History of pre-eclampsia does not appear to be a risk factor for vascular phenotype in women with systemic sclerosis.

BACKGROUND: Vascular phenotype is associated with a poor prognosis in systemic sclerosis (SSc). The identification of its risk factors could facilitate its early detection. OBJECTIVES: To explore risk factors for a vascular phenotype of SSc, among them a history of pre-eclampsia. METHODS: This observational multicentre case-control study enrolled adult women fulfilling European Alliance of Associations for Rheumatology 2013 diagnosis criteria for SSc and having a pregnancy history≥6 months before SSc diagnosis in 14 French hospital-based recruiting centres from July 2020 to July 2022. Cases had specific vascular complications of SSc defined as history of digital ischaemic ulcers, pulmonary arterial hypertension, specific cardiac involvement or renal crisis. Women with SSc were included during their annual follow-up visit and filled in a self-administered questionnaire about pregnancy. A case report form was completed by their physician, reporting data on medical history, physical examination, clinical investigations and current medication. The main outcome was the presence/absence of a personal history of pre-eclampsia before SSc diagnosis, according to the validated pre-eclampsia questionnaire. RESULTS: 378 women were included: 129 cases with a vascular phenotype and 249 matched controls. A history of pre-eclampsia was reported in 5 (3.9%) cases and 12 (4.8%) controls and was not associated with a vascular phenotype (OR=0.96, 95% CI 0.28 to 3.34, p=0.9). Besides, Rodnan skin score and disease duration≥5 years were risk factors for vascular phenotype. CONCLUSIONS: In women with SSc and a pregnancy history≥6 months before SSc, a history of pre-eclampsia is not associated with a vascular phenotype.

Incidence and risk factors for care-related pain in children with physical disabilities.

BACKGROUND: The daily life of children with a physical disability is organized around interventions and care, which is coordinated by a multidisciplinary team. Little is known about the incidence of care-related pain in pediatric rehabilitation centers and health facilities for children. AIM: To determine the incidence and intensity of care-related pain in children with physical disabilities, identify risk factors for pain and practices used to prevent care-related pain in pediatric rehabilitation centers and health facilities for children in France. DESIGN: Non-interventional observational study. SETTING: Sixteen pediatric rehabilitation and special education centers in 4 departments of Brittany (France). POPULATION: A number of 280 children with physical disabilities randomly selected (mean age: 12±4 years). Predominant medical diagnosis was nervous system diseases (68%; e.g., cerebral palsy 33%). METHODS: The FLACC-r scale was used to evaluate pain during each care activity or intervention that required physical contact with the child for five consecutive days and one night. RESULTS: The recorded interventions were 7689. Pain was induced by 6% of physical acts, and 48% of children experienced at least one painful act during the study period. Acts that were more frequently associated with pain and had the highest pain intensity were standing frame use, feeding, gentle mobilizations and bladder catheterization. Age, level of dependency and type of act were all risk factors for care-related pain (P<0.01). Pain prevention was used for only 26.5% of acts. CONCLUSIONS: Care-related pain is frequent and under-recognized in pediatric rehabilitation and health facilities for children. All acts that involve direct physical contact can cause pain. Young and severely dependent children are most at risk of pain. CLINICAL REHABILITATION IMPACT: All professionals who are involved in the care of children with a physical disability and significant limitations in activity and participation must be aware of the issue of pain and that pain can be induced by even the most routine physical act. The management of care-related pain requires a benefit-risk analysis, a prevention and pain assessment, and a family-professional partnership. A multidimensional approach is needed for more individualized pain management and to evaluate the impact of pain on children's participation.

Effect of different form of upper limb muscles training on dyspnea in chronic obstructive pulmonary disease: A study protocol.

INTRODUCTION: In activities involving upper limbs, patients with chronic obstructive pulmonary disease (COPD) report an increase in dyspnea. For this reason, the authors of the recommendations about pulmonary rehabilitation propose to perform upper limbs muscle strengthening in patients with COPD. However, the modalities of strengthening are not clearly established.The aim of this study is to compare the effects of upper limbs endurance strengthening versus upper limbs force strengthening, in patients with COPD during a pulmonary rehabilitation program. METHODS: This study is a randomized, open-label, bi-center controlled trial in parallel groups distributed in a ratio (1:1) comparing upper limbs force strengthening (group F) to the upper limbs endurance strengthening (group E) during a pulmonary rehabilitation program in patients with COPD stages 2 to 4 (A-D).After randomization, patients will be allocated to follow: A 4 weeks pulmonary rehabilitation program with upper limbs resistance strengthening (group F). A 4 weeks pulmonary rehabilitation program with upper limbs endurance strengthening (group E).The primary outcome is dyspnea measured with the London Chest Activity of daily Living questionnaire. The secondary outcomes are dyspnea (using Modified Medical Research Council dyspnea Scale, dyspnea-12 questionnaire, multidimensional dyspnea profile questionnaire), upper limb exercise capacity (using the 6-minute Peg Board and Ring Test), Maximal voluntary strength of deltoid, biceps, and brachial triceps.The sample size calculated is 140 patients per group, or 280 in total. DISCUSSION: The modalities of upper limb strengthening are not very well known, and evidence based is lacking to recommend endurance or resistance upper limb strengthening.We anticipate that the results of this study will be of relevance to clinical practice. They will bring information about the best modality of upper limb strengthening to use during a pulmonary rehabilitation program. TRIAL REGISTRATION: IdRCB n°2018-A00955-50; V1.1 du 11/07/2018; REHABSUP, clinical trial.gov (NCT03611036), registered August 02, 2018, https://clinicaltrials.gov/ct2/show/NCT03611036.