Le sentiment de cohérence et le processus physiologique de la naissance: Travail de Bachelor

Cadre de référence : Le respect du processus phyisologique de la naissance est devenu de plus en plus rare dans la société actuelle alors qu’il participe à diminuer de nombreuses morbidités pour la femme et le nouveau-né. Parmi les éléments qui peuvent influencer ce processus naturel, la femme elle-même semble jouer un rôle essentiel. Plus précisément, l’intensité de son sentiment de cohérence (SOC) pourrait influencer le déroulement de sa grossesse, de son accouchement, du post-partum et éventuellent la protéger de certaines complications obstétricales et psychologiques. But : Effectuer une revue de littérature pour déterminer dans quelle mesure un SOC élevé chez la femme enceinte peut favoriser la physiologie de la naissance. Méthode : À travers des bases de données d’articles scientifiques, 5 études récentes (<10 ans) ont été sélectionnées en fonction de leur pertinence avec la question de recherche. Elles ont fait l’objet d’une description, d’une analyse critique et d’une discussion en fonction de cinq thèmes définis. Résultats : Les résultats montrent qu’un SOC prénatal élevé chez la femme enceinte diminuerait significativement le risque d’accouchement par césarienne et qu’un SOC prénatal bas serait significativement corrélé avec un traitement pour menace d’accouchement prématuré (MAP) pendant la grossesse. Concernant la péridurale, son utilisation ne serait pas en lien direct avec le SOC de la femme. Les études montrent des résultats contradictoires sur la relation du SOC avec l’instrumentation et la provocation de l’accouchement. Par ailleurs, le stress perçu par les femmes et la peur de l’accouchement seraient significativement plus bas chez celles qui ont un SOC élevé. Enfin, un SOC prénatal élevé serait associé à une perception positive par la femme de son soutien social mais pas à la satisfaction de l’accouchement. Conclusion : Un SOC élevé chez la femme enceinte pourrait contribuer à favoriser la physiologie de la naissance en influençant de manière positive certains affects liés à des issues non physiologiques. Concernant les issues obstétricales en particulier, il semble que le SOC soit un facteur protecteur de la césarienne et du traitement pour MAP. Néanmoins, d’autres investigations sont encore nécessaires pour démontrer son impact sur différentes interventions médicales telles que la péridurale, l’instrumentation et la provocation de l’accouchement.Background: The respect of the processus of birth physiology has become increasingly rare in actual society, even though it contributes to the decrease in women’s and newborn’s morbidity. Among elements which can influence this natural process, women seem to play a crucial role. In particular, the intensity of her sense of coherence (SOC) could influence the course of the pregnancy, the delivery and the postpartum, and might even prevent obstetrical and psychological complications. Aim: Conduct a literature review to determine to what extent a pregnant woman’s high SOC could promote birth physiology. Methods: Five recent articles (< 10 years old) were selected from a scientific database according to their relevance to the research question. These articles have been described, critically analysed and discussed in relation to five defined topics. Results: Results demonstrate that a high prenatal SOC for pregnant women significantly reduces the risk of caesarean delivery. Results also show that a low prenatal SOC significantly correlates with the treatment for threatened premature birth during pregnancy. SOC does not seem directly related to the use of epidural. Studies indicate contradictory results in regards to the relation between SOC with instrumentation and induction of labour. Furthermore, perceived stress and fear of childbirth (FOC) seem significantly reduced for a patient with a high SOC. Finally, a high prenatal SOC seems connected to a positive perception of social support, but not to the satisfaction of delivery. Conclusion: A high SOC for pregnant women seems to contribute to fostering birth physiology by positively impacting certain emotions related to non-physiological issues. In regards to obstetrical issues in particular, SOC seems to be a protective factor against caesarean births and treatment of threatened premature birth. However, further investigation remains necessary to demonstrate its impact on various medical interventions such as epidural, instrumentation and induction of labour

P44 Vaccine in pediatric chronic kidney disease (CKD) and hemodialysis

AimsChronic kidney disease is a major risk factor of vaccine preventable infectious diseases due to the altered immune system and the natural evolution of the disease. There are differences in the prescription of some vaccines for this population. The aim of this study is to elaborate a vaccination protocol for chronic kidney disease and haemodialysis patients for a better immunization coverage, care and prevention against preventable infectious diseases.MethodsThe study was conducted by a multidisciplinary team composed by pharmacists, infectious disease paediatrician and nephrology paediatricians. After a literature research (in Medline with MeSH terms: ‘Kidney Failure, Chronic’, ‘Renal Dialysis’ and ‘Vaccines’)1 2, we compared the French immunization schedule3 for the general population with patient with chronic kidney disease or haemodialysis patients and confront it to the physician practice in our nephrology unit. For each vaccine, we collected the following data: indication, any difference concerning dose, schedule, re-administration, antibody titration and reason for these differences.ResultsThe literature analysis showed disparate practices among countries and even medical centres. The most concerned vaccines were: hepatitis A and B virus vaccine, pneumococcal vaccine, flu and measles vaccines. The difference between vaccine scheduled concerned the indication (meningococcus A, B, C, Y and W135, papillomavirus), dose (hepatitis B), the schedule (hepatitis B, hepatitis A, pneumococcal, measles), re-administration (hepatitis B, varicella), antibody titration (hepatitis B, varicella). Patients with chronic kidney disease are more susceptible to develop hepatitis B infection. As for adult population, the haemodialysis patients are vaccinated with double dose4 of hepatitis B vaccine. The antibodies titration at our hospital is made twice a year and anti-HBs level needed are 30 to 50 UI/mL. Hepatitis A is a recommended vaccine for risk population including haemodialysis patients and chronic kidney disease patients. The vaccination schedule is the same for haemodialysis patients with two doses but the second dose is administered earlier, i.e. six months after the first with an antibody screening. For the pneumococcal vaccine, an additional dose is administered at 3 month of age for premature and at risk children and the conjugated vaccine potentiates the polyosidic vaccine. For measles, the second dose may be omitted if the antibody titration confirms the protection to allow the patient to be registered earlier on the renal transplant list. Flu vaccination is recommended with the same dose and schedule that the other patients, but tetravalent vaccines should always be chosen.ConclusionsChildren with chronic kidney disease or on haemodialysis are more at risk of vaccine preventable infectious diseases and should be vaccinated earlier before beginning dialysis. The specific immunization schedule will be presented and may be used by other hospital and countries for concerned patients.ReferencesBakkaloğlu SA, et al. Vaccination Practices in Pediatric Dialysis Patients Across Europe. A European Pediatric Dialysis Working Group and European Society for Pediatric Nephrology Dialysis Working Group Study. Nephron 2018;138:280–286.Costa NCP, da Canhestro MR, Soares CMBM &amp; Rodrigues JS. Monitoring of post-vaccination anti-HBs titles vaccine in children and adolescents in the pre-dialysis of chronic kidney disease. Braz. J. Nephrol. 2017;39:296–304.DGS_Anne.M, DICOM_Jocelyne.M, DGS_Anne.M &amp; DICOM_Jocelyne.M. Le calendrier vaccinal. Ministère des Solidarités et de la Santé (2019). Available at: https://solidarites-sante.gouv.fr/prevention-en-sante/preserver-sa-sante/vaccination/calendrier-vaccinal (Accessed: 28th June 2019)Misurac JM, et al. Immunogenicity of augmented compared with standard dose hepatitis B vaccine in pediatric patients on dialysis: a midwest pediatric nephrology consortium study. Clin. J. Am. Soc. Nephrol 2017;12:772–778.</jats:sec

Effect of anakinra versus usual care in adults in hospital with COVID-19 and mild-to-moderate pneumonia (CORIMUNO-ANA-1): a randomised controlled trial

International audienc

Sarilumab in adults hospitalised with moderate-to-severe COVID-19 pneumonia (CORIMUNO-SARI-1): An open-label randomised controlled trial

International audienc