Exploring the hypothesis of differential care for African immigrant and native women in France with hypertensive disorders during pregnancy: a qualitative study.

OBJECTIVE: To analyse whether prenatal care trajectories among women with hypertensive disorders during pregnancy in France differ between immigrants from sub-Saharan Africa (SSA) and native French women. DESIGN: Qualitative interview study. SETTING: Three public maternity units in the Paris region. POPULATION: Women born in SSA or in France of French parents and treated for hypertension or pre-eclampsia during their pregnancy. METHODS: A sociologist conducted semi-structured in-depth interviews of 33 women during their postpartum hospitalisation and collected data from their medical files. n'vivo 10 (QSR International) was used for line-by-line coding of the transcriptions, to identify emerging themes. Strauss's concept of illness trajectories was then applied to these data. MAIN OUTCOME MEASURES: Themes derived from interviews. RESULTS: Women reported during the interviews that the blood pressure measurement procedures used by hospital staff varied between the two groups, and their medical records supported this finding. Repeated urinary dipstick testing of proteinuria before laboratory testing was more frequent for African women, as was the failure to further test proteinuria levels requiring additional action. The two groups received similar standardised care after severe complications. Other findings showed that African women were less likely to rely on healthcare services. CONCLUSIONS: These results suggest non-medically justified differential prenatal care between African and native women that may have helped delay the diagnosis of hypertension or pre-eclampsia. This study suggests hypotheses for further quantitative studies to explore the potential involvement of this differential care in the higher frequency of severe complications in this subgroup, concordantly reported in European countries hosting SSA migrants. TWEETABLE ABSTRACT: Differential prenatal care may delay diagnosis of pre-eclampsia among African compared with native French women.

Avenues for measuring and characterising violence in perinatal care to improve its prevention: A position paper with a proposal by the National College of French Midwives.

BACKGROUND: France is somewhat behind other countries in its consideration of the issue of violence in perinatal care. Its consequences on maternal, but also neonatal and infant health are recognised internationally. Nonetheless, research and data measuring its frequency and its determinants are inadequate, and the relevant definitions are not always consensual. In this context, we, as midwives and researchers in public health and as members of the National College of French Midwives, seek to propose a scientific and clinical contribution to this debate. AIM: We propose avenues for measuring and characterising violence in perinatal care. Our objective is to quantify and characterise the situations of violence in perinatal care in population-based studies and based on the perceptions of each woman questioned. DISCUSSION: This proposal for questions, simplified compared with those currently in used in the international scientific literature, has the advantage of focusing reflection around three categories: inappropriate medical care, inappropriate human behaviours in care, and sexual abuse. It should also allow the identification of the contexts of care during which violence may be experienced, as well as the categories of health-care workers concerned. CONCLUSION: It seems important to us to distinguish these situations, causal and context, for they require different responses if we hope to reduce the frequency and the effects of violence in perinatal care in the future. We propose questions that could also be used in clinical situations by midwives and other clinicians.

[Medical attitudes regarding the announcement of suspected foetal abnormality in ultrasound scans]. / Attitudes et vécu des échographistes lors de l'annonce d'une anomalie fœtale.

OBJECTIVES: This study's primary objective was to analyse the personal experience of different ultrasonographers during the announcement of suspected foetal abnormalities, seen either in screening or diagnostic ultrasound. The secondary objectives aimed to explore the factors influencing the announcement of the foetal abnormality, whether they complicated or facilitated the consultation. These also comprised the analysis of the knowledge, practice and attitudes of the healthcare professionals as well as the different techniques used during the consultation. Finally, this study aimed to analyse the various tools and skills used by ultrasonographers to improve the quality of their announcement of the diagnosis. METHODS: This qualitative study was based on both the observation of consultations and the results of semi-structured interviews with ultrasonographers, in a maternity hospital in France. RESULTS: The results highlighted feelings of great discomfort for the ultrasonographers on discovering an abnormality on the scan. The different perceptions and practices regarding the announcement of a diagnosis varied between screening ultrasonographers and specialist doctors. The uncertainty of foetal prognosis seemed to complicate the announcement for specialist doctors. Qualities that made the communication of the diagnosis easier included the ultrasonographer's availability and their attitude. Although professional experience was considered a very powerful skill, training for the communication of a diagnosis accelerates the development of good medical practice. CONCLUSIONS: The announcement of suspected foetal abnormalities is a difficult exercice, which impacts the ultrasonographer's personal experience and his attitude. Some professional practices are to be encouraged while others are to be put under question. A trust-based relationship between the healthcare professional and the patient is partly reinforced by the quality of the announcement and its follow-up, as well as the healthcare professional's thoroughness and humanity.

[Screening and healthcare for pregnant women with psycho-social vulnerability : A French national study]. / Dépistage et parcours de soins en cas de vulnérabilités psycho-sociales maternelles : une enquête nationale française.

INTRODUCTION: Psycho-social vulnerabilities are a medical risk factor for both fetus and mother. Association between socioeconomic status and prenatal follow-up has been well established and inadequate follow-up is associated with higher morbidity and mortality in women in unfavorable situations. OBJECTIVE: The objective is to identify screening strategies and to describe existing systems for pregnant women in psycho-social vulnerability in French maternity hospitals. MATERIAL AND METHODES: This is a national survey conducted by questionnaire in all French maternities. RESULTS: Screening by means of targeted questions is carried out by 96.7% of maternity units. Early prenatal interviews are offered systematically by 64% of maternity units and access to them is still difficult for women in vulnerable situations. In order to organize care pathways, 28.7% of maternities have a structured unit within their establishment and 81% state that they have mobilizable caregivers. Multidisciplinary meetings for the coordination of the various stakeholders are held by 85.8% of maternity units. Collaboration with networks and associations is emphasized. CONCLUSION: A large proportion of maternities seek to identify women in situation of psycho-social vulnerabilities and to organize care paths. However, the resources implemented still appear insufficient for many maternity units. Each maternity hospital has resources and is developing initiatives to deal with the difficulties of care.

[Why is perinatal and infant mortality high in the Seine-Saint-Denis district? A consultation with healthcare providers using a Delphi process]. / Quelles sont les causes de la mortalité périnatale et infantile élevée en Seine-Saint-Denis ? Consultation des professionnels du département par un processus Delphi.

OBJECTIVE: In Seine-Saint-Denis, stillbirth and infant mortality rates are markedly higher than in other French departments. Before implementing an audit on stillbirths and neonatal deaths in 2014, we carried out a Delphi consensus process with healthcare providers to generate research hypotheses. MATERIALS AND METHODS: A Delphi process in 3 questionnaires was conducted in 2013 with 32 healthcare providers (pediatricians, obstetricians, general practitioners, midwives, social workers, psychologists, pediatric nurses) and user representatives. The first questionnaire asked open questions about why mortality rates were higher and possible solutions to remedy the situation. In subsequent questionnaires, the panel ranked factors identified in the first questionnaires by importance. RESULTS: One hundred and thirty factors were identified from 42 pages of text responses in the first round. From these, the 75 most highly ranked were grouped into 14 main topics organized around three themes: 1) more underlying health problems in the population, 2) access and organization of care, 3) the health consequences of poor socioeconomic conditions. Coordination of care, provider and patient communication, and access to care were highlighted. CONCLUSION: The Delphi consensus process identified a wide range of hypotheses for the higher mortality in Seine-Saint-Denis which are adapted to the local context and based on the concerns of health practitioners.

Headspace analysis study of evaporation rate of perfume ingredients applied onto skin.

Synopsis Diffusion of perfume ingredients from skin or hair is measured using an original method based on dynamic headspace technology. This has been used for pure odorants, fine fragrances, as well as for perfumed cosmetic applications such as soaps, creams or shampoos, in order to characterize diffusion processes and air/skin or air/hair partitioning. Accordingly, a special collection system, applied on the inner face of the forearm, has been developed, allowing the adsorption of diffusing organic vapours from skin onto Tenax (poly-diphenyl phenylene oxide) with a controlled air flow rate. A simple model composition containing eleven volatile synthetic odorants was prepared in an alcoholic matrix and the solution was applied onto the skin. The diffusion rate of the different components was measured by determining the concentration of each in the gas phase versus time. Conversely, the same experiment was effected by the application of an alcoholic solution of each individual component. In this manner, the relative diffusion from skin of the components alone or mixed was compared using the same experimental technique. The effect of a musky component was also tested. Both compositions (with and without musk) were then applied in a soap base. Thus, following a rigorous protocol, the forearm was washed with the perfumed soap and rinsed with water before collection of the headspace. The results show the different diffusion rates of the individual odorants. In particular, components evaporate slower from the skin when they have been applied from a soap bar compared to when they have been applied from alcoholic solution. We also present results describing the characterization of skin types using a panel comprised of 80 people (40 females and 40 males); amount of sebum, hydration and pH were systematically measured on different parts of the face, the neck as well as the outer and inner faces of the forearm. The panelists were then classified into different sub-groups taking into account these parameters. It should be noted that the foregoing results were obtained on an 'average'skin type.