Pelvic girdle pain is very common during pregnancy. To prevent and relieve pelvic pain, women can use a set of techniques and tools such as a pelvic belt. While scientific evidence is lacking, commercial industries suggest the effectiveness of pelvic belts. DESIGN: Randomised control trial. METHODS: Forty-six pregnant women with pelvic girdle pain were evaluated. Pain analysis included a quantitative and a qualitative assessment. A daily activities questionnaire was used for functional capacity evaluation. Women were tested at two times during the pregnancy for a longitudinal evaluation, and they used one of the two belt models during their pregnancy. RESULTS: Pelvic pain started between the 14th-21st week of pregnancy. Pain intensity was 60 ± 20 mm. Daily activities could increase pain. The use of belts reduced pain. The intensity of pain decreased by 20 mm on a visual analogue scale. The daily activities were also easier. However, all these conclusions are valid only if pregnant women used belts regularly on short periods. CONCLUSIONS: The belts appear to be interesting tools to reduce pelvic pain and improve comfort of pregnant women. This effect might be explained by an analgesic effect with proprioceptive and biomechanical effect. The different types of belts could have differential effects on global, sacroiliac joint and back pain during pregnancy, but this hypothesis requires confirmation. RELEVANCE TO CLINICAL PRACTICE: Relevant for patient: to use an easy and validated tool. Relevant for clinical practice: to suggest a tool scientifically validated for patient. Relevant to economic issues: belts decrease pelvic pain and increase comfort of pregnant women. Sick leave could decrease.

Relationship Between Subjective Experience of Individuals, Practitioner Seniority, Cavitation Occurrence, and 3-Dimensional Kinematics During Cervical Spine Manipulation.

OBJECTIVE: The purpose of this study was to assess individual subjective experience (ISE) of the recipients of a cervical manipulation and to analyze the influence of kinematics, cavitation occurrence, and practitioner seniority on individual experience. METHODS: Practitioners with different seniority (years of experience) manipulated 20 asymptomatic volunteers at C3 and C5 on both sides. Kinematics were recorded using a 3-dimensional electrogoniometer, and ISE data were gathered through a questionnaire to explore the subjects' experiences of manipulation in terms of tactile sensations, relaxation, perception of the task, and therapist handling. Kinematics, occurrence of cavitation, practitioner's seniority, and ISE data were analyzed concurrently. RESULTS: Motion parameters obtained during manipulation were found to be influenced by cavitation occurrence and differences between practitioners. Data analysis indicated that ISE could be grouped into 2 factors. The first revolved around grip firmness and range and speed of practitioner's gesture. The second factor represented patient's relaxation and the precision of handling. Also, most ISE data correlated with kinematics, although a subjective measurement did not always correlate the highest with its objective counterpart. When cavitation occurred, ISE ratings were higher, suggesting that participants may associate cavitation with the success of manipulations. Higher practitioner seniority (more years of experience) induced feelings of higher speed, amplitude, firmness, and precision. CONCLUSIONS: Recipients of cervical manipulation experienced different subjective feelings that can be expressed in 2 dimensions. These feelings are influenced by cavitation occurrence and practitioner's seniority. A better understanding of an individual's subjective experience related to cervical manipulation could increase confidence and improve the patient-therapist relationship, and it may provide further therapeutic perspectives for the practitioners.

Head repositioning accuracy in patients with neck pain and asymptomatic subjects: concurrent validity, influence of motion speed, motion direction and target distance.

BACKGROUND: Cervicocephalic kinesthetic deficiencies have been demonstrated in patients with chronic neck pain (NP). On the other hand, authors emphasized the use of different motion speeds for assessing functional impairment of the cervical spine. PURPOSE: The objectives of this study were (1) to investigate the head repositioning accuracy in NP patients and control subjects and (2) to assess the influence of target distance, motion speed, motion direction and pain. MATERIALS AND METHODS: Seventy-one subjects (36 healthy subjects and 35 NP patients; age 30-55 years) performed the head repositioning test (HRT) at two different speeds for horizontal and vertical movements and at two different distances. For each condition, six consecutive trials were sampled. RESULTS: The study showed the validity and reproducibility of the HRT, confirming a dysfunctional threshold of 4.5°. Normative values of head repositioning error up to 3.6° and 7.1° were identified for healthy and NP subjects, respectively. A distance of 180 cm from the target and a natural motion speed increased HRT accuracy. Repositioning after extension movement showed a significantly larger error in both groups. Intensity, duration of pain as well as pain level did not significantly alter head repositioning error. CONCLUSIONS: The assessment of proprioceptive performance in healthy and NP subjects allowed the validation of the HRT. The HRT is a simple, not expensive and fast test, easily implementable in daily practice to assess and monitor treatment and evolution of proprioceptive cervical deficits.

The effect of humerus diaphyseal shortening on brachial plexus tension: a cadaver study.

PURPOSE: To assess the extent to which diaphyseal shortening of the humerus can allow direct suture in case of rupture or transection injuries of the brachial plexus. METHODS: The use of 3 fresh cadaver specimens allowed for the study of 6 brachial plexuses. Distance measurements were made between reference points placed on the clavicle and on different parts of the plexus. Those measurements were repeated after shortening the humerus by 2, 4, and 6 cm. RESULTS: None of the dissected plexuses had classic anatomy. A humeral shortening of 6 cm allowed for a statistically significant reduction of length between the supraclavicular part of the plexus and the terminal branches, which did not exceed 17 mm on average. The difference of length was much greater for the specimen in which the musculocutaneous nerve did not pierce the coracobrachialis muscle proximally. CONCLUSIONS: In clinical situations, nerve defects are usually larger than the gain observed when doing a 6-cm humeral shortening. Moreover, this procedure implies a large dissection, a functional loss of certain muscles, and a risk of humeral nonunion. CLINICAL RELEVANCE: In the absence of extensive nerve dissection, the observed change of length is insufficient in the most brachial plexus disruptions to allow for a direct suture instead of long nerve grafts.

Head-trunk kinematics during high-velocity-low-amplitude manipulation of the cervical spine in asymptomatic subjects: helical axis computation and anatomic motion modeling.

OBJECTIVE: This study aimed to analyze the in vivo 3-dimensional kinematics of the head during cervical manipulation including helical axis (HA) computation and anatomic motion representation. METHODS: Twelve asymptomatic volunteers were included in this study. An osteopathic practitioner performed 1 to 3 manipulations (high-velocity and low-amplitude [HVLA] multiple component technique) of the cervical spine (between C2 and C5) with the patient in the sitting position. During manipulation, head motion was collected using an optoelectronic system and expressed relative to the thorax. Motion data were processed to analyze primary and coupled motions and HA parameters. Anatomic motion representation including HA was obtained. RESULTS: During manipulation, average maximal range of motion was 39° (SD, 6°), 21° (SD, 7°), and 8° (SD, 5°) for lateral bending (LB), axial rotation (AR), and flexion extension, respectively. For the impulse period, magnitude averaged of 8° (SD, 2°), 5° (SD, 2°), and 3° (SD, 2°), for LB, AR, and flexion extension, respectively. Mean impulse velocity was 139°/s (SD, 39°/s). Concerning AR/LB ratios, an average of 0.6 (SD, 0.3) was observed for global motion, premanipulation positioning, and impulse. Mean HA was mostly located ipsilateral to the impulse side and displayed an oblique orientation. CONCLUSION: This study demonstrated limited range of AR during cervical spine manipulation and provided new perspectives for the development of visualization tools, which might be helpful for practitioners and for the analysis of cervical manipulation using HA computation and anatomic representation of motion.

Influence of movement speed on cervical range of motion.

PURPOSE: Cervical range of motion (RoM) has been the subject of many studies. However, only very few of these studies have considered the influence of movement execution speed on the cervical kinematics. The aim of this study is to evaluate the influence of movement speed on cervical RoM. METHOD: Cervical RoM was recorded using an optoelectronic system; 32 healthy subjects performed movements in two modes: the best possible and as fast as possible. OUTCOME MEASURES: The primary movements (flexion-extension, lateral bending, axial rotation) and coupled movements were studied. Paired Student's tests were performed to compare the two modes of movement. RESULTS: The results showed that cervical RoM differed significantly between movement speeds. Amplitudes were higher for each movement (p < 0.001 for flexion-extension, p < 0.001 for lateral flexion, p = 0.008 for axial rotations) when movements were performed as quickly as possible. The range of movements carried out the best possible reached only 95% of those during movements carried out as fast as possible. Concerning coupled movements, an increase in rotational movements coupled to lateral flexion during fast movements was observed. CONCLUSION: The range of motion reported in the literature corresponds to movement carried out in a mode resembling the best possible of our study. Movements made as quickly as possible can display larger motion ranges.

The lacertus fibrosus of the biceps brachii muscle: an anatomical study.

PURPOSE: The lacertus fibrosus (LF) is involved in various surgical procedures. However, the anatomy, morphometry, topography and biomechanical involvements of LF are not clear. The purpose of this study was to determine the anatomical and morphometric variations of LF, and to correlate this with anthropometric and morphometric measurements of the upper limb. Furthermore, the presence or absence of a deep layer of LF was verified using forearm cross-sections and dissections. METHODS: This anatomical study was performed by observation of dissections and transverse sections obtained from 50 cadavers. Morphometric analyses [length and width of LF and biceps tendon, stature, length of upper limb, forearm, bi-epicondylar width, forearm perimeter, biceps brachii muscle perimeter (BBm)] were also performed. RESULTS: The results demonstrated that there was no significant correlation between LF morphology and morphometric upper limb measurements. The deep layer of LF was observed in all specimens. CONCLUSION: Results of this paper indicate that the LF presents individual characteristics such as length and width. The deeper layer of LF was observed on all specimens. The possible role of LF in force transmission during flexion, BBm moment arm adjustment and supination reduction is discussed in view of these results.

Position paper on how technology for human motion analysis and relevant clinical applications have evolved over the past decades: Striking a balance between accuracy and convenience.

BACKGROUND: Over the past decades, tremendous technological advances have emerged in human motion analysis (HMA). RESEARCH QUESTION: How has technology for analysing human motion evolved over the past decades, and what clinical applications has it enabled? METHODS: The literature on HMA has been extensively reviewed, focusing on three main approaches: Fully-Instrumented Gait Analysis (FGA), Wearable Sensor Analysis (WSA), and Deep-Learning Video Analysis (DVA), considering both technical and clinical aspects. RESULTS: FGA techniques relying on data collected using stereophotogrammetric systems, force plates, and electromyographic sensors have been dramatically improved providing highly accurate estimates of the biomechanics of motion. WSA techniques have been developed with the advances in data collection at home and in community settings. DVA techniques have emerged through artificial intelligence, which has marked the last decade. Some authors have considered WSA and DVA techniques as alternatives to "traditional" HMA techniques. They have suggested that WSA and DVA techniques are destined to replace FGA. SIGNIFICANCE: We argue that FGA, WSA, and DVA complement each other and hence should be accounted as "synergistic" in the context of modern HMA and its clinical applications. We point out that DVA techniques are especially attractive as screening techniques, WSA methods enable data collection in the home and community for extensive periods of time, and FGA does maintain superior accuracy and should be the preferred technique when a complete and highly accurate biomechanical data is required. Accordingly, we envision that future clinical applications of HMA would favour screening patients using DVA in the outpatient setting. If deemed clinically appropriate, then WSA would be used to collect data in the home and community to derive relevant information. If accurate kinetic data is needed, then patients should be referred to specialized centres where an FGA system is available, together with medical imaging and thorough clinical assessments.

Systematic Review of Obstetric and Neonatal Complications Associated With Female Genital Mutilation.

OBJECTIVE: To assess the prevalence of obstetric and neonatal complications in women with female genital mutilation (FGM) compared to women without FGM. DATA SOURCES: Literature searches carried out on three scientific databases (CINAHL, ScienceDirect, and PubMed). STUDY SELECTION: Selected observational studies published from 2010 to 2021 that assessed prolonged second phase of labor, vaginal outlet obstruction, emergency cesarean birth, perineal tear, instrumental births, episiotomy, and postpartum hemorrhage in women with and without FGM, as well as Apgar score and resuscitation of their newborns. RESULTS: Nine studies were selected, including case-control, cohort, and cross-sectional studies. There were associations between FGM and vaginal outlet obstruction, emergency cesarean birth, and perineal tears. CONCLUSION: For obstetric and neonatal complications other than those listed in the "Results" section, researchers' conclusions remain divided. Still, there is some evidence to support the impact of FGM on obstetric and neonatal harm, particularly in cases of FGM Types II and III.

Psychological consequences of female genital mutilation: A mixed-method systematic review.

Background: Female genital mutilation (FGM/C) defined as 'all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons' is a cultural practice having several consequences on women's health. Medical and sexual consequences have been documented, but the link between FGM/C and the development of psychological symptoms is not clearly established. The influence of contextual factors is poorly understood. Objectives: To evaluate the psychological impact of FGM/C and how victims experience it. Method: A mixed method systematic review was conducted. The inclusion criteria were observational primary studies involving women who had undergone FGM/C and had experienced psychological symptoms. Publication bias was assessed by using the Mixed Methods Appraisal Tool. A configurative strategy that involved a comparison of quantitative and qualitative data was used, followed by an analysis of causal link between FGM/C and induced psychological disorders. Results: Fourteen studies were included. Post-traumatic stress disorder (PTSD), depression, anxiety and somatisation showed a significantly higher prevalence in women who have experienced FGM/C versus non-mutilated women. Female genital mutilation type II or III were identified as predictors of disorder severity. Qualitative studies showed a significant difference in the perception of FGM/C between immigrant and non-immigrant women, as well as the multidimensional nature of the factors influencing disorders' onsets. Conclusion: Our study showed a high association of FGM/C (and its degree of severity) with psychological disorders such as PTSD, depression, anxiety and somatisation. It also illustrates contextual factors, including socio-cultural factors that may influence the intensity of these psychological disorders. Clinical implications: It is important for health professionals to be aware of the psychological consequences of FGM/C and the different factors influencing FGM/C perception. Indeed, a feeling of 'Being abnormal' can be awakened among patients because of health professionals' incorrect behaviours.

The use of time-of-flight camera to assess respiratory rates and thoracoabdominal depths in patients with chronic respiratory disease.

INTRODUCTION: Over the last 5 years, the analysis of respiratory patterns presents a growing usage in clinical and research purposes, but there is still currently a lack of easy-to-use and affordable devices to perform such kind of evaluation. OBJECTIVES: The aim of this study is to validate a new specifically developed method, based on Kinect sensor, to assess respiratory patterns against spirometry under various conditions. METHODS: One hundred and one participants took parts in one of the three validations studies. Twenty-five chronic respiratory disease patients (14 with chronic obstructive pulmonary disease (COPD) [65 ± 10 years old, FEV1 = 37 (15% predicted value), VC = 62 (20% predicted value)], and 11 with lung fibrosis (LF) [64 ± 14 years old, FEV1 = 55 (19% predicted value), VC = 62 (20% predicted value)]) and 76 healthy controls (HC) were recruited. The correlations between the signal of the Kinect (depth and respiratory rate) and the spirometer (tidal volume and respiratory rate) were computed in part 1. We then included 66 HC to test the ability of the system to detect modifications of respiratory patterns induced by various conditions known to modify respiratory pattern (cognitive load, inspiratory load and combination) in parts 2 and 3. RESULTS: There is a strong correlation between the depth recorded by the Kinect and the tidal volume recorded by the spirometer: r = 0.973 for COPD patients, r = 0.989 for LF patients and r = 0.984 for HC. The Kinect is able to detect changes in breathing patterns induced by different respiratory disturbance conditions, gender and oral task. CONCLUSIONS: Measurements performed with the Kinect sensors are highly correlated with the spirometer in HC and patients with COPD and LF. Kinect is also able to assess respiratory patterns under various loads and disturbances. This method is affordable, easy to use, fully automated and could be used in the current clinical context. Respiratory patterns are important to assess in daily clinics. However, there is currently no affordable and easy-to-use tool to evaluate these parameters in clinics. We validated a new system to assess respiratory patterns using the Kinect sensor in patients with chronic respiratory diseases.