Association between marked fetal heart rate variability and neonatal acidosis: A prospective cohort study.

OBJECTIVE: To assess the association between marked variability in fetal heart rate (FHR) and neonatal acidosis. DESIGN: Bicentric prospective cohort study. SETTING: From January 2019 to December 2019, in two French tertiary care maternity units. POPULATION: Women in labour at ≥37 weeks of gestation, with continuous FHR monitoring until delivery and with the availability of umbilical arterial pH. Women with intrauterine fetal death or medical termination, multiple pregnancies, non-cephalic presentation or planned caesarean delivery were excluded. METHODS: The exposure was marked variability in FHR in the 60 minutes before delivery, defined as a variability greater than 25 beats per minute, with a minimum duration of 1 minute. To assess the association between marked variability and neonatal acidosis, we used multivariable modified Poisson regression modelling. We then conducted subgroup analyses according to the US National Institute of Child Health and Human Development (NICHD) category of the associated fetal heart rate. MAIN OUTCOME MEASURES: Neonatal acidosis, defined as an umbilical artery pH of ≤7.10. RESULTS: Among the 4394 women included, 177 (4%) had marked variability in fetal heart rate in the 60 minutes before delivery. Acidosis occurred in 6.0% (265/4394) of the neonates. In the multivariable analysis, marked variability was significantly associated with neonatal acidosis (aRR 2.30, 95% CI 1.53-3.44). In subgroup analyses, the association between marked variability and neonatal acidosis remained significant in NICHD category-I and category-II groups. CONCLUSIONS: Marked variability was associated with a twofold increased risk of neonatal acidosis.

[Télédent, an oral tele-expertise experience in a penitentiary environment]. / Télédent, une expérience de téléexpertise bucco-dentaire en milieu pénitentiaire.

The oral health has an important role in the good general health state. Some populations, including those in detention, have not only increased needs, but also limited access to dental care. Télédent is an oral tele-expertise activity that facilitates the screening and prevention of oral disorders, performing as a complementary health tool for screening. With an intra-oral camera, oral images of the prisoners are recorded and then analyzed by a team from the Oral Medicine Department of the Hospital Henri Mondor, giving the UCSA of Fresnes prison a detailed dental expertise. As a result, Télédent enables a cooperation to improve the screening and oral care of prison inmates at the Fresnes Prison, decreasing costs and increasing the security.

TITLE: Télédent, une expérience de téléexpertise bucco-dentaire en milieu pénitentiaire. ABSTRACT: La santé bucco-dentaire participe au maintien d'un bon état général de l'organisme. Certaines populations, dont les personnes détenues, ont des besoins importants mais, simultanément, un accès limité aux soins dentaires. Télédent est un outil complémentaire de téléexpertise bucco-dentaire qui facilite le dépistage et la prévention des troubles oraux. À partir d'une caméra intra-buccale qui enregistre des images qui sont analysées par l'équipe du service de médecine bucco-dentaire de l'Hôpital Henri Mondor, l'Unité sanitaire du centre pénitentiaire de Fresnes dispose d'une expertise dentaire détaillée. Télédent permet ainsi une coopération entre les services qui améliore le dépistage et la prise en charge de soins bucco-dentaires, tout en diminuant les coûts et en favorisant la sécurité des patients détenus.

[The necessary ethical questioning regarding the caring relationship in dental telemedicine]. / Le nécessaire questionnement éthique autour de la relation de soin en télémédecine bucco-dentaire.

Technological innovations in the fields of medical imaging and communication have enabled the rise of dental telemedecine. By transforming the usual caring relationship, dental telemedicine virtualizes the medical procedure and generates a mutation of the classical relational model that rearticulates the relationship between the dentist and the patient. It introduces a positive lever that must stay up to the appraisal of the benefit-risk equation, that an ethical questioning will help to evaluate for every patient. Dental telemedicine must be understood as a mean, and not as an end. It must not be fantasized as a universal dental care model. It seems to be recommanded to investigate systematically the technological innovations and the development of protocols thanks to ethical guidelines in order to evaluate a priori and a posteriori any kind of progress that might be considered.