Universite de la Reunion

To establish why teenagers (13-19 years old) primiparas have higher rates of unassisted vaginal deliveries compared with their older counterparts.

University's maternity, 24.5-year-observational population-based cohort study (2001-2024). All consecutive nulliparous singleton pregnancies. Analysis of the main indications for cesarean sections (c-sections) and also need for operative vaginal procedures of all nulliparous pregnant women with an age range from 14 to 40+ yrs.

Out of 33,785 singleton primiparous livebirth pregnancies, vaginal births represented 91% at the ages 14-15 dropping to just 55% at ≥40 yrs. The rate of c-sections was 9% at the ages 14-15, increasing to a rate of 45% at ≥40 years. Operative vaginal delivery rate was 12.1% at the ages 14-15 years, versus 29.8% at ≥ t 40 years (both χ² for trend, p < .0001). Two-thirds of the indications for c-sections were "abnormal fetal monitoring" (AFM) and "Obstructed Labor" (OL). The indication AFM had a χ² for a negative linear trend p = .0004: a high rate of 39% for the ages 14-15, and 25% for the ages over 40 years. The indication OL had a positive trend with maternal ages but not linear (p = .13): 17% for the ages 14-15 years, 25% for the ages 16-19, followed by a plateau around 32% between 20 and 40 years.

Vaginal births in primiparas without obstetrical assistance occur preferably at younger ages with a regular negative linear trend, p < .001 until the ages 40+. The indication AFM for c-sections also had a negative linear trend, p = .0004, while OL as indication for c-sections represented a minority in teenagers (below breech presentation). In teenagers, the higher rate of unassisted vaginal births may be due to an intrinsic biologic cause (uterine contractility).

This study aimed to evaluate whether combining force-velocity Fv and force-position Fp models, originally developed for single-joint movements, could effectively characterize force production during the push-off phase of a vertical jump. Six force-velocity-position Fv,p models, integrating three Fv (Anderson, Hill, and Linear) and two Fp (Cosine and Quadratic) models were assessed. Fifteen trained CrossFit athletes performed maximal countermovement jumps under varying loads and push-off depths with ground reaction forces recorded via force plates. All six models demonstrated high goodness-of-fit, with r² ranging from 0.885 to 0.886 and RMSE values ranging from 262.6 to 266.5 N, effectively capturing key experimental data characteristics. No significant differences in fitting or descriptive capacity were observed among Anderson, Hill, and Linear models, reflecting the near-linear behavior of the force-velocity relationships in vertical jump. Nevertheless, the Linear model offers simplicity and interpretability by focusing on key physiological parameters (e.g., maximal force, maximal velocity, and optimal position) commonly used in applied sports contexts. The Cosine and Quadratic models showed no significant impact on overall fit quality, although significant differences in optimal vertical position (p_opt) and theoretical maximal force (F_max) were observed. When paired with the Linear model, the Quadratic model slightly reduced F_max deviations in participants with slightly curvilinear force-velocity relationships. This study highlights the strength of a simple three-parameter heuristic model, whose parameters are biomechanically and physiologically relevant, in describing the force production as a function of position and velocity. This combination of simplicity and interpretability represents a significant step forward in the modeling of multi-joint movements, offering practical insights for sport performance optimization.

Wound suturing in emergency departments is a potentially stressful and painful experience for patients. Web app-based music intervention is known as an effective adjuvant treatment for the management of physical pain and anxiety in various medical fields. Only two studies have assessed the effectiveness of music listening on pain and anxiety during wound suturing. However, they found conflicting results and did not evaluate the point of view of healthcare professionals. This article details a prospective, randomized, open-label, multicenter study to evaluate the effect of a web app-based music intervention on pain and anxiety during sutures in the emergency room.

This was an interventional prospective, randomized, open-label, multi-center trial. The primary outcome is the comparison of maximal pain Visual Analogue Scale (VAS) with or without web app-based music intervention (application Music Care®) during the wound closure.

Between June 2022 and February 2023, 170 patients were included. There was no significant difference between the two groups regarding the pain during suturing in this population. The mean pain VAS was 2.1 ± 2.7 cm (cm) in the music group versus 2.6 ± 2.6 cm in the control group (p= 0.197). However, the music group showed significantly lower values of respiratory rate (p = 0.002) and anxiety score (p = 0.042). Finally, satisfaction scores were significantly improved in the music group for the patient (p= 0.0002) and the physician (p < 0.0001).

In this population, which demonstrated an average light maximal pain intensity, we showed no significant difference regarding the pain intensity during wound suturing. However, it does suggest that web app-based music intervention could reduce peri-procedural anxiety, but the robustness of this finding is not demonstrated yet. Nevertheless, it highlights the need for additional studies on this subject to identify its role in the optimal management of procedural pain and the improvement of the patient and practitioner experience.

ClinicalTrials.gov n° NCT05388591 (https://clinicaltrials.gov/study/NCT05388591?term=NCT05388591&rank=1).