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Mensah-Gourmel J, Bourgain M, Kandalaft C, Chatelin A, Tissier O, Letellier G, Gorter JW, Brochard S, Pons C. Starting from the needs: what are the appropriate sources to co-create innovative solutions for persons with disabilities? Disabil Rehabil Assist Technol 2024; 19:623-632. [PMID: 36036377 DOI: 10.1080/17483107.2022.2114554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Technical solutions could facilitate activities and participation in individuals with disabilities. For the development of solutions, hackathons are a method of interdisciplinary collaboration. For hackathon, the definition of pain points that require solutions is crucial. We aimed to determine engineers' preferences and expectations regarding pain point qualities. METHODS We used a collaborative approach involving individuals with disability, families, and healthcare professionals to determine pain points for use by engineering students during a disability Hackathon. A pain point bank was built using 3 upstream sources: a survey (350 responses, 20 pain points selected), interviews (8 children, 13 pain points), and a multidisciplinary workshop based on design thinking methods (45 people, 32 pain points). A fourth source was 20 adults with disabilities present during the Hackathon. Engineering students rated pain point qualities from each source in a questionnaire that included closed questions relating to predefined criteria: achievability, specificity, relevance and attractiveness and open questions to collect non-predefined quality criteria. RESULTS Pain points from the workshop were most frequently used (48%); followed by on-site discussions with mentors (43%), the survey (38%), and interviews (31%). On-site discussions received the highest quality ratings followed by the workshop, survey, and interviews. Three quality criteria emerged from the responses to open questions: "representative", "empathy", and "real-need". CONCLUSIONS To be actionable by engineers, pain points must relate to real needs, be achievable, specific, relevant and attractive but also representative and arouse empathy. We devised a checklist of qualities along with a toolbox of methods to achieve each. Implications For RehabilitationThe first step of the development of technical solutions for children and individuals with disabilities is the identification of their needs and their adequate formulation to be submitted to technical solutions providers.Daily life needs of individuals with disability were gathered for an engineering hackathon and proposed as pain points to 400 engineering students.To facilitate the development of solutions by engineers, pain points must relate to real needs, be specific, relevant, achievable and attractive; be representative and arouse empathy; a toolbox of needs collection methods is proposed to achieve each of those qualities.Discussions with individuals with disability and health professionals should be provided.
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Affiliation(s)
- Johanne Mensah-Gourmel
- PMR Department, CHRU Brest, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Université Bretagne Occidentale, Brest, France
| | - Maxime Bourgain
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, Paris, France
- EPF Graduate School of Engineering, Cachan, France
| | | | | | | | - Guy Letellier
- Pediatric Rehabilitation Hospital, ESEAN-APF, Nantes, France
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Canada
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Sylvain Brochard
- PMR Department, CHRU Brest, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Université Bretagne Occidentale, Brest, France
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
| | - Christelle Pons
- PMR Department, CHRU Brest, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Université Bretagne Occidentale, Brest, France
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Canada
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
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2
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Cacioppo M, Lucas C, Dai S, Bailly R, Pérennou D, Varengue R, Houx L, Lempereur M, Kandalaft C, Chatelin A, Vagnoni J, Vuillerot C, Gautheron V, Dinomais M, Dheilly E, Bouvier S, Brochard S, Pons C, Mensah-Gourmel J, Génot A, Ropars J, Toullet P, De Lattre C, Klinger E, Laffont I, Sitruk C, Van Boagert P, Tessiot C. Parent satisfaction with medical and rehabilitation services for children with physical disabilities during lockdown. Ann Phys Rehabil Med 2023; 66:101726. [PMID: 36565595 DOI: 10.1016/j.rehab.2022.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Marine Cacioppo
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, Brest, France.
| | - Clémence Lucas
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France
| | - Shenhao Dai
- Département de NeuroRéhabilitation Hôpital Sud, CHU Grenoble Alpes ; UMR CNRS 5105 Neuropsychologie et NeuroCognition,Université de Grenoble Alpes, Grenoble, France
| | - Rodolphe Bailly
- Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
| | - Dominic Pérennou
- Département de NeuroRéhabilitation Hôpital Sud, CHU Grenoble Alpes ; UMR CNRS 5105 Neuropsychologie et NeuroCognition,Université de Grenoble Alpes, Grenoble, FranceDépartement de NeuroRéhabilitation Hôpital Sud, Université de Grenoble Alpes, UMR CNRS 5105 Neuropsychologie et NeuroCognition, CHU Grenoble Alpes, Cs 10217, Grenoble Cedex 9 38043, France
| | - Roxane Varengue
- Département de Neurologie Pédiatrique, CHU Angers, Angers, France
| | - Laetitia Houx
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
| | - Mathieu Lempereur
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
| | | | | | - Jacky Vagnoni
- Fédération Française des Associations d'Infirmes Moteurs Cérébraux, France
| | - Carole Vuillerot
- Service de Médecine Physique et de Réadaptation Pédiatrique, Hôpital Mère-Enfant, Hospices Civils de Lyon, Bron 69500, France; Institut Neuromyogène CNRS UMR 5310 INSERM U1217, Université de Lyon, Lyon, France
| | - Vincent Gautheron
- Service de Médecine Physique et de Réadaptation Pédiatrique, CHU Saint-Etienne, Saint-Etienne, France; UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA7424, Université de Lyon, Saint-Etienne, France
| | - Mickael Dinomais
- Service de Médecine Physique et de Réadaptation, CHU Angers -Les Capucins, Angers, France; Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS) EA7315, Université d'Angers, Angers, France
| | - Elea Dheilly
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
| | - Sandra Bouvier
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
| | - Sylvain Brochard
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
| | - Christelle Pons
- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
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- Service de Médecine Physique et de Réadaptation, CHRU Brest, Brest, France; Fondation Ildys, Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, France
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Mensah-Gourmel J, Thépot M, Gorter JW, Bourgain M, Kandalaft C, Chatelin A, Letellier G, Brochard S, Pons C. Assistive Products and Technology to Facilitate Activities and Participation for Children with Disabilities. Int J Environ Res Public Health 2023; 20:2086. [PMID: 36767453 PMCID: PMC9915405 DOI: 10.3390/ijerph20032086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
We aimed to identify activity limitations and participation restrictions encountered by children and youth with disabilities for which assistive products and technology could be helpful. We used a convergent, parallel, mixed-methods design involving a nationwide, French survey composed of closed questions (quantitative) and open questions (qualitative) that enlightened the quantitative data. A total of 1055 responses were received, and 962 included: 92 from children and youth with disabilities, 493 from relatives and 377 from professionals. Difficulties frequently checked and described in detail were participation in recreational activities, leaving the house and traveling, participating in a group, and getting ready. Transversal explanations for difficulties were spontaneously provided (e.g., lack of accessibility and mobility). Solutions proposed included personal assistive devices to facilitate home life, high-tech devices, devices to compensate for impaired body functions, and adaptation of the familiar environment and daily activities. Few public solutions were proposed. The necessity of human assistance was emphasized. The mixed-methods design and involvement of different stakeholders identified common, macroscopic trends in difficulties encountered and desired solutions. Products and technology are required in the following domains: the familiar environment, accessibility and mobility, sports and leisure, high-technology, and family support. We provide suggestions to facilitate the development of innovative solutions.
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Affiliation(s)
- Johanne Mensah-Gourmel
- Physical Medecine and Rehabilitation Department, Centre Hospitalier Régional Universitaire Brest, 29200 Brest, France
- Laboratoire de Traitement de l’information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, 29200 Brest, France
- Pediatric Rehabilitation Department, Fondation Ildys, 29200 Brest, France
| | - Margot Thépot
- Physical Medecine and Rehabilitation Department, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, 3583 TM Utrecht, The Netherlands
| | - Maxime Bourgain
- Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, Institut de Biomécanique Humaine Georges Charpak, 75013 Paris, France
- EPF Graduate School of Engineering, 94230 Cachan, France
| | | | | | - Guy Letellier
- Pediatric Rehabilitation Hospital, Etablissement de Santé pour Enfants et Adolescents de la région Nantaise—APF France Handicap, 44200 Nantes, France
| | - Sylvain Brochard
- Physical Medecine and Rehabilitation Department, Centre Hospitalier Régional Universitaire Brest, 29200 Brest, France
- Laboratoire de Traitement de l’information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, 29200 Brest, France
- Pediatric Rehabilitation Department, Fondation Ildys, 29200 Brest, France
| | - Christelle Pons
- Physical Medecine and Rehabilitation Department, Centre Hospitalier Régional Universitaire Brest, 29200 Brest, France
- Laboratoire de Traitement de l’information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, 29200 Brest, France
- Pediatric Rehabilitation Department, Fondation Ildys, 29200 Brest, France
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, ON L8S 1C7, Canada
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Varengue R, Brochard S, Bouvier S, Bailly R, Houx L, Lempereur M, Kandalaft C, Chatelin A, Vagnoni J, Vuillerot C, Gautheron V, Dheilly E, Pons C, Dinomais M, Cacioppo M. Perceived impact of lockdown on daily life in children with physical disabilities and their families during the COVID-19 pandemic. Child Care Health Dev 2022; 48:942-955. [PMID: 34964148 DOI: 10.1111/cch.12952] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/11/2021] [Accepted: 12/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The first lockdown during COVID-19 pandemic in France led to an abrupt change in children's daily lives. For children with physical disabilities and their families, activities were limited, access to healthcare and therapy was disrupted, and family organization was altered. The objective was to report the impact of the lockdown on daily life activities and well-being of children with physical disabilities as perceived by caregivers. METHODS Two online national surveys were addressed to the parents of children with physical disabilities (ECHO survey: 6 April to 11 May 2020) and without disabilities (E-COPAIN survey: 24 April to 11 May 2020), confined at home during the lockdown. A lockdown impact score was calculated from difficulties related to children's well-being (morale, behaviour and social interaction) and daily life activities (schooling and physical activity) and compared between groups. Data on family environment, parental stress and concerns were collected. RESULTS One thousand three hundred seventy-six children (9.45 ± 4.78 years, 54% girls) in ECHO survey and 367 children (7.3 ± 4.4 years, 48% girls) in E-COPAIN survey were included. A negative impact of lockdown was found on 81% of children with physical disabilities. Behavioural problems were significantly more frequent (59.5% vs. 47.4%, P < .005) and parental stress was higher (6.1 ± 3.33 vs. 5.3 ± 3.01, P = .005) in the ECHO group. Associated impairments (odds ratio [OR] = 1.45 [1.30-1.62], P < .001), parental stress (OR = 1.09 [1.06-1.12], P < .001) and continuation of rehabilitation (OR = 0.80 [0.72-0.89], P < .001) were determinants of the level of difficulty experienced. CONCLUSIONS The lockdown had a considerable, negative impact on the daily life of children with disabilities and their families. Guiding policymakers with the essential daily life activities and the services to provide for children with physical disabilities would offer valuable insights to manage such a sanitary crisis and allow to identify the most vulnerable population.
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Affiliation(s)
- Roxane Varengue
- Department of Pediatric Neurology, CHU Angers, Angers, France
| | - Sylvain Brochard
- Department of Physical Medicine and Rehabilitation, CHRU Brest, Brest, France.,Departement of Pediatric Physical Medicine and Rehabilitation, Fondation Ildys, Brest, France.,Laboratory of Medical Information Processing (LaTIM), Inserm U1101, University of Western Brittany, Brest, France
| | - Sandra Bouvier
- Department of Physical Medicine and Rehabilitation, CHRU Brest, Brest, France.,Laboratory of Medical Information Processing (LaTIM), Inserm U1101, University of Western Brittany, Brest, France
| | - Rodolphe Bailly
- Departement of Pediatric Physical Medicine and Rehabilitation, Fondation Ildys, Brest, France.,Laboratory of Medical Information Processing (LaTIM), Inserm U1101, University of Western Brittany, Brest, France
| | - Laetitia Houx
- Department of Physical Medicine and Rehabilitation, CHRU Brest, Brest, France.,Departement of Pediatric Physical Medicine and Rehabilitation, Fondation Ildys, Brest, France.,Laboratory of Medical Information Processing (LaTIM), Inserm U1101, University of Western Brittany, Brest, France
| | - Mathieu Lempereur
- Department of Physical Medicine and Rehabilitation, CHRU Brest, Brest, France.,Laboratory of Medical Information Processing (LaTIM), Inserm U1101, University of Western Brittany, Brest, France
| | | | | | - Jacky Vagnoni
- French Federation of Associations of Cerebral Palsy (FFAIMC), Paris, France
| | - Carole Vuillerot
- Department of Pediatric Physical Medicine and Rehabilitation, CHU Lyon, Hospital Woman Mother Child, Bron, France.,Neuromyogène Institute CNRS UMR 5310 INSERM U1217, University of Lyon, Lyon, France
| | - Vincent Gautheron
- Department of Pediatric Physical Medicine and Rehabilitation, CHU Saint-Etienne, Saint-Etienne, France.,UJM Saint-Etienne, Interuniversity Laboratory of Motricity Biology, EA7424, University of Lyon, Saint-Etienne, France
| | - Elea Dheilly
- Departement of Pediatric Physical Medicine and Rehabilitation, Fondation Ildys, Brest, France.,Laboratory of Medical Information Processing (LaTIM), Inserm U1101, University of Western Brittany, Brest, France
| | - Christelle Pons
- Department of Physical Medicine and Rehabilitation, CHRU Brest, Brest, France.,Departement of Pediatric Physical Medicine and Rehabilitation, Fondation Ildys, Brest, France.,Laboratory of Medical Information Processing (LaTIM), Inserm U1101, University of Western Brittany, Brest, France
| | - Mickael Dinomais
- Department of Physical Medicine and Rehabilitation, CHU Angers-Les Capucins, Angers, France.,Angevin Systems Engineering Research Laboratory (LARIS) EA7315, University of Angers, Angers, France
| | - Marine Cacioppo
- Department of Physical Medicine and Rehabilitation, CHRU Brest, Brest, France.,Departement of Pediatric Physical Medicine and Rehabilitation, Fondation Ildys, Brest, France.,Laboratory of Medical Information Processing (LaTIM), Inserm U1101, University of Western Brittany, Brest, France
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5
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Alos B, Ferrier L, Chatelin A, Mergy J, Guillevin R, Christiaens L, Bouleti C. CT signs of pulmonary hypertension before TAVI: long-term prognosis in a cohort of 469 patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Patients undergoing TAVI often present with comorbidities, such as pulmonary hypertension (PH), which has been shown to be predictive of poor outcome after TAVI, using echocardiography (TTE). CT scan is systematically performed before TAVI, and PH signs on CT may be used to assess long-term survival after TAVI, but data are scarce on this matter.
Purpose
The main objective of this study was to analyze the association between signs suggestive of PH on CT performed before TAVI and 4-years mortality.
Methods
Between 2013 and 2018, 469 consecutive patients undergoing TAVI at our institution were included. We analyzed all pre-procedural CT for signs of PH: pulmonary artery (PA) diameter, PA to aorta (PA/A) ratio, right ventricle (RV) basal diameter, and inferior vena cava (IVC) diameter, with double reading, blinded to clinical and echocardiographic data.
Results
Our population of elderly patients (mean age 85±6) having a severe aortic stenosis was highly symptomatic (NYHA III–IV in 71% of cases) with moderate PH on TTE (mean sPAP of 43±14 mmHg), and intermediate operative risk (STS-score 6.2±4.5%). After a median follow-up of 4 years after TAVI, multivariate analysis identified IVC and RV axial diameters as CT PH parameters associated with long term mortality (adjusted HR and 95% CI of 1.08 [1.05–1.10] (p<0.0001) and 1.03 [1.01–1,05] (p=0.002), respectively). An IVC diameter ≥20 mm and a RV axial diameter ≥37 mm on CT were independently associated with late mortality, with areas under the curve (AUC) of 0.75; IC95% (0.70–0.80) and 0.67 (0.62–0.72), better than any significant clinical or biological data and than echocardiographic sPAP (Figure 1). 4-year survival was 65±4% if IVC <20 mm vs 44±3% if IVC ≥20 mm (p<0.0001) (Figure 2), and 35±4% if RV <37 mm vs 54±5% if RV ≥37 mm (p<0.0001). Interestingly, TTE IVC diameters were not significantly associated with long-term mortality and could not be assessed in 66 patients (14%) due to poor abdominal echogenicity. On the 403 patients with IVC diameters, assessed both by TTE and CT scan, correlation was poor although significant (R2= 0.1), with significant differences between the 2 methods using a paired T test (17.3±5.4 mm versus 20.3±6.0; P<0.001). Moreover, on the 403 patients, the discrimination was far better with CT scan IVC diameters than with TTE diameters: 0.75 (0.70–0.80) vs 0.54 (0.48–0.59); p<0.001. Regarding RV diameter, too many data were missing on TTE to compare their prognostic impact with CT diameters.
Conclusion
This study is the first to outline IVC and RV diameters on preprocedural CT as being associated to long-term mortality after TAVI. They outperformed other clinical, biological and TTE prognostic factors as well as the usual operative risk scores in terms of discrimination. These simple measurements, which can be performed on any pre-TAVI CT, could therefore be included in routine practice to improve the selection of patients undergoing TAVI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Alos
- University Hospital of Poitiers, Cardiology , Poitiers , France
| | - L Ferrier
- University Hospital of Poitiers, Radiology , Poitiers , France
| | - A Chatelin
- University Hospital of Poitiers, Cardiology , Poitiers , France
| | - J Mergy
- University Hospital of Poitiers, Cardiology , Poitiers , France
| | - R Guillevin
- University Hospital of Poitiers, Radiology , Poitiers , France
| | - L Christiaens
- University Hospital of Poitiers, Cardiology , Poitiers , France
| | - C Bouleti
- University Hospital of Poitiers, Cardiology , Poitiers , France
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Cacioppo M, Bouvier S, Bailly R, Houx L, Lempereur M, Mensah-Gourmel J, Kandalaft C, Varengue R, Chatelin A, Vagnoni J, Vuillerot C, Gautheron V, Dinomais M, Dheilly E, Brochard S, Pons C. Emerging health challenges for children with physical disabilities and their parents during the COVID-19 pandemic: The ECHO French survey. Ann Phys Rehabil Med 2020; 64:101429. [PMID: 32818674 PMCID: PMC7434423 DOI: 10.1016/j.rehab.2020.08.001] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/21/2020] [Accepted: 08/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The daily lives of children with physical disabilities and their families have been significantly affected by the COVID-19 pandemic. The children face health risks, especially mental, behavioral, social and physical risks. OBJECTIVE This study aimed to identify potential healthcare issues relating to the wellbeing of disabled children, continuity of rehabilitation and medical care, and parental concerns during the COVID-19 lockdown. METHODS The Enfant Confinement Handicap besOins (ECHO [child lockdown disability needs]) national survey was developed by a multidisciplinary group and disseminated in France from April 6, 2020 via email and social networks. This online survey was addressed to the parents of children with physical disabilities aged 0 to 18 years. It explored the experiences of children and their families during the lockdown. Information regarding children's wellbeing, rehabilitation and family organization was collected. The first 1000 eligible surveys were analyzed. RESULTS The children (mean [SD] age 9.5 [4.8] years) mostly had cerebral palsy (42%) or neuromuscular diseases (11%). The lockdown had negative effects on morale (44% of children), behaviour (55% of children) and social interactions (55% no contact with other children). Overall, 44% of children stopped physical activities; 76% were educated at home; 22% maintained medical follow-up, and 48% and 27% continued physiotherapy and occupational therapy respectively. For more than 60% of children, parents performed the therapy. The main parental concern was rehabilitation (72%) and their main difficulty was the mental load (50%); parents complained of lack of help and support (60%). CONCLUSIONS This study highlighted substantial effects on the health of children with physical disabilities and loss of opportunity, with a massive interruption of medical follow-up and rehabilitation, during the lockdown. Regular assessment of the health benefit/risk is essential to support families and ensure continuity of care during a pandemic.
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Affiliation(s)
- Marine Cacioppo
- SSR pédiatrique, fondation Ildys, rue Alain-Colas, 29200 Brest, France; Service de médecine physique et de réadaptation, CHRU de Brest, Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France.
| | - Sandra Bouvier
- Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France; CHRU de Brest, Brest, France
| | - Rodolphe Bailly
- SSR pédiatrique, fondation Ildys, rue Alain-Colas, 29200 Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France
| | - Laetitia Houx
- SSR pédiatrique, fondation Ildys, rue Alain-Colas, 29200 Brest, France; Service de médecine physique et de réadaptation, CHRU de Brest, Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France
| | - Mathieu Lempereur
- Service de médecine physique et de réadaptation, CHRU de Brest, Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France
| | | | | | - Roxane Varengue
- Département de neurologie pédiatrique, CHU d'Angers, Angers, France
| | | | - Jacky Vagnoni
- Fédération française des associations d'infirmes moteurs cérébraux, France
| | - Carole Vuillerot
- Service de médecine physique et de réadaptation pédiatrique, hôpital Mère-Enfant, hospices civils de Lyon, 69500 Bron, France; Institut neuromyogène CNRS UMR 5310 inserm U1217, Université de Lyon, Lyon, France
| | - Vincent Gautheron
- Service de médecine physique et de réadaptation pédiatrique, CHU de Saint-Étienne, Saint-Étienne, France; Université de Lyon, UJM Saint-Étienne, laboratoire interuniversitaire de biologie de la motricité, EA7424, 42023, Saint-Étienne, France
| | - Mickael Dinomais
- Service de médecine physique et de réadaptation, CHU d'Angers, Les-Capucins, Angers, France; Laboratoire Angevin de recherche en ingénierie des systèmes (LARIS) EA7315, université d'Angers, Angers, France
| | - Elea Dheilly
- SSR pédiatrique, fondation Ildys, rue Alain-Colas, 29200 Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France
| | - Sylvain Brochard
- SSR pédiatrique, fondation Ildys, rue Alain-Colas, 29200 Brest, France; Service de médecine physique et de réadaptation, CHRU de Brest, Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France
| | - Christelle Pons
- SSR pédiatrique, fondation Ildys, rue Alain-Colas, 29200 Brest, France; Service de médecine physique et de réadaptation, CHRU de Brest, Brest, France; Laboratoire de traitement de l'information médicale (LaTIM), inserm U1101, université Bretagne Occidentale, France
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Chatelin A, Scelles R, Sherlaw W. Facilitating the collective expression of parents of disabled children at a scientific conference. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
The European Academy of Childhood Disability is an academic association with over 500 members (health, social work and educational professionals working with children with disability) from some 35 different countries. The Academy wishes to put families at the heart of its agenda. Partnership with families has the potential to improve care and education outcomes and renew practice. It may also facilitate understanding between professionals and families. To this end for the annual conference in Paris a series of structured interactive group activities have been designed to facilitate the sharing of experience and expression of families and to gather their concerns. These activities designed by disability specialists in partnership with family representatives call on small group work “world café” style focus group methodology. They are structured, varied, interactive and take place in a specially organized conference session over 3 hours. Sensitive feedback is provided by experienced pediatricians in the childhood disability field. Parents provide narratives of significant experiences for their children prior to the conference. These are shared in groups of 3. Questions explored include “What matters for the happiness of your children? “Please give examples of things which have happened in your child’s life which seem to be key experiences” Relating to the concept of F-words, (Rosenbaum, Gorter, 2011) parents have also been asked to consider different dimensions of their children’s well-being such as friendship, functioning, fitness, family, fun, and future. Group discussions are noted, recorded, retranscribed and analysed allowing, the gain of insights and providing possible building blocks for professional training. Such qualitative data allows new topics and research on a joint family-professional agenda to emerge. These may be tackled at future conferences thus building bridges between specialists and families.
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Affiliation(s)
- A Chatelin
- Fondation Paralysie Cérébrale, Paris, France
| | - R Scelles
- ClipsyD (EA 4430), Université Paris Nanterre, Paris, France
| | - W Sherlaw
- Department of Human and Social Sciences, EHESP, Rennes, France
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Chabrier S, Pouyfaucon M, Chatelin A, Bleyenheuft Y, Fluss J, Gautheron V, Newman CJ, Sébire G, Van Bogaert P, Vuillerot C, Brochard S, Dinomais M. From congenial paralysis to post-early brain injury developmental condition: Where does cerebral palsy actually stand? Ann Phys Rehabil Med 2019; 63:431-438. [PMID: 31421273 DOI: 10.1016/j.rehab.2019.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 11/27/2022]
Abstract
Cerebral palsy (CP), an umbrella term for a developmental motor disorder caused by early brain injury (EBI)/interference, remains debated. In this essay, we present a narrative, beginning with the original anatomical-clinical description of the so-called paralysie congéniale (congenial paralysis) by the French psychiatrist Jean-Baptiste Cazauvieilh. We then discuss how the concept has evolved over the last 2 centuries. We aim to illustrate these ideas with the biopsychosocial model of health, especially in light of the current neuroscientific and sociological knowledge of human development. We endeavour to integrate 3 connected but distinct entities: (1) the EBI as a seminal turning point of the individual's story; (2) the clinical findings we call CP, when motor impairment and activity limitation related to post-EBI (or other early non-progressive brain interference) appears, and; (3) a post-EBI developmental condition that encompasses the overall consequences of an EBI. This framework should guide individual, familial and collective care discussions and research strategies beyond the scope of CP.
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Affiliation(s)
- Stéphane Chabrier
- Service de médecine physique et de réadaptation pédiatrique, Inserm CIC1408, Centre national de référence de l'AVC de l'enfant, CHU Saint-Étienne, 42055 Saint-Étienne, France; Inserm, Univ Saint-Étienne, Univ Lyon, UMR1059 SAINBIOSE, 42023 Saint-Étienne, France; Reasearch Institute of McGill University Health Center, Division of Child Neurology, Department of Pediatrics, Montréal, QC, Canada.
| | - Margaux Pouyfaucon
- Département de médecine physique et de réadaptation, Centre national de référence de l'AVC de l'enfant, CHU d'Angers, CHU Angers-Capucins, 49000 Angers, France
| | | | - Yannick Bleyenheuft
- Université catholique de Louvain, Institute of NeuroScience, Brussels, Belgium
| | - Joel Fluss
- Pediatric Neurology Unit, Geneva Children's Hospital, 6, rue Willy-Donzé, 1211 Genève 4, Switzerland
| | - Vincent Gautheron
- Service de médecine physique et de réadaptation pédiatrique, CHU Saint-Étienne, 42055 Saint-Étienne, France; Laboratoire interuniversitaire de biologie de la motricité (LIBM) EA7424, University Saint-Étienne, University Lyon, 42023 Saint-Étienne, France
| | - Christopher J Newman
- Unité de neuropédiatrie et neuroréhabilitation pédiatrique, CHU Vaudois, Lausanne, Switzerland
| | - Guillaume Sébire
- Reasearch Institute of McGill University Health Center, Division of Child Neurology, Department of Pediatrics, Montréal, QC, Canada
| | - Patrick Van Bogaert
- Unité de neuropédiatrie et de neurochirurgie de l'enfant, CHU d'Angers, 49000 Angers, France; Laboratoire Angevin de recherche en ingénierie des systèmes (LARIS) EA7315, Univ Angers, 49000 Angers, France
| | - Carole Vuillerot
- Service de médecine physique et de réadaptation pédiatrique, hôpital Femme-Mère-Enfant, L'Escale, Hospices civils de Lyon, 69500 Bron, France
| | - Sylvain Brochard
- Physical and Rehabilitation Medicine Department, Fondation Ildys, Pediatric Rehabilitation, CHU de Brest, 29200 Brest, France; Inserm, Univ Bretagne Occidentale, UMR 1101 LaTIM, 29238 Brest, France
| | - Mickael Dinomais
- Département de médecine physique et de réadaptation, Centre national de référence de l'AVC de l'enfant, CHU d'Angers, CHU Angers-Capucins, 49000 Angers, France; Laboratoire Angevin de recherche en ingénierie des systèmes (LARIS) EA7315, Univ Angers, 49000 Angers, France
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Horridge KA, Dew R, Chatelin A, Seal A, Macias LM, Cioni G, Kachmar O, Wilkes S. Austerity and families with disabled children: a European survey. Dev Med Child Neurol 2019; 61:329-336. [PMID: 30028502 PMCID: PMC7379637 DOI: 10.1111/dmcn.13978] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2018] [Indexed: 11/27/2022]
Abstract
AIM To describe the impact austerity measures have had on families with disabled children across Europe and on professionals providing services for them. METHOD Cross-sectional surveys were disseminated via professional and family networks in 32 European countries for 3 months from December 2016. RESULTS Families (n=731), of whom 45% met UNICEF criteria for severe poverty, and professionals (n=959) responded from 23 and 32 countries respectively. Respondents were grouped into those from countries with and without austerity. The direct and indirect impact of austerity cuts and worse working conditions were reported more often by professionals from countries with austerity, compared to those without. Most families reported services to be worse in quality than 3 years ago. Families with completely dependent disabled children said the needs of their disabled children are significantly less well met now, compared to 10 years ago. INTERPRETATION A decline in quality of services for disabled children was reported by most family and many professional respondents across Europe, regardless of austerity. Where implemented, austerity measures were reported to have impacted significantly on families with disabled children. What this paper adds Stigma about disability remains a challenge in many countries across Europe. Most families and many health care professionals reported worsening quality of services than 3 years ago, regardless of austerity. Austerity cuts are reported to have impacted especially negatively on families with dependent disabled children.
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Affiliation(s)
- Karen A Horridge
- Paediatric DepartmentCity Hospitals Sunderland NHS Foundation TrustSunderlandUK
| | - Rosie Dew
- Faculty of Health Sciences and WellbeingUniversity of SunderlandSunderlandUK
| | - Alain Chatelin
- Parent Carer Representative, General Management CommitteeEuropean Academy of Childhood DisabilityFondation Paralysie CérébraleParisFrance
| | - Arnab Seal
- Community Paediatric DepartmentEuropean Academy of Childhood DisabilityLeedsUK
| | | | - Giovanni Cioni
- Department of Paediatric NeuroscienceUniversity of Pisa‐Stella Maris Scientific InstitutePisaItaly
| | - Oleh Kachmar
- International Clinic of RehabilitationTruskavetsUkraine
| | - Scott Wilkes
- Faculty of Health Sciences and WellbeingUniversity of SunderlandSunderlandUK
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Cioni G, Chatelin A, Hertz-Pannier L. Foreword. Dev Med Child Neurol 2015; 57 Suppl 2:1-3. [PMID: 25690108 DOI: 10.1111/dmcn.12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Giovanni Cioni
- University of Pisa and Stella Maris Scientific Institute Chair, European Academy of Childhood Disability.
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Simon T, Mary-Krause M, Chatelin A, Thuault M, Jaillon P. [Flecainide controlled-release for prevention of atrial fibrillation relapse]. Arch Mal Coeur Vaiss 2006; 99:109-16. [PMID: 16555693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
UNLABELLED Flecainide acetate instant release (LI) has been prescribed for years in the prevention of atrial fibrillation (AF) relapse after sinus rate conversion. A new controlled-release (LP) formulation of flecainide was recently introduced. The objectives of this observational study were to evaluate the benefit/risk ratio of LI or LP flecainide treatment for prevention of AF relapse. METHODS EPIFLEC study was an open, prospective, observational study conducted by 151 cardiologists who had prescribed either flecainide LI (group 1) to 838 patients or flecainide LP (group 2) to 214 patients or flecainide LI before LP (group 3) to 242 patients. In these patients, AF was either paroxystic (35%) or persistant (65%). Concomitant pathologies were observed in 80% of these patients (mean age 68 years) with a high incidence (50%) of hypertension. The mean duration of treatment was 6.9 +/- 6.7 months in group 1 (LI), 6.2 +/- 3.1 months in group 2 (LP) and 12.7 +/- 5.4 months in group 3 (LI-LP). RESULTS mean daily dosages of flecainide were similar among the 3 groups. Antithrombotic drugs were prescribed in 74% (group 1) to 83% (group 2) of the patients and another antiarrhythmic drug was associated to flecainide among 12 to 21% of the patients. AF relapse was observed in 171 patients in group 1 (LI), 38 patients in group 2 (LP) and 39 patients in group 3 (LI-LP). The incidence of AF relapse was compared in groups 1 and 2 at 10 months of follow-up and AF relapse probability was not significantly different between flecainide LI and LP :26 +/- 2% and 23 +/- 4% respectively (OR = 0.99, CI 95%:0.69-1.4; p = 0.96). A multivariate analysis showed that previous multiples episodes of AF, electrical shock rate conversion and history of flutter and hypertension were independent predictors of AF relapse. Among 11 deaths observed during follow-up, only 2 were cardiovascular. The most frequent non lethal cardiovascular adverse events were arrhythmias or cardiac conduction disorders and were limited to less than 5% of the patients. Only 5 supraventricular transient pro arrhythmias episodes were recorded. CONCLUSION this pharmaco-epidemiological study in private practice confirms that flecainide is able to prevent AF relapse in 75% of patients at 10 months and that the tolerance of the treatment is acceptable in these patients.
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Affiliation(s)
- T Simon
- Service de pharmacologie, AP-HP, faculté de médecine Pierre et Marie Curie, site Saint-Antoine, Université Paris 6, 27, rue Chaligny, 75012 Paris.
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Carbon C, Chatelin A, Bingen E, Zuck P, Rio Y, Guetat F, Orvain J. A double-blind randomized trial comparing the efficacy and safety of a 5-day course of cefotiam hexetil with that of a 10-day course of penicillin V in adult patients with pharyngitis caused by group A beta-haemolytic streptococci. J Antimicrob Chemother 1995; 35:843-54. [PMID: 7559195 DOI: 10.1093/jac/35.6.843] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A 10-day course of penicillin is the antibiotic regimen currently recommended by the American Heart Association (AHA) as treatment for patients with tonsillitis caused by group A beta-haemolytic streptococci (GABHS), with the aim of preventing both the suppurative and non-suppurative complications of this infection. This prospective, multicentre, randomized, double-blind, double-dummy clinical trial was undertaken in order to compare the efficacy of, tolerability of and compliance with a 5-day course of cefotiam hexetil (CTM) 200 mg bd with that of a 10-day course of penicillin V (PEV) 1 megaunit (600 mg) tds, to investigate the significance of recovering GABHS during or after treatment and to evaluate the potential economic advantages of short-term regimens. Two hundred and fifty ambulatory adult patients with a presumptive diagnosis (based on a positive rapid antigen detection test) of GABHS tonsillitis were recruited in 60 centres; the diagnosis was subsequently confirmed by a positive culture of a throat swab. At the time of entry into the trial there was no statistically significant difference between the groups in terms of clinical symptoms. In an intention-to-treat analysis, both the clinical and bacteriological response rates at days 10 and 30 were comparable for each group i.e. 106 of 119 (89.1%) patients and 90 of 109 (82.6%) patients respectively in the CTM group and 103 of 117 (88.0%) patients and 92 of 107 (86.0%) patients respectively in the PEV group. The times until defervescence and resolution of symptoms were also similar. Of the 115 patients in each group who were assessed at day 90, there were three clinical relapses in the CTM group and seven in the PEV group. No non-suppurative complications of GABHS infection were detected. Tolerance was significantly better in the CTM group than in the PEV group, 14 of 119 (11.8%) patients and 26 of 117 (22.2%) patients in the former and latter groups respectively reporting adverse events. In three cases in each group treatment was discontinued prematurely because of adverse events; none of these in the CTM group was serious but one patient in the PEV group experienced a severe allergic reaction. Compliance in both groups was good during the first 5 days of therapy but, by the end of each course, 93.6% of patients in the CTM group had completed treatment, compared with 73.0% in the PEV group.(ABSTRACT TRUNCATED AT 400 WORDS)
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Cherrier P, Tod M, Le Gros V, Petitjean O, Brion N, Chatelin A. Cefotiam concentrations in the sinus fluid of patients with chronic sinusitis after administration of cefotiam hexetil. Eur J Clin Microbiol Infect Dis 1993; 12:211-5. [PMID: 8508820 DOI: 10.1007/bf01967115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Cefotiam hexetil is a prodrug of cefotiam. The concentrations of cefotiam in plasma and sinus secretions were determined in 18 patients (10 males, 8 females, aged 39.3 +/- 13.0 years) with chronic sinusitis. All patients received two 200 mg oral doses of cefotiam hexetil 12 h apart and were divided into four groups according to the time which elapsed between the last dose and collection of secretion samples. The last dose was given 2 h (group I), 3 h (group II), 4 h (group III) or 6 h (group IV) before sinus puncture. Cefotiam concentrations were measured by high-pressure liquid chromatography and microbiological assay, results being very similar with both methods. Mean concentrations of cefotiam with the standard deviation in sinus exudates were 1.04 +/- 0.60 mg/l at 2 h (n = 6), 1.04 +/- 0.33 mg/l at 3 h (n = 4), 0.75 +/- 0.74 mg/l at 4 h (n = 4) and < 0.10 mg/l at 6 h (n = 4). Mean sinus fluid concentrations were higher than mean plasma concentrations in all groups. These results suggest that cefotiam concentrations higher than the MICs for common pathogens are found in sinus secretions up to 4 h after oral administration of cefotiam hexetil.
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Affiliation(s)
- P Cherrier
- Département de Pharmacotoxicologie, Hôpital Avicenne, Bobigny, France
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Chatelin A, Brion R, Moyse D, Droniou J, Le Davay M, Ollivier JP. [Determination of variability factors of arterial pressure using 3843 self-measurements of blood pressure in 34 active hypertensives]. Arch Mal Coeur Vaiss 1989; 82:1013-7. [PMID: 2510623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To assess the role of physical activity, stress and treatment on BP variations in working hypertensives we used repeated self measurements of BP which are cheaper and more simple than ambulatory BP measurements but allow for a smaller number of measurements. 34 working hypertensives self measured daily life BP, at home and at workplace, 7 times a day, for at least one week, before and 6 weeks after beta-blockade with metoprolol 200 to 400 mg daily. They used a Spengler SP9 electronic sphygmometer and specified on 4 grades scales their physical activity and stress just before measurement. The time for self measurement of BP was settled according to occupations more than to clocktime. The equipment was standardized at each visit by measuring BP with a mercury manometer then with the electronic sphygmometer. There were no significant differences neither for SBP nor for DBP and the two measures correlate closely (r = 0.91), P = 0.0001). Analysis of variance on SBP exhibits the role of time (p (0.001) and stress (p (0.0001). Physical activity does not interfere (p = 0.19). There is no difference between work days and sundays (p = 0.17). Treatment effect was very strong (p (0.0001) but there was no interaction neither with physical activity nor stress. Analysis of variance on DBP exhibits similar results except that BP on workdays is significantly higher than on sundays (p = 0.03). We conclude that: Repeated self measurement of BP is able to display variation of BP with occupations and stress. Beta-blockade lowers BP but does not interfere with variability.
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Affiliation(s)
- A Chatelin
- Service de cardiologie, hôpital militaire du Val de Grâce, Paris
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