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Objectives: The objective is to describe the informative value and the added value of a qualitative multiphase methodology in order to investigate the conceptions of children aged 6–11 on the determinants of health and cancer.Method: This article provides an analysis of the “Determ'Ados” research protocol, a qualitative study in human and social sciences, carried out with children aged 6–11 years. This protocol, organized in three phases, addresses in the first global health with the tool “e.Photoexpression©,” in the second questions and knowledge around the topic of cancer with the tool “QC” and in the third cancer again with the “Photonarration” tool. The methodology of this innovative, open and exploratory research protocol aims to collect data relating to the experiences, declared practices and knowledge specific to each child who express themselves through photography and storytelling.Results: The analysis of the Déterm'Ados methodology reveals a density and richness of results among all the children interviewed, even among the youngest: 1,498 productions (4 productions per child) were made by 381 children resulting in a wealth of data available thanks to the multiphase protocol. This massive qualitative survey brings complementarity as the collection phases progress and guarantees continuity in the discourse of each child which allows them to deepen their conceptions and to know how they create or not meaning between the determinants of health and cancer.Perspectives: The density and quality of the proposals collected from the children reinforce the validity and rigor of the Determ'Ados methodology. Multiphase is the innovative aspect of the tools used. The e.Photoexpression© and the Photonarration are complementary and inseparable to bring out concepts on health and cancer. These research results, transferable into interventions and current practices, present prevention officers to act more effectively, closer to the conceptions and needs of children.

Energy and protein intakes lower than requirements are associated with worsening health outcomes. Here we set out to evaluate gaps between energy and protein intakes and requirements in older adults in hospitals and in nursing homes (NH). A cross-sectional study included 360 inpatients and residents aged 75 years and older in two acute care wards; i.e., a multidisciplinary care unit (MCU) and a geriatric care unit (GCU), a geriatric rehabilitation unit (GRU), and two NH. Intakes were measured for three days. Requirements were based on French National Health Authority recommendations. Energy and protein intakes were under the minimum requirement of 30 kcal/kg/day and 1.2 g/kg/day in 89.5% and 100% of MCU patients, respectively, 75.5% and 64.2% of GCU patients, 92.7% and 90.9% of GRU patients, and 83.8% and 83.8 of NH residents. Intake-to-requirement gaps were not significantly associated with malnutrition, except in the GCU group where non-malnourished patients had higher energy gaps than malnourished patients. Intakes fell dramatically short of requirements in older adults in both hospital and NH settings irrespective of malnutrition status. A new paradigm based on a patient-centered approach should be developed to adapt meals served in hospital and in NH. [ABSTRACT FROM AUTHOR]

Background: Our research hypothesis was that most French indicators of quality of care have been validated by experts who are not clinicians and might not always be meaningful for clinicians. Our objective was to define a core set of measurable indicators of care quality during delivery and the immediate postpartum period relevant to clinical practice. Methods: A steering committee comprising nine specialists in obstetrics and/or public health conducted a literature review to develop potential indicators. A panel of obstetrician-gynecologists and midwives working in a delivery unit rated each indicator for appropriateness in a two-round Rand-modified Delphi procedure and a physical meeting. The consensus among the panelists was assessed. Results: In the first round, 145 panelists (110 obstetrician-gynecologists and 35 midwives) assessed 77 indicators and 3 definitions: 6 related to labor onset, 20 to delivery, 3 to pain management, 23 to neonatal morbidity/mortality, and 28 to maternal morbidity. In the second round, 132 panelists (98 obstetrician-gynecologists and 34 midwives) assessed 42 indicators and 1 definition. The final set comprised 50 indicators and 2 definitions. Conclusions: This Delphi procedure selected 50 indicators that reflect the quality of perinatal care. These indicators should be recorded in each French maternity ward's birth register for each delivery. [ABSTRACT FROM AUTHOR]

A mobile application has the potential to involve people with chronic NSLBP in their rehabilitation. To refine the design of a smartphone application for people with chronic NSLBP using mixed quantitative and qualitative approaches. We used a user-centred design approach involving people with chronic NSLBP and healthcare professionals (HCPs). We used a three-step methodology: developing consensus on the features, content, and design of the app; developing a user interface; and usability testing of the app and assessing users' experience. Transcripts of interviews of users were analyzed by qualitative content analysis. A total of 18 people (aged 45 [23–53] years old) with chronic NSLBP, and 7 HCPs (aged 29.5 [25–55] years old) involved in NSLBP management were interviewed. The overall experience of using the smartphone eLombactif app was initially assessed. Then, with close-ended questions we evaluated users' judgements on the content, its presentation and navigation. Finally, we asked for suggestions: "application content and functionality" and "content presentation" from participants regarding the use and development of the app analyzed by a qualitative methodology. This study described how we refined the design of our application for people with chronic NSLBP using a qualitative and quantitative approaches. This methodology allows for deepening the knowledge of the needs and expectations of potential users by measuring their user experience. Non-specific low back pain (NSLBP) is a major global public health issue leading to considerable economic cost and is primarily responsible for pain and disability. Mobile application has the potential to involve people with chronic NSLBP in their rehabilitation. This study described how we refined the design of our application for people with chronic NSLBP using a qualitative and quantitative approaches. [ABSTRACT FROM AUTHOR]

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Background: Systematic iron supplementation may be harmful in pregnant women with non-depleted iron. Our objectives were to estimate the prevalence of anemia at the third trimester of pregnancy (T3) and to identify the parameters at the first trimester (T1), which best predict anemia at T3. Methods: This prospective cohort study in France included pregnant women at T1 without non-iron deficiency anemia. Clinical and social characteristics, health-related quality of life, blood count, and a frozen blood sample were collected at T1 and/or T3. Secondly, a matched nested case–control study was built for women with anemia at T3 but not at T1. Multivariate analyses and ROC curves were used to identify the best predictive parameter(s) of anemia at T3. Results: The prevalence of anemia at T3 in the cohort (629 women) was 21.9% (95% CI 18.7–25.2%). In the matched nested case–control study (256 women), hemoglobin (Hb), serum ferritin (SF) and the SF/soluble transferrin receptor ratio at T1 were predictive of anemia at T3 (p < 0.001); however, clinical and social characteristics, as serum hepcidin were not. In multivariate analyses, Hb at T1 was the best predictive biomarker of anemia at T3 with a cut-off value of 120 g/L (specificity 87.5%). Conclusions: The prevalence of anemia at the end of pregnancy remained high in a High-Income Country. Clinical, social, and biochemical parameters did not seem useful to predict anemia at T3 and could not guide iron supplementation. We suggest systematically performing a simple blood count in the first trimester of pregnancy and offering oral iron supplementation for women with Hb < 120 g/L. [ABSTRACT FROM AUTHOR]

The paper deals with the design by optimization in pre-sizing step of a drive system that combines a switched capacitor system and a permanent magnet synchronous machine (PMSM). The sizing of the converter and the machine are considered strongly dependent due to the series quasi-resonant topology. The system modelling is based on a semi-analytical approach validated by finite element (FE) simulations. It involves an analytical modelling of the electrical machine and a numerical time solving of the electrical circuit sub-model because of the natural switching events of diodes. The optimization is carried out by SQP (Sequential Quadratic Programming). The model gradients are computed combining mathematical laws, symbolic derivation and automatic differentiation. Finally, trade-offs and gains on the machine power density, the magnet volume and the efficiency are investigated through a Pareto approach. [ABSTRACT FROM AUTHOR]

Substandard care, which can result from a delayed recognition of the severity of blood loss, can increase maternal morbidity. Our objectives were to assess the incidence of postpartum hemorrhage (PPH) and of second-line procedures in maternity units according to the quality of their PPH protocol. We used a mixed design, a prospective cohort (3442 women with PPH after vaginal delivery; February–July 2011), and an audit of the written protocols (177 French maternity units; September 2010–June 2011). A quality score was calculated for the protocol of each unit. Maternity units were classified into three categories according to this score: category 1 (total score: 0–8), category 2 (9–12.5), and category 3 (>12.5). The PPH incidence (>500 mL) was 3.2%, 3.3% and 4.6% among maternity units in categories 1, 2 and 3, respectively (p < 0.0001). The incidence of severe maternal morbidity (surgery and/or artery embolization and/or blood transfusion) was higher among maternity units in category 1 (54.8%; 95% CI: 51.9, 57.7) than in either category 2 (50.1%; 95% CI: 47.8, 52.5) or 3 (38.0%; 95% CI: 33.8, 42.4]) (p < 0.0001). The risks of severe maternal morbidity were lower for category 3 than category 1 and 2 (respectively, adjusted RR 0.68, 95% CI 0.60–0.86 and 0.77, 95% CI 0.68–0.87). Finally, maternity units with higher scores identified PPH better and used fewer curative second-line procedures. [ABSTRACT FROM AUTHOR]