Palmitoyl-carnitine increases RyR2 oxidation and sarcoplasmic reticulum Ca2+ leak in cardiomyocytes: Role of adenine nucleotide translocase.

Long chain fatty acids bind to carnitine and form long chain acyl carnitine (LCAC), to enter into the mitochondria. They are oxidized in the mitochondrial matrix. LCAC accumulates rapidly under metabolic disorders, such as acute cardiac ischemia, chronic heart failure or diabetic cardiomyopathy. LCAC accumulation is associated with severe cardiac arrhythmia including ventricular tachycardia or fibrillation. We thus hypothesized that palmitoyl-carnitine (PC), alters mitochondrial function leading to Ca(2+) dependent-arrhythmia. In isolated cardiac mitochondria from C57Bl/6 mice, application of 10µM PC decreased adenine nucleotide translocase (ANT) activity without affecting mitochondrial permeability transition pore (mPTP) opening. Mitochondrial reactive oxygen species (ROS) production, measured with MitoSOX Red dye in isolated ventricular cardiomyocytes, increased significantly under PC application. Inhibition of ANT by bongkrekic acid (20 µM) prevented PC-induced mitochondrial ROS production. In addition, PC increased type 2 ryanodine receptor (RyR2) oxidation, S-nitrosylation and dissociation of FKBP12.6 from RyR2, and therefore increased sarcoplasmic reticulum (SR) Ca(2+) leak. ANT inhibition or anti-oxidant strategy (N-acetylcysteine) prevented SR Ca(2+) leak, FKBP12.6 depletion and RyR2 oxidation/S-nitrosylation induced by PC. Finally, both bongkrekic acid and NAC significantly reduced spontaneous Ca(2+) wave occurrences under PC. Altogether, these results suggest that an elevation of PC disturbs ANT activity and alters Ca(2+) handling in a ROS-dependent pathway, demonstrating a new pathway whereby altered FA metabolism may contribute to the development of ventricular arrhythmia in pathophysiological conditions.

[Hospital information system performance for road traffic accidents analysis in a hospital recruitment based area]. / Performance d'un système d'information hospitalier pour étudier l'accidentologie routière dans le bassin de recrutement d'un hôpital.

BACKGROUND: Road traffic accidents in France are mainly analyzed through reports completed by the security forces (police and gendarmerie). But the hospital information systems can also identify road traffic accidents via specific documentary codes of the International Classification of Diseases (ICD-10). The aim of this study was therefore to determine whether hospital stays consecutive to road traffic accident were truly identified by these documentary codes in a facility that collects data routinely and to study the consistency of results from hospital information systems and from security forces during the 2002-2008 period. METHODS: We retrieved all patients for whom a documentary code for road traffic accident was entered in 2002-2008. We manually checked the concordance of documentary code for road traffic accident and trauma origin in 350 patient files. The number of accidents in the Grenoble area was then inferred by combining with hospitalization regional data and compared to the number of persons injured by traffic accidents declared by the security force. RESULTS: These hospital information systems successfully report road traffic accidents with 96% sensitivity (95%CI: [92%, 100%]) and 97% specificity (95%CI: [95%, 99%]). The decrease in road traffic accidents observed was significantly less than that observed was significantly lower than that observed in the data from the security force (45% for security force data against 27% for hospital data). CONCLUSION: Overall, this study shows that hospital information systems are a powerful tool for studying road traffic accidents morbidity in hospital and are complementary to security force data.

Effect of point-of-care influenza tests on antibiotic prescriptions by emergency physicians in a French hospital.

BACKGROUND: Influenza is a public health issue worldwide. Although antibiotics should not be used to treat viral infections, they are often prescribed to patients with influenza-like illness (ILI). Such misuse promotes antibiotic resistance. The role of rapid point-of-care tests (POCTs) in preventing antibiotic misuse in adults with ILI symptoms remains relatively unexplored. AIM: To evaluate whether POCT implemented in 2018-2019 to detect influenza viruses led to a decrease in antibiotic prescriptions compared with laboratory-based influenza tests. METHODS: Adult patients with ILI in one emergency department (ED) were retrospectively enrolled over three epidemic seasons (from 2016-2017 to 2018-2019). The primary outcome was the rate of antibiotic prescriptions, which was compared between the three seasons in bivariate and multivariate analyses. Prescriptions for ancillary laboratory tests, chest X-rays and oseltamivir were also compared, along with hospitalizations and length of stay (LOS) at the ED. FINDINGS: Overall, 1849 patients were included. Median age was over 70 years throughout all three seasons. The number of antibiotic prescriptions was significantly different between the three periods in bivariate analysis (48.3% in 2016/2017, 44% in 2017/2018 and 31.1% in 2018/2019; P<0,0001) and in multivariate analysis (adjusted odds ratio (aOR) = 0.48, 95% confidence interval (CI) = 0.30-0.76 for 2018/2019 and aOR = 0.99, 95%CI = 0.67-1.46 for 2017/2018, compared with 2016/2017). There were significantly fewer prescriptions of ancillary laboratory tests, X-rays, hospitalizations and more oseltamivir prescriptions in 2018/2019, compared with the previous seasons. LOS was significantly lower in 2018/2019 only for influenza-positive patients. CONCLUSIONS: ED influenza POCT decreased antibiotic use and led to less ancillary testing, X-rays and hospitalizations among patients with ILI. However, medico-economic studies are necessary before formulating definite recommendations.

Efficient characterization of the TCR repertoire in lymph nodes by flow cytometry.

Analysis of the T-cell receptor (TCR) repertoire by flow cytometry proved to be relevant for investigating T-cell diversity and detecting reactive cells in blood samples. We used this approach to characterize non-malignant T-lymphocytes in lymph nodes and give insights into their origin. The TCR repertoire of CD4+ and CD8+ T-cells from 81 lymph nodes was analyzed with a four-color flow cytometer using a wide panel of 25 anti-Vbeta monoclonal antibodies. Flow cytometry proved to be a useful and informative technique. We demonstrated a diversified TCR-Vbeta repertoire, and only low level expansions, in 53% of the samples. They involved nearly all Vbeta families, were more frequent in the CD8+ subset of older patients, but were not related to pathology. No evidence could be demonstrated in favor of stimulation by common antigens. Interestingly, the TCR-Vbeta repertoire proved to be very similar in lymph nodes and blood samples. Our results argue that in the cases studied, lymph node enlargement is mainly due to an increased homing of circulating T-cells. They also provide reference values for expression of 25 TCR-Vbeta in lymph nodes, which could serve as a basis for further applications in diagnosis of T-cell lymphoproliferative disorders.

Health status of children with cerebral palsy living in Europe: a multi-centre study.

AIM: The aim of this report is to describe the health status of 8-12-year-old children with cerebral palsy (CP) of all severities in Europe using the Child Health Questionnaire (CHQ). METHOD: A total of 818 children with CP from nine centres in defined geographical areas participated. CP type, gross and fine motor function, additional impairments were classified and family data were obtained. The CHQ was used to measure the parent's perception of their child's physical (PHY) and psychosocial (PSY) health. RESULTS: PHY scores were lower than the reference samples with a median of 46. The severity of gross motor function influenced the CHQ scores significantly in the PHY scale with the lowest scores for children with least gross motor function. There were significant differences between the CP types in PHY with the higher scores for children with unilateral spastic and the lowest scores for children with bilateral spastic and dyskinetic CP type. Fine motor function severity significantly affected both the PHY and PSY scales. The severity of intellectual impairment was significantly associated with CHQ scores in most dimensions with higher scores for higher IQ level in PHY and PSY. Children with seizures during the last year had a significantly lower health compared with children without seizures. The results of the multivariate regression analyses (forward stepwise regression) of CHQ scores on CP subtype, gross and fine motor function, cognitive function, additional impairments, seizures, parental education and employment revealed gross motor function, cognitive level and type of school attended were significant prognostic factors. CONCLUSION: This report is based on the largest sample to date of children with CP. Health status as measured using the CHQ was affected in all children and was highly variable. Gross motor function level correlates with health from the PHY well-being perspective but the PSY and emotional aspects do not appear to follow the same pattern.

Incidence and prevention of infective endocarditis and bacteraemia after transcatheter aortic valve implantation in a French university hospital: a retrospective study.

Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a rare but severe complication. Among 326 patients who underwent TAVI at Grenoble Alpes University Hospital, six (1.8%) cases of IE and 11 (3.4%) cases of bacteraemia were identified. No cases of IE were linked to the intervention; one was due to Staphylococcus aureus despite a screening and targeted decolonization strategy. This underscores the need for randomized studies to evaluate the benefit and cost-effectiveness of this policy.

Longitudinal DRG-based survey of all-cause and pneumococcal pneumonia and meningitis for inpatients in France (2005-2010).

OBJECTIVE: This population-based retrospective study quantified the burden of all-cause and pneumococcal pneumonia and meningitis in the Rhône-Alpes region of France from 2005 to 2010, when the 7-valent pneumococcal conjugate vaccine uptake increased from 50 to>90% in children. PATIENTS AND METHODS: Hospital admission data was obtained from the French Diagnosis Related Groups program database (French acronym PMSI). Patients were residents of the Rhône-Alpes region hospitalized for the diseases of interest during 2005-2010. Hospitalization and in-hospital mortality rates were calculated by age, sex, and year on the basis of the Rhône-Alpes region population. Hospitalization and in-hospital mortality rates were compared using Chi(2) tests with statistical significance adjusted for multiple comparisons. RESULTS: The highest hospitalization rates by age group were: all-cause pneumonia, oldest group (>65 years); all-cause and pneumococcal meningitis, youngest group (0-4 years), and pneumococcal pneumonia, youngest and oldest groups. Hospitalization rates significantly decreased for all-cause pneumonia (5-19 years: -12.71%) and all-cause meningitis (20-49 years: -29.22%). Pneumococcal disease rates did not significantly change in any age group. Mortality rates from all-cause pneumonia and meningitis were highest in the oldest age groups. CONCLUSIONS: The burden of all-cause and pneumococcal pneumonia and meningitis remains substantial. Significant changes (decreases) between 2005 and 2010 in hospitalization rates were limited and varied among age groups, most likely because this study began 2 years after PCV7 was first introduced in France for children at broadly-defined high risk. Further research is needed on the relationship between serotype epidemiology and clinical patterns of disease.

[++Scintimammography: a new imaging technique for diagnosis and follow-up of breast cancer]. / Apport de la mammoscintigraphie 99m Tc MiBi dans le diagnostic et le suivi des cancers du sein.

99m Tc MiBi has emerged as a new imaging technique for primary breast carcinomas. The aim of this study was to analyze the diagnostic performance and the additional information provided by scintimammography (SMN). Two hundred and forty consecutive women referred to surgery for abnormalities breast or suspicious breast cancer were scanned before surgery. Sensitivity and specificity were respectively 92% and 53%. PPV: 77.5% and PVN: 79.3%. All false negative scans occurred in cancers 1 cm. SMN detected multiple foci of uptake in the same breast in 13%, that were all confirmed to be multifocal disease and histology. Controlateral focal uptake was also detected; at this time 5/27 are confirmed to be bilateral breast neoplasms; 22 patients are in follow-up. SMN is reliable in the diagnosis of breast cancer and also with difficult cases of mammography. Moreover, SMN provides additional qualitative information in 19.6% of breast carcinomas, such as chest wall infiltration, multifocal or bilateral breast cancer.

[Diagnostic modalities and treatment of cancer of the pancreas. Evolution in the population in the department of Côte d'Or from 1976 to 1988]. / Les modalités diagnostiques et le traitement du cancer du pancréas. Evolution dans la population du département de la Côte-d'Or de 1976 à 1988.

There is no study establishing time trends for the diagnostic and therapeutic approaches to pancreatic cancer based on population data. The data of the Registry of Digestive Tumors of Côte-d'Or (France) were used to this end in 544 cancers diagnosed between 1976 and 1988. The proportion of the histologically confirmed cases increased annually by 13.4% (P < 0.001). This was mainly due to progress in percutaneous biopsy (+25.7% per year between 1983 and 1988, P < 0.001). As regards the diagnosis, ultrasonography was used more frequently (+21.9% per year, P < 0.001) as well as CT scan since its introduction in 1983 (+19.6% per year, P < 0.001). Pancreatic cancer was diagnosed by sonography in 16.7% of the cases in 1976 and 70.6% in 1988 (mean annual variation: +5.7%, P < 0.001). The proportions for CT scan were 12.8% in 1983 and 23.5% in 1988 (mean annual variation: +3.5%, NS). There was no significant change in the use of retrograde cholangiopancreatography over time. Other diagnosis criteria were less frequently used: laparoscopy was no longer used after 1983 and intraoperative diagnosis was made less frequently (-2.5% per year, P < 0.001). Endoscopy or radiographic data were rarely used as a diagnosis criterion. These changes in approaches to the diagnosis of pancreatic cancer were not accompanied by any progress in diagnosis stage, therapeutic approach or survival suggesting that when clinical symptoms become evident, pancreatic cancer is already advanced. Therapeutic advances, early diagnosis in patient at risk or identification or reasons for pancreatic cancer are the only means of progress in this problem.

[Relationship between in-hospital mortality rate and patient volume for total hip arthroplasty in the Rhône-Alpes public hospitals]. / Relation entre volume d'activité et mortalité intra-hospitalière après intervention pour pose de prothèse totale de hanche dans les établissements publics de la région Rhône-Alpes.

BACKGROUND: Comparisons between hospitals using surgical volume, among other criteria can be made using large hospital databases. A relationship between hospital volume and care results, particularly mortality, is assumed to justify the use of activity volume as a comparison criterion. We aimed to assess a relationship between hospital volume and mortality after total hip replacement using the data available in the French Diagnosis Related Groups (Programme de Médicalisation des Systèmes d'Information, PMSI). We also searched for a threshold associated with mortality. METHODS: We included all stays with a surgical procedure for total hip replacement in public hospitals in the Rhône-Alpes region in France in 1997 (n=5521). We examined the relationship between mortality and the number of procedures per hospital and assessed activity threshold using logistic regression. RESULTS: Using the number of procedures as the continuous variable, we observed a relationship with mortality (OR=0.94 [0.91; 0.96] for an increase in activity of 100 total hip replacements). We found no evidence of an activity threshold. The reason for performing total hip replacement (OR=6.36 [2.78; 14.55] for trauma compared with rheumatology diseases) and patient age (OR=1.76 [1.31; 2.36] for a 10-year increase in age) were strongly related to mortality. CONCLUSIONS: PMSI only collects in-hospital mortality, limiting the impact of our findings. The relationship between mortality and hospital volume is significant, but too small and consequently of little use. We found no activity threshold. It would be difficult to recommend surgical volume as a criterion for comparing hospitals.

[Early readmission as an indicator of hospital quality of care]. / Evaluation du taux de réadmissions précoces comme indicateur de la qualité des soins à l'hôpital.

BACKGROUND: The purpose of this study was to assess early readmission as an indicator of quality of care, to estimate the frequency of avoidable emergency readmission in a French hospital, and then to describe the feasibility and contribution of routine use of this indicator. METHODS: A randomly selected sample of 469 readmissions within 30 days after a conventional hospitalization was chosen among the database of 40,242 hospitalizations during the first half of 1997. Two independent practitioners, whose true agreement was measured with a kappa test, studied the features of readmission recorded on the patient files, classing them as "unforeseeable" or "potentially avoidable". Database criteria that could automatically class the readmission in either group were analyzed. RESULTS: There were 119 unforeseeable readmissions (25.4%). The two physicians agreed on the unforeseeable nature of 97 of these readmissions and 50 of them were judged avoidable. None of the database criteria allowed identifying all unforeseeable and avoidable readmissions. Readmission via the emergency unit was a sure indicator of unforeseeable readmission in 66% of the cases and of avoidable readmissions in 60%. The frequency of unforeseen readmissions was estimated at 3.9% of all conventional stays during the first half of 1997. The frequency of avoidable readmissions was 1.5%. CONCLUSIONS: Unforeseen early readmission can be an indicator of quality of the care taking process. It is however impossible to use the current database to classify with certainty readmissions as "unforeseeable" or "avoidable". Emergency unit readmission could offer a possible approach to measuring the frequency of unforeseen readmission. This ratio can provide caretakers with information concerning the quality of care and thus help in making decisions concerning reorganization for improvement.

[Birth mortality and pregnancy terminations: how can collected Diagnosis Related Group System data be used?]. / Mortinatalité et interruptions de grossesse: comment peut-on utiliser les données du PMSI?

In France since 1995, information on diagnoses and care are routinely collected for each patient hospitalised in a public or private hospital, using the Diagnosis Related Group system. Information on birth events constitutes a good example of possible use of this information for other aims than economic activity evaluation. In this paper, in order to highlight possible epidemiological use, some recommendations are proposed for collecting data on stillbirths and pregnancy terminations. The lack of usual knowledge on these two adverse events is the reason for this choice. While the improvements in prenatal diagnosis lead to an increase in pregnancy terminations, a minimum common core of collected data should allow routine epidemiological monitoring of these adverse perinatal events.

[Economic benefit of using antibiotics prophylactically in cesarean sections with little risk of infection]. / Bénéfice économique de l'antibioprophylaxie dans les césariennes dépourvues de haut risque infectieux.

A randomised double trial was carried out in 266 women who had Caesarean without any high risk of infection in order to study the efficacy of prophylactic antibiotics given during the operation. One group received 1 gram of cefotetan when the cord was being clamped and the other had an injection of placebo under the self-same conditions. Apart from studying the clinical efficacy, evaluation of the economics of the treatment was carried out using, as parameters, the length of stay in hospital and the cost of the antibiotics which were prescribed after the operation. The following results were obtained: 75% of the Caesarean operations carried out in the Maternity Units of the University Regional Hospital Centre were without high risk of infection. Prophylactic antibiotics are proficient because they reduce post Caesarean morbidity due to: endometritis, superficial and deep abscesses and septicaemia. 12.5% in the group who had antibiotics developed infections as against 26% in the placebo group. Post Caesarean infections which required antibiotics cost on an average for each Caesarean 16 francs in the groups who received antibiotics as against 52 francs in the groups that received the placebo. Even including the cost of the antibiotics given prophylactically the costs of antibiotics (prophylactic and curative) was higher in the antibiotic group than in the placebo group. The length of hospital stay was significantly reduced in the group that received prophylactic antibiotics.

[Economic aspects of surgical antibiotic prophylaxis]. / Aspects économiques de l'antibioprophylaxie chirurgicale.

The cost of an antibiotic is easily evaluated in the case of antimicrobial prophylaxis. The other expenses, either direct or indirect costs, are much more difficult to assess. Studies evaluating the economical impact of the prophylactic antibiotics are rather rare. Antibiotic prescription for prophylaxis is evaluated to represent about 20 to 30% of the total antibiotic administration in French hospitals. The most significant studies evaluate the cost/benefit ratio and demonstrate the advantage of prophylaxis in orthopaedic, vascular and gynaecologic surgery.

[Neurologic involvement in sarcoidosis. Federation of Systemic Diseases of Grenoble]. / Les atteintes neurologiques de la sarcoïdose. Fédération des Maladies de système de Grenoble.

OBJECTIVE: Study the incidence, clinical features, prognosis and diagnostic and therapeutic strategies in neurological lesions of sarcoidosis. PATIENTS AND METHODS: The 207 cases of sarcoidosis followed at the Grenoble University Hospital between 1992 and 1998 were identified. After collecting data, the cases with neurological signs related to sarcoidosis were selected. RESULTS: Sixteen patients (7.7%) had neurosarcoidosis. Ten had central nervous system involvement, with 5 reaching the hypothalamus and pituitary glands, 2 cases of meningoencephalitis, 2 pseudotumoral lesions, and 1 bitemporal lesion. Six had peripheral nervous system involvement, 3 had facial palsies and 3 had neuropathies. Laboratory tests were not contributive to diagnosis. Ten magnetic resonance imaging series were pathological out of 11 performed. Three central nervous system biopsies were obtained. Corticosteroid therapy was the most frequent treatment. For hypothalamic and pituitary dysfunction, the only treatment was substitutive hormone therapy. The course was favorable in 11 cases, stable in 4 cases. Symptoms worsened despite treatment in only 1 case. CONCLUSION: The incidence of neurosarcoidosis may be much higher than is generally realized. The association of suggestive MRI signs, and clinical and laboratory findings evoke the diagnosis. Brain biopsy remains necessary for the pseudotumoral forms and the primitive neurological forms.

[Prospective and comparative study of 2 antibiotic therapy protocols in 66 febrile neutropenic patients. Ceftazidime-vancomycin versus ticarcillin-vancomycin-amikacin]. / Etude prospective et comparative de deux protocoles d'antibiothérapie chez 66 malades neutropéniques fébriles. Ceftazidime-vancomycine versus ticarcilline-vancomycine-amikacine.

Out of 66 febrile neutropenic patients, 33 were treated with a ceftazidime-vancomycin combination (group A) and 33 with a ticarcillin-vancomycin-amikacin combination (group B). There was no significant difference in satisfactory results between the two groups (group A 79 per cent, group B 88 per cent), and both regimens were equally active in all febrile episodes. Reversible side-effects (renal and cutaneous toxicity) were observed in 15 per cent of the cases. Two cases of superinfection and one case of resistance occurring during treatment were noted in group B patients. At a time when Gram-positive infections are increasingly frequent among febrile neutropenic patients, the ceftazidime-vancomycin combination seems to be as effective as the ticarcillin-vancomycin-amikacin triple drug combination.

[Antibiotic prophylaxis in cesarean sections without high risk of infection. Therapeutic trial of cefotetan versus placebo]. / Antibioprophylaxie dans les césariennes sans "haut risque infectieux". Essai thérapeutique céfotétan contre placebo.

Caesarean sections are performed with an ever increasing frequency, and their morbidity rate due to infection varies between 35 and 40 per cent. The effectiveness of antibiotic prophylaxis has been demonstrated in caesarean sections with a high risk of infection, but few studies have been devoted to caesarean sections without this high risk. The purpose of our study was to evaluate the effectiveness of antibiotic therapy in this second type of caesarean section since its postoperative infection rate is not negligible (about 25 per cent). We therefore set up a two-centre randomized trial comparing two groups of 133 women without any particular risk of infection. At the moment of umbilical cord clamping, one group received cefotetan 1 g intravenously, while the other group received an intravenous injection of a placebo solution. The postoperative infection rate was 12.5 per cent in the treatment group and 26.9 per cent in the control group (P less than 0.05). The relative risk in the placebo-treated women was 2.15 (95 per cent confidence limits, 1.41 to 3.28). Antibiotic prophylaxis prevented 53.5 per cent of postoperative infections (95 per cent confidence limits, 29 to 69.5 per cent). Moreover, in the treatment group infections were less severe, resulting in a significant decrease in hospital stay and a lower overall cost. We conclude that antibiotic prophylaxis with cefotetan is effective in caesarean sections without a high risk of infection, as it significantly reduces the postoperative morbidity due to infection.

Quality assessment of discharge letters in a French university hospital.

The quality of discharge letters has been evaluated in order to initiate a process of improved communications between the hospital and general practitioners. From each of 37 volunteer clinical departments of the hospital, a random sample of 30 stays was selected among the hospitalisations for one year. The quality of discharge letters was assessed according to recipients' needs and to French legislation. In total, 1,024 medical records were relevant and were analysed. This study showed deficiencies in management of discharge letters in the hospital. It constitutes the first step of a quality improvement process based on the awareness of concerned actors through information feedback and the follow-up of specific indicators.

Arterial embolization of post-partum hemorrhage.

The case of a 24-year-old patient with severe post-partum hemorrhage resistant to medical therapy is reported. Active bleeding was documented on CT and confirmed by angiography. Selective embolization of the cervico-uterine artery promptly stopped the bleeding. Selective embolization is recommended as the treatment of choice for intractable post-partum hemorrhage.

[Impact on parents of cerebral palsy in children: a literature review]. / Impact sur les parents de la paralysie cérébrale chez l'enfant : revue de la littérature.

Cerebral palsy is the commonest cause of motor impairment in childhood. Parents of children with this particular neurodevelopmental disorder face many problems encountered by disabled children's parents. The aim of the present paper is to report the current knowledge on this parental impact, highlighting consensus and disagreement. A literature search was conducted using the key words "Cerebral palsy" and "Parents/Father/Mother" and "Adapt/Adjust/Cost/Economic/Impact/Well-being" in the Medline and PsycInfo databases searching for articles published between 1989 and 2009. Seven parental impact dimensions were distinguished: time spent, occupational restrictions, social relationships, family relationships, psychological well-being, physical health, and financial burden. Of 40 selected references, the studies were mostly cross-sectional, although longitudinal surveys highlighted the causal relationship between factors. Despite various methodologies, this review confirms that parents of CP children have greater risk of experiencing a sense of burden than parents of typically normally developing children. Time spent caring for the child appears to be an important factor that depends on the child's autonomy. The 7 impact dimensions seem to be related to each other and to child's and caregiver's characteristics. The severity of motor impairment is not unanimously viewed as a worsening factor: however, the child's behavioral problems influence the impact experienced by the parents. The level of intellectual impairment also has a negative influence on family relationships and on the parent's psychological well-being. The child's developmental stage seems to be related to the level of parental impact, but there is no agreement on the dimensions involved. We also observed that the mother and father do not experience this situation in the same way, probably because of the role played by each one in the family. The current literature lacks data on caregiver characteristics, identifying families at risk of burden, and the environmental context that would allow for a less negative impact on parents. In addition, the tools measuring the impact lack standardization. No questionnaire covering all 7 dimensions exists, but useful validated questionnaires for different dimensions were identified. We consider that the caregiver's occupation and physical health needs further research. The current knowledge is insufficient for proposing an overall model taking all the dimensions into account. Research is needed before a complete model of the CP child's impact on parents can be tested in view of providing guidelines to professionals for identifying families with a risk of maladaptation and suggesting solutions to decrease the negative impact.