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Background: One of the most consistent findings reported in the paediatric cochlear implant (CI) literature is the heterogeneity of language performance observed more in grammatical morphology than in lexicon or pragmatics. As most of the corpus studies addressing these issues have been conducted in English, it is unclear whether their results can be generalized to other languages. In particular, little is known about languages known for their grammatical complexity, such as French. Aims: The aim of this corpus study was to compare the productive use of function words (FWs) and some agreement features (AGRs) in children with CIs and children with typical development (TD) matched for mean length of utterance in words (MLUwords), a general index of grammatical complexity, and auditory experience, as measured by hearing age (HA) and chronological age (CA), respectively. Methods & Procedures: Natural speech samples from 116 monolingual French‐speaking children, including 40 children with CIs followed longitudinally and 76 TD children, were collected. FWs and AGRs were analysed using a Part of Speech Tagger (POS‐T) from the Child Language Data Exchange System (CHILDES). Outcomes & Results: The two groups differed by 3 years for HA and CA. No effect of family socio‐economic status (SES) was found in the CI group. Stepwise regression analyses showed that the two groups did not share the same predictors of MLUwords: plurals and determiners predicted MLUwords in children with CIs, at 2 and 3 years of HA, whereas feminine markers and subject‐pronouns were found to best predict MLUwords in TD children at 2 and 3 years of CA. Structural equation models (SEMs), a combination of confirmatory factor analysis (CFA) and path analysis, yielded a different hierarchical structure of grammatical relations (GRs). Selective difficulties affecting verbal clitics and other pronominal forms were found specifically in the CI group (object‐pronouns, reflexive, relative and past participles). Dependency grammar analysis confirmed these contrasting developmental profiles in multiword utterances, such as preposition/nouns, subject/verbs, and verb/determiner/nouns. Conclusions & Implications: Atypical grammatical patterns in children with CIs reflect a specific architecture of syntactic dependencies of FWs underpinning morphological complexity and syntactic connectivity. Clinical implications are discussed for assessment and intervention planning. What This Paper Adds: What is already known on this subject: The productive use of FWs has been identified as a particular area of weakness in children with CIs compared with TD children. In addition, heterogenous grammatical performance has often been found after 1–3 years of CI use, regardless of demographic factors such as age at implantation, duration of deafness or SES. What this paper adds to existing knowledge: Assessing the early building of FWs and AGRs in children with CIs helps to understand the syntactic complexity and hierarchical structure of their language. Since most corpus studies on grammatical morphology have been conducted in English, it is not clear whether their difficulties can be generalized to other languages. The French language has a system of FWs and inflections that determine the morphophonological properties of nominal and verbal forms. Early grammar learning in children with CIs born with profound deafness were compared with the two groups of TD children matched both for duration of auditory experience (i.e., HA of CI children, CA of TD children) and for MLUwords. We found a similar profile between groups at 2 years but not at 3 years for HA and CA. The two groups do not share the same predictors of MLUwords: namely, plurals and determiners for CI children versus feminine markers and subject pronouns for TD children. They show a different syntactic organization of GRs. Children with CIs struggle with selective difficulties affecting verbal clitics and pronominal forms (object‐pronouns, reflexive, relative and past participles). Consistent with theories of morphophonological richness and syntactic connectivity, our results support the distributional learning hypothesis of language acquisition that infants and toddlers are sensitive to FWs and AGRs at an early age. Specific components of syntactic organization are disrupted in children with CIs. What are the potential or actual clinical implications of this work?: This work has potential clinical implications because it unravels the limitations of morphophonological processing in children with CIs. Its results highlight a specific difficulty in learning FWs and AGRs in a verbal inflectional morphology context. [ABSTRACT FROM AUTHOR]

Background: Digital game‐based learning is gaining increased attention from both researchers and educators for improving mathematics instruction. However, the evidence for game‐based learning is mixed and research with rigorous research design and analyses are limited. Objective: Here, in a pre‐registered randomized controlled study, we investigated whether a fraction game designed collaboratively by educational experts and professional game developers may serve as a useful tool to enhance students' fraction knowledge. Methods: We assigned French fifth graders to either an experimental group who used the game (n = 110) or a control group (n = 78) who received traditional instruction on fractions. Fraction knowledge was assessed pre‐ and post‐intervention. Results: Results show that students in the active control group had superior overall fraction performance than students in the experimental group at the end of intervention. However, the game had a positive effect on decimal learning. We also found a positive relation between game performance and overall fraction knowledge scores at post‐test. Contribution: The study highlights the importance of game metrics as indicators of personalized assessment tools. Given the increased usage of games in learning mathematics and the equivocal results on the effectiveness of these games, our study also highlights the importance of pre‐registration and randomized controlled studies. Lay Description: What is already known about this topic: Digital game‐based learning (DGBL) is gaining popularity in mathematics teaching.DGBL shows potential for teaching difficult abstract concepts such as fractions.However, research evaluating DGBL for fractions is limited. What this paper adds: The study examines a fraction game designed by education experts and game designers.Students fraction knowledge is assessed using paper‐based test.Challenges associated with DGBL in the classroom are discussed in the paper. Implications for practice: The results will guide educators in designing effective fraction instruction in classroom.The study highlights the critical role of instructional support in DGBL for fractions.Game based metrics can be used to individualize instruction in the classroom. [ABSTRACT FROM AUTHOR]

The objective of this paper is to describe gestational weight gain (GWG), to assess the applicability of the 2009 Institute of Medicine (IOM) guidelines, and to derive a GWG adequacy classification within a French cohort. We included twins from the national, prospective, population‐based JUmeaux MODe d'Accouchement (JUMODA) cohort study (2014–2015). Following the IOM approach, we selected a 'standard' population of term pregnancies with 'optimal' birthweight (≥2500 g; n = 2562). GWG adequacy (insufficient; adequate; excessive) was defined using IOM recommendations (normal body mass index [BMI]: 16.8–24.5 kg [also utilized for underweight BMI]; overweight: 14.1–22.7 kg; obese: 11.4–19.1 kg). Additionally, using the IOM approach, we determined the 25th and 75th percentiles of GWG in our standard population to create a JUMODA‐derived GWG adequacy classification. GWG and GWG adequacy were described, overall and by BMI and parity. In the JUMODA standard population of term twin livebirths with optimal birthweight, mean GWG was 16.1 kg (standard deviation 6.3). Using IOM recommendations, almost half (46.5%) of the women had insufficient and few (10.0%) had excessive GWG, with similar results regardless of BMI or parity. The 25th and 75th percentiles of GWG in the JUMODA standard population (underweight: 13–21 kg; normal weight: 13–20 kg; overweight: 11–19 kg; obese: 7–16 kg) were lower than the IOM recommendations. The IOM recommendations classified a relatively high percentage of French women as having insufficient and a low percentage as having excessive GWG. Additional research to evaluate recommendations in relation to adverse perinatal outcomes is needed to determine whether the IOM recommendations or the JUMODA‐derived classification is more appropriate for French twin gestations. Key messages: Using the 2009 Institute of Medicine (IOM) recommendations to define gestational weight gain (GWG) adequacy in our French cohort classified almost half of women as having insufficient GWG and a relatively low percentage as having excessive GWG.The USA‐derived IOM definition for adequate GWG may not apply in France or in other non‐USA, contemporary obstetric populations.Additional research in large, population‐based contemporary cohorts with prospective GWG ascertainment and assessment of GWG adequacy classifications in relation to adverse outcomes is needed to inform evidence‐based GWG recommendations for twin pregnancies. [ABSTRACT FROM AUTHOR]

Background: Articulatory excursion and vocal intensity are reduced in many children with dysarthria due to cerebral palsy (CP), contributing to the children's intelligibility deficits and negatively affecting their social participation. However, the effects of speech‐treatment strategies for improving intelligibility in this population are understudied, especially for children who speak languages other than English. In a cueing study on English‐speaking children with dysarthria, acoustic variables and intelligibility improved when the children were provided with cues aimed to increase articulatory excursion and vocal intensity. While French is among the top 20 most spoken languages in the world, dysarthria and its management in French‐speaking children are virtually unexplored areas of research. Information gleaned from such research is critical for providing an evidence base on which to provide treatment. Aims: To examine acoustic and perceptual changes in the speech of French‐speaking children with dysarthria, who are provided with speech cues targeting greater articulatory excursion (French translation of 'speak with your big mouth') and vocal intensity (French translation of 'speak with your strong voice'). This study investigated whether, in response to the cues, the children would make acoustic changes and listeners would perceive the children's speech as more intelligible. Methods & Procedures: Eleven children with dysarthria due to CP (six girls, five boys; ages 4;11–17;0 years; eight with spastic CP, three with dyskinetic CP) repeated pre‐recorded speech stimuli across three speaking conditions (habitual, 'big mouth' and 'strong voice'). Stimuli were sentences and contrastive words in phrases. Acoustic analyses were conducted. A total of 66 Belgian‐French listeners transcribed the children's utterances orthographically and rated their ease of understanding on a visual analogue scale at sentence and word levels. Outcomes & Results: Acoustic analyses revealed significantly longer duration in response to the big mouth cue at sentence level and in response to both the big mouth and strong voice cues at word level. Significantly higher vocal sound‐pressure levels were found following both cues at sentence and word levels. Both cues elicited significantly higher first‐formant vowel frequencies and listeners' greater ease‐of‐understanding ratings at word level. Increases in the percentage of words transcribed correctly and in sentence ease‐of‐understanding ratings, however, did not reach statistical significance. Considerable variability between children was observed. Conclusions & Implications: Speech cues targeting greater articulatory excursion and vocal intensity yield significant acoustic changes in French‐speaking children with dysarthria. However, the changes may only aid listeners' ease of understanding at word level. The significant findings and great inter‐speaker variability are generally consistent with studies on English‐speaking children with dysarthria, although changes appear more constrained in these French‐speaking children. What this paper addsWhat is already known on the subjectAccording to the only study comparing effects of speech‐cueing strategies on English‐speaking children with dysarthria, intelligibility increases when the children are provided with cues aimed to increase articulatory excursion and vocal intensity. Little is known about speech characteristics in French‐speaking children with dysarthria and no published research has explored effects of cueing strategies in this population.What this paper adds to existing knowledgeThis paper is the first study to examine the effects of speech cues on the acoustics and intelligibility of French‐speaking children with CP. It provides evidence that the children can make use of cues to modify their speech, although the changes may only aid listeners' ease of understanding at word level.What are the potential or actual clinical implications of this work?For clinicians, the findings suggest that speech cues emphasizing increasing articulatory excursion and vocal intensity show promise for improving the ease of understanding of words produced by francophone children with dysarthria, although improvements may be modest. The variability in the responses also suggests that this population may benefit from a combination of such cues to produce words that are easier to understand. [ABSTRACT FROM AUTHOR]

Policy PointsPrivate health insurance (PHI) in France has been facing critical changes over the past 30 years. A complementary and voluntary scheme, it has been historically dominated by nonprofit entities. However, the share of for‐profit insurance companies in the sector has significantly increased. Nonprofit firms also changed their strategies and mimicked some for‐profit behaviors.The present paper argues that this process is a result of the conflict‐provoking coevolution of the insurance and health care sectors. Trying to improve the regulation of the insurance industry as whole, two European directives first jeopardized the business model of nonprofit entities. Then, two national reforms designed to improve health coverage significantly increased competition among insurers, notably in the area of corporate‐level contracts.Decoupling the insurance and health care sectors has become a major source of policy feedback and unexpected outcomes of reforms affecting the very organization of PHI. Context: In France, private health insurance (PHI) has an exceptionally high level of coverage and accounts for 13.7% of health expenditures. A complementary and voluntary scheme, it has been historically dominated by nonprofit, mutual benefit societies. Over the past 20 years, however, the market share of for‐profit insurance companies has increased by 47%. Financialization of the field developed, and competition based on new risk management strategies also increased. The broad aim of this paper is to characterize and to elucidate the causes of this trend. More specifically, we are interested in how and to what extent a series of supranational and national policies contributed to this situation. Method: Our data come from three sources. We first reviewed documents published by health insurers, government reports, and newspaper articles. We then conducted two semistructured interview campaigns between September 2017 and May 2018. The first mostly covered private and public actors and their involvement in European Union (EU) policymaking (n = 21). The second series of interviews was conducted with another group of actors directly involved at the French level (n = 16). Findings: Our findings support preliminary observations. PHI in France, we argue, is indeed facing a development of competition and marketlike instruments. Four major policies (two EU directives and two national reforms) played a significant role in this outcome. Surprisingly, however, it has never been the purpose of legislators and policymakers: while EU directives created a regulatory framework for insurance activities within the Single Market, policies adopted at the national level initially aimed at improving health coverage. We show that it is the interactions and the noncoordination among all of these policies that explain their unexpected outcome. Conclusions: The trend described in this paper is twofold. The first is Europeanization, as PHI in France is increasingly affected by EU legislation. Since this framework tends to favor larger firms and for‐profit companies, a reduction in statutory coverage can no longer be considered a quasi‐neutral transfer from (publicly owned) social security to nonprofit providers. At the same time, PHI is shifting toward collectivization: as competition increases, complementary health coverage is becoming gradually standardized and based at the corporate level. Together, these changes are likely to reduce freedom of choice and individual welfare, an assumption supported by studies published on the most recent period. [ABSTRACT FROM AUTHOR]

Background: As educational digital technologies are increasingly being used in schools, past research left unanswered the question of these technologies' impact on the socioeconomic achievement gap even when equal access is guaranteed. Objectives: The objectives of the present study are to examine whether and how the socioeconomic achievement gap can be reduced through the use of computer‐assisted instruction (CAI). Methods: We addressed this issue experimentally by comparing CAI to conventional teacher‐led classroom instruction with more than 800 middle and high school students from disadvantaged and highly privileged socioeconomic backgrounds in a range of topics. Results and Conclusions: Both disadvantaged and highly privileged students taught with CAI outperformed those taught with conventional instruction, thus maintaining the socioeconomic achievement gap constant. However, we also found that disadvantaged students receiving CAI performed as well as highly privileged students receiving conventional teacher‐led instruction. Takeaways: The positive effects associated with CAI may therefore help compensate the difficulties of students with a disadvantaged background, a still neglected possibility. Lay Description: What is already known about this topic?: Socioeconomic status affects academic achievement especially in students from disadvantaged backgrounds.Inequal access to digital learning is a by‐product of socioeconomic status.Computer‐assisted instruction is known to yield positive effects on learning. What this paper adds?: It examines the effectiveness of computer‐assisted instruction on reducing the socioeconomic achievement gap when equal access to digital education is guaranteed at the school level.It shows that computer‐assisted instruction (relative to teacher‐led conventional instruction) benefited disadvantaged students and their highly privileged counterparts equally, shifting the socioeconomic achievement gap upward.However, disadvantaged students receiving CAI may reach similar performance level as their highly privileged counterparts receiving conventional instruction, thus compensating the socioeconomic achievement gap. Implications for practice and/or policy: This finding strengthens the importance of targeting teaching methods depending on students' socioeconomic characteristics to allow disadvantaged students to maximize their learning potential and chances to access to higher education. [ABSTRACT FROM AUTHOR]

Many studies have demonstrated the crucial role of vocabulary in predicting reading performance in general. More recent work has indicated that one particular facet of vocabulary (its depth) is more closely related to language comprehension, especially inferential comprehension. On this basis, we developed a training application to specifically improve vocabulary depth. The objective of this study was to test the effectiveness of a mobile application designed to improve vocabulary depth. The effectiveness of this training was examined on 3rd and 4th grade children's vocabulary (breadth and depth), decoding and comprehension performances. A randomized waiting‐list control paradigm was used in which an experimental group first received the intervention during the first 4 weeks (between pretest and post‐test1), thereafter, a waiting control group received the training for the next 4 weeks (between postest1 and posttest2). Results showed that the developed application led to significant improvements in terms of vocabulary depth performance, as well as a significant transfer effect to reading comprehension. However, we did not observe such a beneficial effect on either vocabulary breadth or written word identification. These results are discussed in terms of the links between vocabulary depth and comprehension, and the opportunities the app presents for remedying language comprehension deficits in children. Lay Description: What is already known about this topic:Vocabulary is a powerful predictor of both word identification and text comprehensionVocabulary depth rather than breadth is more closely related to language comprehensionDepth of vocabulary is particularly predictive of inferencing skills What this paper adds:We develop a new training application specifically targeting vocabulary depthThe training led to significant gain in children's knowledge for the taught wordsWe also observe a transfer effect with significant improvements in reading comprehension Implications for practice and/or policy:Vocabulary depth trainings represent a good way for remedying language comprehension deficits [ABSTRACT FROM AUTHOR]

Tumour genetics is currently turning into a massive clinical approach. This paper is an enquiry into its practices as they expand beyond expert and experimental contexts and become routinised in clinical hospital settings. Studying a French university hospital, we unpack the content and everyday organization of diagnostic labour in this context. Exploring the sociotechnical frictions that arise in the process, we describe the ways in which they are collectively controlled, and stabilized through organizational fictions, that are instrumental in making tumour genetics doable in the hospital, at a large scale. We further show that the new role of external regulations in the production of clinical values for mutations has a strong impact on diagnostic work, making it possible to be performed locally without resorting to expert bioclinical collectives, and outside the professional jurisdiction of clinical geneticists. This division of labour appears as a necessary condition for the rise in clinical productivity required by a new function assigned to genetics: to guide the prescription of drugs for common diseases. This turn in the way genetics is embedded in the clinic calls for a thorough reassessment of its impacts on clinical discourses, practices and decisions. [ABSTRACT FROM AUTHOR]

Recent research suggests that inducing fixed (rather than malleable) beliefs about groups leads to more negative attitudes toward out-groups. The present paper identifies the underlying mechanism of this effect. We show that individuals with a fixed belief about groups tend to construe intergroup settings as threatening situations that might reveal shortcomings of their in-group (perceived threat). In the present research, we measured (Study 1) and manipulated (Study 2) participants' lay theories about group malleability. We found that the extent to which individuals had an entity (versus an incremental) group theory influenced the level of threat they felt when interacting with out-group members, and that perceived threat in turn affected their level of ethnocentrism and prejudice. These findings shed new light on the role of lay theories in intergroup attitudes and suggest new ways to reduce prejudice. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Information seeking (IS) has become a critical activity in video‐based environments. Up to now, the effects of support on information seeking (i.e., scaffolding) have seldom been assessed. The twofold aim of the current study was to (a) assess the effects of scaffolding on IS in videos and (b) determine the characteristics of the users' mental models after an IS activity with or without scaffolding. We divided 50 participants into two groups that either did or did not benefit from initial scaffolding during an IS task. Both groups then had to perform a localization task without any further access to scaffolding. Results showed that scaffolding the video by providing a table of contents and markers on a timeline helped students to engage in highly efficient IS, but they had less accurate mental representations of the video than those without scaffolding. The hypothesis that scaffolding provides a usable but external model was therefore supported. Lay Description: What is already known about this topic: Videos are increasingly used in learning.Searching for information in videos may be a complex activity.So far, very few studies have been conducted on the potential effect of scaffolding videos during an information‐seeking (IS) task. What this paper adds: In this study, we put in place the scaffolding of the video by adding a table of contents and markers on the timeline.Structuration and segmentation have positive effects on the performance in IS, in terms of response success, time spent on each search, relevance, and perceived difficulty.Scaffolding has a negative impact on the users' internal representations of the video. Implications for practice: Incorporating a table of contents and a structured timeline into a video facilitates the search activity.Without scaffolding, the search activity is longer and cognitively more costly.Paradoxically, users have a poorer representation of the video (i.e., poorer mental model) after the IS task when they were given scaffolding.Future studies should focus on the benefits of providing structuring and segmentation in learning tasks. [ABSTRACT FROM AUTHOR]

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Copyright of Developmental Medicine & Child Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Breastfeeding is recommended until 6 months of age, but a wide range of infant formula is available for nonbreastfed or partially breastfed infants. Our aim was to describe infant formula selection and to examine social- and health-related factors associated with this selection. Analyses were based on 13,291 infants from the French national birth cohort Etude Longitudinale Française depuis l'Enfance. Infant diet was assessed at Month 2 by phone interview and monthly from Months 3 to 10 via internet/paper questionnaires. Infant formulas were categorized in 6 groups: extensively or partially hydrolysed, regular with or without prebiotics/probiotics, and thickened with or without prebiotics/probiotics. Associations between type of infant formula used at 2 months and family or infant characteristics were assessed by multinomial logistic regressions. At Month 2, 58.1% of formula-fed infants were fed with formula enriched in prebiotics/probiotics, 31.5% with thickened formula, and 1.4% with extensively hydrolysed formula. The proportion of formula-fed infants increased regularly, but the type of infant formula used was fairly stable between 2 and 10 months. At Month 2, extensively hydrolysed formulas were more likely to be used in infants with diarrhoea or regurgitation problems. Partially hydrolysed formulas were more often used in families with high income, with a history of allergy, or with infants with regurgitation issues. Thickened formulas were used more with boys, preterm infants, infants with regurgitation issues, or in cases of early maternal return to work. The main factors related to the selection of infant formula were family and infant health-related ones. [ABSTRACT FROM AUTHOR]

Introduction: Parents of persons with profound intellectual and multiple disabilities (PIMD) play a major and often lifelong role in the care and support of their child. A better understanding of parents' perspectives regarding their experiences of parenting their child with PIMD is essential to support them more effectively. Although this topic has been explored extensively in Anglo‐Saxon and Northern European countries, little is known about the experience of these parents in a highly institutionalized context such as that in France. Objective: We explored parents' experiences of the activities they performed to care for their child with PIMD (namely, the 'parenting work') in the French context. Method: Qualitative semistructured interviews were conducted by telephone with 34 parents of persons with PIMD aged 8–35. The resulting data were analyzed using thematic analysis. Results: The analysis highlighted the diversity of activities performed by parents as well as the influence of context on the forms of this parenting work. Five themes were developed: (1) navigating the challenges of obtaining medical recognition; (2) negotiating a concealed domain and becoming an expert; (3) unfolding medical and medicosocial care management; (4) navigating the challenges of daily living and (5) shaping one's child's possibilities. Conclusion: This study offers a better understanding of the challenges, levers and expectations of parents of children with PIMD in France. Contextual factors such as the lack of knowledge of PIMD among health professionals, access to knowledge and know‐how associated with care management, the administrative complexity of access to care and equipment, institutional issues (e.g., professional turnover) and societal ableism (e.g., access to infrastructures, interpersonal discrimination) shape the work parents perform to support their child's needs. It is necessary to consider contextual aspects to better support these parents and their children. Suggestions for applications are provided in the discussion. Patient or Public Contribution: One of the researchers, a parent of a child with PIMD, supported the research design and provided feedback on the study's procedures and manuscript. [ABSTRACT FROM AUTHOR]

Introduction: Despite various efforts to improve human papillomavirus (HPV) vaccine coverage in France, it has always been lower than in most other high‐income countries. The health authorities launched in 2018 the national PrevHPV research programme to (1) co‐develop with stakeholders and (2) evaluate the impact of a multicomponent complex intervention aimed at improving HPV vaccine coverage amongst French adolescents. Objective: To describe the development process of the PrevHPV intervention using the GUIDance for rEporting of intervention Development framework as a guide. Methods: To develop the intervention, we used findings from (1) published evidence on effective strategies to improve vaccination uptake and on theoretical frameworks of health behaviour change; (2) primary data on target populations' knowledge, beliefs, attitudes, preferences, behaviours and practices as well as the facilitators and barriers to HPV vaccination collected as part of the PrevHPV Programme and (3) the advice of working groups involving stakeholders in a participatory approach. We paid attention to developing an intervention that would maximise reach, adoption, implementation and maintenance in real‐world contexts. Results: We co‐developed three components: (1) adolescents' and parents' education and motivation using eHealth tools (web conferences, videos, and a serious video game) and participatory learning at school; (2) general practitioners' e‐learning training on HPV using motivational interviewing techniques and provision of a decision aid tool and (3) easier access to vaccination through vaccination days organised on participating middle schools' premises to propose free of charge initiation of the HPV vaccination. Conclusion: We co‐developed a multicomponent intervention that addresses a range of barriers and enablers of HPV vaccination. The next step is to build on the results of its evaluation to refine it before scaling it up if proven efficient. If so, it will add to the small number of multicomponent interventions aimed at improving HPV vaccination worldwide. Patient or Public Contribution: The public (adolescents, their parents, school staff and health professionals) participated in the needs assessment using a mixed methods approach. The public was also involved in the components' development process to generate ideas about potential activities/tools, critically revise the successive versions of the tools and provide advice about the intervention practicalities, feasibility and maintenance. [ABSTRACT FROM AUTHOR]

Objectives: To examine the characteristics of the first Advanced Practice Nurses in France and to compare the French model to international standards. Background: Common barriers and facilitators to their integration in healthcare provision have been identified internationally. In France, the legislative framework was introduced in 2016, and the first graduates entered the workforce in 2019. Methods: The French model was examined in comparison with Hamric's conceptual framework and to the International Council of Nurses' guidelines and definitions. A cross‐sectional survey was also conducted, using three self‐administered online questionnaires. Two were distributed to 2019 and 2020 graduates and a third to the accredited programme directors. The characteristics of advanced practice nursing graduates were described and compared based on employment status and field of practice (primary vs secondary/tertiary care). Results: Although the French model of advanced practice nursing meets Hamric's primary criteria and core competencies, it does not differentiate between Nurse Practitioner and Clinical Nurse Specialist roles. Of the 320 students enrolled in one of the 11 accredited training programmes 165 participated in the survey. Mean age was 40, and mean prior nursing experience was 15 years. By February 2021, 30% of respondents were still employed as Registered Nurses. Barriers to practice included insufficient income generation (primary care), the lack of position creation (secondary/tertiary care), the physician‐dependent patient referral process and delays in prescription credentials approval. Conclusions: The implementation of advanced practice nursing in France faces several barriers. Legislative adjustments and greater financial incentives to practice seem warranted. Relevance to clinical practice: as in other countries, France introduced advanced practice nursing to respond to the Public Health challenge of improving access to quality health care in the context of increasing chronic disease prevalence and limited resource allocation. Facilitating its integration in the healthcare provision landscape seems paramount. [ABSTRACT FROM AUTHOR]

Background: Direct support workers (DSWs) accompany adults with autism spectrum disorder (ASD) and intellectual disability (ID) in residential care homes. Such DSWs, without specialised ASD training, are exposed to chronic stress linked to supporting ASD‐ID clients and must adjust by coping strategies adapted to the needs of the residents. Nevertheless, difficulties adjusting constitute a burnout risk for DSWs, characterised by high levels of emotional exhaustion, depersonalisation and loss of a sense of personal accomplishment. We aimed to describe the burnout of DSWs who support adults with ASD‐ID and to identify personal variables (experience and specialised training for ASD) and transactional variables (perceived stress and coping strategies) that could predict and mediate burnout. Method: In total, 125 DSWs accompanying ASD‐ID adults on a daily basis were included. Each participant answered four questionnaires measuring burnout, sociodemographic and professional variables, coping strategies and perceived stress. Results: Five per cent of DSWs were in a state of burnout. Eighteen, six and fifty‐nine per cent showed high average scores of emotional exhaustion, depersonalisation and loss of a sense of personal accomplishment, respectively. Being older, specialised training in ASD, stress perceived as a challenge and problem‐focused coping strategies were associated with low levels of depersonalisation and loss of a sense of personal accomplishment. Conclusions: Understanding the burnout process of ASD‐ID DSWs may require the assessment of the organisational characteristics linked to the quality of life of the DSWs and the recognition of their specific needs when facing difficulties. The necessary ASD‐focused training and support depends on an appraisal that would be individualised to adult ASD‐ID DSWs. [ABSTRACT FROM AUTHOR]

Decades of research have shown that social dominance orientation (SDO) is one of the most important predictors of anti‐immigrant attitudes. However, the mechanisms through which SDO can explain prejudice have been studied insufficiently. Using rich and diverse samples from France and from the province of Québec in Canada, the present research provides a cross‐national (N = 1,852) and prospective (N = 534) analysis of a theoretical model in which the dimensions of SDO are indirectly predicting anti‐immigrant prejudice via the intergroup ideologies of assimilation, multiculturalism, colour blindness and interculturalism. Results showed that interculturalism, a hierarchy‐attenuating ideology was found to be a robust mechanism to explain the subtle effects of SDO‐E on anti‐immigrant prejudice whereas assimilation, a hierarchy‐enhancing ideology was playing a more important role to explain direct and blatant effects of SDO‐D on prejudice. The two most studied diversity approaches, multiculturalism and colour blindness, were largely redundant once interculturalism was considered. This pattern occurred in both France and Québec hence, favouring the context‐independent pathway. [ABSTRACT FROM AUTHOR]

This article provides a detailed account of how surgeons perceived and used a device‐procedure that caused widespread patient harm: transvaginal mesh for the treatment of pelvic floor disorders in women. Drawing from interviews with 27 surgeons in Canada, the UK, the United States and France and observations of major international medical conferences in North America and Europe between 2015 and 2018, we describe the commercially driven array of operative variations in the use of transvaginal mesh and show that surgeons' understanding of their hands‐on, sensory experience with these variations is central to explaining patient harm. Surgeons often developed preferences for how to manage actual and anticipated dangers of transvaginal mesh procedures through embodied operative adjustments, but collectively the meaning of these preferences was fragmented, contested and deferred. We critically reflect on surgeons' understandings of their operative experience, including the view that such experience is not evidence. The harm in this case poses a challenge to some ways of thinking about uncertainty and errors in medical sociology, and calls for attention to a specific feature of surgical work: the extent and persistence of operative practices that elude classification as right or wrong but are still most certainly better and worse. [ABSTRACT FROM AUTHOR]

Background: The Scottish Government introduced a free Baby Box scheme for all new parents in 2017, modelled on the Finnish scheme, to give every baby 'an equal start in life'. There is little evidence that it results in better health outcomes, but there has been limited research into different perspectives and discourses on such schemes. Methods: Four focus groups were conducted with 21 parents in North‐East Scotland. Recordings were transcribed verbatim, anonymized and analysed thematically with NVivo 12 software. Our thematic analysis was both inductive and deductive—remaining open to themes identified by participants themselves but also informed by the social policy literature on universalism and social cohesion. Results: Across all the focus groups, we found a high degree of positivity about the principle of the Baby Box scheme, and for the most part the practical value of the contents. This was remarkably consistent across different communities and backgrounds. There was little evidence of the strongly polarized views present in media reporting. Parents seemed considerably less focused than the media on safety and health outcomes, and more focused on practical, material and social impacts. They reported little in the way of feeling patronized or monitored by the government. Conclusion: Our findings have important implications for future economic evaluations of the baby box. Such evaluations should broaden the valuation space beyond health outcomes to allow for the value of feelings of inclusion, solidarity and being part of a community. Patient or Public Contribution: This small project was designed in response to parent views already collected in the early roll‐out of the Baby Box scheme in Scotland, about their priorities and responses to the scheme. Additional views were sought on the topic guide for the focus groups, and local community groups advised us on recruitment and the best timing and location for the focus groups to be held. The focus groups themselves were conducted as research, but with the intent of ensuring parent views featured more prominently in a debate that has been largely dominated by clinical and public health perspectives. [ABSTRACT FROM AUTHOR]

Summary: Background: Cord blood leptin is an indicator of neonatal fat mass and could shape postnatal adiposity trajectories. Investigating genetic polymorphisms of the leptin receptor gene (LEPR) could help understand the mechanisms involved. Objectives: We aimed to investigate the association of cord blood leptin level and the LEPR rs9436303 polymorphism, with body mass index (BMI) at adiposity peak (AP) and age at adiposity rebound (AR). Methods: In the EDEN cohort, BMI at AP and age at AR were estimated with polynomial mixed models, for 1713 and 1415 children, respectively. Multivariable linear regression models allowed for examining the associations of cord blood leptin level and LEPR rs9436303 genotype with BMI at AP and age at AR adjusted for potential confounders including birth size groups. We also tested interactions between cord blood leptin level and rs9436303 genotype. Results: Increased leptin level was associated with reduced BMI at AP and early age at AR (comparing the highest quintile of leptin level to the others). Rs9436303 G‐allele carriage was associated with increased BMI at AP and later age at AR but did not modulate the association with leptin level. Conclusion: These results illustrate the role of early life body composition and the intrauterine environment in the programming of adiposity in childhood. [ABSTRACT FROM AUTHOR]

Aim: To gather information from nurses and allied health professionals in the French context of the emergence of research in the field so as to inform the development of a new tool: The research in nursing and allied health sciences' Ideas Generator (GénI) capable of sustaining the identification of research ideas from professionals in the field. Background: In many countries, research in nursing and allied health sciences remains underdeveloped. Introduction: Before developing the Ideas Generator tool, it was essential to explore professionals' basis of reference in providing care, then investigate (1) their representation of research in this field of science and (2) their perception of needs for and obstacles to starting a research process. Methods: The qualitative research design used focus groups. The study population included 24 participants naive to research in four hospitals in eastern France (13 nurses and 11 allied health professionals). Thematic analysis was used to analyze the data. The study was reported in compliance with the consolidated criteria for reporting qualitative research criteria. Findings: Professionals used tacit knowledge and their experiences to address care, but the culture of scientific evidence was clearly missing (lack of knowledge of the origin of care guidelines, few bibliographic skills). Participation in a research process could hardly be envisaged without a supervised collaboration with a physician. Research was perceived not to be part of professionals' culture. They self‐censured for lack of methodological competencies. Discussion: Findings underlined some leverage, obstacles, and need to consider to generate a stimulation in the field, especially in countries where such research is still in its infancy. Implication for nursing, health, and education policy: Strengthening the field of nursing and allied health research is essential to extend the skills of nurses and allied health workers and to improve the quality of patient care by taking into account results from the literature. The Ideas Generator tool will be implemented to sustain learning the skills of research through education and training. [ABSTRACT FROM AUTHOR]

Background: Taking into account international studies interested in the development of evidence-based practice (EBP) in the speech and language therapy field, this survey investigated key issues with regard to students' perception of EBP. Aims: To determine how final-year students in France conceive EBP; to know if they feel competent in this area; to investigate any barriers to the use of EBP; and to assess their intention of using the EBP approach in their professional practice after graduating. Methods & Procedures: Between January and April 2019, 182 advanced French students from 15 French speech-language university training centres (SLUTC) completed an online survey addressing these questions. Outcomes & Results: The results show that 68.7% of students in the sample had a positive perception of the EBP. Between 54.9% and 73.6% of students felt rather competent to apply part of the approach, and 17% were sure to implement it in their own practice later on. Step 3 'Critically evaluating the evidence' was the most difficult. Regardless of the different EBP steps, the most important barrier for students who felt competentwas the lack of practice; for students who did not feel competent, the major barriers were both the lack of theoretical knowledge and the lack of practice. A total of 61% of students reported not seeing EBP being practised by their clinical practice placements supervisors; 55% reported never having used their EBP knowledge during their clinical practice placements. Conclusions & Implications: The students interviewed had a positive perception of EBP. Nevertheless, these results demonstrate a need to improve the EBP curricula and to include EBP in clinical education, under the guidance of clinical practice placements supervisors. [ABSTRACT FROM AUTHOR]

Background: Many critically ill children can be fed orally at some point during their paediatric intensive care (PICU) stay, but reduced appetite and other factors may impact their intake. At home, oral feeding is usually delivered by parents, so involving parents more actively during mealtimes in the PICU may contribute to improved patient/family satisfaction. Aim: To assess the impact of a new "room service" initiative involving parents on mealtime quality and on both family and health care professional (HCP) satisfaction. Methods: A prospective, single‐centre, before‐and‐after intervention study was designed as part of a PICU quality‐of‐care improvement programme in 2013 to 2016. Two questionnaires assessing oral nutrition practices and family/HCP overall satisfaction were disseminated among the parents of critically ill children capable of oral feeding during their PICU admission and among the whole PICU HCP team (nurses, nurse assistants, and medical doctors). Categorical variables were compared using the chi‐square test, and Likert scales were compared between groups with the Mann‐Whitney‐Wilcoxon test. Results: the pre‐intervention surveys were completed by 97 of 130 (75%) HCPs and 52 families and the post‐intervention surveys by 74 of 130 (57%) HCPs and 54 families. After the intervention, a marked improvement was observed in the overall quality of meal service rating by both HCPs and families (medians and IQR: 5 (5‐7) to 7 (7, 8) and 6 (6‐8) to 8 (7‐9), respectively; P <.01) and also in parents' involvement; in children's, families', and HCP satisfaction; in meal‐dedicated facilities and equipment; and in perception that oral nutrition is an important aspect of PICU care. Conclusions: Implementation of an improved "room service" initiative in the PICU was feasible and improved the perceived quality of care and satisfaction around oral feeding. This family‐centred care initiative can be integrated in an overall quality improvement strategy. [ABSTRACT FROM AUTHOR]

Aim: To describe maternal employment and the socio-economic status of the household up to 8 years after the very preterm birth of a child, according to the presence and type of motor or cognitive impairment.Method: A total of 1885 families from the French EPIPAGE cohort of children who were born very preterm between 1997 and 1998 were included. Motor and cognitive impairments were identified in children between the ages of 2 and 8 years in 770 families and were classified according to type. The 1115 families with children born very preterm without these impairments were considered the reference group.Results: Mothers of children with severe motor or cognitive impairments were less often working at 5 years after the birth than the reference mothers (21% and 30% vs 57%; p<0.001). Those working before birth returned to work less often and those not working started to work less often after the birth than did reference mothers. At 8 years, mothers of children with severe impairments reported financial difficulties more often than mothers of children without impairments.Interpretation: Despite a fairly protective regulatory framework in France, families of infants born very preterm with severe motor or cognitive impairments are socially underprivileged. Measures to maintain an acceptable standard of living for these families and their children are needed. [ABSTRACT FROM AUTHOR]

The aim of this study was to document the extent to which diabetic patients who adhered to required medical follow-ups in France experienced reduced hospital admissions over time. The main assumption was that enhanced monitoring and follow-up of diabetic patients in the primary care setting could be a substitute for hospital use. Using longitudinal claim data of diabetic patients between 2010 and 2015 from MGEN, a leading mutuelle insurance company in France, we estimated a dynamic logit model with lagged measures of the quality of adherence to eight medical follow-up recommendations. This model allowed us to disentangle follow-up care in hospitals from other forms of inpatient care that could occur simultaneously. We found that a higher adherence to medical guidance is associated with a lower probability of hospitalization and that the take-up of each of the eight recommendations may help reduce the rates of hospital admission. The reasons for the variation in patient adherence and implications for health policy are discussed. [ABSTRACT FROM AUTHOR]

Background: Blood donor selection, consisting of a pre-donation questionnaire and interview, excludes potential donors who may be at risk of transfusion-transmissible infections. Assessing the reasons for noncompliance with blood donor selection criteria is important to maintain a high level of viral safety of blood products.Study Design and Methods: An anonymous French online survey of a sample of blood donors (Complidon) was conducted from September to December 2017. Data were poststratified to be representative of all donors who donated blood between July 2016 and December 2017.Results: Of 420,190 solicited donors, 108,386 completed the survey (26%). Overall, noncompliance was estimated at 5.6%. The least respected criteria regarded sex with more than one partner during the previous 4 months for donors (1.9%) and for donors' partners (1%), travel-related criteria (1.2%) and sex between men during the previous 12 months (0.73% of men). Reasons for noncompliance differed according to criteria. Donors who were non-compliant to sexuality-based criteria mainly said they did not want to be excluded or that the questions were too personal. Conversely, donors who were exclusively non-compliant to criteria other than sexuality-based criteria more often mentioned their non-compliance during the pre-donation interview but were nevertheless authorized to donate blood.Conclusion: Despite noncompliance to blood donor criteria being relatively low in France, it still represents a threat to blood safety. Accordingly, improved communication is important to ensure that donors fully understand each selection criterion and to emphasize to health professionals the importance of listening carefully without judging during pre-donation interviews. [ABSTRACT FROM AUTHOR]

As other neurodegenerative diseases, Alzheimer's disease, the most frequent dementia in the elderly, is characterized by multiple progressive impairments in the brain structure and in clinical functions such as cognitive functioning and functional disability. Until recently, these components were mostly studied independently because no joint model for multivariate longitudinal data and time to event was available in the statistical community. Yet, these components are fundamentally interrelated in the degradation process toward dementia and should be analyzed together. We thus propose a joint model to simultaneously describe the dynamics of multiple correlated components. Each component, defined as a latent process, is measured by one or several continuous markers (not necessarily Gaussian). Rather than considering the associated time to diagnosis as in standard joint models, we assume diagnosis corresponds to the passing above a covariate-specific threshold (to be estimated) of a pathological process that is modeled as a combination of the component-specific latent processes. This definition captures the clinical complexity of diagnoses such as dementia diagnosis but also benefits from simplifications for the computation of maximum likelihood estimates. We show that the model and estimation procedure can also handle competing clinical endpoints. The estimation procedure, implemented in an R package, is validated by simulations and the method is illustrated on a large French population-based cohort of cerebral aging in which we focused on the dynamics of three clinical manifestations and the associated risk of dementia and death before dementia. [ABSTRACT FROM AUTHOR]

Although several studies have shown a positive association between socio‐economic position and size at birth, not enough is known about the modifiable factors that may be involved. We aimed to investigate whether maternal prepregnancy body mass index (BMI), smoking, diet, and depression during pregnancy mediate the positive association between maternal education and birth size. Weight and length z‐scores specific for gestational age and sex were calculated for 1,500 children from the EDEN mother–child cohort. A mediation analysis of the associations between maternal education and birth size was conducted with a counterfactual method, adjusted for recruitment centre, parity, maternal height, and age. In the comparison of children of mothers with low versus intermediate education levels, maternal smoking during pregnancy explained 52% of the total effect of education on birth weight. Similar findings were observed with birth length z‐score (37%). The comparison of children of mothers with high versus intermediate education levels yielded a non‐significant total effect, which masked opposite mediating effects by maternal BMI and smoking during pregnancy on both birth weight and length. Prepregnancy BMI and maternal smoking during pregnancy mediate the positive association between maternal education and birth weight and length z‐scores. These mediators, however, act in opposite directions, thereby masking the extent to which healthy prenatal growth is socially differentiated. [ABSTRACT FROM AUTHOR]

Objectives: The European RHAPSODY project sought to develop and test an online information and support programme for caregivers of individuals diagnosed with young onset dementia. The objectives were to assess user acceptability and satisfaction with the programme and to test outcome measures for a larger effectiveness study.Design: A pilot randomised controlled trial in England, France, and Germany was conducted with 61 caregivers for adults with young onset Alzheimer's disease or frontotemporal degeneration. Evaluations at baseline, week 6, and week 12 assessed user acceptability and satisfaction. Use of the programme was measured from online back-end data. Qualitative feedback on user experiences was collected via semi-structured interviews. Measures of caregiver well-being (self-efficacy, stress, burden, frequency of patient symptoms, and caregiver reactions) were explored for use in a subsequent trial.Results: Participants logged in online on average once a week over a 6-week period, consulting approximately 31% of programme content. Seventy percent of participants described the programme as useful and easy to use. Eighty-five percent expressed intent to use the resource in the future. Reductions in reported levels of stress and caregivers' negative reactions to memory symptoms were observed following use of the programme.Conclusions: Results indicated that the RHAPSODY programme was acceptable and useful to caregivers. The programme may be complementary to existing services in responding to the specific needs of families affected by young onset dementia. Distribution of the programme is underway in England, France, Germany, and Portugal. [ABSTRACT FROM AUTHOR]

Abstract: Background: The detection of specific language impairment (SLI) in children growing up bilingually presents particular challenges for clinicians. Non‐word repetition (NWR) and sentence repetition (SR) tasks have proven to be the most accurate diagnostic tools for monolingual populations, raising the question of the extent of their usefulness in different bilingual populations. Aims: To determine the diagnostic accuracy of NWR and SR tasks that incorporate phonological/syntactic complexity as discussed in recent linguistic theory. The tasks were developed as part of the Language Impairment Testing in Multilingual Settings (LITMUS) toolkit, in two different national settings, France and Germany, and investigated children with three different home languages: Arabic, Portuguese and Turkish. Methods & Procedures: NWR and SR tasks developed in parallel were administered to 151 bilingual children, aged 5;6–8;11, in France and in Germany, to 64 children in speech–language therapy (SLT) and to 87 children not in SLT, whose first language (L1) was Arabic, Portuguese or Turkish. Children were also administered standardized language tests in each of their languages to determine likely clinical status (typical development (TD) or SLI), and parents responded to a questionnaire including questions about early and current language use (bilingualism factors) and early language development (risk factors for SLI). Monolingual controls included 47 TD children and 29 children with SLI. Results were subjected to inter‐group comparisons, to diagnostic accuracy calculation, and to correlation and multiple regression analyses. Outcomes & Results: In accordance with previous studies, NWR and SR identified SLI in the monolingual children, yielding good to excellent diagnostic accuracy. Diagnostic accuracy in bilingual children was fair to good, generally distinguishing children likely to have SLI from children likely to have TD. Accuracy was necessarily linked to the determination of clinical status, which was based on standardized assessment in each of the child's languages. Positive early development, a composite risk factor for SLI, and not variables related to language exposure and use, generally emerged as the strongest predictor of performance on the two tasks, constituting additional, independent support for the efficacy of NWR and SR in identifying impairment in bilingual children. Conclusions & Implications: NWR and SR tasks informed by linguistic theory are appropriate for use as part of the diagnostic process for identifying language impairment in bilingual children for whom the language of assessment is different from the home language, in diverse sociolinguistic contexts. [ABSTRACT FROM AUTHOR]

Aims To develop an empirically derived short version of the Hypoglycaemia Fear Survey II that still accurately measures fear of hypoglycaemia. Methods Item response theory methods were used to generate an 11-item version of the Hypoglycaemia Fear Survey from a sample of 487 people with Type 1 or Type 2 diabetes mellitus. Subsequently, this scale was tested on a sample of 2718 people with Type 1 or insulin-treated Type 2 diabetes taking part in DIALOG, a large observational prospective study of hypoglycaemia in France. Results The short form of the Hypoglycaemia Fear Survey II matched the factor structure of the long form for respondents with both Type 1 and Type 2 diabetes, while maintaining adequate internal reliability on the total scale and all three subscales. The two forms were highly correlated on both the total scale and each subscale (Pearson's R > 0.89). Conclusions The short form of the Hypoglycaemia Fear Survey II is an important first step in more efficiently measuring fear of hypoglycaemia. Future prospective studies are needed for further validity testing and exploring the survey's applicability to different populations. [ABSTRACT FROM AUTHOR]

Aims To assess the effectiveness of the 2015 version of the French Évin Law that was implemented in 1991 with the objective of protecting young people from alcohol advertising. Design Data were obtained from survey questions measuring exposure and receptivity to alcohol advertisements that were introduced for the first time in the 2015 European School Survey Project on Alcohol and Other Drugs (ESPAD). Participants and setting A representative sample of 6642 10th-12th grade students (mean age 17.3 years) were interviewed in 198 schools in France by a self-administered questionnaire. Measurements Information was collected on alcohol advertising exposure in different media (outside billboards, internet, etc.) and receptivity to recent advertisements (attractiveness, incentive to drink, etc.). Findings The majority of students declared that they had been exposed at least once a month to alcohol advertisements in supermarkets (73.2%), in movies (66.1%), magazines and newspapers (59.1%), on billboards in streets (54.5%), and on the internet (54.1%). Concerning the last recalled advertisements, 27.8% remembered the beverage type, 18.2% the brand, 13% felt like having a drink after having seen the advertisement and 19.6% found the advertisement attractive (boys ranked significantly higher than girls for all these indicators; P-value < 0.05). Conclusion The 2015 version of the French Évin law does not appear to protect young people effectively from exposure to alcohol advertising in France. [ABSTRACT FROM AUTHOR]

Background and aims To identify the nature of visual alcohol references in alcohol advertisements during televised broadcasts of the 2014 FIFA World Cup Tournament matches and to evaluate cross-national differences according to alcohol marketing policy restrictiveness. Design Content analysis using the Delphi method and identification of in-game sponsorships. Setting Television broadcasts of the 2014 FIFA World Cup in Argentina, Brazil, Canada, Finland, France, Mexico, Spain and the United States. Cases Eighty-seven alcohol advertisements; 20 matches. Measurements Quantitative rating scales, combined with the Delphi rating technique, were used to determine compliance of the alcohol advertisements with the International Alliance for Responsible Drinking's (IARD) Guiding Principles. Recordings of five matches from four countries were also used to identify the number of in- and out-of-game alcohol brand appearances. Findings A total of 86.2% of all unique alcohol advertisements contained at least one violation of IARD's Guiding Principles, with violation rates ranging from 72.7% (Mexico) to 100% (Brazil). Countries with the least restrictive marketing policies had a higher prevalence of violations in guidelines designed to protect minors. There were 2.76 in-game alcohol brand appearances and 0.83 out-of-game alcohol brand appearances per minute. Brand appearances did not differ across countries or according to a country's marketing policy restrictiveness. Conclusions Self-regulation and statutory policies were ineffective at limiting alcohol advertising during the 2014 FIFA World Cup Tournament television broadcasts. Most advertisements contained content that violated the self-regulation codes, and there were high levels of within-broadcast brand appearances. [ABSTRACT FROM AUTHOR]

Studies suggest that stimulation of the left dorsolateral prefrontal cortex (DLPFC) reduces food craving in bulimic patients, but evidence supporting repetitive transcranial magnetic stimulation (rTMS) as a therapeutic tool is lacking. We investigated the safety and therapeutic efficacy of an adjunct high-frequency rTMS programme targeting the left DLPFC. Forty-seven women with bulimia nervosa were randomised to a real or sham stimulation group. The real group underwent 10 rTMS sessions, each consisting of 20 trains of 5 seconds with 55-second intervals between trains, at a frequency of 10 Hz. The main outcome was the number of binge episodes in the 15 days following the end of stimulation. Overall, no significant improvement in bingeing and purging symptoms was noted after the programme. rTMS was well tolerated. This suggests that 10 sessions of high-frequency rTMS to the left DLPFC provide no greater benefit than placebo. Future studies should consider methodological issues as well as alternative targets. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Aim A split-mouth randomized clinical trial was carried out to assess the effectiveness of a school-based dental sealant ( SBDS) program for French children from low-income backgrounds within 3 years of follow-up. The secondary objectives were to determine the risk factors for the occurrence of new carious lesions ( ICDAS 3-6) on first permanent molars, to evaluate the effectiveness of the program according to risk factors and to assess sealant retention. Methods The study included 276 6- to 7-year old pupils (457 pairs of first permanent molars) from Nice. The sealing was performed in first- or second-grade children. The first permanent molars were randomized into two groups: One received resin-based sealant and the other formed a nontreatment group. Carious lesions ICDAS 3-6 on permanent and primary teeth, visible plaque, streptococcus mutans and/or lactobacillus counts were recorded at baseline to assess individual caries risk ( ICR). The putative confounders recorded at baseline were sex, grade level, and characteristics of first permanent molars. An intent-to-treat analysis was performed, where the study outcome was the occurrence of new carious lesions within 3 years of follow-up. Univariate and multivariate Cox proportional hazards models (hazard risk, HR) using the procedure PHREG with the option of Covsandwich were performed in SAS to assess the effectiveness of the SBDS program. Results At 3 years of follow-up, 228 children (378 tooth pairs) remained in the analysis. The survival analysis showed that first permanent molars that received sealants had 67% (adjusted HR: 0.33; 95% CI: 0.24-0.46) less risk of developing new carious lesions during all the follow-up than molars without sealant. In addition, children with carious lesions ICDAS 3-6 on permanent and primary teeth, that is, high ICR, had three times the risk of having a new carious lesion than others without, independently of the sealant treatment (adjusted HR: 3.00; 95% CI: 1.55-5.75). Effectiveness of the SBDS program at 3 years of follow-up depended on the presence of carious lesions ICDAS 3-6 ( HR in 173 children with carious lesions: 0.32; 95% CI: 0.23-0.46) at baseline ( HR in 103 children without carious lesions: 0.42; 95% CI: 0.16-1.12). Finally, the overall retention rate was 32.3%. Conclusion The effectiveness of the SBDS program was demonstrated in low socioeconomic areas. Selection of schoolchildren according to the presence of carious lesions ICDAS 3-6 should be considered in a SBDS program. [ABSTRACT FROM AUTHOR]

To reduce energy consumption, technical equipment alone is not sufficient. Adjustment of behaviours so that equipment is used appropriately is also necessary. Numerous studies have shown how difficult it is to change behaviours and how many factors are involved. The aim of this study is to identify the psychosocial factors facilitating or inhibiting energy-saving behaviours in the appropriation of energy-saving equipment by residents. Forty-one semi-directive interviews were conducted with tenants of terraced houses (12 people) and flats (29 people) located in the same residential area in a French city. The blocks of flats and terraced houses are managed by a proprietor of social housing. The results of a categorical content analysis highlight the importance of the relationship between tenants and proprietor and tenants' low motivation concerning the energy-saving renovations. Consequently, we argue for the importance of favouring active participation by tenants in order to promote acceptance and appropriation of the new equipment. Furthermore, both the social and physical contexts of residents must be taken into account and energy saving must be integrated into other types of environmental behaviours in the neighbourhood in order to improve coherence and credibility. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Experimental studies investigating the impact of advertising with ecological stimuli on alcohol-related cognition are scarce. This research investigated the cognitive processes involved in learning implicit attitudes toward alcohol after incidental exposure to alcohol advertisements presented in a dynamic context. We hypothesized that incidental exposure to a specific alcohol brand would lead to heightened positive implicit attitudes toward alcohol due to a mere exposure effect. Methods In total, 108 participants were randomly exposed to dynamic sporting events excerpts with and without advertising for a specific brand of alcohol, after completing self-reported measures of alcohol-related expectancies, alcohol consumption, and attitudes toward sport. Participants then completed a lexical decision task and an affective priming task. Results We showed that participants were faster to detect brand name after being exposed to advertising during a sports game, and that implicit attitudes of participants toward the brand were more positive after they were exposed to advertising, even when alcohol usage patterns were controlled for. Conclusions Incidental exposure to alcohol sponsorship in sport events impacts implicit attitudes toward the advertised brand and alcohol in general. The effect of incidental advertising on implicit attitudes is also likely to be due to a mere exposure effect. However, further studies should address this point specifically. [ABSTRACT FROM AUTHOR]

Backround Baseline depressive symptoms have been consistently associated with the onset of cardiovascular disease ( CVD). Objectives Since depressive symptoms vary over time in elderly persons, and to help clarify whether or not depression is an etiological factor for CVD, we quantified the association between the course of depressive symptoms and occurrence of first coronary heart disease ( CHD) and stroke events in older adults. Design A population-based prospective observational study. Setting Participants were randomly selected from the electoral rolls of three large French cities. Participants A total of 9,294 participants were examined at baseline between 1999 and 2001, and thereafter at repeated study visits over 10 years. Measurements High levels of depressive symptoms ( HLDS) were defined as a score ≥16 on the 20-item Center for Epidemiologic Studies Depression Scale. The number of study visits with HLDS was used as a time dependent variable in Cox proportional hazard models. Results There were 7,313 participants (36.6% males) aged 73.8 ± 5.4 years with no history of CHD, stroke or dementia at baseline. After a median follow-up of 8.4 years ( SD 2.3 years), 629 first CHD or stroke events occurred. After adjustment for sociodemographic characteristics and vascular risk factors, the risk of CHD and stroke combined increased 1.15-fold (95% CI: 1.06 to 1.25) per each additional study visit with HLDS. The results remained unchanged when accounting for the presence of disability and antidepressant intake at baseline and during follow-up. Conclusion Elderly persons exposed to HLDS at several occasions over 10 years showed substantial increased risk of coronary heart disease and stroke events. [ABSTRACT FROM AUTHOR]

The aim of the Impact d'une démarche QUAlité sur l'évolution des pratiques et le déclin fonctionnel des Résidents en Établissement d'hébergement pour personnes âgées dépendantes ( IQUARE) study was to examine the effects of a global intervention comprising professional support and education for nursing home ( NH) staff on quality indicators ( QIs) and functional decline and emergency department ( ED) transfers of residents. One hundred seventy-five NHs in France (a total of 6,275 residents randomly selected from NHs) volunteered and were enrolled in a nonrandomized controlled multicenter individually customize trial with 18-month follow-up. NHs were allocated to a quality audit and feedback intervention (control group: 90 NHs, 3,258 residents) or to the quality audit and feedback intervention plus collaborative work meetings between a hospital geriatrician and NH staff (experimental group: 85 NHs, 3,017 residents). At the NH level, prevalence of assessment of kidney function, cognitive function, risk of pressure ulcers, behavioral disturbances, depression, pain, weight measurement, and transfer to the ED were recorded. Ability to perform basic activities of daily living was assessed at the resident level. At baseline, NH QIs were generally low (with large standard deviations), and annual rate of transfer to the ED was high (~20%) and similar in both groups. The intervention had a significant positive effect on the prevalence of assessment of pressure ulcer risk, depression, pain, and prevalence of ED transfers. It had no significant effect on functional decline. Large-scale efforts to improve QIs involving collaboration between hospital and NH providers and based on audit and collaborative discussion are feasible and improve some aspects of quality of care in NHs. [ABSTRACT FROM AUTHOR]

Objectives To investigate the association between hearing loss, hearing aid use, and cognitive decline. Design Prospective population-based study. Setting Data gathered from the Personnes Agées QUID study, a cohort study begun in 1989-90. Participants Individuals aged 65 and older (N = 3,670). Measurements At baseline, hearing loss was determined using a questionnaire assessing self-perceived hearing loss; 137 subjects reported major hearing loss, 1,139 reported moderate problems (difficulty following the conversation when several persons talk at the same time or in a noisy background), and 2,394 reported no hearing trouble. Cognitive decline was measured using the Mini-Mental State Examination ( MMSE), administered at follow-up visits over 25 years. Results Self-reported hearing loss was significantly associated with lower baseline MMSE score (β = −0.69, P < .001) and greater decline during the 25-year follow-up period (β = −0.04, P = .01) independent of age, sex, and education. A difference in the rate of change in MMSE score over the 25-year follow-up was observed between participants with hearing loss not using hearing aids and controls (β = −0.06, P < .001). In contrast, subjects with hearing loss using a hearing aid had no difference in cognitive decline (β = 0.07, P = .08) from controls. Conclusion Self-reported hearing loss is associated with accelerated cognitive decline in older adults; hearing aid use attenuates such decline. [ABSTRACT FROM AUTHOR]

Objectives To examine the associations between amyloid- β brain deposition and physical activity ( PA) in elderly adults without dementia and to investigate whether the association has a dose-response relationship. Design Cross-sectional study. Setting French community-dwelling people. Participants Elderly adults with normal or mildly impaired cognition (mean age 74.7 ± 4.2; 60.4% female) with available information on current self-reported PA and amyloid- β brain deposition measured using positron emission tomography ( PET) using the PET-ligand florbetapir F 18 (n = 268). Measurements A standardized uptake value ratio ( SUVR) was obtained for each subject. Participants were divided according to amyloid plaque cortical retention defined according to a SUVR cutoff of 1.10 ( SUVR+ vs SUVR−). Results Bivariate and multivariate analyses showed that PA was not significantly associated with SUVR. SUVR+ and SUVR− participants did not differ in terms of volume (continuous PA variables) and levels (categorical PA variables) of PA. PA was not correlated with SUVR in apolipoprotein E ε4 carriers or noncarriers. PA was not associated with cognitive function. Conclusion Although PA protects against dementia, there is no solid evidence that this protection involves a reduction in amyloid- β brain deposition. Further studies are needed to determine whether PA (ideally measured at several time-points using objective measures) is involved in the pathophysiology of Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Background Data on the characteristics of consumers of phytosterol-enriched products and modalities of consumption are rare. An observational study evaluating the lifestyle characteristics and cardiovascular risk ( CVR) profile of phytosterol-enriched yogurt consumers was performed in France. Methods Subjects were recruited from general practitioners via electronic medical records. Data were obtained from 358 consumers and 422 nonconsumers with 519 subject questionnaires (243 consumers, 276 nonconsumers; 67% response). Results Consumers had more cardiovascular risk factors than nonconsumers (2.0 ± 1.5 versus 1.6 ± 1.4; P < 0.001) and a higher 10-year SCORE cardiovascular risk (1.8 ± 2.0% versus 1.6 ± 2.2%; P = 0.008); they were older ( P = 0.030) and had a higher incidence of hypercholesterolaemia ( P < 0.001) and family or personal history of heart disease ( P = 0.023/ P = 0.026, respectively). Among consumers not on cholesterol-lowering medication, 99% were eligible for lifestyle interventions and 56% were eligible for lipid-lowering drug according to European guidelines. Consumers had a healthier lifestyle, with a higher (fruit/vegetable - saturated fatty acid) score than nonconsumers ( P = 0.035), focused more on low-intensity leisure activity ( P = 0.023), spent more time travelling by foot or bicycle ( P = 0.012) and were more likely to act to reduce CVR. Phytosterol-enriched yogurt intake conformed to recommendations in two-thirds of consumers and was mainly consumed because of concerns over cholesterol levels and CVR. Conclusions The higher cardiovascular disease risk profile of phytosterol-enriched yogurt consumers corresponds to a population for whom European guidelines recommend lifestyle changes to manage cholesterol. The coherence of the data in terms of risk factors, adherence to lifestyle recommendations and the consumption of phytosterol-enriched yogurt conforming to recommendations reflects a health-conscious consumer population. [ABSTRACT FROM AUTHOR]

Background and aims It is well established that craving increases following exposure to substance-related 'cues', but the role of life-styles or substance use habits that are unique to each person remains poorly understood. This study examines the association of substance-specific and personal cues with craving and substance use in daily life. Design Ecological momentary assessment was used during a 2-week period. Setting Data were collected in a French out-patient addiction treatment centre. Participants A total of 132 out-patients beginning treatment for alcohol, tobacco, cannabis or opiate addiction were included. Measurements Using mobile technologies, participants were questioned four times per day relative to craving, substance use and exposure to either substance-specific cues (e.g. seeing a syringe) or personal cues unique to that individual (e.g. seeing the specific person with whom the substance is used). Findings Craving intensity was associated with the number of concurrently assessed substance-specific cues ( t = 4.418, P < 0.001) and person-specific cues ( t = 4.006, P < 0.001) when analysed jointly within the same model. However, only person-specific cues were associated with increases in craving over subsequent hours of the day ( t = 2.598, P < 0.05). Craving intensity, in turn, predicted increases in later substance use ( t = 4.076, P < 0.001). Causal mediation analyses demonstrated that the association of cues with later substance use was mediated by craving intensity (mediated effect = 0.007, 95% confidence interval = 0.004-0.011). Conclusions Unique person-specific cues appear to have a robust effect on craving addictive substances, and the duration of this association may persist longer than for more general substance-specific cues. Mobile technologies provide new opportunities for understanding these person-specific risk factors and for providing individually tailored interventions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the differential impact of a computer-based comprehension training programme according to second graders' comprehender profiles. These profiles differed in the children's abilities to process three types of textual information: literal information, text-connecting inferences and gap-filling inferences. The results showed that all the profiles improved significantly after the training on the question type that had caused them the greatest amount of difficulty on the pretest. In addition, factors that could a priori predict the effectiveness of the programme were investigated by comparing children who benefited from the instruction (responders) with those who did not benefit (nonresponders). Before instruction, these children differed in their lexical knowledge level and logical reasoning skills, but not in their memory or comprehension-monitoring abilities. The results support the claim that children with comprehension difficulties form a heterogeneous group and emphasize the need to examine the differential impact of comprehension instruction according to the characteristics of poor comprehenders. [ABSTRACT FROM AUTHOR]

Objectives To examine whether living alone predicted hospitalizations, nursing home admission, weight loss, and death in individuals with mild to moderate Alzheimer's disease ( AD) over 2 years of follow-up. Design Data are from the Plan de Soin et d'Aide dans la maladie d'Alzheimer study, a 24-month trial with a cluster randomization of memory clinics in two arms: a multidomain intervention and usual care. Setting Memory clinics in France (N = 50). Participants Community-dwelling individuals with AD with a Mini-Mental State Examination score between 12 and 26 and an identified caregiver. Measurements A neurogeriatric evaluation was conducted twice a year in the intervention group and annually in the control group. Hospitalizations, nursing home admission, weight loss, and death occurring during the past year were recorded. Information on sociodemographic characteristics, clinical conditions, therapy, and physical and cognitive status was recorded. Results At inclusion, 348 (30.8%) of the 1,131 participants lived alone. Living alone did not increase the risk of mortality or weight loss in individuals with mild to moderate AD, but significant associations with risk of hospitalization (hazard ratio ( HR) = 1.33, 95% confidence interval ( CI) = 1.01-1.74) and institutionalization ( HR = 2.53, 95% CI = 1.84-3.47) were reported. A protective effect of physical function on institutionalization and mortality was found. Conclusion These results might support clinicians in making decisions about institutionalization of individuals with AD living alone or improving home health care, such as increasing screening and managing functional impairment in this complex population. [ABSTRACT FROM AUTHOR]

The link between students' spelling level and their text-messaging practice gives rise to numerous questions from teachers, parents and the media. A corpus of 4524 text messages produced in daily-life situations by students in sixth and seventh grade ( n = 19, 11-12 years of age) was compiled. None of the participants had ever owned or used a mobile phone before the start of the study; their text messages were collected monthly over the course of a year. The comparison between the group with mobile phones and the control group without mobile phones ( n = 30) showed no difference between the level of traditional writing at the beginning of the text-message collection and during the collection. The results showed that the correlation between the level of traditional spelling and the density of textisms was dependent upon the type of textisms (consistent/breaking with traditional code), the type of spelling (usage-based/rule-based), the grades in French class and the duration of text-messaging practice. On the whole, students who were skilled or less skilled in traditional writing at the beginning of the text-message collection remained respectively skilled or less skilled throughout the year, despite their text-messaging use (density and type of textisms). The discussion of this study's academic implications tends towards a complementarity between traditional writing and text messaging. [ABSTRACT FROM AUTHOR]

Objectives To identify factors associated with driving restriction in elderly men and women. Design Prospective cohort study of French drivers from 2003 to 2009. Setting The Three-City Cohort of Bordeaux, a prospective study of 2,104 people aged 65 and older. Participants Five hundred twenty-three drivers with a mean age of 76 (273 male, 250 female). Measurements Sociodemographic characteristics, driving habits, health variables, cognitive evaluation and dementia diagnosis. Predementia was defined as no dementia at one follow-up and dementia at the next follow-up. Results Over the 6-year period, 54% of men and 63% of women stopped driving or reduced the distance they drove. Predementia, Parkinson's disease, older age, and a high number of kilometers previously driven were common restriction factors in both sexes. Prevalent dementia, depressive symptomatology, a decline in one or more instrumental activities of daily living, and poor visual working memory were specific factors in men. In women, low income, fear of falling, slow processing speed, and severe decline in global cognitive performance all affected driving restriction. Conclusion Older women restricted their driving activity more than older men, regardless of the number of kilometers previously driven, physical health, and cognitive status. Factors affecting driving restriction differed according to sex, and women were more likely to stop driving than men in the period preceding a dementia diagnosis. [ABSTRACT FROM AUTHOR]

We described the introduction of complementary food (ICF) during the first year of life and identify associations observed with maternal and infant characteristics. We studied 3368 children included in the Epifane cohort, France, 2012. Maternal and infant characteristics and age at introduction of 28 complementary foods were collected at birth and at 1, 4, 8 and 12 months. Kaplan-Meier plots were used to represent probabilities of ICF. A score was used as tertiles in multinomial logistic regression to identify maternal and infant factors associated with ICF agreement with French recommendations. Median age of ICF was 152 days. While 12.6% of infants received complementary food before the age of 4 months, 95% of them were introduced after 7 months. Recommendations were generally followed, except for eggs and added fats, introduced in only 23.2% and 53.1% of 1-year-old infants, respectively. Factors significantly associated with the first ICF score tertile (low agreement with recommendations) vs. third tertile were as follows: maternal age 18-24 years (OR = 2.24 [1.49-3.35]) or 25-29 years (OR = 1.57 [1.21-2.04]), education less than or equal to high school graduation (OR = 1.94[1.51-2.48]), birthplace in France (OR = 2.13 [1.41-3.21]), three or more children (OR = 1.70 [1.15-2.51]), no follow-up antenatal classes (OR = 1.58 [1.22-2.04]), unemployment before and after pregnancy (OR = 1.64 [1.04-2.59]), unemployment before pregnancy and return to work within 12 months (OR = 2.06 [1.05-4.02]), no breastfeeding (OR = 2.08 [1.55-2.79]) or lasting <28 days (OR = 1.68 [1.22-2.31]) or 1-4 months (OR = 1.45 [1.08-1.96]). Recommendations concerning complementary food were generally followed. However, guidelines should be clarified and adapted to families who have difficulties in adopting them. [ABSTRACT FROM AUTHOR]