[Validation of the questionnaire for assessing the childbirth experience (QACE) in a French population]. / Validation de l'échelle d'évaluation du vécu de l'accouchement (QEVA) auprès d'une population française.

BACKGROUND: A woman's negative perception of her subjective childbirth experience can have consequences on the mother's psychological state and on early mother-baby relationships. To date, there is no validated tool in France allowing to evaluate childbirth experience in a multidimensional way. The aim of this study is to validate the Questionnaire Assessing the Childbirth Experience (QEVA) in a French sample of mothers. This tool was developed in a previous study where the authors combined 25 items into 6 dimensions: representations and expectations, sensory perceptions, feeling of control, perceived social support (medical staff and partner), emotions (positive and negative) and first moments with the baby. METHODS: The sample included 256 women recruited in a maternity ward. Sociodemographic and obstetric characteristics of our sample were compared to those of the French national perinatal survey. The structure of the QEVA with 17 items was explored by an exploratory structural equation modeling (ESEM). An analysis of the internal consistency was conducted on the sub-scores of the identified factors, and the concurrent validity was assessed with the Peri-traumatic Distress Inventory (PDI) through a correlation and its associated t-test. RESULTS: The characteristics of our sample and those of the national perinatal survey do not differ on age, marital status, parity, cannabis use, infertility treatment, epidural and baby weight, in favour of the good representativeness of our sample. The study of the QEVA structure revealed a 4-dimensional structure. Analysis of the psychometric qualities showed a good internal consistency, with an observed alpha value ranging from 0.69 to 0.86. The QEVA also shows a good concurrent validity with the peri-traumatic distress scores (r=0.51). CONCLUSION: To date, the QEVA is the first standardized tool allowing a multidimensional evaluation of the subjective experience of childbirth. It has been validated on a French population using an exploratory structural equation modeling. This tool, which is simple to use and well accepted by mothers, enables health professionals not only to screen mothers experiencing difficult childbirth and in need of support, but also to adapt health care according to the dimensions of the birth experience and its associated difficulties (emotions during the birth, interactions with health professionals, first moments with the baby, or post-partum emotions).

Language or music? Environmental influences on infants' handedness from 5 to 12 months.

The main purpose of this study was to test the influence of music environment on hand-use preference in infants from 5 to 12 months, compared to speech environment. According to hemispheric specialization, our hypothesis was that infants would reach for objects more with their right hand in a speech context (left hemisphere), and more with their left hand in a music context (right hemisphere). 61 full-term infants aged from 5 to 12 months participated in this study. A prehension task was proposed successively in two sound environments (music and speech) in a counterbalanced order. Left-, right-movement and/or bimanual movements were scored. Results show that whatever the sound context, from 8 months a lateral right bias occurs and increases strongly. However, 5- to 7-months-old infants used more their left hand when they listen to a piece of classical music that an adult speech. Bimanual movements were more frequent at 6 and 7 months than unimanual movements in the speech condition. Results are discussed in terms of manual specialization.

[Consultation liaison during the peripartum: Network care between liaison and mobile unit]. / La liaison en « Périnatalogie ¼ : des soins entre réseau, liaison et prise en charge mobile.

OBJECTIVES: The pregnancy periods of peripartum and immediate postpartum represent moments of opportunity to access care. Both prevention and therapeutic management can be offered with a better chance of success during these periods. Our specific Consultation Liaison (CL) team PPUMMA was created in order to respond to the need for early detection of psychopathology and rapid implementation of therapeutic management and preventive measure for mother and child. The importance of urgently intervening "on site" seemed a necessity since duration of hospitalization in maternity wards is very short. Women might not know or understand their symptoms or be ready to ask for a referral for themselves but could be ready to respond positively to a team approach where the psychiatrist is part of the Ob-Gyn department. Working with an interdisciplinary approach tends to lower stress linked to the psychiatric side of the consultation and stigma related to psychological or psychiatric issues; therefore, PPUMMA intervenes within 48 to 72hours of birth. It deals with assessment and diagnosis during the peripartum period and orientation and referral for both mother and infant when necessary after birth. The Perinatal Psychiatry emergency mobile unit PPUMMA was created in order to address these issues. METHODS: From 2008 to 2015, 1907 patients were assessed but data were missing for 90 patients. We therefore analyzed 1817 patient files looking at age, diagnosis origin of referral, time of referral (pre or postpartum) and delay from referral to assessment. RESULTS: Most patients were between 20 and 40 (81.5 %). One hundred and eighteen patients were under 20 years of age, of whom 64 were minors (3.5 %), and 218 were 40 or more (12 %). These two groups were over-represented close to threefold when comparing with national birth data records. A psychologist had first seen three out of four women. Midwives and Ob-Gyn referred 9 % and 8 % of patients while Social workers sent in 4 %. Two thirds of the women were seen during pregnancy, 50 % were seen the same day and 80 % received a consultation within 72hours. Three out of five of women had an assessment that concluded in a "Neurotic, stress-related and somatoform disorders" type code disorder linked to stress and somatoform disorder in ICD 10 (F40-F49). This is due to a high number (47.2 %) of F43 "Reaction to severe stress, and adjustment disorders". Twentynine present of women had a mood disorder (F30-39), and close to one third (31.6 %) had a personality disorder diagnosis attached. Schizophrenia, schizotypal and delusional disorders (F20-F29) represented 4.4 % of diagnoses. One third of the population had comorbid disorders: meeting either two (28.5 %) or three (3.7 %) diagnostic criteria for a psychiatric disorder. Most co-morbidity is due to personality disorder (82 % F60-F69). CONCLUSION: The number of referrals and diagnostic criteria met show how essential a psychiatric CL team assessing and orienting women during pregnancy and immediate postpartum is. Opportunity for adaptation of treatment during the peripartum period and more long-term tailored management of disorders can be organized during this period in a multidisciplinary approach. Knowing how essential maternal mental health is for women, for infant development and for mother-infant interactions, this is a unique window for access to care and intervention. Maternal mental health is a public health issue. Access to psychiatric assessment and care during the peripartum period offers unique possibilities for prevention and care.

The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale.

BACKGROUND: Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset. METHOD: Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA. RESULTS: Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) 0.01), but not between European countries (∆*CFI < 0.01). CONCLUSIONS: Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.

Neonatal manual specialization in language and music conditions: Consistency with the hemispheric specialization adult model.

The main purpose of this study was to test in neonates the influence of the sound environment, i.e., language versus music, on asymmetric hand movement activity in the presence of a target object. Based on hemispheric specialization, our hypothesis was that infants would use their right hand more in the speech context (left hemisphere) and their left hand more in the music context (right hemisphere). The study involved 19 full-term 3-day-old neonates. An object was presented successively in the two sound environments in counterbalance order for 120 s each. Left and right movements and mouth activity were scored during the target object presentation. Results show that neonates moved their left hand twice as much as their right hand in the music condition than in the language condition, and they moved their right hand a longer time in the language condition than in the music condition. The average number of sucking bursts was significantly higher in the language condition than in the music condition. We discuss the results in terms of manual specialization in relation to the development of hemispheric specialization.

Should we use the Parental Stress Index-Short Form in parents of children with ASD? A French validation study.

BACKGROUND: Parents of children with Autism Spectrum Disorder (ASD) exhibit higher levels of parental stress than parents of typically developing children. The most frequently used tools to assess parental stress is the Parenting Stress Index (PSI) or its Short Form (PSI-SF). AIMS: This study was designed to test the validity of the PSI-SF in French parents of children with ASD (N = 370). METHODS AND PROCEDURES: First, a confirmatory factor analysis was conducted to test the initial 3-factor structure (36 items) which indicate a poor model fit. Then, an exploratory factor analysis was performed and convergent validity was assessed. OUTCOMES AND RESULTS: A 3-factor structure (21 items) explaining 44 % of the variance was observed. Dimensions were moderately correlated and exhibited good internal consistency. Convergent validity was checked through the PSI-SF association with anxiety and depression (HADS), quality of life (WHOQOL-Brief) and appraisal of being a parent of a child with ASD (ALES). CONCLUSIONS AND IMPLICATIONS: Future research should use the full version of the PSI-SF and examine its factor structure. More studies on the factor structure of the PSI-SF are needed to find out if it is a suitable tool for measuring stress in parents of children with ASD in France.

The Still-Face: A Greater Challenge for Infants of Mothers With Borderline Personality Disorder.

The main aim of this study was to ascertain whether infants as young as 3 months of age, whose mothers suffer from borderline personality disorder (BPD), are already at risk of greater dysregulation than infants of mothers without BPD when faced with a minor stressful experience. Nineteen mothers diagnosed with BPD and 41 controls with no history of psychopathology and their 3-month-old infants were observed using Tronick's Face-to-Face Still-Face paradigm. The authors found that infants whose mothers have BPD express less positive vocalizations and less nonautonomic self-regulation than infants of mothers with no psychopathology. The stress of the Still-Face episode affects their gaze and self-regulation behaviors more strongly than those of infants of controls. The Reunion episode seems particularly challenging for mothers with BPD, who show fewer smiles and an increase in intrusive behavior. Because infants and their mothers with BPD are already dysregulated at 3 months postpartum, envisaging very early intervention seems warranted.

Kangaroo supported diagonal flexion positioning: New insights into skin-to-skin contact for communication between mothers and very preterm infants.

OBJECTIVE: Skin-to-skin contact shows benefits in the relationship developed between a mother and her premature infant. In the skin-to-skin session, face-to-face exchanges are impossible in vertical infant positioning. We therefore undertook an observational, prospective, single-center study using kangaroo "supported diagonal flexion" (SDF) positioning. The first aim was to evaluate the safety of kangaroo SDF positioning compared to the usual vertical positioning. The second aim was to evaluate SDF positioning on early communication between the mother and her infant and to improve their well-being. PARTICIPANTS AND SETTING: Fifteen mothers and their very premature infants (birth 26<32 weeks' gestation) were assigned to one of the two kangaroo positioning modes, either the current vertical positioning (n=7) or SDF positioning (n=8). DESIGN: Physiological variables and critical events were recorded before, during, and after ten successive skin-to-skin contact sessions. The first and last sessions were videotaped to allow later behavioral measurements. Mothers' risk for depression and feelings about the way they experienced communication with their infant were assessed through questionnaires. RESULTS: In terms of the infant's physiology, no negative effects were associated with SDF positioning in comparison with the usual vertical positioning. SDF positioning led to fewer disorganized gestures, negative vocalizations, and drowsiness, in favor of more deep sleep. SDF led to more mother-infant eye-to-eye contact as well as maternal vocalizations, smiles, and caressing, although these differences did not reach significance. The score for the risk of postnatal depression decreased significantly between the first and the last session in the SDF group, whereas it did not change in the vertical positioning group. CONCLUSION: These results support the idea that the kangaroo SDF positioning technique is physiologically safe, has obvious immediate benefits on mothers' infant-directed communicative behaviors, and respects the baby's naturally flexed and asymmetrical tonic neck posture. It is an innovative, inexpensive, easy-to-use technique in daily practice, by all healthcare professionals working in a neonatal intensive care unit. These data suggest that the current kangaroo positioning technique could be improved. More studies are needed to confirm the benefits and safety of the kangaroo SDF positioning in larger groups of preterm infants.

[First French national survey on lifestyle and toxic factors in infertile couples]. / Première enquête nationale française sur les modes de vie et les facteurs toxiques chez les couples infertiles.

OBJECTIVES: The purpose of our study is to assess, prior to any treatment for infertility, the environment and quality of life of candidate couples for medically assisted procreation (MAP) and the toxic factors which may be related to their difficulty in conceiving. PATIENTS AND METHODS: A screening questionnaire aimed at 796 patients (348 couples) has been collected by 43 assisted reproductive techniques (ART) centers in France. Stress factors, anxiety, toxic and environmental factors have been recorded and analysed. RESULTS: Women were on average younger than men (34.9 y ± 5.3 vs. 37.5 y ± 7.5), with a normal BMI, and 78% of them had no children. Sexual relations are regular: 2.14 per week. However, 1 in 8 women reports having sexual problems as opposed to 2 in 100 men (P < 0.0001), the most common problems being painful intercourse, insensitivity and bleeding. Fifty percent of the surveyed women say they have painful periods. Smoking and cannabis use were significantly higher in the men (32% vs. 20% and 6,4% vs. 1,2%). Alcohol consumption is more common in men (32 vs. 23%, P < 0.01). Stress related to infertility was significantly higher in the women (54% vs. 23%; P < 0.001). DISCUSSION AND CONCLUSION: This first prospective French survey has revealed an increased incidence of smoking and an escalation of sexual problems (decrease in sexual relations, dyspareunia) and dysmenorrhea in women. It has also revealed stress at work in couples, and increased stress levels due to infertility in the female partners participating in this study. Our study suggests that there are numerous toxic and environmental factors which are potentially harmful for a couple's fertility and which should be corrected before any MAP treatment is attempted in order to optimise the results in ART and to increase natural fertility.

Confabulation, but not executive dysfunction discriminate AD from frontotemporal dementia.

We examined confabulation and performance on frontal/executive tasks in Alzheimer's disease (AD) patients and patients with a diagnosis of probable frontotemporal dementia (FTD). Twenty-two patients with probable AD, 10 patients with probable FTD and 32 normal control subjects entered the study. Executive functions were assessed with the Modified Card Sorting test; a verbal fluency test; the Cognitive Estimation test; and the Stroop test. Confabulations were assessed with a modified version of the Confabulation Battery. The Confabulation Battery included 10 questions tapping each of the following domains: Episodic Memory (memories of personal past episodes), Semantic Memory (knowledge of famous facts and famous people), and Personal Future (personal plans). The results revealed that both AD patients and FTD patients were clearly and equally impaired on tests of executive functions. Both patients' groups confabulated across the three tasks of the Confabulation Battery, but FTD patients confabulated significantly more than AD patients on Episodic Memory and Personal Future. The results failed to provide any evidence of a correlation between the performance on frontal/executive tasks and the tendency to produce confabulatory reports. According to our results, confabulation, more than a deficit of frontal/executive functions, discriminate between AD and FTD. Therefore, screening for confabulation and, possibly, for other types of memory distortions may constitute a useful additional clinical tool in order to discriminate AD from FTD.