Recurrence of hypertensive disorders of pregnancy: results from a nationwide prospective cohort study (CONCEPTION).

OBJECTIVE: To assess the risk of gestational hypertension (GH) and pre-eclampsia (PE) during a second pregnancy after occurrence during a first pregnancy. DESIGN: Prospective cohort study. SETTING: CONCEPTION is a French nationwide cohort study that used data from the National Health Data System (SNDS) database. METHODS: We included all women who gave birth for the first time in France in 2010-2018 and who subsequently gave birth. We identified GH and PE through hospital diagnoses and the dispensing of anti-hypertensive drugs. The incidence rate ratios (IRR) of all hypertensive disorder of pregnancy (HDP) during the second pregnancy were estimated using Poisson models adjusted for confounding. MAIN OUTCOME MEASURES: Incidence rate ratios of HDP during the second pregnancy. RESULTS: Of the 2 829 274 women included, 238 506 (8.4%) were diagnosed with HDP during their first pregnancy. In women with GH during their first pregnancy, 11.3% (IRR 4.5, 95% confidence interval [CI] 4.4-4.7) and 3.4% (IRR 5.0, 95% CI 4.8-5.3) developed GH and PE during their second pregnancy, respectively. In women with PE during their first pregnancy, 7.4% (IRR 2.6, 95% CI 2.5-2.7) and 14.7% (IRR 14.3, 95% CI 13.6-15.0) developed GH and PE during their second pregnancy, respectively. The more severe and earlier the PE during the first pregnancy, the stronger the likelihood of having PE during the second pregnancy. Maternal age, social deprivation, obesity, diabetes and chronic hypertension were all associated with PE recurrence. CONCLUSION: These results can guide policymaking that focuses on improving counselling for women who wish to become pregnant more than once, by identifying those who would benefit more from tailored management of modifiable risk factors, and heightened surveillance during post-first pregnancies.

A global assessment of freshwater mollusk shell oxygen isotope signatures and their relation to precipitation and stream water.

Records of δ18O in stream flow are critical for understanding and modeling hydrological, ecological, biogeochemical and atmospheric processes. However, the number of such records are extremely limited globally and the length of such time series are usually less than a decade. This situation severely handicaps their use in model testing and evaluation. Here we present a global assessment of freshwater mollusk (bivalves & gastropods) isotope data from 25 river basins that have stream water isotope values, water temperature data and shell material isotope signatures. Our data span a latitude range of 37.50°S to 52.06°N. We show that δ18O signatures in freshwater mollusks are able to explain 95% of the variance of stream water δ18O. We use shell δ18O values and water temperature data to reconstruct stream water δ18O signatures. With freshwater mussel life expectancy ranging from a few years up to 200 years, this translation of mollusk metabolic properties into long term stream water isotope records is a promising approach for substantially extending global stream water isotope records in time and space.

[Delayed diagnosis in a patient with Creutzfeldt-Jakob disease in a psychiatric hospital]. / Late diagnose bij een patiënt met de ziekte van Creutzfeldt-Jakob in een psychiatrisch ziekenhuis.

A 51-year-old female teacher of dance was referred to the diagnostic unit of our psychiatric hospital with symptoms of anxiety and depression. The clinical image was suggestive of organic pathology, but this could not be determined with certainty until a late stage. We discuss the course of the patient's illness. Her symptoms appeared to be psychiatric and closely resembled those of Creutzfeldt-Jakob disease. We comment on some of the signs that could have led to an earlier diagnosis and we discuss the tools that are needed.

[Multidisciplinary management of children with disabling chronic pain in a French pediatric rehabilitation center: Current management and perspectives]. / Prise en charge multidisciplinaire des enfants souffrant de douleurs chroniques invalidantes dans un centre de rééducation fonctionnelle pédiatrique français : analyse rétrospective d'une série et perspectives.

INTRODUCTION: Chronic pain in children and adolescents has a major impact on their life in terms of school, sleep as well as family and social life. Teenagers aged 13-15 and girls are at the highest risk. Zeltzer et al. established a bio-psychosocial model of chronic pain in 1998 to account for all its dimensions and advocated a multidisciplinary management plan. Programs based on their principles target specific symptoms such as anxiety and loss of function, while treating underlying factors and teaching coping skills to patients and their families. They aim for patients to regain autonomy rather than focusing on pain resolution. Such programs, with varied protocols, have existed outside of France for approximately 15 years. The efficacy of these multidisciplinary programs has been shown in studies in Germany, the United Kingdom, the United States, Canada, and Australia. To our knowledge, there are no French studies on this topic; therefore, our aim was to describe a French program. We hypothesized that the program would be effective in reducing chronic pain and its impact. METHODS: The aim of this study was to describe the multidisciplinary management of chronic pain in a French pediatric functional rehabilitation center. It is a public health establishment located in the suburbs of Lille, offering care for children aged 0-18 with various conditions. It has 52 hospital beds, can accommodate up to 22 day-hospital visits per day and has comprehensive technical facilities. This prospective study consisted in a chart review of all consecutive patients who were hospitalized in the functional rehabilitation center for chronic pain with significant disability since 2010. We reviewed the treatment protocol for each patient as well as the treatment results for the composite primary endpoint, comprising pain characteristics and the impact of pain on function and schooling after discharge. RESULTS: Twenty-nine patients, aged 9.4-17.8 years, 62.1% of whom were girls, were hospitalized for chronic pain with a significant impact on their daily life between 2010 and August 2014. The most common diagnosis was complex regional pain syndrome type 1 (CRPS1) (37.9%). Pain had major consequences, with total disability in 69% of cases and 100% of children taking pain medications. In 65.5% of cases, patients were hospitalized in an inpatient setting, and 34.5% attended an outpatient program. Treatment lasted from 1 to 68 weeks (mean, 24.3; standard deviation [SD], 21.6). Patients received a combination of medical care, physical therapy (100%), occupational therapy (37.9%), psychological counseling (100%), pain medications (96.6%), and schooling (96.6%). Pain improved significantly in 89.7% of patients (95% confidence interval [95% CI] [0.73-0.98]) and pain medication consumption decreased significantly in 72.4% of children (95% CI [0.53-0.87]). Patients who had stopped walking could ambulate again in 91.7% of cases (95% CI [0.73-0.99]) and 86.4% of patients who had been missing school were back at school full time (95% CI [0.65-0.97]). There were no significant differences for these results between inpatient and outpatient management programs. Improvements were maintained at 3-6 months after discharge in 83.3% of cases. CONCLUSION: The multidisciplinary pain management program in this French pediatric functional rehabilitation center shows results comparable to the programs described in other countries. Chronic pain should be evaluated with standardized and validated tools, such as the measurement of the pain-related disability with the Functional Disability Index.

Perioperative progress check of interdental forces following extraction of the third molars. A prospective long-term study.

With the aim of checking the progress of mesially directed forces in a complete dental arch, we measured the interdental frictional forces in a population of 44 patients with erupting maxillary and mandibular third molars. The measurements were taken preoperatively and postoperatively 1, 2, 3, 7, and 12 weeks and also 1 year after extraction or surgical removal of the third molars in all 4 quadrants. In addition, the interdental frictional forces of a total of 40 test persons in 3 control groups were similarly measured in a state of inertia, after a period of 1 hour spent in supine position, and after a 5-minute period of chewing activity. Over the first 4 to 12 weeks the interdental forces showed a significant postoperative average decrease of 16.1% in the maxilla and 18.0% in the mandible. After 1 year the average reduction in the level of interdental forces in the patient population was 10.3% in the maxilla and 10.9% in the mandible. A significant postoperative reduction in force of 40.7% was registered for third molars with a mesial angle of 66 degrees to 90 degrees to the tooth axis of the second molar in the mandible. Following a 1-year control period, the level of interdental force in the patient population was found to be on average 27.4% below the preoperative baseline value. In control group I, the margin of fluctuation of interdental forces in a state of inertia was +/- 3.5% over a 3-month period. In control group II, a significant average decrease in interdental forces was measured in the maxilla (15.1%) and mandible (13.2%) following a 1-hour period in supine position. In control group III, a non-significant average reduction in interdental forces was established in the maxilla (7.8%) and mandible (8.6%) following a 5-minute period of chewing activity.

In vitro evaluation of a measurement method to analyze the interdental, mesially directed force.

In order to evaluate interdental forces as a benchmark for mesial drift, a measurement technique was tested and evaluated on a human specimen. The measurement technique is based on the principle that a mesially directed horizontal force (FH) within a complete dental arch has an effect on interdental friction at the points of contact. The dynamic force (FZ), needed to pull out a defined metal strip from the interdental space is equal to the interdental frictional force (FR). Assuming unmodified approximal surfaces and unchanged tooth mobility in a complete dental arch, relative modifications of the interdental frictional force level provide a way of measuring horizontal force fluctuations. The validity of this measurement technique was measured by applying mesially directed forces of 1 to 5 N to the distal surface of the 2nd molar in a human specimen. The frictional forces measured increased in proportion to the distally applied force. The mesially directed force on the 2nd molar was transmitted in the dental arch anteriorly up to the incisor region and resulted in an increase of frictional forces. The reproducibility of this measurement technique was tested by quantitative analysis of potential measurement errors in the human specimen. The effect on interdental force measurement of the speed at which the metal strip is pulled was evaluated in a range of 50 to 500 mm/min. At the maximum pulling speed of 500 mm/min, a maximum scatter of 8% was recorded. Dependency of the dynamic force on direction of pull was measurable only when the metal strip was angled at more than 15 degrees. Experimental tests on the human specimen confirmed that the measurement technique presented here is sufficiently valid and reproducible for clinical long-term studies of interdental forces.