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The authentic teaching and learning approach introduces real-world scenarios into the classroom to better engage Generation Z students. Considering this, we introduced an authentic learning practical exercise (breakfast meal and glycemic variation) to undergraduate biology students at the University of La Reunion (France). Here, students were initially briefed regarding the practical and subsequently determined their baseline glucose values (glucometer). They then consumed 200 mL of fruit juice together with a pain au chocolat (chocolate pastry) and subsequently recorded their glucose values at regular intervals. The last reading was done after 150 min, and they thereafter plotted such data to reveal temporal glycemic variations. During this time, the students also worked on a report to document information collected and began to supply responses to several listed questions. Three weeks after completion of the practical, we evaluated whether this intervention would lead to changes in their views regarding the nature and regularity of breakfast meal intake (employing survey questions). Our findings show that a reasonable proportion of the students indicated that the intervention did change their dietary habits, with 50% sometimes opting for an improved breakfast, whereas 10% also changed their habits albeit for only a small while. Of note, >60% of students indicated that they changed their breakfast intake habits by the end of the endocrinology module. These findings show that the beneficial effects of authentic teaching approaches may elicit relatively long-lasting changes in terms of breakfast behavioral patterns in young people and that such effects may also impact the broader society. New & Noteworthy: This study introduced an authentic learning exercise (endocrinology practical exercise) to undergraduate biology students and ascertained whether it changed their views regarding the nature and regularity of breakfast meals. Here, many altered their breakfast dietary habits, which persisted even after the completion of their module. Authentic teaching approaches can therefore trigger relatively long-lasting changes in terms of breakfast behavioral patterns in young people and may also impact the broader society.

Lectures constitute a basic component of physiology instruction in scientific and healthcare curricula. Technological progress has allowed a switch from face to face to video lectures, yet there is no evidence of video efficacy in physiology. Because videos increase the cognitive load during a learning task, identifying tools that decrease students' cognitive load during video lectures is critical. Segmenting videos with pauses and inducing joint attention with eye movement modeling examples (EMME) could reduce the cognitive load and improve second-year medical students' learning in physiology video lectures. Second-year medical students were randomized into four groups [EMME þ pauses (EMME þ P), EMME without pause`s (EMME-NoP), pauses only (NoEMME þ P), and no EMME and no pause (NoEMME-NoP)], took pretest quizzes, watched a renal physiology video lecture, and answered a cognitive load questionnaire and posttest quizzes on the Moodle learning management system. Student prior knowledge was assessed by a pretest, and learning gains were assessed by the difference between posttest and pretest scores. One hundred ninety-five students completed the experiment. Pauses improved learning gains (P < 0.01) but not EMME (P = 0.11). Student prior knowledge has several interactions with other variables: low-prior knowledge students obtained better learning gains (P < 0.001) and high-prior knowledge students had lower learning gains with EMME (P < 0.05). Our study shows the potential role of tools designed to reduce students' cognitive load during a renal physiology video lecture and the critical need for empirical validation of pedagogical solutions that are adapted to the specificities of physiology lectures.

We describe here a collective and experimental research project-based learning (ERPBL) for master's students that can be used to illustrate some basic concepts on glucose/lipid homeostasis and renal function around a topical issue. The primary objective of this ERPBL was to strengthen students' knowledge and understanding of physiology and pathophysiology. The secondary objectives were to help students to develop technical/practical abilities and acquire transversal skills with real-world connections. Obesity is a worldwide public health problem that increases the risk for developing type 2 diabetes and nephropathies. To study the impact of western dietary habits, students evaluated the effects of a diet enriched with fat and cola [high-fat and cola diet (HFCD)] on metabolism and renal function in mice. Students mainly worked in tandem to prepare and perform experiments, but also collectively to compile, analyze, and discuss data. Students showed that HFCD-fed mice 1) developed obesity; 2) exhibited glucose homeostasis impairments associated to ectopic fat storage; and 3) displayed reduced glomerular filtration. The educational benefit of the program was estimated using three evaluation metrics: a conventional multicriteria assessment by teachers, a pre-/posttest, and a self-evaluation questionnaire. They showed that the current approach successfully strengthened scientific student knowledge and understanding of physiology/pathophysiology. In addition, it helped students develop new skills, such as technical and transversal skills. We concluded that this ERPBL dealing with the pathophysiology of obesity was strongly beneficial for master's students, thereby appearing as an efficient and performing educational tool.

The maximal rate of O[subscript 2] consumption (VO[subscript 2max]) constitutes one of the oldest fitness indexes established for the measure of cardiorespiratory fitness and aerobic performance. Procedures have been developed in which VO[subscript 2max]is estimated from physiological responses during submaximal exercise. Generally, VO[subscript 2max]is estimated using the classical renowned Astrand-Ryhming test. In young adults, poor fitness and low aerobic performance are often associated with a sedentary lifestyle, which is a well-described factor for the development of obesity and its related disorders such as cardiovascular diseases and type 2 diabetes. In the Indian Ocean, the inhabitants of La Reunion Island, a French overseas department, exhibit an increasing prevalence of obesity and type 2 diabetes. At the University of La Reunion, a new laboratory course involving students was designed to teach the indirect evaluation of their VO[subscript 2max]from the classical Astrand-Ryhming test and using a cycle ergometer as the exercise mode. Inverse and significant correlations were established between the students' fat mass percentages and their VO[subscript 2max]and between their waist-to-hip ratio and VO[subscript 2max]as well. Results from the international physical activity questionnaire showed that most participants in this laboratory were sedentary students. Therefore, this laboratory makes the students practice and understand the use of a classical test to estimate their VO[subscript 2max]. It also alerts them to the correlation between a sedentary lifestyle and higher body fat content. This exercise allowed students to use a scientific method to engage the problem of sedentary lifestyle, which is a real world issue. (Contains 7 figures.)

The role of hypovitaminosis D as a possible risk factor for multiple sclerosis is reviewed. First, it is emphasized that hypovitaminosis D could be only one of the risk factors for multiple sclerosis and that numerous other environmental and genetic risk factors appear to interact and combine to trigger the disease. Secondly, the classical physiological notions about vitamin D have recently been challenged and the main new findings are summarized. This vitamin could have an important immunological role involving a number of organs and pathologies, including autoimmune diseases and multiple sclerosis. Furthermore, human requirements for this vitamin are much higher than previously thought, and in medium- or high-latitude countries, they might not be met in the majority of the general population due to a lack of sunshine and an increasingly urbanized lifestyle. Thereafter, the different types of studies that have helped to implicate hypovitaminosis D as a risk factor for multiple sclerosis are reviewed. In experimental autoimmune encephalomyelitis, vitamin D has been shown to play a significant immunological role. Diverse epidemiological studies suggest that a direct chain of causality exists in the general population between latitude, exposure to the sun, vitamin D status and the risk of multiple sclerosis. New epidemiological analyses from France support the existence of this chain of links. Recently reported immunological findings in patients with multiple sclerosis have consistently shown that vitamin D significantly influences regulatory T lymphocyte cells, whose role is well known in the pathogenesis of the disease. Lastly, in a number of studies on serum levels of vitamin D in multiple sclerosis, an insufficiency was observed in the great majority of patients, including at the earliest stages of the disease. The questionable specificity and significance of such results is detailed here. Based on a final global analysis of the cumulative significance of these different types of findings, it would appear likely that hypovitaminosis D is one of the risk factors for multiple sclerosis.

Our previous studies have shown that Portuguese primary school pupils and teachers have three main difficulties in the representation of the digestion process: the sequence of the digestive tract, blood absorption, and the relationship of the digestive function with other human functions. In this study we analysed the topic of digestion in 63 Portuguese textbooks (1920-2005). In general, the textual explanation of the digestive process (including reference to blood absorption) is clear, but "confusion" in images is persistent throughout the period studied. To demonstrate the influence of the period of the Portuguese dictatorship (1926-1974), a brief comparison with French textbooks (which developed during the same period with the aim of presenting clearer representations of the digestive tract) was carried out. Results suggest that inadequate images in textbooks may be the main didactic obstacle to accurate learning of the digestive function. (Contains 7 tables and 5 figures.)

In 2 experiments, the authors examined the electro-physiological auditory responses of monolingual French listeners to American English vowel contrasts as a function of the surrounding vowel context. The context was determined on the basis of behavioral results (C.Meunier, C. Frenck-Mestre, T. Lelekov-Boissard & M. Le Besnaris, 2003, 2004). In the 1st experiment, where the vowel /I/ was placed in a context in which it could easily be discriminated from the surrounding vowels (82% /i/ and 3% /ae/), the electro-physiological response to this vowel showed both acoustic and phonemic responses in line with behavioral results. In the 2nd experiment, where the same vowel /I/ was placed in a "difficult" context (82% /e/ and 3% /ae/), the electro-physiological response of French participants to this vowel revealed a greatly reduced phonemic response, showing assimilation of the vowel to the surrounding context, again in line with behavioral results. The results of a 3rd control experiment with American participants showed both an acoustic and a phonemic response to the vowel /I/ in the difficult context (82% /e/ and 3% /ae/). This pattern demonstrates the fluctuations in perception as a function of context, and hints at a supple system that may be modified through experience. (Contains 5 figures, 1 table and 3 footnotes.)

Anatomical modifications implemented during bariatric surgery not only result in weight loss, but also lead to metabolic corrections that translate into better glycemia stability and improvement in cardiovascular and liver disorders. The logical extension of surgical indications beyond mere reduction of the body mass index (BMI) (i.e. patients with < 35 kg/m2) is a hot topic today in France and worldwide. Metabolic surgeries make use of multiple modalities (endoscopic, mini-invasive, invasive) that should be carried out by trained physicians and within the same type of multidisciplinary formation as that for bariatric surgery. The aim of this update is to describe the physiological mechanisms that result in the benefits of bariatric surgery, the various procedures currently available and the perspectives for this new field in visceral and digestive surgery. [ABSTRACT FROM AUTHOR]

The buds of perennial plants become dormant in autumn and must integrate the information related to chilling and forcing temperatures to resume their growth in spring. In many studies, the initial date for chilling accumulation (DCA) is set arbitrarily using various rules resulting in high variability across studies and sites. To test the relevancy of different rules to set DCA, sequential models (taking into account or not the negative effect of warm temperature) were optimized by minimizing the sums of squares between observed and predicted values for 34 endodormancy release and 77 budbreak dates for the walnut Juglans regia L. cv Franquette across France. Optimization of these different models highlighted that many of the DCA rules, incorporating a photoperiod signal on endodormancy induction, were effective (predicted root mean square standard error less than 10 and 8 days for endodormancy onset and bud break, respectively). Furthermore, the use of functions that compute negative chilling accumulation did not improve the performance of the models. Among the different rules, the projections of the best models were explored under different climates (current climate and Representative Concentration Pathways RCP scenarios). The projections revealed a tipping point at a mean annual temperature between 13 and 15°C, beyond which the advance in ontogenic development during ecodormancy does not compensate for the delay in endodormancy release. Although the physiological mechanisms driving the onset of endodormancy may be profoundly altered by global change, they appear to have minimal impact on the way current models predict dormancy and budbreak dates in walnut. [ABSTRACT FROM AUTHOR]

Background: Many countries publish periodic Report Cards on physical activity for children and youth. This paper presents the results from the first French Report Card providing a systematic synthesis and assessment of the national engagements to facilitate childhood physical activity. Methods: A search for nationally representative data on 8 indicators of physical activity was conducted and the data were assessed by an expert panel according to international procedures. Whether children across France are achieving specific benchmarks was rated using an established grading framework [A, B, C, D, F, or INC (incomplete)]. Data were interpreted, grades assigned and detailed in the 2016 Report Card that was produced and disseminated. Results: The expert panel awarded the following grades: Overall Physical Activity: INC; Organized Sport Participation: D; Active Transportation: D; Sedentary Behaviors: D; Family and Peers: INC; School: B; Community and the Built Environment: INC; Government Strategies and Investment: INC. Conclusions: The grades reveal that efforts must be done to improve youth's physical activity and that several gaps in the literature still need to be addressed. Collectively the results highlight that children's physical activity levels are low and that further national supports and investments are needed to promote childhood healthy active living in France. [ABSTRACT FROM AUTHOR]

Climate is a major evolutionary force in driving adaptive differentiation and plasticity in plant function. Xylem anatomy and hydraulic architecture are critical to water use, growth and responses of trees to drought and thus important in delimiting their ecological niches. How wood properties have been shaped through evolution by their climatic origins and the importance of plasticity for species persistence remain open questions critical to understanding plant responses to changing climate.We measured 11 wood anatomical traits for 18 Quercus (oak) species in arboreta that span contrasting climates (California‐US, southwestern France and central England). We investigated coordinate evolution of xylem anatomical properties with climatic niche and intraspecific variation in relation to growth environment.Species originating from climates with drier summers had traits associated with higher resistance to drought—higher density of vasicentric tracheids (VT), lower vessel hydraulic diameter (Dmh) and lower hydraulic conductivity. Species that evolved in climates with drier, hotter summers or colder winters had higher numbers of VT than those from mesic climates, supporting hypotheses that VT are critical for water transport during drought. We found limited intraspecific variation in xylem traits associated with growth environment—only four traits (pit fraction, VT, vessel density and Dmh)—differed among gardens.Xylem traits showed high lability across the phylogeny, consistent with evidence for parallel sympatric adaptive radiation and global diversification of the oaks. Our results provide evidence for the physiological mechanisms that underlie adaptation to changing environments and responses to climate change. [ABSTRACT FROM AUTHOR]

A robust and reproducible scapular coordinate system is necessary to study scapulothoracic kinematics. The coordinate system recommended by the ISB (International Society of Biomechanics) is difficult to apply in studies using medical imaging, which mostly use a glenoid-centered coordinate system. The aim of this study was to assess the robustness of a glenoid-centered coordinate system compared with the ISB coordinate system, and to study the reproducibility of this coordinate system measure during abduction. A Monte-Carlo analysis was performed to test the robustness of the two coordinate systems. This method enabled the variability of the orientation of the coordinate system to be assessed in a laboratory setting. A reproducibility study of the glenoid-centered coordinate system in the thorax reference frame was performed during abduction in the scapular plane using a low-dose stereoradiography system. We showed that the glenoid-centered coordinate system was slightly more robust than the ISB-recommended coordinate system. Most reproducible rotation was upward/downward rotation (x axis) and most reproducible translation was along the Y axis (superior-inferior translation). In conclusion, the glenoid-centered coordinate system can be used with confidence for scapular kinematics analysis. The uncertainty of the measures derived from our technique is acceptable compared with that reported in the literature. Functional quantitative analysis of the scapulothoracic joint is possible with this method. [ABSTRACT FROM AUTHOR]

CONTEXT: In women's handball, the large numbers of throws and passes make the shoulder region vulnerable to overuse injuries. Repetitive throwing motions generate imbalance between shoulder internal- and external-rotator muscles. It has not yet been established whether sling-based training can improve shoulder external-rotator muscle strength. OBJECTIVE: This study investigated the effectiveness of a 6-wk strengthening program in improving shoulder functional profile in elite female high school handball players. DESIGN: Crossover study. SETTING: National elite handball training center. PARTICIPANTS: 25 elite female high school handball players. INTERVENTIONS: The program, completed twice per week for 6 wk, included sling-based strengthening exercises using a suspension trainer for external rotation with scapular retraction and scapular retraction alone. MAIN OUTCOMES: Maximal shoulder external- and internal-rotation strength, shoulder external- and internal-rotation range of motion (ROM), and maximal throwing velocity were assessed preintervention and postintervention for dominant and nondominant sides. RESULTS: After sling training, external- and internal-rotation strength increased significantly for both sides (P ≤ .001, and P = .004, respectively), with the result that there was no significant change in external- and internal-rotation strength ratios for either the dominant or the nondominant shoulder. No significant differences were observed for external-rotation ROM, while internal-rotation ROM decreased moderately, in particular in the dominant shoulder (P = .005). Maximal throwing velocity remained constant for the dominant arm, whereas a significant increase was found for the nondominant arm (P = .017). CONCLUSIONS: This 6-wk strengthening program was effective in improving shoulder external-rotator muscle strength but resulted in a decrease in the ROM in shoulder internal rotation, while throwing velocity remained stable. Adding a stretching program to this type of sling-based training program might help avoid potential detrimental effects on shoulder ROM [ABSTRACT FROM AUTHOR]

Objective: Our main objective was to examine if parental prenatal preferences predict delivery-room management of extremely preterm periviable infants. The secondary objectives were to describe parental involvement and the content of prenatal counseling given to parents for this prenatal decision. Design: Prospective study of neonates liveborn between 22 and 26 weeks of gestation in France in 2011 among the neonates included in the EPIPAGE-2 study Setting: 18 centers participating in the “Extreme Prematurity Group” substudy of the EPIPAGE-2 study. Patients: 302 neonates liveborn between 22–26 weeks among which 113 with known parental preferences while parental preferences were unknown or unavailable for 186 and delivery room management was missing for 3. Results: Data on prenatal counseling and parental preferences were collected by a questionnaire completed by professionals who cared for the baby at birth; delivery room (DR) management, classified as stabilization or initiation of resuscitation (SIR) vs comfort care (CC). The 113 neonates studied had a mean (SD) gestational age of 24 (0.1) weeks. Parents of neonates in the CC group preferred SIR less frequently than those with neonates in the SIR group (16% vs 88%, p < .001). After multivariate analysis, preference for SIR was an independent factor associated with this management. Professionals qualified decisions as shared (81%), exclusively medical (16%) or parental (3%). Information was described as medical with no personal opinion (71%), complete (75%) and generally pessimistic (54%). Conclusion: Parental involvement in prenatal decision-making did not reach satisfying rates in the studied setting. When available, prenatal parental preference was a determining factor for DR management of extremely preterm neonates. Potential biases in the content of prenatal counselling given to parents need to be evaluated. [ABSTRACT FROM AUTHOR]

Background: Weight-control interventions in pregnant women with overweight or obesity have limited effectiveness for fetal growth and birth outcomes. Interventions or prevention programs aiming at the pre-pregnancy period should be considered. However, how the woman's weight change before pregnancy affects fetal growth is not known. We investigated the association between weight change over the year before pregnancy and birth weight.Methods and Findings: We used the inclusion data of 16,395 women from the ELFE French national birth cohort, a nationally representative cohort in which infants were enrolled at birth with their families in 2011. Maternal weight change was self-reported and classified into 3 groups: moderate weight variation or stable weight, weight loss > 5 kg, and weight gain > 5 kg or both weight loss and gain > 5 kg. Multiple linear regression models were used to investigate the association between pre-pregnancy weight change and a birth weight z-score calculated according to the French Audipog reference, adjusted for a large set of maternal characteristics. The analyses were stratified by maternal body mass index (BMI) at conception (<25 versus ≥25 kg/m2) and adjusted for BMI within these categories. We used the MacKinnon method to test the mediating effect of gestational weight gain (GWG) on these associations. Mother's mean age was 30.5 years, 87% were born in France, and 26% had overweight or obesity. For women in either BMI category at conception, GWG was more than 2 kg higher, on average, for women with weight loss before pregnancy than for women with stable weight or moderate weight variation. For women with BMI < 25 kg/m2 at conception, birth weight was significantly higher with weight loss than stable weight before pregnancy (β = 0.08 [95% CI 0.02; 0.14], p = 0.01), and this total effect was explained by a significant mediating effect through GWG. For women with BMI ≥ 25 kg/m2 at conception, birth weight was not associated with pre-pregnancy weight loss during the year before pregnancy. Mediation analysis revealed that in these women, the direct effect of pre-pregnancy weight loss that would have resulted in a smaller birth weight z-score (β = -0.11 [95% CI -0.19; -0.03], p = 0.01) was cancelled out by the GWG. The mediating effect of GWG was even higher when weight loss resulted from a restrictive diet in the year before pregnancy. Weight gain before pregnancy was not associated with birth weight. Although we included a large number of women and had extensive data, the only potential cause of pre-pregnancy weight loss that was investigated was dieting for intentional weight loss. We have no information on other potential causes but did however exclude women with a history of pre-pregnancy chronic disease. Another limitation is declaration bias due to self-reported data.Conclusions: Health professionals should be aware that GWG may offset the expected effect of weight loss before conception on fetal growth in overweight and obese women. Further studies are required to understand the underlying mechanisms in order to develop weight-control interventions and improve maternal periconceptional health and developmental conditions for the fetus. [ABSTRACT FROM AUTHOR]

Introduction: Our objective was to assess whether clusters of centers with similar peritoneal dialysis (PD) catheter related practices were associated with differences in the risk of technique failure. Methods: Patients on incident PD in French centers contributing to the French Language PD Registry from 2012 to 2016 were included in a retrospective analysis of prospectively collected data. Centers with similar catheter cares practices were gathered in clusters in a hierarchical analysis. Clusters of centers associated with technique failure were evaluated using Cox and Fine and Gray models. A mixed effect Cox model was used to assess the influence of a center effect, as explained by the clusters. Results: Data from 2727 catheters placed in 64 centers in France were analyzed. Five clusters of centers were identified. After adjustment for patient-level characteristics, the fourth cluster was associated with a lower risk of technique failure (cause specific-HR 0.70, 95%CI 0.54–0.90. The variance of the center effect decreased by 5% after adjusting for patient characteristics and by 26% after adjusting for patient characteristics and clusters of centers in the mixed effect Cox model. Favorable outcomes were observed in clusters with a greater proportion of community hospitals, where catheters were placed via open surgery, first dressing done 6 to 15 days after catheter placement, and local prophylactic antibiotics was applied on exit-site. Conclusion: Several patterns of PD catheter related practices have been identified in France, associated with differences in the risk of technique failure. Combinations of favorable practices are suggested in this study. [ABSTRACT FROM AUTHOR]

Background and objective: Pain, a symptom often present in patients with Chronic Obstructive Pulmonary Disease (COPD), alters quality of life. COPD exacerbation augments several mechanisms that may cause pain (dyspnea, hyperinflation and inflammation) and therefore we hypothesized that pain might be increased during exacerbation. Methods: A prospective cohort study was conducted in patients admitted for acute exacerbations of COPD (AECOPD) in two emergency departments in France and Canada. Patients with cancer-related pain or recent trauma were not included. The Short Form McGill Pain Questionnaire (SF-MPQ) and the Brief Pain Inventory (BPI) scale were used to evaluate pain intensity and location. Patients also completed the Borg Dyspnea Scale and Hospital Anxiety and Depression Scale. The questionnaires were completed again during an outpatient assessment in the stable phase. The primary outcome was difference in pain intensity (SF-MPQ) between the exacerbation and stable phases. Results: Fifty patients were included. During exacerbation, 46 patients (92%) reported pain compared to 29 (58%) in the stable phase (p<0.001). Pain intensity was higher during exacerbation (SF-MPQ 29.7 [13.6–38.2] vs. 1.4 [0.0–11.2]; p<0.001). Pain was predominantly located in the chest during exacerbation and in the limbs during the stable phase. Pain intensity during exacerbation correlated with anxiety score. Conclusion: The frequency and intensity of pain were higher during AECOPD, with a specific distribution. Pain should therefore be routinely assessed and treated in patients with AECOPD. [ABSTRACT FROM AUTHOR]

Objectives: To assess premedication practices before tracheal intubation of premature newborns in the delivery room (DR). Study design: From the national population-based prospective EPIPAGE 2 cohort in 2011, we extracted all live born preterms intubated in the DR in level-3 centers, without subsequent circulatory resuscitation. Studied outcomes included the rate and type of premedication, infants’ and maternities’ characteristics and survival and major neonatal morbidities at discharge from hospital. Univariate and multivariate analysis were performed and a generalized estimating equation was used to identify factors associated with premedication use. Results: Out of 1494 included neonates born in 65 maternities, 76 (5.1%) received a premedication. Midazolam was the most used drug accounting for 49% of the nine drugs regimens observed. Premedicated, as compared to non premedicated neonates, had a higher median [IQR] gestational age (30 [28–31] vs 28 [27–30] weeks, p<10−3), median birth weight (1391 [1037–1767] vs 1074 [840–1440] g, p<10−3) and median 1-minute Apgar score (8 [6–9] vs 6 [3–8], p<10−3). Using univariate analyses, premedication was significantly less frequent after maternal general anesthesia and during nighttime and survival without major morbidity was significantly higher among premedicated neonates (56/73 (81.4%) vs 870/1341 (69.3%), p = 0.028). Only 10 centers used premedication at least once and had characteristics comparable to the 55 other centers. In these 10 centers, premedication rates varied from 2% to 75%, and multivariate analysis identified gestational age and 1-minute Apgar score as independent factors associated with premedication use. Conclusion: Premedication rate before tracheal intubation was only 5.1% in the DR of level-3 maternities for premature neonates below 34 weeks of gestation in France in 2011 and seemed to be mainly associated with centers’ local policies. [ABSTRACT FROM AUTHOR]

Background: Reducing unplanned rehospitalizations is one of the priorities of health care policies in France and other Western countries. An easy-to-use algorithm for identifying patients at higher risk of rehospitalizations would help clinicians prioritize actions and care concerning discharge transitions. Our objective was to develop a predictive unplanned 30-day all-cause rehospitalization risk score based on the French hospital medico-administrative database. Methods: This was a retrospective cohort study of all 2015 discharges from acute-care inpatient hospitalizations in a tertiary-care university center comprising four hospitals. The study endpoint was unplanned 30-day all-cause rehospitalization via emergency departments, and we collected sociodemographic, clinical, and hospital characteristics based on hospitalization database computed for reimbursement of fees. We derived a predictive rehospitalization risk score using a split-sample design and multivariate logistic regression, and we compared the discriminative properties with the LACE index risk-score. Result: Our analysis included 118,650 hospitalizations, of which 4,127 (3.5%) led to rehospitalizations via emergency departments. Variables independently associated with rehospitalization were age, gender, state-funded medical assistance, as well as disease category and severity, Charlson comorbidity index, hospitalization via emergency departments, length of stay (LOS), and previous hospitalizations 6 months before. The predictive rehospitalization risk score yielded satisfactory discriminant properties (C statistic: 0.74) exceeding the LACE index (0.66). Conclusion: Our findings indicate that the possibility of unplanned rehospitalization remains high for some patient characteristics, indicating that targeted interventions could be beneficial for patients at the greatest risk. We developed an easy-to-use predictive rehospitalization risk-score of unplanned 30-day all-cause rehospitalizations with satisfactory discriminant properties. Future works should, however, explore if other data from electronic medical records and other databases could improve the accuracy of our predictive rehospitalization risk score based on medico-administrative data. [ABSTRACT FROM AUTHOR]

Background: Preterm prelabor rupture of membranes is a frequent obstetric condition associated with increased risks of maternal and neonatal morbidity and mortality. Conventional management is in hospital. Outpatient management is an alternative in selected cases; however, the safety of home management has not been established.Objective: To study the obstetric and neonatal outcomes of women with preterm premature rupture of membranes between 24 and 34 weeks who were managed as outpatient (outpatient care group), compared with those managed in hospital (hospital care group).Study Design: A retrospective cohort study between 1 January 2009 and 31 December 2013 in three French tertiary care centers.Results: Ninety women were included in the outpatient care group and 324 in the hospital care group. In the outpatient care group, the gestational age at membrane rupture was lower, compared to the hospital care group (28.8 (26.6-30.5) vs. 30.3 (27.6-32.1) weeks; p < .01) and the cervical length at admission was higher (31.7 ± 10.4 vs. 24.3 ± 11.8 mm; p < .01). In the outpatient care group, no delivery or major obstetric complication occurred at home.Conclusion: We observed no major complication related to home care after a period of observation. A randomized study would be necessary to confirm its safety. [ABSTRACT FROM AUTHOR]

Background: During pregnancy, the diet of a mother-to-be should be adapted to meet increases in nutrient requirements. We analyzed the theoretical efficiency and acceptability of different types of tailored dietary changes for pregnant women. Methods: The nutrient adequacy of the diet was evaluated using the PANDiet score, by comparing the nutrient intakes of 344 non-pregnant premenopausal women (18–44y) with dietary reference intakes for the first trimester of pregnancy. Simulations were performed to evaluate the theoretical efficiency of three types of ten successive tailored dietary changes in improving nutrient adequacy, with graded difficulty in implementation. The acceptability (declared intention to use in the diet) of most efficient dietary changes was evaluated during an online randomized study including 115 French pregnant women (22–41y). Results: Modifying the amount consumed of foods (type-1) did not modify the food repertoire and resulted in the smallest theoretical efficiency (increase in the PANDiet score of 9.8±0.2 points), but changes were the most acceptable (probability of the intention to use: 0.30–0.78). Conversely, replacing food items by items from the same group or eaten at the same time (type-3) broadened the food repertoire (3.6±1.3 food subgroups added) and resulted in the greatest theoretical efficiency (+23.9±0.3) but changes were the least acceptable (0.07–0.23). Replacing food items within the same subgroup (type-2) slightly broadened the food repertoire (+8.0±1.3 foods) and resulted in moderate theoretical efficiency (+14.8±0.2) and intermediate acceptability (0.11–0.35). Conclusion: A clear trade-off exists between the theoretical efficiency and acceptability of dietary changes, with a graded broadening of the food repertoire. [ABSTRACT FROM AUTHOR]

Objective: To identify individual and contextual socio-economic factors associated with an increase in fruit and vegetable (F&V) consumption over a 12-year period and evaluate if some socio-economic factors were differentially associated with the change in consumption of some types of F&V.Design: Associations between increased F&V consumption and socio-economic factors were studied with multivariate logistic regression.Setting: E3N, a French prospective cohort study of 98 995 women.Subjects: E3N participants (n 58 193) with information on diet in 1993 and 2005, and numerous individual and contextual socio-economic factors available.Results: Associations between some individual socio-economic factors and changes in F&V consumption were observed. For instance, women who lived in a large household (>3 children v. no child) had higher probability of increasing their vegetable consumption (OR=1·33; 95 % CI 1·24, 1·42). This association was driven by higher consumption of courgette and raw cucumber. Living with a partner was associated with higher odds of increasing consumption of fruits (OR=1·07; 95 % CI 1·02, 1·13) such as pear, peach and grape.Conclusions: Certain individual socio-economic factors, but none of the contextual socio-economic factors examined, were associated with an increase in F&V consumption. Factors associated with an increase in total F&V consumption were not necessarily associated with an increase in fruit or vegetable consumption separately, or with an increase in each subtype of fruit or vegetable. Magnitudes of the different associations observed also differed when F&V were considered together, separately or by subtype. Increases in F&V consumption were mostly observed in women with high socio-economic position. To develop effective nutritional interventions and policies that take the socio-economic environment of individuals into account, we recommend future research to further focus on (i) pathways through which population characteristics might influence changes in F&V consumption and (ii) existing interactions between individual and contextual socio-economic factors. [ABSTRACT FROM AUTHOR]

Temporal processing in French children with dyslexia was evaluated in three tasks: a word identification task requiring implicit temporal processing, and two explicit temporal bisection tasks, one in the auditory and one in the visual modality. Normally developing children matched on chronological age and reading level served as a control group. Children with dyslexia exhibited robust deficits in temporal tasks whether they were explicit or implicit and whether they involved the auditory or the visual modality. First, they presented larger perceptual variability when performing temporal tasks, whereas they showed no such difficulties when performing the same task on a non-temporal dimension (intensity). This dissociation suggests that their difficulties were specific to temporal processing and could not be attributed to lapses of attention, reduced alertness, faulty anchoring, or overall noisy processing. In the framework of cognitive models of time perception, these data point to a dysfunction of the ‘internal clock’ of dyslexic children. These results are broadly compatible with the recent temporal sampling theory of dyslexia. [ABSTRACT FROM AUTHOR]

Context: Few researchers have identified intrinsic risk factors for shoulder injury in team handball players by analyzing measurements of maximal isokinetic rotator muscle strength. Objective: To identify possible intrinsic risk factors for shoulder injury by analyzing measurements of maximal isokinetic rotator muscle strength. Design: Cross-sectional study. Setting: Male team handball senior divisions (the highest level) in France and Belgium. Patients or Other Participants: A total of 108 male highlevel handball players (age = 24 ± 4 years, height = 189 ± 6 cm, mass = 87 ± 11 kg) were enrolled. Main Outcome Measure(s): All players completed a preseason questionnaire and performed a bilateral isokinetic assessment of the shoulder rotator muscles. On a monthly questionnaire, players reported any shoulder injury that they sustained during the season. Results: On the preseason questionnaire, 51 of 108 (47%) participants reported a history of dominant-shoulder injury. A total of 106 participants completed the in-season questionnaire, with 22% (n = 23) reporting a shoulder injury on their dominant side during the subsequent season. Fourteen percent (n = 15) sustained microtraumatic injuries, and 8% (n = 8) described a traumatic injury. Backcourt players had a 3.5-times increased risk of injury during the new season compared with players in other positions. Among the isokinetic results, no risk factor for further injury was identified in handball players with microtraumatic injuries. For traumatic injuries, the concentric maximal strength developed by the internal rotators at high speed (2408/s) in the dominant shoulder was a protective factor against the risk of further injury. Conclusions: These results can potentially identify intrinsic risk factors for shoulder injury and may be used to determine potential interventions for reducing this risk in handball players. [ABSTRACT FROM AUTHOR]

Pregnant women and their unborn child are exposed to a large number of substances during pregnancy. Some of these substances may cross the placenta, resulting in exposure of the foetus. There is growing evidence that certain substances could interact to produce a mixture effect. It is therefore essential to identify the main mixtures mothers are exposed to. This study aimed to identify the major mixtures French pregnant women included in EDEN and ELFE cohorts were exposed to, on the basis of the 441 substances analysed in the second French total diet study. Exposure systems and the composition of substances were identified from co-exposures using sparse non-negative matrix under-approximation to generate the main mixtures. Individuals were clustered to define clusters with similar co-exposure profiles. Six clusters associated with eight mixtures were identified. For example in ELFE, cluster 2 comprising 10% of the population was characterised by mixtures “Pest-1” mainly contains pesticides and ”TE-F-PAH″ contains trace elements, furans and polycyclic aromatic hydrocarbons. Five other clusters were also described with their associated mixtures. Similar results were observed for EDEN. This study helps to prioritise mixtures for which it is crucial to investigate possible toxicological effects and to recommend epidemiological studies concerning health effects. [ABSTRACT FROM AUTHOR]

Background: Recent research, especially from the USA, suggests that comorbid binge eating (BE) behaviour and BE disorder are frequent in individuals with Bipolar Disorder (BD). Although basic clinical associations between BD and BE have been investigated, less is known about psychological or temperamental dimensions and qualitative aspects of eating habits. In a French cohort of patients with BD, we investigated the prevalence of BE behaviour and any associations with illness characteristics, anxiety, impulsivity, emotional regulation and eating habits.Methods: 145 outpatients with BD (I and II) were assessed for the presence of BE behaviour using the Binge Eating Scale (BES). Characteristics identified in univariate analyses as differentiating BD cases with and without BE behaviour were then included in a backward stepwise logistic regression (BSLR) model.Results: In this sample, 18.6% of BD patients met criteria for BE behaviour. Multivariate analysis (BSLR) indicated that shorter duration of BD, and higher levels of anxiety and emotional reactivity were observed in BD with compared to BD without BE behaviour.Limitations: Relatively small sample referred to specialist BD clinics and cross-sectional evaluation meant that it was not possible to differentiate between state and trait levels of impulsivity, emotional instability and disinhibition. These dimensions may also overlap with mood symptoms.Conclusion: BE behaviour is common in females and males with BD. Emotional dysregulation and anxiety may represent important shared vulnerability factors for worse outcome of BD and increased likelihood of BE behaviour. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore whether ketamine prevents or exacerbates acute or post-traumatic stress disorders in military trauma patients. We conducted a retrospective study of a database from the French Military Health Service, including all soldiers surviving a war injury in Afghanistan (2010-2012). The diagnosis of post-traumatic stress disorder was made by a psychiatrist and patients were analysed according to the presence or absence of this condition. Analysis included the following covariables: age; sex; acute stress disorder; blast injury; associated fatality; brain injury; traumatic amputation; Glasgow coma scale; injury severity score; administered drugs; number of surgical procedures; physical, neurosensory or aesthetic sequelae; and the development chronic pain. Covariables related to post-traumatic and acute stress disorders with a p ≤ 0.10 were included in a multivariable logistic regression model. The data from 450 soldiers were identified; 399 survived, of which 274 were analysed. Among these, 98 (36%) suffered from post-traumatic stress disorder and 89 (32%) had received ketamine. Fifty-four patients (55%) in the post-traumatic stress disorder group received ketamine vs. 35 (20%) in the no PTSD group (p < 0.001). The 89 injured soldiers who received ketamine had a median (IQR [range]) injury severity score of 5 (3-13 [1-26]) vs. 3 (2-4 [1-6] in the 185 patients who did not (p < 0.001). At multivariable analysis, only acute stress disorder and total number of surgical procedures were independently associated with the development of post-traumatic stress disorder. In this retrospective study, ketamine administration was not a risk factor for the development of post-traumatic stress disorder in the military trauma setting. [ABSTRACT FROM AUTHOR]

Lyme borreliosis is the most common tick-borne disease in the northern hemisphere. In Europe, it is transmitted by Ixodes ticks that carry bacteria belonging to the Borrelia burgdorferi sensu lato complex. The objective of this work was to explore eco-epidemiological factors of Lyme borreliosis in peri-urban forests of France (Sénart, Notre-Dame and Rambouillet). We investigated whether the introduction of Tamias sibiricus in Sénart could alter the density of infected ticks. Moreover, the density and tick infection were investigated according to the tree species found in various patches of Sénart forest. For this purpose, ticks were sampled during 3 years. In the Sénart forest, the density of nymph and adult ticks showed no significant difference between 2008, 2009 and 2011. The nymph density varied significantly as a function of the month of collection. Regarding the nymphs, a higher rate of infection and infected density were found in 2009. Plots with chipmunks (C) presented a lower density of both nymphs and adult ticks than plots without chipmunks (NC) did. A higher rate of infection of nymphs with Borrelia was seen in C plots. The prevalence of the various species of Borrelia was also found to vary between C and NC plots with the year of the collect. The presence of chestnut trees positively influenced the density of both nymphs and adults. The infected nymph density showed a significant difference depending on the peri-urban forest studied, Sénart being higher than Rambouillet. The prevalence of Borrelia species also differed between the various forests studied. Concerning the putative role that Tamias sibiricus may play in the transmission of Borrelia, our results suggest that its presence is correlated with a higher rate of infection of questing ticks by Borrelia genospecies and if its population increases, it could play a significant role in the risk of transmission of Lyme borreliosis. [ABSTRACT FROM AUTHOR]

Coastal waters corresponding to macrotidal systems are among the most variable marine biotopes. Sessile animals as bivalve mollusks may however be found forming intertidal beds at high densities, as allowed by full adaptation to local conditions. A better knowledge of adaptive responses to environmental factors is required to foresee possible adverse effects of global change. At the sub-cellular level, transcriptional responses are among the earliest signals of environmental disturbances and they can reveal subtle and meaningful changes in organism exposed to stress. Three blue mussel ( Mytilus spp. ) populations inhabiting the Bay of Brest (France) in sites exposed to different levels of chronic pollution, from low to moderate, were surveyed upon a seasonal schedule, with special attention to the reproductive cycle. Major seawater parameters were monitored over a full-year in the framework of the S!RANO project, based on an automatic high frequency acquisition system installed aboard a ship of opportunity. The health status of mussels has been assessed by measuring a condition index and gametogenesis has been followed by histology. Selected biological responses to environmental stress were detected using a multimarker approach including expression of genes involved in chemical stress response and energetic metabolism, and cellular immune parameters. Environmental parameters showed deep seasonal variations which differed among sites. Most biological responses followed a seasonal pattern. Late winter and spring corresponded to an active reproduction period in the Bay of Brest. Earlier spawning was observed in harbor areas compared to the oceanic site and an altered physiological state was assumed in commercial harbor mussels during the reproductive period, suggesting that their health is compromised at this time of year. However, no signs of severe chemical stress were detected in both harbor mussel populations, which could reflect adaptive responses to adverse environmental conditions. [ABSTRACT FROM AUTHOR]

Background: International guidelines recommend extended duration secondary prophylaxis in cancer patients who develop primary venous thromboembolism (VTE). Agent selection is guided in part by one large randomized trial (i.e., CLOT; Lee et al., N Engl J Med 349:146-53, 2003) which demonstrated that dalteparin reduced the relative risk of recurrence by 52% compared with oral vitamin K antagonists (VKA; HR = 0.48, 95% CI, 0.30 to 0.77). In a subgroup analysis from that same trial, patients with renal impairment also derived benefit with dalteparin (VTE rates = 3% vs. 17%; p = 0.011). To measure the economic value of secondary VTE prophylaxis with dalteparin, a patient-level pharmacoeconomic analysis was conducted from the Austrian and French healthcare system perspectives.Methods: Chapter 1 Healthcare resource use collected during the CLOT trial was extracted and converted into direct cost estimates. Incremental cost differences between the dalteparin and VKA groups were then combined with health state utilities to measure the cost per quality-adjusted life year (QALY) gained.Results: The dalteparin group had significantly higher costs than the VKA group in both countries (Austria: dalteparin = €2687 vs. VKA = €2012; France: dalteparin = €2053 vs. VKA = €1352: p < 0.001). However, when the incremental costs were combined with the utility gain, dalteparin had a cost of €6600 and €4900 per QALY gained in Austria and France, respectively. The analyses in patients with renal impairment suggested an even better economic profile, with the cost per QALY gained being less than €4000 in both countries.Conclusions: Secondary prophylaxis with dalteparin is a cost-effective alternative to VKA for the prevention of recurrent VTE in patients with cancer. [ABSTRACT FROM AUTHOR]

Background: Lung cancer aetiology and clinical aspects have been mainly studied in men, although specific risk factors probably exist in women. Here we present the rationale, design and organization of the WELCA study (Women Epidemiology Lung CAncer) that has been launched to investigate lung cancer in women, focusing particularly on hormonal and occupational factors.Methods/design: WELCA is a population based case-control study and planned to recruit 1000 cases and 1000 controls in three years, based on study power calculation. Eligible cases are female patients newly diagnosed with lung cancer, living in Paris and the Ile de France area and aged up to 75 years. Almost all Parisian pneumology and oncology clinical departments are involved. The control group is a random sample of the population living in the same area, frequency-matched on age and additionally stratified on the distribution of socio-professional categories of women residing there. After acquisition of written consent, research nurses administer standardized computer assisted questionnaires to all the subjects in face-to-face interviews and acquire anthropometric measures. Besides usual socio-demographic characteristics, information is gathered about menstrual and reproductive factors, hormonal treatments, lifestyle and leisure characteristics, occupational history, personal and familial medical history. Biological samples are also collected, in order to establish a biobank for molecular epidemiology studies. Molecular characteristics of the tumours will be obtained and patients will be followed up for five years.Discussion: The WELCA study aims to answer key questions in lung cancer aetiology and clinical characteristics specifically in women. The role of hormonal impregnation is investigated, and the interactions with cigarette smoking or body mass index (BMI) will be analyzed in detail. The occupational history of the subjects is carefully reconstructed, focusing in particular on the service sector. The creation of a biobank for collection of serum, plasma, DNA and tumour tissue will allow the genetic and biochemical characterization of both the subjets and the tumours. The follow-up of the patients will help in disentangling the role of hormonal factors and tumour molecular characteristics in survival. [ABSTRACT FROM AUTHOR]

Background: According to rare studies, the age at EBV primary infection (PI) has recently risen in some developed countries. A later age at infection is generally considered a risk factor for severe EBV PI, although few studies exist on this subject. Our investigation aimed to determine whether EBV seroprevalence and EBV PI epidemiology have evolved in France, and to what extent age and infection intensity (regarding biological parameters) are correlated. Methods and findings: We conducted a retrospective study of the following EBV serological tests databases: tests carried out at Grenoble University Hospital (2000–2016) (n = 53,553); and tests carried out by a network of city laboratories in Grenoble area (2008–2015) (n = 27,485). The hospital population showed a continuous, significant decrease in EBV seroprevalence over the studied period for patients aged 20 and over (p<0.01). The seroprevalence also decreased for different age classes (<10, 15–19, 20–30, and 30–40 years old) over the periods 2001–2005, 2006–2010, and 2011–2015. Consistently, the age at PI was significantly higher in the years 2008–2015 than in the years 2001–2007 (15.6±12.0 vs. 13.7±11.0; p = 0.03). The city laboratory population showed the same trend of decreasing seroprevalence (p = 0.06); no significant variations in age at PI were observed. The age at PI was positively correlated with ASAT, ALAT, γGT, and bilirubin blood levels (p<0.01) and negatively correlated with platelet counts (p<0.05). Conclusion: In the last 15 years, the age at EBV PI has increased, whereas seroprevalence has decreased. Moreover, our findings confirm the positive correlation between age and biological abnormalities. Taken together, these results suggest that the incidence of severe EBV PI will increase in the future. [ABSTRACT FROM AUTHOR]

Introduction: Peripheral venous catheters (PVC) are medical devices most frequently used during hospital care. Although the frequency of specific PVC-related adverse events (PVCAEs) has been reported, the global risk related to the insertion of this device is poorly estimated. The aim of this study is to determine the incidence of PVCAEs during the indwell time, after catheter removal, and to identify practice-mirroring risk factors. Methods: A prospective observational study was conducted as a part of a research project, called CATHEVAL, in one surgery ward and four medicine wards from three public general tertiary care hospitals in Northern France that were invited to participate between June-2013 and June-2014. Each participating ward included during a two-month study period all patients older than 15 years carrying a PVC. All inserted PVCs were monitored from insertion of PVC to up to 48 hours after removal. Monitored data included several practice-mirroring items, as well as the occurrence of at least one PVCAE. A multivariate Cox proportional hazard model, based on a marginal risk approach, was used to identify factors associated with the occurrence of at least one PVCAE. Results: Data were analysed for 815 PVCs (1964 PVC-days) in 573 patients. The incidence of PVCAE was 52.3/100 PVCs (21.9/100 PVC-days). PVCAEs were mainly clinical: phlebitis (20.1/100 PVCs), haematoma (17.7/100 PVCs) and liquid/blood escape (13.1/100 PVCs). Infections accounted for only 0.4/100 PVCs. The most frequent mechanical PVCAEs, was obstruction/occlusion of PVC (12.4/100 PVCs). The incidence of post-removal PVCAEs was 21.7/100 PVCs. Unstable PVC and unclean dressing were the two main risk factors. Conclusion: Limitation of breaches in healthcare quality including post-removal monitoring should be reinforced to prevent PVC-related adverse events in hospital settings. [ABSTRACT FROM AUTHOR]

Charles Cléophas Person (1801-1884), French physician, transformed into researcher of thermodynamic properties such as latent heats of fusion, vaporization, and dilution, the specific heat of pure compounds and saline solutions, thermometry, neural physiology, etc. Among his achievements we can mention a procedure for improving the lecture of thermometers, a galvanometer for detecting weak instantaneous currents, and an adiabatic calorimeter. [ABSTRACT FROM AUTHOR]

Introduction Worldwide, air pollution has become a main environmental cause of premature mortality. This burden is largely due to fine particles. Recent cohort studies have confirmed the health risks associated with chronic exposure to PM 2.5 for European and French populations. We assessed the mortality impact of PM 2.5 in continental France using these new results. Methods Based on a meta-analysis of French and European cohorts, we computed a shrunken estimate of PM 2.5 –mortality relationship for the French population (RR 1.15 [1.05:1.25] for a 10 μg/m 3 increase in PM 2.5 ). This RR was applied to PM 2.5 annual concentrations estimated at a fine spatial scale, using a classical health impacts assessment method. The health benefits associated with alternative scenarios of improving air quality were computed for 36,219 French municipalities for 2007–2008. Results 9% of the total mortality in continental France is attributable to anthropogenic PM 2.5 . This represents > 48,000 deaths per year, and 950,000 years of life lost per year, more than half occurring in urban areas larger than 100,000 inhabitants. If none of the municipalities exceeded the World Health Organization guideline value for PM 2.5 (10 μg/m 3 ), the total mortality could be decreased by 3%, corresponding to 400,000 years of life saved per year. Conclusion Results were consistent with previous estimates of the long-term mortality impacts of fine particles in France. These findings show that further actions to improve air quality in France would substantially improve health. [ABSTRACT FROM AUTHOR]

The mechanisms that drive the transition from commensality to invasiveness in Staphylococcus aureus are poorly understood. We recently reported that >50% of S. aureus isolates from uninfected diabetic foot ulcers in French patients harbor a prophage, ROSA-like, that is absent from invasive isolates from diabetic foot infections, including osteomyelitis. Here we show that the ROSA-like insertion abolishes the ability of S. aureus to replicate within osteoblasts, the bone-forming cells, greatly reducing damage to infected cells. These results unravel an important mechanism by which particular S. aureus strains are maintained in a commensal state in diabetic foot ulcers. [ABSTRACT FROM AUTHOR]

Blood circulates through the vascular system to carry oxygen, nutrients and metabolites to and away from tissues, and as such is a key-component of animal physiology. The impacts of metal pollution on blood, however, are poorly documented in free-ranging vertebrates. While the counteracting effect of selenium on mercury toxicity is well known in marine mammals, its potential role against the toxicity of other metals is less studied, especially on terrestrial wildlife. We explored the consequences of chronic exposure to two non-essential metals (cadmium and lead) along a pollution gradient in Northern France, on eleven haematological parameters in two free ranging small mammals, the wood mouse Apodemus sylvaticus and the bank vole Myodes glareolus. We hypothesized that haematology was related to metal concentrations in tissues, and that selenium might exert modulating effects. Concentrations of cadmium and lead in the tissues indicated an increased chronic exposure to and accumulation of metals along the gradient. Some haematological parameters were not explained by any measured variables while some others varied only with gender or age. Red blood cells, red blood cells distribution width, and blood iron concentration, however, decreased with increasing cadmium in the tissues in wood mice. Red blood cells and haemoglobin decreased with increasing renal lead and hepatic cadmium, respectively, in bank voles. Red blood cells distribution width in wood mice increased with cadmium concentrations in the liver but this was counteracted by high selenium levels in the same organ. An interaction of selenium and lead on red blood cells was also observed in bank voles. Further, selenium concentrations were associated with an increase of monocytes in wood mice. The present results show that toxic metals were related to haematology changes, particularly erythrocyte indicators, and that some essential elements like selenium should be measured as well since they may counteract toxic effects. [Display omitted] • Haematological responses to trace metals chronic exposure were studied in rodents. • Non-essential metals were measured in tissues as a proxy of chronic exposure. • Some essential metals like iron and selenium were also measured. • Some erythrocyte indicators decreased with increasing Cd or Pb tissue concentration. • Selenium could modulate the effects of toxic metals on some erythrocyte indicators. [ABSTRACT FROM AUTHOR]

Several studies have suggested that a healthier overall diet was associated with a lower risk of depression, which is one of the main causes of disability worldwide. Our objective was to investigate the prospective association of adherence to dietary guidelines at midlife, measured by the French Programme National Nutrition Santé-Guideline Score (PNNS-GS), with chronic or recurrent depressive symptoms. The association between the PNNS-GS and chronic or recurrent depressive symptoms was evaluated among participants of the French Supplémentation en Vitamines et Minéraux AntioXydants (SU.VI.MAX) cohort with available data on the PNNS-GS at baseline (1994-1996) and on the Center for Epidemiologic Studies-Depression Scale (CES-D) in 1996-1997 and follow-up (2007-2009) (n=3328). Chronic or recurrent depressive symptoms were defined by a CES-D score ≥16 at baseline and follow-up. Odds ratios (OR) and 95%-confidence intervals (95%-CI) were estimated across quartiles (Q) of the PNNS-GS, using logistic regression models. In our study, 10.1% of the participants (n=335) had chronic or recurrent depressive symptoms. After adjustment for potential confounders, the PNNS-GS was inversely associated with chronic or recurrent depressive symptoms: ORQ4 vs. Q1: 0.42 (95%-CI: 0.29, 0.60). Modelling the PNNS-GS as a continuous variable yielded similar results: OR for a 1-point increment in the PNNS-GS: 0.86 (95%-CI: 0.80, 0.92). In conclusion, higher adherence to French dietary guidelines at midlife was associated with a lower rate of chronic or recurrent depressive symptoms, which suggests that these recommendations may be highly relevant, not only to avoid chronic diseases, but also for the overall well-being. [ABSTRACT FROM AUTHOR]

Background: Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are the most common bacteria involved in sexually transmitted infections (STIs). In France, combined screening for CT and NG using nucleic acid amplification tests is recommended in populations that are considered at risk. However, no data have been published about victims of sexual assaults. The aim of this retrospective study was to assess the usefulness of real-time PCR for the rapid detection of CT and NG genomic DNA, and the prevalence of CT/NG infections in a sample of sexual assault victims examined at a department of forensic medicine.Methods: Between July 2012 and July 2013, 326 adults and adolescents aged over 12 years reported a sexual assault and they were referred to the Department of Forensic Medicine for a medical and forensic examination. Secretions from urogenital (cervix or vagina), anorectal, or pharyngeal sites were collected for CT/NG assays.Results: CT and NG were detected in 48/326 (15%) and 16/326 patients (5%), respectively, where 10 (3%) had a CT/NG co-infection. Among 48 patients with CT infection, 13 (27.1%) patients had co-occurring genital and anorectal infections. For the pharyngeal sites, 3/21 men (14.3%) were NG-positive.Conclusions: Given the high prevalence of CT and NG infections, systematic screening of both pathogens at the time of forensic examination should provide an opportunity for the early treatment of diagnosed STIs. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) compromises Health-related Quality of Life (HRQL) with detriments to Physical, Mental and Social health domains. Treatment with interferon and ribavirin is associated with side effects which further impair HRQL. New treatments appear potent, effective and tolerable. However, Patient Reported Outcomes instruments that capture the impact on HRQL for people with hepatitis C are largely non-specific and will be needed in the new treatment era. Therefore, we developed a conceptually valid multidimensional model of HCV-specific quality of life and pilot survey instrument, the Patient Reported Outcome Quality of Life survey for HCV (PROQOL-HCV).Methods: HCV patients from France (n = 30), Brazil (n = 20) and Australia (n = 20) were interviewed to investigate HCV-HRQL issues raised in the scientific literature and by treatment specialists. Interviews were recorded, transcribed and translated into English and French.Results: Fifteen content dimensions were derived from the qualitative analysis, refined and fitted to four domains: (1) Physical Health included: fatigue, pain, sleep, sexual impairment and physical activity; (2) Mental Health: psychological distress, psychosocial impact, and cognition; (3) Social Health: support, stigma, social activity, substance use; (4) TREATMENT: management, side effects, and fear of treatment failure. The impact of some dimensions extended beyond their primary domain including: physical activity, cognition, sleep, sexual impairment, and the three treatment dimensions. A bank of 300 items was constructed to reflect patient reports and, following expert review, reduced to a 72-item pilot questionnaire.Conclusion: We present a conceptually valid multidimensional model of HCV-specific quality of life and the pilot survey instrument, PROQOL-HCV. The model is widely inclusive of the experience of hepatitis C and the first to include the treatment dimension. [ABSTRACT FROM AUTHOR]

Background: The "motoric cognitive risk" (MCR) syndrome is a newly reported predementia syndrome combining cognitive complaint and slow gait speed. We hypothesized that individuals with MCR syndrome would have lower brain volumes compared with non-MCR individuals. This study aims (i) to compare the cognitive profile of nondemented older community-dwellers with and without MCR syndrome and (ii) to examine association of global and regional brain volumes with MCR syndrome.Methods: A total of 171 individuals (28 MCR and 143 non-MCR) were included in this cross-sectional study. Total white matter abnormalities, total white matter, total cortical and subcortical gray matters, hippocampus, motor cortex, premotor cortex, and prefrontal cortex were examined. Brain volumes were quantified from a three-dimensional T1-weighted magnetic resonance imaging using semi-automated software. Age, gender, education level, number of drugs taken daily, use of psychoactive drugs, and cognitive profile were also measured.Results: The distribution of cognitively healthy individuals and those with mild cognitive impairment was not different in participants with and without MCR. Multiple logistic regression models showed that smaller volumes of total gray matter (p = .016), total cortical gray matter (p = .010), premotor cortex (p = .018), prefrontal cortex (p = .026), and dorsolateral segment of prefrontal cortex (p = .032) were associated with MCR status. The premotor cortex presented the highest mean difference for brain regional volume between MCR and non-MCR participants (p = .03).Conclusions: The findings revealed similar cognitive profile in MCR and non-MCR participants, and MCR-related smaller global and regional gray matter volumes involving premotor and prefrontal cortices, suggesting that the MCR syndrome may predict cortical neurodegenerative dementia more than subcortical dementia. [ABSTRACT FROM AUTHOR]

Objective: The pattern of renal function decline prior to cardiovascular (CV) events in type 2 diabetes is not well known. Our aim was to describe the association between renal function trajectories and the occurrence of a CV event.Research Design and Methods: We considered patients with type 2 diabetes from the SURDIAGENE (Survie, Diabete de type 2 et Genetique) study (discovery cohort) and the DIABHYCAR (Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril) study (replication cohort). Global patterns of estimated glomerular filtration rate (eGFR) (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and serum creatinine (SCr) prior to a major CV event (MACE) or last update were determined using a linear mixed-effects model and annual individual slopes computed by simple linear regression.Results: In the 1,040 participants of the discovery cohort, establishment of global patterns including 22,227 SCr over 6.3 years of follow-up showed an annual eGFR decline and an annual SCr increase that were significantly greater in patients with MACE compared with patients without (-3.0 and -1.7 mL/min/1.73 m(2)/year and +10.7 and +4.0 μmol/L/year, respectively; P < 0.0001 for both). Median annual individual slopes were also significantly steeper in patients with MACE, and adjusted risk of MACE was 4.11 times higher (3.09-5.45) in patients with rapid decline in eGFR (change less than -5 mL/min/1.73 m(2)/year). Consideration of renal function trajectories provided significant additive information helping to explain the occurrence of MACE for both SCr and eGFR (PIDI < 0.0001 and P = 0.0005, respectively). These results were confirmed in the replication cohort.Conclusions: Renal function decline was associated with a higher risk of MACE. The pattern of renal function decline, beyond baseline kidney function, is an independent factor of CV risk. [ABSTRACT FROM AUTHOR]

Understanding the neurobiological basis of individual differences in second language acquisition (SLA) is important for research on bilingualism, learning, and neural plasticity. The current study used quantitative electroencephalography (qEEG) to predict SLA in college-aged individuals. Baseline, eyes-closed resting-state qEEG was used to predict language learning rate during eight weeks of French exposure using an immersive, virtual scenario software. Individual qEEG indices predicted up to 60% of the variability in SLA, whereas behavioral indices of fluid intelligence, executive functioning, and working-memory capacity were not correlated with learning rate. Specifically, power in beta and low-gamma frequency ranges over right temporoparietal regions were strongly positively correlated with SLA. These results highlight the utility of resting-state EEG for studying the neurobiological basis of SLA in a relatively construct-free, paradigm-independent manner. [ABSTRACT FROM AUTHOR]

Background: The burden on caregivers of patients with Alzheimer's disease (AD) is associated with the patient's functional status and may also be influenced by chronic comorbid medical conditions, such as diabetes. This post-hoc exploratory analysis assessed whether comorbid diabetes in patients with AD affects caregiver burden, and whether caregivers with diabetes experience greater burden than caregivers without diabetes. Caregiver and patient healthcare resource use (HCRU) were also assessed.Methods: Baseline data from the GERAS observational study of patients with AD and their caregivers (both n = 1495) in France, Germany and the UK were analyzed. Caregiver burden was assessed using the Zarit Burden Interview (ZBI). Caregiver time on activities of daily living (ADL: basic ADL; instrumental ADL, iADL) and supervision (hours/month), and caregiver and patient HCRU (outpatient visits, emergency room visits, nights hospitalized) were assessed using the Resource Utilization in Dementia instrument for the month before the baseline visit. Regression analyses were adjusted for relevant covariates. Time on supervision and basic ADL was analyzed using zero-inflated negative binomial regression.Results: Caregivers of patients with diabetes (n = 188) were younger and more likely to be female (both p < 0.05), compared with caregivers of patients without diabetes (n = 1307). Analyses showed caregivers of patients with diabetes spent significantly more time on iADL (+16 %; p = 0.03; increases were also observed for basic ADL and total caregiver time but did not reach statistical significance) and had a trend towards increased ZBI score. Patients with diabetes had a 63 % increase in the odds of requiring supervision versus those without diabetes (p = 0.01). Caregiver and patient HCRU did not differ according to patient diabetes. Caregivers with diabetes (n = 127) did not differ from those without diabetes (n = 1367) regarding burden/time, but caregivers with diabetes had a 91 % increase in the odds of having outpatient visits (p = 0.01).Conclusions: This cross-sectional analysis found caregiver time on iADL and supervision was higher for caregivers of patients with AD and diabetes versus without diabetes, while HCRU was unaffected by patient diabetes. Longitudinal analyses assessing change in caregiver burden over time by patient diabetes status may help clarify the cumulative impact of diabetes and AD dementia on caregiver burden. [ABSTRACT FROM AUTHOR]

Exercise involving eccentric muscle contractions is known to decrease range of motion and increase passive muscle stiffness. This study aimed at using ultrasound shear wave elastography to investigate acute changes in biceps brachii passive stiffness following intense barbell curl exercise involving both concentric and eccentric contractions. The effect of local vibration (LV) as a recovery modality from exercise-induced increased stiffness was further investigated. Eleven subjects performed 4 bouts of 10 bilateral barbell curl movements at 70% of the one-rep maximal flexion force. An arm-to-arm comparison model was then used with one arm randomly assigned to the passive recovery condition and the other arm assigned to the LV recovery condition (10 min of 55-Hz vibration frequency and 0.9-mm amplitude). Biceps brachii shear elastic modulus measurements were performed prior to exercise (PRE), immediately after exercise (POST-EX) and 5 min after the recovery period (POST-REC). Biceps brachii shear elastic modulus was significantly increased at POST-EX (+53 ± 48%; p < 0.001) and POST-REC (+31 ± 46%; p = 0.025) when compared to PRE. No differences were found between passive and LV recovery (p = 0.210). LV as a recovery strategy from exercise-induced increased muscle stiffness was not beneficial, probably due to an insufficient mechanical action of vibrations. [ABSTRACT FROM AUTHOR]

Background: Vascular aging is accompanied by gradual remodeling affecting both arterial and cardiac structure and mechanical properties. Hypertension is suggested to exert pro-inflammatory actions enhancing arterial stiffness. Objectives: To determine the influence of thoracic aortic inflammation and calcifications on arterial stiffness and cardiac function in hypertensive and normotensive older subjects. Design: A prospective study. Setting: An acute geriatrics ward of the University Hospital of Nancy in France. Subjects: Thirty individuals ≥ 65 years were examined, including 15 hypertensive subjects and 15 controls well-matched for age and sex. Measurements: Applanation tonometry was used to measure aortic pulse wave velocity (AoPWV) and carotid/brachial pulse pressure amplification (PPA). Left ventricular parameters were measured with magnetic resonance imaging. Local thoracic aortic inflammation and calcification were measured by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography imaging. Biomarkers of low-grade inflammation were also quantified. Results: AoPWV was higher in elderly hypertensive subjects comparatively to normotensive controls (15.5±5.3 vs. 11.9±2.5, p=0.046), and hypertensives had a higher calcification volume. In the overall population, calcifications of the thoracic descending aorta and inflammation of the ascending aorta accounted for respectively 18.1% (p=0.01) and 9.6% (p=0.07) of AoPWV variation. Individuals with high levels of calcifications and/or inflammation had higher AoPWV (p=0.003). Inflammation had a negative effect on PPA explaining 13.8% of its variation (p<0.05). Conclusions: This study highlights the importance of local ascending aortic inflammation as a potential major actor in the determination of PPA while calcifications and hypertension are more linked to AoPWV. Assessment of PPA in the very elderly could provide complementary information to improve diagnostic and therapeutic strategies targeting ascending aortic inflammation. [ABSTRACT FROM AUTHOR]

When bovine tuberculosis (bTB) circulates in a multi-host system, it is paramount to characterize the interactions between wildlife and livestock as they may lead to interspecific transmission. To that purpose, we undertook a 1-year survey in 25 farms located in an infected area in the Burgundy region (east central France). We used camera traps deployed on 101 water and food access points located in pastures and farm buildings considered as attractive points for red deer, wild boar, and badgers. For each species, we analyzed the duration of each visit, the number of individuals, their behavior, and the frequency of visits. Wild boar was the most frequent species, with 5.0 visits/100 nights, and their visits occurred most frequently around water sources and in summer. The frequency of visits from red deer was highest at salt licks and in summer. Badger was more frequent in winter and on pasture feed troughs. These results highlight the wide variation in the patterns of contact at the wildlife-cattle interface among the different bTB-susceptible species. Combined with other epidemiological data, these data could be used both to assess the risk of bTB transmission in Burgundy and to implement biosecurity measures. [ABSTRACT FROM AUTHOR]

Objective Non-Hodgkin's lymphoma (NHL) is a severe complication of primary Sjögren's syndrome (SS). Ectopic germinal centers (GCs) in the salivary glands are predictors of the occurrence of NHL. Given the association between CCL11 and CXCL13 and ectopic GCs, we assessed the link between these chemokines and NHL, as well as the association between these chemokines and disease activity, in patients with primary SS. Methods Serum levels of CCL11 and CXCL13 were evaluated by multiplex assay in 385 patients included in the Assessment of Systemic Signs and Evolution of Sjögren's Syndrome (ASSESS) cohort. The association between chemokine levels, B cell biomarkers, and patient subsets was assessed using Spearman's test for continuous data and the nonparametric Mann-Whitney U test for categorical data. Multivariate analyses were performed to identify parameters associated with lymphoma and disease activity. Results Seventeen patients had a history of lymphoma, and 5 of them had developed NHL during followup. The median serum levels of CCL11 and CXCL13 in the total cohort were 106.48 pg/ml (interquartile range 69.33-149.85) and 108.31 pg/ml (interquartile range 58.88-200.13), respectively. Patients with lymphoma had higher levels of CXCL13 than did patients without lymphoma ( P = 0.006) and a trend toward a higher level of CCL11 ( P = 0.056). Low C4 and high BAFF levels were associated with NHL on multivariate analysis ( P = 0.01 and P = 0.0002, respectively). CCL11 and CXCL13 levels correlated positively with the rheumatoid factor titer, the κ-to-λ free light chain ratio, and the β2-microglubulin level. CXCL13 was the only parameter associated with disease activity on multivariate analysis. Conclusion These findings demonstrate a link between CXCL13 and CCL11 and disease activity and lymphoma. This highlights the continuum between chronic B cell activation, disease activity, and lymphomagenesis in patients with primary SS. [ABSTRACT FROM AUTHOR]

Background: Use of antidepressants is seen to be a risk factor for type 2 diabetes, even though the underlying mechanisms remain unclear. We examined whether antidepressant use was associated with change in fasting plasma glucose, glycated haemoglobin (HbA1c), β-cell function (HOMA2-%B) and insulin sensitivity (HOMA2-%S) over time.Methods: Participants in the French D.E.S.I.R. cohort study included over 4700 men (48.1%) and women, free of diabetes, aged 30-65 years at baseline in 1994-96 (D.E.S.I.R. 0), who were followed for 9 years at 3-yearly intervals (D.E.S.I.R. 3, 1997-99; 6, 2000-02; 9, 2003-05). Antidepressant use, fasting plasma glucose, HbA1c, HOMA2-%B and HOMA2-%S were assessed concurrently at four medical examinations. Linear mixed models were used to examine the cross-sectional and longitudinal associations of time-dependent antidepressant use with changes in these four biological parameters.Results: Mean fasting plasma glucose and HbA1c increased whereas HOMA2-%B and HOMA2-%S decreased over the follow-up. In a fully adjusted model, there were no differences in: mean fasting plasma glucose (β = 0.01 mmol/l, P = 0.702); HbA1c (β = 0.01 %, P = 0.738); HOMA2-%B (β = 0.00, P = 0.812); or HOMA2-%S (β =-0.01, P = 0.791) at baseline (1994-96) between antidepressant users and non-users. The interaction term with time also suggested no differences in the annual change in: fasting plasma glucose (β = 0.00 mmol/l, P = 0.322); HbA1c (β = 0.00 %, P = 0.496); HOMA2-%B (β = 0.00, P = 0.609); or HOMA2-%S (β = 0.00, P = 0.332) between antidepressant users and non-users. Similar associations were observed in analyses of type and cumulative use of antidepressants over follow-up.Conclusion: Our longitudinal data show that use of antidepressants is not associated with altered glucose metabolism, suggesting that the association between antidepressant use and diabetes reported by previous studies may not be causal. Detection bias or clinical ascertainment bias may account for much of this apparent association. [ABSTRACT FROM AUTHOR]

Objective: To investigate the contribution of endotoxemia to the severity of postcardiac arrest shock.Design: A prospective monocentric study.Setting: A tertiary hospital in Paris, France.Patients: Patients admitted in our ICU after a successfully resuscitated out-of-hospital cardiac arrest.Interventions: None.Measurements and Main Results: Endotoxin measurement was performed in the 12 hours following return of spontaneous circulation using the endotoxin activity assay. Endotoxin level was classified as low (< 0.4 endotoxin activity), intermediate (0.4 to < 0.6 endotoxin activity), or high (≥ 0.6 endotoxin activity) according to manufacture guidelines. Severity of shock was assessed by the vasopressor-free days and by the mean daily dose of vasopressor to insure a mean arterial pressure of 65-75 mm Hg. Among 92 patients included in the study, 60 presented a postcardiac arrest shock. Endotoxemia level was higher in patients with postcardiac arrest shock. Among these patients, by multivariate linear regression, high endotoxin class (adjusted estimate -2.0; 95% CI, -3.90 to -0.11), public place of cardiac arrest (adjusted estimate, 1.47; 95% CI, 0.007 to 2.93), and time to return of spontaneous circulation (adjusted estimate -0.08; 95% CI, -0.13 to -0.03) were independently associated with the number of vasopressor-free days. Furthermore, high endotoxin class (adjusted estimate, 97.95; 95% CI, 20.5 to 175.4) and a nonshockable rhythm (adjusted estimate, 59.9; 95% CI, 6.2 to 113.7) were the sole factors independently associated with the mean daily dose of vasopressors.Conclusions: In patients successfully resuscitated from cardiac arrest with a postcardiac arrest shock, high level of endotoxemia is independently associated with duration of postcardiac arrest shock and the amount of vasopressive drugs. Whether treatment targeting endotoxemia could be beneficial in the management of postcardiac arrest shock needs to be studied in further randomized controlled studies. [ABSTRACT FROM AUTHOR]