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Objective: To estimate the prevalence of flatus-only and faecal incontinence, to describe their risk factors and to analyse the association between anal incontinence and psychological distress over the first year postpartum.Design: Cohort study from pregnancy to 12 months postpartum.Setting: Two university hospital maternity wards in France.Population: A total of 2002 pregnant women were recruited between 2003 and 2006. Data on anal incontinence were available for the 1632 women who comprise the sample for analysis.Methods: Women were enrolled during pregnancy. A postal questionnaire was sent at 4 and 12 months postpartum.Main Outcome Measures: Anal (flatus-only and faecal) incontinence was assessed at 4 months postpartum. Mental health was assessed at 4 and 12 months postpartum by the Edinburgh Postpartum Depression Scale (EPDS) and use of antidepressant drugs as well as by self-rated mental health.Results: At 4 months postpartum, the prevalence for flatus-only incontinence was 14.4% and for faecal incontinence 1.7%; multivariate analysis, restricted to women reporting no anal incontinence before the index pregnancy, showed that continuing breastfeeding at 4 months was related to a higher risk of de novo postpartum anal incontinence (OR = 2.23). Women who reported anal incontinence at 4 months were more frequently depressed (EPDS ≥10 or antidepressant use) at 12 months postpartum: 36.0% of those with faecal incontinence were depressed, 23.3% of those with flatus-only incontinence and only 14.8% of the continent women.Conclusion: Postnatal faecal incontinence was rare but associated with poorer maternal mental health. Postnatal screening should be encouraged, and psychological support offered.Tweetable Abstract: Postnatal faecal incontinence was associated with depression; postnatal screening should be encouraged and psychological support offered. [ABSTRACT FROM AUTHOR]

ABSTRACT Larroque, B.; Arnould P.; Luthon F.; Poncet, P.A.; Rahali, A., and Abadie, S., 2018. In-situ measurements of wave impact pressure on a composite breakwater: preliminary results. In: Shim, J.-S.; Chun, I., and Lim, H.S. (eds.), Proceedings from the International Coastal Symposium (ICS) 2018 (Busan, Republic of Korea). Journal of Coastal Research, Special Issue No. 85, pp. 1086–1090. Coconut Creek (Florida), ISSN 0749-0208. A detached horizontally composite breakwater protecting the Saint Jean de Luz bay (French Basque Coast, Bay of Biscay, France) has been equipped with two pressure sensors displayed vertically onto the vertical wall. The two sensors recorded wave impact pressure in ten minute burst each hour at 10 kHz. In parallel, incoming waves were also recorded about 1 km off the structure with a directional wave buoy giving access to spectral wave parameters as well as raw data. Finally water level, wind magnitude and direction were also acquired. The whole dataset covers winter 2015–2016 from January to March. The results show first the statistical distribution of the measured parameters confirming preceding similar studies in which significantly lower impact pressure values were obtained compared to physical experiments or numerical simulations. A linear multivariate model has then been adjusted showing the overwhelming influence of wave heights to explain maximum pressure variability, followed by water level. Nevertheless this result has still to be confirmed for data reduced to impulsive impacts. Finally, interesting events supposedly corresponding to, or approaching flip-through impact type, have been identified and need further investigations. [ABSTRACT FROM AUTHOR]

Larroque, B.; Arnould P.; Luthon F.; Poncet, P.A.; Rahali, A., and Abadie, S., 2018. In-situ measurements of wave impact pressure on a composite breakwater: preliminary results. In: Shim, J.-S.; Chun, I., and Lim, H.S. (eds.), Proceedings from the International Coastal Symposium (ICS) 2018 (Busan, Republic of Korea). Journal of Coastal Research, Special Issue No. 85, pp. 1086–1090. Coconut Creek (Florida), ISSN 0749-0208. A detached horizontally composite breakwater protecting the Saint Jean de Luz bay (French Basque Coast, Bay of Biscay, France) has been equipped with two pressure sensors displayed vertically onto the vertical wall. The two sensors recorded wave impact pressure in ten minute burst each hour at 10 kHz. In parallel, incoming waves were also recorded about 1 km off the structure with a directional wave buoy giving access to spectral wave parameters as well as raw data. Finally water level, wind magnitude and direction were also acquired. The whole dataset covers winter 2015–2016 from January to March. The results show first the statistical distribution of the measured parameters confirming preceding similar studies in which significantly lower impact pressure values were obtained compared to physical experiments or numerical simulations. A linear multivariate model has then been adjusted showing the overwhelming influence of wave heights to explain maximum pressure variability, followed by water level. Nevertheless this result has still to be confirmed for data reduced to impulsive impacts. Finally, interesting events supposedly corresponding to, or approaching flip-through impact type, have been identified and need further investigations. [ABSTRACT FROM AUTHOR]

Background Studies conducted on mild intellectual disability ( MID) in children are infrequent and the prevalence rates vary widely. This study aimed to estimate the prevalence of MID in children in a French county ( Isère), to describe the clinical signs and associated comorbidities, and to specify the aetiologies of this disability. Methods The target population was comprised of the 15 100 children born in 1997 residing in Isère County, France, in 2008. Our goal was to find the children in this group with MID diagnosed between 9 and 13 years of age. MID was defined as an overall IQ score of between 50 and 69 [ International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD-10)]; this definition was adjusted for the study by integrating confidence intervals so that the risk of IQ measurement relativity and possible discrepancy of scores could be taken into account. Children were identified through an administrative data source designed to assist disabled persons that contains health information, and an educational data source. Parents who agreed to let their children participate responded to an in-depth questionnaire on their child's medical and academic history. A genetic investigation was proposed for those children whose MID had an unknown aetiology. Results The preliminary selection included 267 children, resulting in a prevalence rate of 18 per 1000 ( CI [15.6; 19.9]), within the expected mean. Of these 267 cases, 181 families agreed to participate in the study (68%). MID more often affected boys [male gender ratio = 1.4 ( CI [1.2; 1.6])], low socioeconomic groups, and families with a history of intellectual disability. The clinical signs and comorbidities associated with MID were very frequent, with 54% spoken language disorders and 10% pervasive developmental disorder. Only 9% of the children had undergone a genetic investigation before the study. The known aetiology rate for MID was 19% among all the children who had had genetic tests performed. Conclusion MID is an important public health issue based on its prevalence. The associated clinical signs and comorbidities may be warning signs of MID in case of learning difficulties. This study may help decision-makers to develop and organise screening and care for MID. [ABSTRACT FROM AUTHOR]

Objective The aim of the study was to identify risk factors associated with pre-transplant fecal carriage of extended-spectrum β-lactamase ( ESBL)-producing Enterobacteriaceae in liver transplant recipients. Patients and methods Over a 3-year period (January 2009-December 2011), 317 patients who underwent liver transplantation were screened preoperatively for fecal carriage of ESBL-producing Enterobacteriaceae. Risk factors for fecal carriage were investigated by univariate analysis and stepwise logistic regression. Results Of the 317 patients screened, 50 (15.7%) harbored an ESBL-producing isolate. Previous infection with an ESBL-producing organism had developed during the last 6 months in 20% of fecal carriers versus in none of the non-carriers. Other variables associated with fecal carriage were a model for end-stage liver disease score ≥25, pre-transplant stay in the intensive care unit ≥48 h, hospital stay ≥10 days in the last 6 months, a history of spontaneous bacterial peritonitis ( SBP), exposure to a β-lactam agent in the last month, and prophylaxis with norfloxacin. Independent predictors of fecal carriage in the multivariate logistic regression model were exposure to a β-lactam agent in the month preceding transplantation (odds ratio [ OR] = 7.8, confidence interval [ CI] = 4-15.5, P < 0.001), and a history of SBP ( OR = 2.4, CI = 1.1-4.9, P = 0.02). Conclusions Previous infection with an ESBL-producing isolate, recent exposure to a β-lactam agent, and a history of SBP are risk factors for preoperative fecal carriage of ESBL-producing Enterobacteriaceae in liver transplant recipients. Patients at risk of fecal carriage should receive intraoperative prophylaxis and, when necessary, empiric postoperative antimicrobial treatment that includes coverage for these organisms. [ABSTRACT FROM AUTHOR]

Background It is not yet known whether the risk of developing atopic dermatitis ( AD) is influenced by preterm birth. Moreover, AD risk has not been assessed in a large sample of extremely preterm infants (< 29 weeks' gestation). Objectives To determine whether the risk of AD is influenced by preterm birth. Methods We investigated the relationship between gestational age ( GA) and AD using data from two independent population-based cohorts, including a total of 2329 preterm infants, of whom 479 were born extremely preterm. Results There was a lower percentage of children with AD in the extremely preterm group compared with those born at a greater GA (Epipage cohort, 2-year outcome: 13·3% for 24-28 weeks, 17·6% for 29-32 weeks, 21·8% for 33-34 weeks, P = 0·02; LIFT cohort, 5-year outcome: 11% for 24-28 weeks, 21·5% for 29-32 weeks, 19·6% for 33-34 weeks, P = 0·11). After adjusting for confounding variables, a lower GA (< 29 weeks) was significantly associated with decreased risk of AD in the Epipage cohort [adjusted odds ratio ( aOR) 0·57, 95% confidence interval (CI) 0·37-0·87; P = 0·009] and the LIFT cohort ( aOR 0·41, 95% CI 0·18-0·90; P = 0·03). Conclusions Very low GA (< 29 weeks) was associated with a lower risk of AD compared with higher GA (29-34 weeks) and full-term birth. [ABSTRACT FROM AUTHOR]

Objective To assess the impact of antenatal corticosteroids (ACS) on neonatal mortality, cerebral lesions and 5-year neurodevelopmental outcome of infants born at 24–27 and 28–32 weeks of gestational age (GA). Design Observational population-based study including all births at GAs between 22 and 32 weeks in 1997 in nine regions of France. Survivors were assessed at the age of 5 years. Sample and methods The population enrolled in the follow up comprised 2323 infants; there were 23 deaths before age 5 years and outcome at 5 years was available for up to 1781 subjects. Two GA subgroups (24–27 and 28–32 weeks of GA) were analysed separately. Propensity scores were used to reduce bias in the estimation of the association between ACS treatment and outcomes. Main outcome measures Neonatal death, neonatal white matter injury, cerebral palsy, mental processing composite (MPC) of the Kaufman Assessment Battery for Children test and behavioural difficulties at 5 years. Results In the 28- to 32-week GA subgroup, there was a significant association between ACS and a decreased risk of both neonatal death (OR = 0.61 [0.41–0.91]) and white matter injury (OR = 0.60 [0.46–0.79]) but only a nonsignificant trend for improved 5-year outcome (cerebral palsy, MPC < 70). In the 24- to 27-week GA subgroup, ACS was associated with a significant decrease risk of neonatal death (OR = 0.43 [0.27–0.68]) but there was only a trend for a lower risk of white matter injury and no beneficial impact on outcome at 5 years. Limiting the analysis to only those who received complete courses of ACS did not modify the results. Conclusion The study shows that ACS therapy greatly increases the survival of very preterm infants, including the most immature, but there is little evidence that ACS affects long-term neurodevelopmental and behavioural outcome in 28- to 32-week survivors, and none in <28-week survivors. [ABSTRACT FROM AUTHOR]

Objectives: To assess the relation between cigarette smoking during pregnancy and neonatal respiratory distress syndrome (RDS) in very preterm birth, and to analyse the differential effect of antenatal steroids on RDS among smokers and non-smokers. Design: A population based cohort study (the French Epipage study). Setting: Regionally defined births in France. Methods: A total of 858 very preterm liveborn singletons (27-32 completed weeks of gestation) of the French Epipage study were included in this analysis. The odds ratio for RDS in relation to smoking in pregnancy was estimated using a logistic regression to control for gestational age. The odds ratio for RDS in relation to antenatal steroids was estimated taking into account an interaction between antenatal steroids and cigarette smoking, using multiple logistic regression to control for gestational age, birthweight ratio, main causes of preterm birth, mode of delivery, and sex. Results: The odds ratio for RDS in relation to smoking in pregnancy adjusted for gestational age (aOR) was 0.59 (95% confidence interval (Cl) 0.44 to 0.79). The aOR for RDS in relation to antenatal steroids was 0.31 (95% CI 0.19 to 0.49) in babies born to non-smokers and 0.63 (95% CI 0.38 to 1.05) in those born to smokers; the difference was significant (p = 0.04). Conclusions: Cigarette smoking during pregnancy is associated with a decrease in the risk of RDS in very preterm babies. Although antenatal steroids reduce the risk of RDS in babies born to both smokers and non-smokers, the reduction is smaller in those born to smokers. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the outcome for all infants born before 33 weeks gestation until discharge from hospital. DESIGN: A prospective observational population based study. SETTING: Nine regions of France in 1997. PATIENTS: All births or late terminations of pregnancy for fetal or maternal reasons between 22 and 32 weeks gestation. MAIN OUTCOME MEASURE: Life status: stillbirth, live birth, death in delivery room, death in intensive care, decision to limit intensive care, survival to discharge. RESULTS: A total of 722 late terminations, 772 stillbirths, and 2901 live births were recorded. The incidence of very preterm births was 1.3 per 100 live births and stillbirths. The survival rate for births between 22 and 32 weeks was 67% of all births (including stillbirths), 85% of live births, and 89% of infants admitted to neonatal intensive care units. Survival increased with gestational age: 31% of all infants born alive at 24 weeks survived to discharge, 78% at 28 weeks, and 97% at 32 weeks. Survival among live births was lower for small for gestational age infants, multiple births, and boys. Overall, 50% of deaths after birth followed decisions to withhold or withdraw intensive care: 66% of deaths in the delivery room, decreasing with increasing gestational age; 44% of deaths in the neonatal intensive care unit, with little variation with gestational age. CONCLUSION: Among very preterm babies, chances of survival varies greatly according to the length of gestation. At all gestational ages, a large proportion of deaths are associated with a decision to limit intensive care. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between cigarette smoking during pregnancy and very preterm births, according to the main mechanisms of preterm birth.Design: Case-control study (the French Epipage study).Setting: Regionally defined population of births in France.Population: Eight hundred and sixty-four very preterm live-born singletons (between 27 and 32 completed weeks of gestation) and 567 unmatched full-term controls.Methods: Data from the French Epipage study were analysed using a polytomous logistic regression model to control for social and demographic characteristics, pre-pregnancy body mass index and obstetric history. The main mechanisms of preterm delivery were classified as gestational hypertension, antepartum haemorrhage, premature rupture of membranes, spontaneous preterm labour and other miscellaneous mechanisms.Main Outcome Measures: Odds ratios for very preterm birth for low to moderate (1-9 cigarettes/day) and heavy (>/=10 cigarettes/day) maternal smoking in pregnancy, estimated according to the main mechanisms leading to preterm birth.Results: Smokers were more likely to give birth to very preterm infants than non-smokers [adjusted odds ratio (aOR) 1.7, 95% confidence interval (CI) 1.3-2.2]. Heavy smoking significantly reduced the risk of very preterm birth due to gestational hypertension (aOR 0.5, 95% CI 0.3-1.0), whereas both low to moderate and heavy smoking increased the risk of very preterm birth due to all other mechanisms (aOR between 1.6 and 2.8).Conclusion: These data from the Epipage study show that maternal smoking during pregnancy is a risk factor for very preterm birth. The impact of maternal smoking on very preterm birth appears to be complex: it lowers the risk of very preterm birth due to gestational hypertension, but increases the risk of very preterm birth due to other mechanisms. These findings might explain why maternal smoking is more closely related to preterm birth among multiparous women than among nulliparous women. [ABSTRACT FROM AUTHOR]

Aim: To evaluate whether precociously treated subjects with congenital hypothyroidism (CH) are at risk of poor school performance in early adolescence, and to investigate which factors affect their school achievement.Methods: All children treated early for congenital hypothyroidism and born in France during the first 7 y (1979-1985) of the national screening program for congenital hypothyroidism were selected for the study. School performance during childhood, assessed according to age at entry into the first grade of secondary school, was evaluated as normal (usually 11 y of age) vs late entry (> or = 12 y). The national register of children with congenital hypothyroidism enabled a comparison to be made with data from the national population for the same school years.Results: School achievement was similar among the 682 patients with CH and in the national population. After an adjustment for the sex and socioprofessional category of the parents, the severity of CH as assessed by the type (athyreosis. the most severe vs other types), the initial low serum T4 levels (< or = 53 nmol/L vs >53 nmol/L), and the profound bone maturation delay (absence vs presence of the two knee epiphyseal ossification centres at diagnosis), initially low L-thyroxine dosage (below vs > or = 7 microg/kg/day), the absence of near normalization of thyroid hormone levels after 15 d of treatment and poor adequacy of treatment throughout childhood were associated with an increased risk of school delay. School achievement was unaffected by the age at start of treatment (mean age = 22.8 +/- 6.8 d). In a multivariate logistic regression analysis, recurrent episodes of insufficiently suppressed TSH levels (> or = 15 mUi/L at least four times during follow-up from the age of 6 mo onwards) were the most important variable associated with school delay.Conclusion: Careful follow-up of the adequacy of treatment is required throughout childhood, to reduce the risk of school delay. [ABSTRACT FROM AUTHOR]

This study analysed the characteristics of respondent and nonrespondent mothers at each stage of a survey procedure, from a initial questionnaire to a reminder letter and two repeated mailings. Of 938 mothers of liveborn children who, while maternity inpatients, received a questionnaire and information about a mail survey to follow 2 months later, 828 completed and returned the initial questionnaire, 708 agreed to participate in the mail survey and were sent the mail questionnaire, and 612 finally completed and returned the questionnaire at 2 months. There were differences between respondents and non-respondents for socio-demographic factors at each stage of the process. The final response rate to the mail questionnaire was higher among mothers who were younger, were breast feeding, and had more education, an occupation and fewer children. The characteristics of late respondents were intermediate between those of early to middle respondents and nonrespondents for age, educational level, breast feeding and occupation. Maternal and infant health varied only slightly according to response status. Repeated mailings increased response and diminished selection. A mail questionnaire after contact in a maternity ward is a cost-effective means of gathering data about a large sample of recent mothers and their children. [ABSTRACT FROM AUTHOR]

The teratogenic effects of alcohol have been recognized in the fetal alcohol syndrome. The syndrome is associated with very high levels of maternal consumption. Studies of the relation between much lower levels of consumption and pregnancy outcome seem to indicate consistently lower birthweight among children born to mothers drinking more than 140 g absolute alcohol per week, or about two drinks a day. [ABSTRACT FROM AUTHOR]

Objectives. This study investigated the effect of moderate prenatal alcohol exposure on psychomotor development of preschool-age children in a longitudinal study. Methods. Pregnant women were interviewed about their alcohol consumption at their first visit to the maternity hospital in Roubaix, France. Alcohol consumption before pregnancy and during the first trimester was assessed with a structured questionnaire. The psychomotor development of 155 children of these woman was assessed with the McCarthy scales of children's abilities when the children were about 4 1/2 years old. Results. Consumption of 1.5 oz of absolute alcohol (approximately three drinks) or more per day during pregnancy was significantly related to a decrease of 7 points in the mean score on the general cognitive index of the McCarthy scales, after gender, birth order, maternal education, score for family stimulation, family status, maternal employment, child's age at examination, and examiner were controlled for. Conclusions. This study showed that moderate to heavy alcohol consumption during pregnancy, at levels well below those associated with fetal alcohol syndrome, has effects on children's psychomotor development. [ABSTRACT FROM AUTHOR]

The article reports a study to determine mortality and development in the first year based on gestation type. Researchers examined a cohort of very pre-term births. Results of the study revealed that multiple pregnancy was associated with a lower rate of stillbirth than singleton. Among live born infants, a trend to a lower survival was seen in infants of multiple than single gestation. Infants born from multiple pregnancy had a higher percentage of motor delay. Researchers concluded that very pre-term infants from multiple gestations have a slight increased risk for mortality or delay of development in the first year compared with infants from single pregnancy.

OBJECTIVES: To evaluate growth for children born very preterm with particular focus on those born small-for-gestational age (SGA) or with ex utero growth restraint (GR), and to identify risk factors for short stature at 5 years of age. STUDY DESIGN: Population-based study of children born at less than 33 completed weeks of gestation (Étude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE)). Short stature was defined as height <-2SD on WHO growth curves. Ex utero GR was considered to have occurred in children with appropriate size for gestational age at birth and with a height and/or weight below -2SD at 2 years of corrected age. Logistic regression models were used to test associations between risk factors and short stature. RESULTS: The authors measured height at 5 years of age for 1,597 of 2,193 children (73%), 5.6% (95% CI 4.6 to 6.9) of whom were diagnosed as having a short stature. Height was measured at 2 and 5 years of age in 1417 children. Among these, 24% of those born SGA and 36% of those with ex utero GR (p=0.002) had a short stature at 5 years. Predictors of short stature were SGA or birth length <-2SD, maternal height <= 160 cm, gestational age <29 weeks and systemic corticosteroids. Breastfeeding at discharge decreased the risk of short stature. CONCLUSIONS: Short stature at 5 years of age is common in children born preterm. The highest incidence was observed in the group with ex utero GR. Systemic steroids have a long-term impact on growth and should be used with caution. Breastfeeding at discharge appeared to be protective. [ABSTRACT FROM AUTHOR]

The article reports a study to determine behavioural outcome at 3 years age in very premature infants in a regionally defined, prospective cohort study. Results of the study revealed that on the behaviour questionnaire, the very premature infants showed significantly higher difficulties than term children. Boys had higher total difficulty and hyperactivity scores. A lower socioeconomic status was related to a higher frequency of behavioural problems, which was significant for total difficulty score, conduct problems score and pro social behaviour score. Researchers concluded that the prevalence of behavioural problems assessed by parents at 3 years of very premature infants was higher than in term infants.

The article reports a study that assessed the developmental outcome of very pre-term children at 1 year in a large population based cohort by questions to parents in a postal questionnaire. The study also examined the influence of gestational age, gender, intrauterine growth retardation and cerebral lesions at neonatal ultrasound on infant development. Results of the study revealed that the incidence of a delay increased with decreasing gestational age for motor score. The same pattern was seen for coordination and socialization scores. Researchers concluded that child developmental delay was related to lower gestational ages and severity of cerebral lesions.

The teratogenic effects of alcohol have been recognized in the fetal alcohol syndrome. The syndrome is associated with very high levels of maternal consumption. Studies of the relation between much lower levels of consumption and pregnancy outcome seem to indicate consistently lower birthweight among children born to mothers drinking more than 140 g absolute alcohol per week, or about two drinks a day. [ABSTRACT FROM PUBLISHER]