Mortality in French people with polyhandicap/profound intellectual and multiple disabilities.

BACKGROUND: In recent decades, progress has been made in the care of people with polyhandicap/profound intellectual and multiple disabilities (PIMD) through a better understanding of the pathophysiology and the development of new care management and rehabilitation strategies adapted to these extreme pathologies. Although there is a lack of knowledge about the health status and care management of the oldest people, a better understanding of the natural course of life of people with polyhandicap/PIMD would consequently allow the optimisation of preventive and curative care management strategies. Few robust data on mortality and life expectancy have been documented for this population in France. Our aims are to estimate the median survival time and assess the factors associated with mortality in people with polyhandicap/PIMD receiving care in France. METHODS: This study included people with polyhandicap/PIMD, followed by the French national cohort 'Eval-PLH' since 2015. These individuals were included in specialised rehabilitation centres and residential institutions. The people included in the first wave of the cohort (2015-2016) were eligible for the present study. Vital status on 1 January 2022 (censoring date) was collected in two ways: (1) spontaneous reporting by the participating centre to the coordinating team and (2) systematic checking on the French national death platform. According to the vital status, survival was calculated in years from the date of birth to the date of death or from the date of birth to the censoring date. The factors associated with mortality were evaluated using the Cox proportional regression hazards model. RESULTS: Data from 780 individuals aged between 3 and 67 years were analysed. At the censoring date, 176 (22.6%) had died, and the mean survival was 52.8 years (95% confidence interval: 51.1-54.5). Mortality was significantly associated with a progressive aetiology, recurrent pulmonary infections, drug-resistant epilepsy and a higher number of medical devices. CONCLUSIONS: This study shows for the first time the survival and impact of factors associated with mortality in people with polyhandicap/PIMD in France.

Atención farmacéutica en pacientes con inmunodeficiencia adquirida y/o tuberculosis en el área ambulatoria de un hospital pediátrico / Pharmacovigilance in patients with acquired immunodeficiency and/or tuberculosis in the outpatient area of a pediatric hospital

La Atención farmacéutica (AF) ayuda a los pacientes a alcanzar objetivos terapéuticos reduciendo los problemas relacionados al medicamento (PRM). Objetivos: analizar los PRM en la práctica de la AF a pacientes con inmunodeficiencia adquirida (IDA) y/o tuberculosis (TBC) y evaluar su impacto. Método: estudio, descriptivo, observacional, en el área ambulatoria de Farmacia. Se incluyeron pacientes con IDA y/o TBC con: inicio de tratamiento, polifarmacia, reinternaciones frecuentes, regular/mala adherencia, reacciones adversas a medicamentos (RAM) previas y/o comorbilidades. Se entrevistaron pacientes o cuidadores y se registraron PRM, errores, grados de adherencia y conocimiento farmacoterapéutico, retiro oportuno de medicamentos y parámetros clínicos. Se registró la intervención farmacéutica y entregó material educativo. Se repitieron las mediciones en una segunda entrevista. Resultados: Se estudiaron 54 pacientes (28 con IDA y 26 con TBC). Se realizaron 93 intervenciones (29.9% dirigidas al prescriptor, 27.8% a otros profesionales) y se detectaron 8 RAM y 53 errores (28 IDA y 25 TBC), el principal PRM fue la mala/regular adherencia con bajo porcentaje de conocimiento farmacoterapéutico completo. Después de la AF, en IDA el grado de adherencia tuvo una mejora estadísticamente significativa (p= 0.012), también fue significativa la mejora en el retiro oportuno de la medicación (28.6% a 71.4% p=0.005 IDA). Se obtuvieron resultados favorables de carga viral (CV) en 72% pacientes con IDA y aumento de peso en 92% pacientes con TBC, aunque no fueron estadísticamente significativos. Conclusiones: mediante AF se mejoró la adherencia y la comunicación en pacientes pediátricos con IDA y/o TBC (AU)

Pharmacovigilance (PV) helps patients achieve therapeutic goals by reducing drug-related problems (DRP). Objectives: to analyze DRPs in the practice of PV in patients with acquired immunodeficiency (AIDS) and/or tuberculosis (TB) and to evaluate its impact. Methods: A descriptive, observational study was conducted in the outpatient pharmacy area. Patients with AIDS and/or TB with: treatment initiation, polypharmacy, frequent readmissions, regular/poor adherence, previous adverse drug reactions (ADR) and/or comorbidities were included. Patients or caregivers were interviewed, and DRP, errors, adherence and pharmacotherapeutic knowledge, timely drug withdrawal, and clinical parameters were recorded. The pharmaceutical intervention was recorded and educational material was delivered. Measurements were repeated in a second interview. Results: We studied 54 patients (28 with AIDS and 26 with TB). Ninety-three interventions were performed (29.9% addressed to the drug prescriber, 27.8% to other professionals) and 8 ADRs and 53 errors were detected (28 AIDS and 25 TB). The main DRP was poor/regular adherence together with a low level of complete pharmacotherapeutic knowledge. After PV, in patients with AIDS the degree of adherence statistically significantly improved (p= 0.012). The improvement in timely medication withdrawal was also significant (28.6% vs. 71.4% p=0.005 AID). Favorable viral load results were obtained in 72% of patients with AIDS and weight gain in 92% of patients with TB, although they were not statistically significant. Conclusions: PV improved adherence and communication in pediatric patients with AIDS and/or TB (AU)

Prevalence and factors associated with active cybersexuality among teenagers between 15 and 17 years old: a cross sectional study in Normandy, France.

OBJECTIVE: Teenagers use the Internet to obtain and exchange information in multiple fields, including about taboo subjects such as sexuality. Our objectives were to determine the prevalence and vulnerability factors related to active cybersexuality among teenagers aged between 15 and 17 years in western Normandy. MATERIAL AND METHODS: This was an observational, cross-sectional, multicenter study integrated into sexual education classes for teenagers between 15 and 17 years old. An anonymous questionnaire, designed for the study, was given at the beginning of each session. RESULTS: The study had a 4-month duration and involved 1,208 teenagers. The results revealed that 66% of them engaged in cybersex, with sexting being the most widespread practice: 21% sent such sexts, 60% received such sexts, and 12% of boys shared such texts with others. Other practices, such as dedipix, dating websites, and skin parties, were more marginal, but 12% of teenagers had met someone in real life after meeting them first online. A history of experiencing violence, a lack of parental control, female gender, poor self-esteem, and consuming toxic drugs were associated with a higher risk of cybersexuality with an odds ratio (OR) of 1.63, 1.95, 2.07, 2.27, and 2.66, respectively. Number of friends on social networks >300 and daily viewing of pornography were also strongly associated with cybersexuality with an OR of 2.83 and 6.18, respectively. CONCLUSIONS: This study shows that cybersex is practiced by two thirds of teens. Vulnerability factors most strongly associated with cybersexuality were female gender, poor self-esteem, consuming toxic drugs, number of friends on social networks >300, and daily viewing of pornography. Cybersexuality involves risks (social exclusion, bullying, dropout, poor self-esteem, breakdown) that are possible to prevent by highlighting this theme during sexual education classes.

Methods used by Canadian dairy farmers for on-farm euthanasia and the emotions associated with the decision and the practice of euthanasia.

On-farm euthanasia is complicated in that farmers have to make the decision to end the life of an animal they are caring for. Studies have shown that some culling decisions are made too late, which results in animal welfare issues. However, information about on-farm euthanasia methods and the decision process leading to the euthanasia of an animal is limited. Additionally, emotions and feelings are involved in the decision and the act of euthanasia. The objectives of this study were to describe current practices related to on-farm euthanasia performed by Canadian dairy farmers and to assess the emotions and complex feelings surrounding the act. A cross-sectional study design was used to gather this information through an online questionnaire completed exclusively by Canadian dairy farmers. Data were analyzed descriptively using frequencies, and associations between the participants' characteristics and their practices and emotions regarding on-farm euthanasia were assessed using logistic regression models. A total of 479 dairy farmers from 5 provinces answered the survey. The most commonly used primary method of on-farm euthanasia was a firearm (>70%). Unacceptable euthanasia methods, such as standard 0.22-caliber long rifle for adult cows or no adjunct method following the use of captive bolt, were used by 25%, 18%, and 58% of the participants for calves, replacement animals, and dairy cows, respectively. Ninety-four percent of the participants reported that the farm owner was the person who always or often made the euthanasia decisions. In addition, 32% of the participants reported that the veterinarian always examined the animal before performing euthanasia, 51% reported at least one person received training to perform euthanasia, and 16% reported having a decision tree for euthanasia. Some participants (17%) were troubled with the responsibility for ending the life of their animals, and 19% perceived other people on the farm to be uncomfortable with performing euthanasia. Half of the participants reported that people performing euthanasia on the farm felt at least one related painful emotion or complex feeling, and half reported they had at least one reason to feel anxiety or unease concerning euthanasia. The results of this study showed gaps such as the limited use of acceptable euthanasia methods and decision trees by Canadian dairy farmers, low availability of on-farm training for euthanasia, and variable involvement of veterinarians.

[Impact of pelvic floor educational sessions on teenage girls]. / Impact de sessions d'éducation périnéale chez des adolescentes.

INTRODUCTION: Our objective was to evaluate the impact of pelvic floor educational sessions on teenage girls about their general knowledge of pelvic floor disorders (PFD) and the anatomy of the pelvic floor. MATERIAL: Educational sessions were offered to teenage girls from middle and high schools in the city of Caen. Each session included pelvic floor anatomy, urinary and digestive physiology as well as situations that favor PFD. At the beginning and end of the session, the participants received a questionnaire on their knowledge and questions concerning their satisfaction were asked at the end of the session. A questionnaire was sent at 2 months to assess the changes in their urinary and digestive habits as well as the dissemination of information to those around them. RESULTS: One hundred and five teenage girls, average age 15, participated in these sessions; 61% responded at 2 months. The educational sessions have significantly improved knowledge about the pelvic floor. After the sessions, 92% and 52% reported having changed their urinary and defecatory habits. Participants found the sessions very useful and all participants recommended these sessions to a friend. CONCLUSION: Pelvic floor educational sessions improve the knowledge of teenage girls and limit behaviors that favor PFD. Teenage satisfaction is important and the dissemination of information is high. A pelvic floor educational program in schools could help limit risky behaviors for the pelvic floor.

Development of a multivariable prediction model to identify dairy calves too young to be transported to auction markets in Canada using simple physical examination and body weight.

Calves born on Eastern Canadian dairy farms that are not kept in the herds are traditionally sold through auction markets and are raised for meat purposes such as veal calves. Since February 2020, a new Canadian federal regulation has forbidden calves <9 d old to be sold through auction markets. However, in the absence of a real-time birth registry consultation system, it would be of interest to look for predictors that could be associated with age to allow identification of calves too young to be transported. In the current retrospective cross-sectional study, 1,178 calves with a declared birth date (411 calves aged <9 d old; 34.9%) were assessed in 2 large Québec auction sites. Easy-to-record covariates [body weight (BW), breed phenotype, and presence of an umbilical cord remnant] as well as other clinical signs (umbilical swelling, enlargement, umbilical pain, wet umbilicus, skin tent, sunken eyes, ocular and nasal secretion, and hide cleanliness) were assessed. Two logistic regression models using age as a dichotomous dependent variable (<9 d old vs ≥9 d old) were built. The first model (model 1) considered all covariates, which were selected after univariable analyses and a backward stepwise selection process, whereas a more pragmatic model (model 2) only included the 3 easy-to-record variables (i.e., BW, breed, umbilical cord). Both models had similar accuracy to detect calves <9 d old (sensitivity of 38.4 and 37.5%, and specificity of 85.7 and 84.6% for model 1 and 2, respectively). Model 2 was subsequently more specifically studied as it employs a faster and easier assessment. Decision thresholds were tested for their robustness based on misclassification cost term (MCT) analysis with various prevalence of calves <9 d old and various costs of false-negative:false-positive ratio. Despite statistical significance, model accuracy, even if refined with MCT analysis, was limited at the individual level, showing the limits of using physical signs and BW or their combination as a reliable proxy of age. The sensitivity of these models to find calves <9 d old was not to be used for monitoring compliance with the Canadian federal regulation. The relatively high model specificity may help to use this model as a rule-in test (i.e., targeting positive calves for further investigation) rather than a rule-out test (due to its low sensitivity).

Tiny but risky: The reasons why the Caspar pin distractor causes suffocating cervical hematoma-Two cases and a literature review.

Symptomatic cervical hematoma (CH) after cervical spine surgery through an anterolateral approach is a feared complication. In up to 60% of CH cases, no source of bleeding is detected during drainage. Bleeding from the pin holes of the Caspar distractor is a known complication, briefly mentioned in the patent, but harmfulness has never been thoroughly assessed. Our team experienced two consecutive postoperative acute CHs, in which the origin of active bleeding obviously came from pin holes, despite careful obturation. The aim of this study was to report these two cases and provide a comprehensive assessment of the dangers of Caspar pin distractors. The intrabody vascularization was well organized and there was a central pedicle arising from the center of the posterior wall. The pedicle penetrated deeply into the body and constituted Batson's channel posteriorly. Retrospectively, it was well-identified in both cases on preoperative imaging. Given the morphological features of the vertebral cervical bodies and Caspar pin, the pin may reach the center of the posterior wall where the pedicle arises. Comparison between vertebral body volumes and the volume of the screwable part of the pins revealed that the pin could occupy up to 7.3% of the total body if randomly inserted. However, pins are in fact inserted into a particular place that contains the pedicle. Epidural bleeding is variable and may be undetected before closure. This also depends on blood pressure variations and changes in the patient's position. Even though Caspar pins are tiny, the likelihood of intrabody vascularization damage appears to be significant. Caspar pins should not be used systematically. Pin hole obturation must be solid and deep. Alternative options such as an interbody distractor and a microscope for the discectomy should be considered.

Impact of an intensive multimodal educative program on behavioral disorders of polyhandicapped patients: A randomized controlled trial.

BACKGROUND: Hospitalized children and young adults with polyhandicap (PLH) often present with behavioral and relational disorders that are mainly related to their difficulties in communicating and interacting with their environments. Educational support is rarely provided to these patients. An intensive multimodal educative program could help in reducing behavioral disorders and in improving the quality of life of healthcare workers, including nurses and auxiliary nurses. METHODS: A multicenter, randomized controlled trial compared the impact of the usual practice of an educative program (1 h a week) to a multimodal intensive educative program (5 h a week) at 12 months. Patients aged 3-25 with PLH defined by the combination of five criteria (motor deficiency, severe-to-profound mental impairment, daily life dependence, restricted mobility, onset of cerebral lesion at younger than 3 years, and at least one behavioral disorder per week [withdrawn behavior, unexplained crying, teeth grinding, self-injury, aggression, stereotypy, or merycism]) were included. The primary outcome was the evolution of the predominant behavioral disorder between study inclusion and 12 months. Healthcare workers completed questionnaires about chronic stress, coping strategies, and quality of life at study inclusion and at 12 months. RESULTS: Overall, 60 patients were included. Despite a tendency toward reduced teeth grinding, withdrawn and self-injury behaviors, the intervention was not significantly effective: The median duration of continuous behavioral disorders (stereotypy, unexplained crying, withdrawn behavior, and teeth grinding) did not differ between groups. The median frequency of the discontinuous behavioral disorders (self-injury) did not differ between groups. Considering each disorder separately, there was a decrease in teeth grinding, self-injury, and autistic-like traits in the intervention group, although it did not reach statistical significance. This study also suggested decreased depersonalization feelings by healthcare workers. CONCLUSION: Although the study did not show a significant reduction in behavioral disorders in patients with PLH, these results encourage further evaluation of educational management, particularly in regard to patients with self-injury and with withdrawn and teeth-grinding behaviors.

[Ovarian teratoma in children. Clinical case and review of the literature]. / Tératome ovarien chez l'enfant. Revue de la littérature à propos d'un cas clinique.

Summmary : Teratomas are the most common histologic type of germ cell tumors in pediatrics. There are two types of teratomas, mature, benign and immature, malignant. Initial diagnosis is essential for optimal management. This work, based on a clinical case, aims to review the clinical, radiological, biological and histological characteristics allowing them to be differentiated.

Les tératomes sont le type histologique le plus fréquent des tumeurs germinales en pédiatrie. Il existe deux types de tératomes, matures, bénins et immatures, malins. Le diagnostic initial est primordial pour une prise en charge optimale. Ce travail, basé sur un cas clinique, a pour but de reprendre les caractéristiques cliniques, radiologiques, biologiques et histologiques permettant de les différencier.

Impact of COVID-19 on surgical emergencies: nationwide analysis.

BACKGROUND: The COVID-19 pandemic has had a major impact on healthcare in many countries. This study assessed the effect of a nationwide lockdown in France on admissions for acute surgical conditions and the subsequent impact on postoperative mortality. METHODS: This was an observational analytical study, evaluating data from a national discharge database that collected all discharge reports from any hospital in France. All adult patients admitted through the emergency department and requiring a surgical treatment between 17 March and 11 May 2020, and the equivalent period in 2019 were included. The primary outcome was the change in number of hospital admissions for acute surgical conditions. Mortality was assessed in the matched population, and stratified by region. RESULTS: During the lockdown period, 57 589 consecutive patients were admitted for acute surgical conditions, representing a decrease of 20.9 per cent compared with the 2019 cohort. Significant differences between regions were observed: the decrease was 15.6, 17.2, and 26.8 per cent for low-, intermediate- and high-prevalence regions respectively. The mortality rate was 1.92 per cent during the lockdown period and 1.81 per cent in 2019. In high-prevalence zones, mortality was significantly increased (odds ratio 1.22, 95 per cent c.i. 1.06 to 1.40). CONCLUSION: A marked decrease in hospital admissions for surgical emergencies was observed during the lockdown period, with increased mortality in regions with a higher prevalence of COVID-19 infection. Health authorities should use these findings to preserve quality of care and deliver appropriate messages to the population.

Clinical characteristics of COVID-19 infection in polyhandicapped persons in France.

AIM: Little is known about the clinical profile of COVID-19 infection in polyhandicapped persons. This study aimed to describe the characteristics of this infection among individuals with polyhandicap. METHOD: This was a retrospective observational study. Polyhandicap was defined by the combination of motor deficiency, profound mental retardation, and age at onset of cerebral lesion younger than 6 years. A positive COVID-19 status was considered for patients with a positive COVID-19 laboratory test result, or patients presenting with compatible symptoms and living in an institution or at home with other patients or relatives who had laboratory-confirmed COVID-19 infection. Data collection included sociodemographic data, clinical and paraclinical characteristics, as well as the management and treatment for COVID-19 infection. RESULTS: We collected 98 cases, with a sex ratio of 0.98 and a mean age of 38.5 years (3 months to 73 years). COVID-19 infection was paucisymptomatic in 46% of patients, 20.6% of patients presented with dyspnea, while the most frequent extra-respiratory symptoms were digestive (26.5%) and neurological changes (24.5%); 18 patients required hospital admission, four adults died. The mean duration of infection was longer for adults than for children, and the proportion of taste and smell disorders was higher in older patients. CONCLUSION: These findings suggest that PLH persons often develop paucisymptomatic forms of COVID-19 infection, although they may also experience severe outcomes, including death. Clinicians should be aware that COVID-19 symptoms in PLH persons are often extra-respiratory signs, mostly digestive and neurologic, which may help in the earlier identification of COVID-19 infection in this particular population of patients.

Short communication: Efficacy of a second intrauterine cephapirin infusion for the treatment of purulent vaginal discharge and endometritis in postpartum dairy cows.

The objective of this study was to quantify the efficacy of a second intrauterine cephapirin treatment administered 14 d after the initial one on subsequent reproductive performance of postpartum dairy cows affected by purulent vaginal discharge (PVD) or endometritis (ENDO). In total, 4,140 Holstein cows from 30 commercial herds were enrolled in a randomized clinical trial. At 36 (±7) d in milk, cows were examined using the Metricheck device to diagnose PVD. An endometrial cytology sample was also collected from each cow to perform a leukocyte esterase test for diagnosing ENDO. Diagnosis of PVD and ENDO was done cow-side. Cows diagnosed with PVD or ENDO were assigned to receive 1 of 2 treatments: (1) a single intrauterine cephapirin infusion (500 mg of cephapirin benzathin; Metricure, Merck Animal Health, Kirkland, QC, Canada) at the time of initial examination or (2) a single intrauterine infusion at the time of initial examination and a second one 14 d later. Subsequent reproductive and culling events were collected until 200 d in milk. Statistical analyses were performed using univariable and multivariable mixed logistic regression models. In cows affected by PVD, a second intrauterine cephapirin infusion increased the pregnancy risk at first insemination in comparison with cows that only received one treatment (28.0 vs. 38.8%). In cows affected by ENDO, a second treatment also increased the pregnancy risk at first insemination compared with cows that only received one treatment (30.3 vs. 39.2%). Overall, these results demonstrate that administering a second intrauterine cephapirin infusion 14 d after the initial treatment in postpartum cows affected by PVD or ENDO did improve their subsequent reproductive performance.

Randomized controlled trial of pegbovigrastim as an adjunct therapy for naturally occurring severe clinical mastitis cases in dairy cows.

The main objective of this study was to quantify the effect of pegbovigrastim (PEG) as an adjunct therapy for naturally occurring severe mastitis cases on survival, intramammary bacteriological cure, and subsequent milk production. A double-blinded, randomized controlled trial was conducted on a single commercial dairy farm. During the study period, all cows having a case of severe clinical mastitis, defined as the presence of abnormal milk and inflammation in one quarter or more combined with the presence of systemic signs (pyrexia, dehydration, or recumbency), were enrolled in the study. In addition to a standardized therapy combining systemic and intramammary antimicrobials as well as systemic anti-inflammatory drugs, cows received a subcutaneous injection of either 2.7 mL of 0.9% sterile saline (control group; CON) or 2.7 mL of PEG (PEG group). A milk sample for bacteriological analysis was taken before treatment was administered and a second sample was taken 14 d after enrollment. Survival (30 d post-treatment) and bacteriological cure (14 d post-treatment) were analyzed by survival analysis and chi-squared tests, respectively, whereas daily milk production was treated as a repeated measure in mixed regression models. The 77 cows enrolled in the study were of parity 2 to 4 (mean = 3) and between 3 and 302 d in milk (mean = 154). The bacteria identified in milk at enrollment were Klebsiella spp. (n = 48; 62%), Escherichia coli (n = 16; 21%), Enterobacter spp. (n = 10; 13%), or no growth (n = 3; 4%). The probability of survival during the first 30 d after treatment was higher in the PEG group (84%) than in the control group (46%). Daily milk production over the 30-d period following treatment and bacteriological cure 14 d post-treatment did not differ between groups. Overall, cows treated with PEG as an adjunct therapy for naturally occurring cases of severe clinical mastitis had a better survival than cows treated with saline.

Randomized controlled trial of reinsemination strategies in dairy cows diagnosed nonpregnant using color flow Doppler ultrasonography on d 21 after insemination.

The objective of this study was to quantify the reproductive performance of 4 reinsemination strategies in cows diagnosed nonpregnant using corpus luteum color flow Doppler ultrasonography on d 21 after last insemination. A total of 2,140 color flow Doppler ultrasonography exams from 845 Holstein cows from 10 commercial dairy herds were used in this study. Farms were visited every 2 wk by the research team. On d 7 after insemination, cows were enrolled in a randomized controlled trial to be assigned 1 of 4 treatments if they were subsequently diagnosed nonpregnant on d 21. All cows were then examined on d 21 using Doppler ultrasonography to diagnose nonpregnancy. Treatment A (CON) was the control group: nonpregnant cows were programmed to receive a standard Ovsynch protocol starting on d 32. Nonpregnant cows in treatment B (GnRH) were injected i.m. with GnRH on d 21 after insemination and reinseminated immediately. Cows in treatment C (2×GnRH) received an i.m. injection of GnRH on d 11 after insemination. If diagnosed nonpregnant on d 21 after insemination, they were injected i.m. with GnRH on d 21 after insemination and inseminated immediately. Cows in treatment D (Resynch) received an i.m. injection of GnRH on d 14 after insemination. If diagnosed nonpregnant on d 21 after insemination, they were injected i.m. with PGF2α on d 21 after insemination and injected i.m. with GnRH on d 24. Then, a standard Ovsynch protocol was started on d 32. Statistical analyses were performed using mixed logistic regression models accounting for cow clustering and herd effect. A theoretical simulation was performed for each treatment to quantify the proportion of cows remaining nonpregnant 42 d after initial insemination. Of the 2,140 color flow Doppler ultrasonography exams in the study, 870 (40.6%) had a Doppler score of D0 (n = 444) or D1 (n = 426), which were indicative of nonpregnancy and used for data analysis. Overall, the number of exams assigned to each treatment was as follows: CON = 223 (25.6%), GnRH = 214 (24.6%), 2×GnRH = 220 (25.3%), and Resynch = 213 (24.5%). The final mixed multivariable logistic regression model included treatment, parity, days in milk at enrollment, and herd. Conception risk at first insemination following enrollment was 31.4, 20.6, 31.9, and 48.7% for treatments CON, GnRH, 2×GnRH, and Resynch, respectively. Based on the simulation, if 100 cows were diagnosed nonpregnant at their color flow Doppler ultrasonography exam on d 21 after last insemination, the total number of cows remaining nonpregnant 42 d after the initial insemination would be 69, 72, 58, and 51 for treatments CON, GnRH, 2×GnRH, and Resynch, respectively. Thus, the treatments used in groups 2×GnRH and Resynch for cows diagnosed nonpregnant on d 21 after insemination yielded better results than those used in the other groups.

Development and initial validation of the polyhandicap severity scale.

OBJECTIVES: Providing a new tool, based on the point of view of experts in polyhandicap, which assesses the global severity of the health status of polyhandicapped persons is necessary. We present herein the initial validation of the polyhandicap severity scale (PSS). METHODS: The initial development of the tool was undertaken in two steps: item selection and validation process. The final set included 10 items related to abilities and 17 items related to comorbidities and impairments. The patient selection criteria were as follows: age>3 years, age at onset of cerebral lesion under 3 years old, with a combination of motor deficiency and profound intellectual impairment, associated with restricted mobility and everyday life dependence. External validity, reproducibility (20 patients), responsiveness (38 patients), and acceptability were explored. RESULTS: During the 18-month study period, a total of 875 patients were included. Two scores were calculated: an abilities score and a comorbidities/impairments score (higher score, higher severity). The 2 scores were higher for: older patients, patients with a progressive etiology, patients with more devices and more medications, patients with higher dependency and lower mobility. Indicators of reproducibility and responsiveness were satisfactory. The mean time duration of fulfilling was 22minutes (standard deviation 5). CONCLUSIONS: Quantifying the health severity of polyhandicapped persons is necessary for both healthcare workers and health decision makers. The polyhandicap severity scale provides the first reliable and valid measure of the health severity status for children and adults.

Health issues in polyhandicapped patients according to age: Results of a large French cross-sectional study.

INTRODUCTION: A better understanding of the natural course of the health status of patients with polyhandicap may optimize preventive and curative care management. From a large sample of patients aged from 3 to 25 years, we reported the description of their health status. METHODS: This was an 18-month cross-sectional study including patients aged from 3 to 25 years with a combination of severe motor deficiency and profound intellectual impairment. The patients were recruited from 4 specialized rehabilitation centers, 9 residential facilities, and a pediatric/neurological department. The following data were collected: polyhandicap etiology, health status (impairments, comorbidities, and neurodevelopmental status), medical devices, and rehabilitation procedures. RESULTS: A total of 545 patients were included (n=80 [3-5 years], n=166 [6-11 y], n=155 [12-17 y], and n=144 [18-25 y]). The etiology of polyhandicap was unknown for 11.5% of the cases. Behavioral disorders and (orthopedic and digestive) comorbidities were more frequent in the oldest age classes. The neurodevelopmental status of the patients was close to those of a 5- to 7-month-old child without progression across age. Gastrostomy was the most frequent device needed by the patients. DISCUSSION/CONCLUSION: Early detection and management of impairments and comorbidities may improve the disease course of the patients.

Health characteristics and health care trajectory of polyhandicaped person before and after 1990.

INTRODUCTION: Polyhandicap is defined as the combination of severe mental impairment and severe motor deficit resulting in reduced mobility and an extreme reduction in autonomy. Over the last 20years, care management for these patients has become more structured, however, their care pathway is not always optimal. OBJECTIVE: To describe/compare the health characteristics, treatment and history of the care pathways of subjects who received care before and after 1990. METHOD: Multicentre cross-sectional study, population studied: patients with polyhandicap: (i) causal brain damage<3years, (ii) severe mental impairment, (iii) motor disability, (iv) reduced mobility, (v) extreme restriction of autonomy. DATA COLLECTED: clinical and medical, care procedures, treatments, history of care pathways. RESULTS: Patients are divided into 2 groups: 545 patients who received care after 1990 and 330 before 1990. Older patients present more recurrent urinary infections, slow transit, behavioural disorders and pain, and are prescribed a greater number of drugs. For those who received care before 1990, the age of admission to an establishment is lower, with one-third receiving a consultation dedicated to the transition from paediatric to adult teams. DISCUSSION/CONCLUSION: The care sector for patients with polyhandicap makes it possible to meet their needs throughout their lives, however, there is still progress to be made in terms of formalisation and of coordinating the care pathway in order to facilitate the transition from paediatric to adult services/establishments.

Short communication: Accuracy of corpus luteum color flow Doppler ultrasonography to diagnose nonpregnancy in dairy cows on day 21 after insemination.

The main objective of this study was to determine the accuracy of corpus luteum color flow Doppler ultrasonography (CLCFDU) to diagnose nonpregnant dairy cows 21 d after insemination. A secondary objective was to determine the accuracy of other indirect tests such as corpus luteum size and progesteronemia. Data from 1,632 Holstein cows (10 commercial herds) were used for the analysis in this prospective cohort study. The herds were visited weekly by a veterinarian and an animal health technician. During farm visits, cows were examined on d 21 after insemination using transrectal B-mode ultrasonography to quantify the presence and size of the corpus luteum. After identification of the corpus luteum, CLCFDU was performed and scored as D0, D1, D2, or D3 when 10% or less, between 11 and 30%, between 31 and 60%, or 61% or more of the corpus luteum surface was colored, respectively. A blood sample from coccygeal vessels was also collected to quantify progesteronemia. Farmers were blinded to these findings and no intervention was performed following examination. On d 32 after insemination, the cows were examined by the regular herd veterinarian using transrectal palpation and B-mode ultrasonography to determine whether the cows were pregnant or not (the reference test). Statistical analyses were conducted using 2 × 2 contingency tables. The apparent prevalence, sensitivity, specificity, positive predictive value, and negative predictive value of CLCFDU for predicting nonpregnancy were 22.0, 36.6, 99.0, 98.1, and 52.0%, respectively, when using D0 only as the diagnostic criterion; they were 47.2, 76.4, 94.8, 93.5, and 73.8%, respectively, for D0+D1 criteria. The same measures for cows with a corpus luteum <15 mm were 8.0, 11.7, 97.5, 86.9, and 43.4%, respectively, and they were 51.9, 67.4, 70.4, 76.6, and 60.0%, respectively, for progesteronemia <1 ng/mL. The measures of accuracy of CLCFDU to identify nonpregnant cows on d 21 after insemination were high, and the apparent prevalence varied depending on the diagnostic criteria used. The measures of accuracy of corpus luteum size (<15 mm) for the same purpose were high; however, apparent prevalence was low. The measures of accuracy of progesteronemia (<1 ng/mL) were low. In conclusion, CLCFDU had excellent accuracy to diagnose nonpregnancy in dairy cows on d 21 after insemination.

Risk of preterm birth in a twin pregnancy after an early-term birth in the preceding singleton pregnancy: a retrospective cohort study.

OBJECTIVE: To evaluate whether a history of spontaneous early-term birth (37+0 -38+6  weeks of gestation) in the previous singleton pregnancy is a risk factor for preterm birth (PTB) in a subsequent twin pregnancy. DESIGN: Retrospective cohort study. SETTINGS: Two French university hospitals (2006-2016). POPULATION: All women who delivered twins from 24+0  weeks after a preceding singleton pregnancy birth at 37+0 to 41+6  weeks. METHODS: Multivariate logistic regression analysis of association between twin PTB and a previous spontaneous singleton early-term birth. MAIN OUTCOME MEASURES: Twin PTB rate before 37, 34 and 32 weeks of gestation. RESULTS: Among 618 twin pregnancies, 270 were born preterm, 92 of them with a preceding spontaneous singleton early-term birth. The univariate analysis showed a significantly higher risk of twin PTB before 37, 34 and 32 weeks among those 92 women compared with those with a full- or late-term birth in their previous singleton pregnancy. This association remained significant after logistic regression (odds ratio [OR] between 2.42 and 3.88). The secondary analysis, restricted to the twin pregnancies with spontaneous PTB found similar results, with a risk of PTB before 37, 34 and 32 weeks significantly higher among women with a previous spontaneous singleton early-term birth, including after logistic regression analysis (OR between 3.51 and 3.56). CONCLUSION: A preceding spontaneous singleton early-term birth is a strong and easily identified risk factor for PTB in twin pregnancies. TWEETABLE ABSTRACT: Spontaneous 'early-term' birth of a singleton is a significant risk factor for future preterm births in twin pregnancies.