Promptness of oxytocin administration for first-line treatment of postpartum hemorrhage: a national vignette-based study among midwives.

BACKGROUND: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Midwives play a key role in the initial management of PPH. Uterotonic agents are widely used in its prevention and treatment, with oxytocin the first-line agent. Nonetheless, a standardized guideline for optimal dose and rate of administration has not been clearly defined. The aim of this study was to investigate French midwives' practices regarding first-line oxytocin treatment and the factors influencing its delayed administration. METHODS: This multicenter study was based on clinical vignettes of PPH management collected using an anonymous online questionnaire. A random sample of midwives from 145 maternity units in France from 15 randomly selected perinatal networks were invited to participate by email. The Previously validated case vignettes described two different scenarios of severe PPH. Vignette 1 described a typical immediate, severe PPH, and vignette 2 a less typical case of severe but gradual PPH They were constructed in three successive steps and included multiple-choice questions proposing several types of clinical practice options at each stage. For each vignette separately, we analyzed the lack of prompt oxytocin administration and the factors contributing to them, that is, characteristics of the midwives and organizational features of maternity units. Bivariate analysis and multivariable logistic regression analysis were applied. RESULTS: In all, 450 midwives from 87 maternity units provided complete responses. Lack of promptness was observed in 21.6% of responses (N = 97) in Vignette 1 and in 13.8% (N = 62) in Vignette 2 (p < .05). After multivariate analysis, the risk of delay was lower among with midwives working in university maternity hospitals (ORa 0.47, 95% 0.21, 0.97) and in units with 1500 to 2500 births per year (ORa 0.49, 95% CI 0.26, 0.90) for Vignette 1. We also noticed that delay increased with the midwives' years of experience (per 10-year period) (ORa 1.30, 95% CI 1.01, 1.69). CONCLUSIONS: This study using clinical vignettes showed delays in oxytocin administration for first-line treatment of PPH. Because delay in treatment is a major cause of preventable maternal morbidity in PPH, these findings suggest that continuing training of midwives should be considered, especially in small maternity units.

Should We Worry About Nutrition Of Adults With Minor Burns? An Audit Of Their Intakes.

Small burn injuries are managed in an outpatient setting by surgeons and/or nurses. Nutrition in minor burn patients is rarely investigated. This observational study aimed to quantify their nutritional intakes, and o compare them to theoretical adequate values. Their average daily food intakes since injury were evaluated by a dietician using a ten-point visual assessment of consumed portions during the last meal (SEFI tool) and a food anamnesis. Macro- and micronutrient intakes were compared to national recommended dietary allowances (RDA) for healthy subjects: intakes <66% RDA were considered inadequate. Forty-two patients with a median age of 45 (34-56) years, BMI of 25.9 (23.5-28.9) kg/m2, and burn surface area (BSA) of 2 (1-3) % were included. Energy and protein RDA were reached in 28.6 and 71.4% of the patients, respectively. Intakes of n-3 fatty acids were inadequate in 80.9% of the patients. A SEFI <7 was associated with insufficient intakes regards both energy and proteins. Inadequate intakes of different micronutrients were frequently observed, but no risk factors could be detected. Vitamin A and C were the most impacted: 71.4% of the patients had inadequate intakes. Vitamin D intake was low: 225 (56-431) UI/d. In contrast, intakes of iron, selenium and zinc were adequate in at least 61.9% of the patients. In conclusion, this audit highlighted that a majority of macronutrient and micronutrient intakes did not reach the levels recommended by the RDA. Such data should help in designing further studies aimed at assessing the impact of optimized nutrition on outcomes.

Certains patients, souffrant de brûlures mineures, sont suivis en externe par des chirurgiens et/ou des infirmières. La nutrition de tels patients est rarement étudiée. Cette étude observationnelle a pour but de quantifier leurs apports nutritionnels et de les comparer aux apports théoriques nécessaires. Leurs apports moyens depuis la brûlure ont été évalués par une diététicienne en utilisant une échelle visuelle (0 à 10) d'évaluation des portions consommées lors du dernier repas (échelle SEFI) et un historique de leurs repas. Les apports macro- et micronutritionnels réels ont été comparés aux apports recommandés aux sujets sains, un apport <66 % étant considéré comme insuffisant. Quarante deux patients d'âge médian de 45 ans (34- 56), à l'IMC de 25,9 (23,5- 28,9) kg/m² et brûlés sur 2 % (1- 3) SCT ont été inclus. Les apports en énergie et protéines étaient suffisants dans 28,6 et 71,4 % des cas. Ceux en acides gras 3 étaient insuffisants dans 80,9 % des cas. Un SEFI < 7 était associé à des apports insuffisants aussi bien en calories qu'en protéines. Des apports insuffisants en micronutriments étaient fréquemment observés, sans facteur de risque particulier, les apports en vitamines A et C étant ceux ayant été le plus souvent considérés comme insuffisants (dans 71,4 % des cas). Les apports de vitamine D (225- 56/431) UI/j étaient faibles eux aussi. À l'opposé, les apports en Fe, Se et Zn étaient considérés comme satisfaisants chez au moins 61,9 % des patients. En conclusion, cette étude montre que les patients, dans leurs majorité, n'ingèrent pas les quantités de macro- et micronutriments recommandés. Elle peut servir de point de départ à des études évaluant l'impact d'une optimisation nutritionnelle dans cette situation.

[Demodex and ocular surface disease]. / Demodex et pathologies de la surface oculaire.

Demodex is a saprophytic mite of the ocular adnexa, which can in certain circumstances proliferate on the skin of the face and on the eyelid margins. It is involved in facial rosacea (especially in the papulopustular form) and in the development or aggravation of anterior and/or posterior blepharitis or even keratoconjunctivitis, often in association with cutaneous lesions ; the pathophysiology is often multifactorial. Symptoms are non-specific, but the presence of cylindrical sleeves on the eyelashes is very suggestive of infestation, and certain techniques of biomicroscopic examination or imaging, such as confocal microscopy in vivo, allow direct visualization of the parasite. Parasitological examination of the eyelashes can confirm the diagnosis and can be improved by good sampling technique. Eyelid hygiene and oil-based ointments are the cornerstone of treatment. New specific treatments, in particular topical treatments based on tea tree oil, ivermectin, as well as pulsed light therapy and micro-exfoliation of the eyelid margin, can help to reduce the parasitic load and improve symptoms.

Variations in Postpartum Hemorrhage Management among Midwives: A National Vignette-Based Study.

OBJECTIVE: To assess variations in adherence to guidelines for management of postpartum hemorrhage (PPH) among midwives. METHODS: A multicentre vignette-based study was e-mailed to a random sample of midwives from 145 maternity units in France. They were asked to describe how they would manage the PPH described in 2 case-vignettes. These previously validated case-vignettes described 2 different scenarios for severe PPH. Vignette 1 described a typical immediate, severe PPH and vignette 2 a less typical case of severe but gradual PPH. They were constructed in 3 successive steps and included multiple-choice questions proposing several types of clinical practice options at each step. An expert consensus defined 14 criteria for assessing adherence to guidelines issued by the French College of Obstetricians and Gynecologists in 2004 in the midwives' responses. We analyzed the number of errors among the 14 criteria to quantify the level of adherence. RESULTS: We obtained 450 complete responses from midwives from 87 maternity units. The rate of complete adherence (no error for any of the 14 criteria) was low: 25.1% in vignette 1 and 4.2% in vignette 2. The error rate was higher for pharmacological management, especially oxytocin use, than for non-pharmacological management and communication-monitoring-investigation. Adherence to guidelines varied substantially between and within maternity units, as well as between the vignettes for the same midwives. CONCLUSION: Reponses to case-vignettes demonstrated substantial variations in PPH management and especially individual variations in adherence to guidelines. Midwives should participate in continuous and individualized training.

Staff and Institutional Factors Associated with Substandard Care in the Management of Postpartum Hemorrhage.

OBJECTIVE: to identify staff and institutional factors associated with substandard care by midwives managing postpartum hemorrhage (PPH). METHODS: A multicenter vignette-based study was e-mailed to a random sample of midwives at 145 French maternity units that belonged to 15 randomly selected perinatal networks. Midwives were asked to describe how they would manage two case-vignettes about PPH and to complete a short questionnaire about their individual (e.g., age, experience, and full- vs. part-time practice) and institutional (private or public status and level of care) characteristics. These previously validated case-vignettes described two different scenarios: vignette 1, a typical immediate, severe PPH, and vignette 2, a severe but gradual hemorrhage. Experts consensually defined 14 criteria to judge adherence to guidelines. The number of errors (possible range: 0 to 14) for the 14 criteria quantified PPH guideline adherence, separately for each vignette. RESULTS: 450 midwives from 87 maternity units provided complete responses. Perfect adherence (no error for any of the 14 criteria) was low: 25.1% for vignette 1 and 4.2% for vignette 2. After multivariate analysis, midwives' age remained significantly associated with a greater risk of error in guideline adherence in both vignettes (IRR 1.19 [1.09; 1.29] for vignette 1, and IRR 1.11 [1.05; 1.18] for vignette 2), and the practice of mortality and morbidity reviews in the unit with a lower risk (IRR 0.80 [0.64; 0.99], IRR 0.78 [0.66; 0.93] respectively). Risk-taking scores (IRR 1.41 [1.19; 1.67]) and full-time practice (IRR 0.83 [0.71; 0.97]) were significantly associated with adherence only in vignette 1. CONCLUSIONS: Both staff and institutional factors may be associated with substandard care in midwives' PPH management.

Systematic tuning of the conduction mechanisms in ferroelectric thin films.

We have investigated the macroscopic and microscopic properties of large sets of Ba0.7Sr0.3TiO3 thin films including several substitution rates of manganese. Thanks to a high degree of control of the processing parameters at each stage we have been able to find a link between the dc leakage current and the low and high frequency dielectric permittivity and losses. We supplemented these macroscopic observations with in depth investigations of the defect states through x-ray photoelectron spectroscopy. We found that both the leakage current and the extrinsic dielectric parameters arise from a large density of charged point defects related to oxygen vacancies. At the outer surfaces of the films, the density of such charged defects is so high that it can raise the Fermi level to close to the conduction band. Such degradation of the films' performance can be relieved by appropriate manganese substitution for the titanium host ions. Such doping is able to move back the Fermi level to close to the center of the bandgap thus changing the conduction process from interfacial Schottky to bulk Poole Frenkel and decreasing the extrinsic losses. This beneficial effect was already inferred in ceramics and thin films but we have established a clear link between the macroscopic parameters and the microscopic defect state. This model can be transferred to many high permittivity oxides.

[Hypovitaminosis D and burn injury]. / Hypovitaminose D du patient brûulé: une équation à plusieurs inconnues.

Vitamin D deficiency is common in adults and even in children, appearing to be more frequent than expected.Accumulating data about the pleiotropic effects of vitamin D have raised renewed interest in this hormone. Severe burn injury represents a unique trauma leading to major systemic dysfunctions such as bone loss, mineral disruptions, myopathy, or immunosuppression. Moreover, burn patients are at high risk of hypovitaminosis D. In this context, vitamin D supplementation could help counteract post-burn sequelae. The aim of the present review is to summarize the current knowledge on vitamin D with a special focus on burn related hypovitaminosis D.

Dietary intakes and antioxidant status in mind-body exercising pre- and postmenopausal women.

OBJECTIVE: The decline in antioxidant defenses due to both estrogen loss and frequent adoption of poor dietary choices exposes postmenopausal women to cardiovascular diseases. Adequate nutrition and physical exercise are two factors of health promotion. This study investigated whether regular practice of mind-body exercise (yoga and/or tai chi) alters dietary intake and antioxidant status and balances the menopause-related increases in lipid peroxidation and cardiovascular risk. DESIGN: Cross-sectional study. SETTING: The study was conducted in an urban community in Bangkok (Thailand) between May and August 2007. PARTICIPANTS: Premenopausal (Pre M; 39±8 yrs; n=56) and postmenopausal (Post M; 54±5 yrs; n=39) women who had been practicing yoga (Y) and/or tai chi (TC) more than 3 hours/week for a year, or who had no regular physical activity practice (sedentary, S). MEASUREMENTS: All participants completed food frequency questionnaires and 4-day food and activity records. Blood was collected on day 5. Factorial ANOVA tests were performed according to menopause status, exercise, and hormone replacement therapy (HRT) groups. RESULTS: Post M had higher (p = 0.01) dietary fiber intake compared with Pre M. Yoga practitioners had lower BMI (p = 0.004) and lower fat intake (p = 0.02) compared with their S and TC counterparts. Plasma total antioxidant status was significantly and independently lower and higher in Y and Post M groups, respectively. However, no difference was shown after adjusting for BMI. Regardless of menopause status and HRT, the activity of erythrocyte glutathione peroxidase - an aerobic training-responsive enzyme - was higher (p < 0.001) in TC practitioners compared with other groups. No effects were shown on erythrocyte superoxide dismutase activity, plasma lipid peroxidation (TBARS) or total homocysteine concentrations. CONCLUSION: Yoga and tai chi exercises can be used as components of a strategy to promote healthy lifestyles (balanced diet and moderate intensity exercise) in vulnerable populations, such as menopausal women, in order to prevent aging induced oxidative stress-related diseases.

Does physical exercise modify antioxidant requirements?

Physical training is known to induce a biochemical adaptive response which might require an increase in the ingestion and/or the absorption of micronutrients. A question that is still being raised is whether acute or chronic exercise modifies antioxidant requirements. First, the present review brings to light the most crucial studies on the topic. Second, it interprets the established relationships between antioxidant micronutrient intakes and the adaptive response of antioxidant systems. Finally, it exposes the major questions connected with antioxidant micronutrient requirements for athletes. To this effect, the training-load interaction with nutrition is taken into account. As oxidative stress cannot be avoided, the imbalance between oxidants and antioxidants can be alleviated to minimise oxidative damage and outcomes. There is growing evidence that one specific antioxidant cannot by itself prevent oxidative stress-induced damage, as direct adverse effects of supplementation are attributed to undesirable synergic effects. Other effects can be supposed that limit the endogenous adaptive effect of training. High doses of antioxidant supplements can minimise the effects of radical oxygen species themselves or generate pro-oxidant effects. Effects are only exhibited when nutritional status is deficient. There are no convincing effects of supplementation in well-trained athletes. Risk/benefit analysis emerges on evidence for an unknown risk of supranutritional intakes, a supposed impairment of adaptive effects and a still unknown long-term risk. Appropriate status can be achieved by a diversified and balanced diet, adapted to specific needs, by awareness of high-density food intakes (avoiding products containing a low density of micronutrients).

Indicator of risk of water contamination by phosphorus from Canadian agricultural land.

The indicator of risk of water contamination by phosphorus (IROWC_P) is designed to estimate where the risk of water P contamination by agriculture is high, and how this risk is changing over time based on the five-year period of data Census frequency. Firstly developed for the province of Quebec (2000), this paper presents an improved version of IROWC_P (intended to be released in 2008), which will be extended to all watersheds and Soil Landscape of Canada (SLC) polygons (scale 1:1, 000, 000) with more than 5% of agriculture. There are three objectives: (i) create a soil phosphorus saturation database for dominant and subdominant soil series of SLC polygons--the soil P saturation values are estimated by the ratio of soil test P to soil P sorption capacity; (ii) calculate an annual P balance considering crop residue P, manure P, and inorganic fertilizer P--agricultural and manure management practices will also be considered; and (iii) develop a transport-hydrology component including P transport estimation by runoff mechanisms (water balance factor, topographic index) and soil erosion, and the area connectivity to water (artificial drainage, soil macropores, and surface water bodies).

In vitro and in vivo study of the antithyroid side effects of trimeprazine.

Trimeprazine (TMP), a phenothiazine used as antipsychotic drug, was previously shown to induce a decrease in thyroid hormone serum levels in rats. Different mechanisms might be involved, mainly (i) a central mechanism, involving a reduction of thyroid-stimulating hormone (TSH) secretion; (ii) a peripheral mechanism, acting upon the synthesis of thyroid hormones, by inhibition of thyroperoxidase (TPO) or trapping of molecular iodine present in the thyroid gland. These different hypotheses were investigated in the present study, using in vitro and in vivo experiments. In vitro studies concerned TMP and its three main metabolites: trimeprazine sulphoxide (TSO), N-desmethyl trimeprazine (NDT), and 3-hydroxy-trimeprazine (3-OHT). TMP and TSO expressed a high affinity for iodine in vitro, contrary to NDT, which did not complex iodine. Only 3-OHT inhibited TPO in vitro. Administration of 5 mg/kg TMP ip twice daily for 11 days to Wistar rats induced a decrease of free triiodothyronine and free thyroxine (fT(3) and fT(4)) and a trend toward an increase of TSH serum levels. Thyroid concentrations of TMP, NDT, and TSO were significantly higher than serum levels, while 3-OHT was never detected. An iodine-supplemented diet administered to a group of rats treated with TMP significantly increased the thyroid concentration of TMP and TSO, but not that of NDT, while it did not affect the concentrations observed in serum and other organs. The increase in plasma TSH is not consistent with the central mechanism hypothesis, and the absence of TPO inhibition by TMP, TSO, and NDT contradicts the TPO inhibition hypothesis. On the contrary, three findings support the hypothesis of iodine trapping through formation of a complex with TMP and TSO: these molecules complex iodine in vitro, they accumulate in the thyroid, and their thyroid concentration is increased when the rats are fed an iodine-supplemented diet.

[ Neuro-depressive properties of essential oil of lavender]. / Sur les propriétés neuro-dépressives de l'huile essentielle de Lavande.

Toxicity for albino rats is very low. In mice an anxiolytic effect is exhibited and the pentobarbital evokated sleeping time is increased in animals given essential oil, but this effect disappears if they are administrated during five days.

[Neurodepressive effects of the essential oil of Lavandula angustifolia Mill]. / Effets neurodépresseurs de l'huile essentielle de Lavandula angustifolia Mill.

Mice Swiss are orally given essential oil of lavander diluted at 1/60 in olive oil. Sedative effects are observed with some tests (hole board test, four plates test, plus-maze test, potentiation of barbiturate sleeping time). A significant interaction exists with pentobarbital: the sleeping time is increased and the asleeping time shortened.