[Fear of childbirth among nulliparous women: Relations with pain during delivery, post-traumatic stress symptoms, and postpartum depressive symptoms]. / La peur de l'accouchement chez des nullipares: lien avec la douleur lors de l'accouchement, les symptômes de stress post-traumatique et les symptômes dépressifs post-partum.

OBJECTIVE: Fear of childbirth is common in women who are pregnant with their first child and is associated with important consequences such as abortions and miscarriages. Twenty percent of nulliparous women seem to exhibit a mild or moderate fear, while 6% present an excessive and irrational fear known as tocophobia. Tocophobia is suggested to be associated with many negative consequences such as postpartum depression (PPD) and Post-traumatic stress (PTS). However, there is little empirical evidence to support these relationships. Recently, Fairbrother and Woody (2007) did not observe a link between the fear of childbirth and symptoms of PPD and PTS in nulliparous women. Some results, near the significance level, could be explained by a lack of statistical power. The present study focused on the link between the fear of childbirth and the process of delivery, the perception of pain, PPD and PTS. More specifically, it aimed to test three hypotheses: (i) fear of childbirth will be linked to the process of delivery, especially regarding the perception of pain, the use of anaesthesia and the use of Caesarean section; (ii) a high level of fear of childbirth will be associated with more negative postpartum consequences (namely PPD/PTS symptoms); (iii) the process of delivery and pain will also be related to post-delivery symptoms. Mediation effects were tested. METHOD: Data from a longitudinal study were used to meet the hypotheses. A total of 176 nulliparous pregnant women responded to questionnaires at two time measurements (during pregnancy and at 5weeks postpartum). RESULTS: Fear of childbirth is related to the perception of pain at birth among women delivering vaginally, in the absence of anaesthesia. It is also linked to symptoms of PPD and PTS, regardless of whether or not anaesthesia was used. Fear of childbirth also appears to be strongly associated to symptoms of PTS in women who have experienced an unplanned caesarean section. Thus, symptoms of postpartum PTS could play a mediating role in the link between fear of childbirth and PPD. CONCLUSIONS: These results support the relevance of taking into account the fear of childbirth and perception of pain in connection with symptoms of PTS and PPD in nulliparous women. The unplanned caesarean section (including emergency caesarean) also appears to be important in the study of the relationship between fear and symptoms of PTS. Fear of childbirth could render the experience of childbearing more negative and predispose to PTS and PPD. Enabling psychological vulnerabilities could also be an interesting avenue for understanding these links. Limitations are discussed.

[French adaptation and validation of a scale measuring the fear of childbirth]. / Évaluation de la peur de l'accouchement. Validation et adaptation française d'une échelle mesurant la peur de l'accouchement.

OBJECTIVES: The fear of childbirth, a central aspect of tokophobia, recently started to capture the attention of the scientific community as a potential determinant of obstetric and post-natal complications. However, studies on this subject are still few and this can be partly explained by the lack of validated instruments, especially in French. This paper presents the results from two studies designed to develop and evaluate the psychometric properties of a French version of the Traumatic Event Scale (TES), adapted to assess fear of childbirth (Söderquist et al., 2004 [21]). METHOD: The first study presents details regarding the development of this scale and checks the quality of the resulting items as well as their internal consistency, convergent validity and factorial validity. This study relied on a sample of 65 mothers with at least one child under the age of 36 months. In the second study, the psychometric properties of the instrument developed in Study 1 were tested more systematically on a sample of 204 women who were at the time experiencing their first pregnancy. RESULTS AND CONCLUSION: The results from the first study show adequate psychometric properties, strong correlations with measurements assessing worry, and support a five factor model. Results from this second study replicated the results from the first one on the basis of confirmatory factor analyses. Findings presented in these studies confirm that this instrument presents very good psychometric properties as a measurement of the fear of childbirth in pregnant women.

Evolution of subcutaneous adipose tissue fibrosis after bariatric surgery.

AIM: Obesity is associated with the development of metabolic complications such as insulin resistance (IR). The mechanisms leading to IR remain unclear. This study aimed to investigate the relationship between adipose tissue fibrosis and IR in obese patients before and after bariatric surgery. METHODS: Thirty-five obese patients awaiting bariatric surgery (12 with type 2 diabetes) were included in the study. Non-diabetic patients were classified as either insulin-sensitive (n=11) or insulin-resistant (n=12), based on the Matsuda insulin sensitivity index (ISIMatsuda). Homoeostasis model assessment (HOMA-IR) was used for longitudinal evaluation of insulin resistance. Fibrosis was quantified by Masson's trichrome staining on microscopy, and mRNA levels of fibrosis-related genes were examined in subcutaneous (SAT) and visceral adipose tissue (VAT) biopsies collected during and 6 months after bariatric surgery (SAT only). RESULTS: Despite their similar age, body mass index and fat mass, SAT fibrosis was significantly higher in diabetic vs insulin-sensitive patients (P<0.05), and associated with IR as assessed by both ISIMatsuda (r=-0.417, P=0.038) and HOMA-IR (r=0.464, P=0.007) at baseline, whereas VAT fibrosis was not. Six months after surgery and significant weight loss, fibrosis levels remained unchanged in SAT, although IR was significantly reduced in all groups (P<0.0001). No correlation was found between SAT fibrosis and IR after surgery. CONCLUSION: Overall, these results show a significant but, most likely, transient association between SAT fibrosis and IR in obese humans.

Agreement of bioelectric impedance analysis and dual-energy X-ray absorptiometry for body composition evaluation in adults with cystic fibrosis.

Malnutrition in cystic fibrosis (CF) is associated with increased mortality and can lead to fat-free (FFM) and fat mass (FM) loss. Dual-energy X-ray absorptiometry (DXA) is used and validated to measure FFM and FM. DXA's high cost has led to the utilization of less costly techniques such as bioelectrical impedance analysis (BIA). The aim of this study was to determine the agreement of FFM, FM and %FM measurements taken with DXA and BIA in adults with CF. We measured FFM, FM and %FM in 34 adults with CF with a leg-to-leg BIA and an iDXA and determined agreement using Bland-Altman analysis. While DXA and BIA measurements were well correlated (r > 0.8), mean biases between both methods were between 8 and 11%. BIA underestimated FM and %FM and overestimated FFM. In a clinical research setting where these measurements are used to phenotype patients, BIA cannot replace DXA.

Scanning electron microscope (SEM) evaluation of clinical failures of single crystal ceramic brackets.

The objective of this work was to perform failure analysis on Starfire brackets that failed in clinical use. The failed brackets were examined with a scanning electron microscope (SEM) to obtain micrographs at magnifications of 20, 50, 100, and other magnifications, whenever necessary. With the aid of the micrographs, the fracture origin and the probable defect that initiated the fracture were identified. The percentages of failure origins for each area of the bracket were arch wire slot 36.0%, tie wing slot 22.0%, undetermined 11.0%, saddle 9.0%, impact 9.0%, during removal 7.5%, and parting area 5.5%. By observing the micrographs pertaining to each field failure, the primary causes of failure were internal defects 47.5%, machining interference 42.5%, and undetermined 10.0%.