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International audience; Dietary patterns, or the combination of foods and beverages intake, have been associated with better cognitive function in older persons. To date, no study has investigated the link between a posteriori nutrient patterns based on food intake, and cognitive decline in longitudinal analyses. The aim of this study was to evaluate the relationship between nutrient patterns and cognitive function and decline in two longitudinal cohorts of older persons from France and Canada. The study sample was composed of participants from the Three-City study (3C, France) and the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge, Quebec, Canada). Both studies estimated nutritional intakes at baseline, and carried out repeated measures of global cognitive function for 1,388 and 1,439 individuals, respectively. Nutrient patterns were determined using principal component analysis methodology in the two samples, and their relation with cognitive function and decline was estimated using linear mixed models. In 3C, a healthy nutrient pattern, characterized by higher intakes of plant-based foods, was associated with a higher global cognitive function at baseline, as opposed to a Western nutrient pattern, which was associated with lower cognitive performance. In NuAge, we also found a healthy nutrient pattern and a Western pattern, although no association was observed with either of these patterns in the Canadian cohort. No association between any of the nutrient patterns and cognitive decline was observed in either cohort. There is a need for longitudinal cohorts focusing on nutrient patterns with substantial follow-up, in order to evaluate more accurately associations between nutrition and cognition in older persons.

Few studies have been interested in the relationship between dietary patterns and activity limitation in older adults yet. We analysed the association between dietary patterns and the risk of self-reported activity limitation – that is mobility restriction, limitation in instrumental activities in daily living (IADL) and in activities in daily living (ADL) – in community-dwellers aged 67+ years initially free of activity limitation in 2001–2002 and re-examined at least once over 10 years – that is 583 participants for mobility restriction, 1114 for IADL limitation and 1267 for ADL limitation. At baseline, five sex-specific dietary clusters were derived by hybrid clustering method from weekly frequency of intake of twenty food and beverage items. Self-reported mobility restriction, limitations in IADL and in ADL were assessed using the Rosow–Breslau, the Lawton–Brody and the Katz scales, respectively. Associations between dietary clusters and the risk of each activity limitation were assessed using Cox proportional hazard models. In models adjusted for socio-demographic and health-related covariates, compared with the ‘Healthy’ cluster the ‘Biscuits and snacking’ cluster was associated with a higher risk of mobility restriction (hazard ratio (HR)=3·0; 95 % CI 1·6, 5·8) and limitation in IADL (HR=2·1; 95 % CI 1·1, 4·2) in men and limitation in ADL in women (HR=2·3; 95 % CI 1·3, 4·0). In this French cohort of community-dwellers aged 67+ years, some unhealthy dietary patterns may increase the risk of activity limitation all along the disablement process in older adults.

L’enseignement a distance serait, pour certains, devenu la reponse a toutes les situations d’enseignement et de formation complexes, quels que soient le public cible, les contenus transmis et les competences visees. Il permettrait de resoudre la difficulte majeure de la copresence spatiale entre l’enseignant et ses apprenants (distance spatiale) et pourrait ainsi permettre d’apprendre « quand on veut » (distance temporelle) et de rapprocher les milieux professionnels, academiques et culturelles (distance socio-economique et socio-culturelle). Mais comme le souligne G. Jacquinot, les defis de la formation a distance sont bien d’apprivoiser la distance et de supprimer l’absence, pour cela il est necessaire d’user avec connaissance d’une ingenierie de formation adaptee. Il s’agira au cours de cette presentation de resituer l’attrait de l’enseignement a distance et son evolution et de presenter les differentes dimensions de l’ingenierie de formation de l’EAD (technologique, pedagogique mais aussi economique). De plus les elements favorables et ceux nefastes au developpement d’une FAD seront pointes, pour mettre en evidence l’importance de ne concevoir un enseignement a distance uniquement en ayant une connaissance precise des contenus d’apprentissage, des profils des futurs apprenants et de l’environnement economique dans lequel se developpera la formation.

Objective: To analyze the association between dietary patterns and the 12-year risk of frailty and its components in community-dwelling elderly French adults. Design: A prospective cohort study. Setting: The Bordeaux sample of the Three-City Study. Participants: A total of 972 initially nonfrail nondemented participants (336 men and 636 women) aged 73 years on average, re-examined at least once over 12 years. Measurements: Five sex-specific dietary clusters were previously derived at baseline. Frailty incident to the baseline visit was defined as having at least three out of the following 5 criteria: unintentional weight loss, exhaustion, low energy expenditure, slowness, and muscle weakness. Multivariate Cox proportional hazard models were used to assess the association between dietary clusters and the risk of frailty and its components. Results: In total, 78 men for 3719 person-years and 221 women for 7027 person-years became frail over the follow-up. In multivariate analyses, men in the “pasta” pattern and women in the “biscuits and snacking” pattern had a significantly higher risk of frailty compared with those in the “healthy” pattern [hazard ratio (HR) 2.2; 95% confidence interval (CI) 1.1–4.4 and HR 1.8; 95% CI 1.2–2.8, respectively; P = .09 and P = .13 for the global test of significance of risk difference across clusters, respectively]. In men, “biscuits and snacking” and “pasta” patterns were significantly associated with higher risk for muscle weakness (HR 3.3; 95% CI 1.6–7.0 and HR 2.1; 95% CI 1.2–3.7, respectively; P = .003 for global test). Conclusions: This 12-year prospective population-based study suggests that some particular unhealthy dietary patterns may increase the risk of frailty in older adults.

Background: Dietary and nutrient patterns have been linked to health outcomes related to aging. Food intake is influenced by environmental and genetic factors. The aim of the present study was to compare nutrient patterns across two elderly populations sharing a common ancestral cultural background, but living in different environments. Methods: The diet quality, lifestyle and socioeconomic characteristics of participants from the Three-City Study (3C, France, n = 1712) and the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge, Quebec, Canada, n = 1596) were analyzed. Nutrient patterns and their food sources were identified in the two samples using principal component analysis. Diet quality was compared across sample-specific patterns by describing weekly food intake and associations with the Canadian Healthy Eating Index (C-HEI). Results: Three nutrient patterns were retained in each study: a healthy, a Western and a more traditional pattern. These patterns accounted for 50.1% and 53.5% of the total variance in 3C and NuAge, respectively. Higher education and non-physical occupations over lifetime were associated with healthy patterns in both studies. Other characteristics such as living alone, having a body mass index lower than 25 and being an ex-smoker were associated with the healthy pattern in NuAge. No association between these characteristics and the nutrient patterns was noted in 3C. The healthy and Western patterns from each sample also showed an inverse association with C-HEI. Conclusion: The two healthy patterns showed important similarities: adequate food variety, consumption of healthy foods and associations with common sociodemographic factors. This work highlights that nutrient patterns derived using a posteriori methods may be useful to compare the nutritional quality of the diet of distinct populations.

Higher adherence to a Mediterranean diet (MeDi) and n-3 PUFA may both contribute to decreased dementia risk, but the association between MeDi adherence and lipid status is unclear. The aim of the present study was to analyse the relationship between plasma fatty acids and MeDi adherence in French elderly community dwellers. The study population (mean age 75·9 years) consisted of 1050 subjects from Bordeaux (France) included in the Three-City cohort. Adherence to the MeDi (scored as 0–9) was computed from a FFQ and 24 h recall. The proportion of each plasma fatty acid was determined. Cross-sectional analysis of the association between plasma fatty acids and MeDi adherence was performed by multi-linear regression. After adjusting for age, sex, energy intake, physical activity, smoking status, BMI, plasma TAG and apoE-ɛ4 genotype, plasma palmitoleic acid was significantly inversely associated with MeDi adherence, whereas plasma DHA, the EPA+DHA index and total n-3 PUFA were positively associated with MeDi adherence. The n-6:n-3 PUFA, arachidonic acid (AA):EPA, AA:DHA and AA:(EPA+DHA) ratios were significantly inversely associated with MeDi adherence. Plasma EPA was positively associated with MeDi adherence only in apoE-ɛ4 non-carriers. There was no association between MeDi adherence and SFA and total MUFA. The present results suggest that the protective effect of the MeDi on cognitive functions might be mediated by higher plasma DHA and lower n-6:n-3 PUFA ratios.

International audience; OBJECTIVE: This study aimed to describe the nutritional status of geriatric home residents according to their place of dwelling and to identify institutional factors associated with higher rates of undernutrition. METHODS: All institutions (514) in the Aquitaine region were interviewed for staff ratio, nutritional procedures, staff training, and other procedures in the area of nutrition. A stratified random sample of 601 residents in a subsample of 42 institutions underwent Mini-Nutritional Assessment. RESULTS: The estimated prevalence of undernutrition was 19.1 (95% confidence interval [CI] 14.0-24.2), with a higher rate in long-term care (48.0%, 95% CI 15.9-80.2) than in nursing homes (14.5%, 95% CI 10.6-18.4, P < 0.0001). In univariate analyses the risk of undernutrition was higher in long-term care (P < 0.0001), in settings with better weighing equipment (P < 0.0001), with a higher staff ratio (P = 0.0001), and a higher rate of subjects needing help for eating (P < 0.0001) and was lower in settings with a higher rate of training in nutritional screening (P = 0.0001) and management (P < 0.0001). In nursing homes, each item of the Mini-Nutritional Assessment Short Form was independently predictive of undernutrition. In multivariate analyses in nursing homes only, better weighing equipment (adjusted odds ratio 2.34, 95% CI 1.39-4.12, P = 0.0017) and higher staff ratio (adjusted odds ratio 1.03, 95% CI 1.00-1.05, P = 0.0230) were associated with higher rates of undernutrition. CONCLUSION: Undernutrition in institutions was linked to the resident health problems, with little evidence in favor of the influence of institutional policies.

Resume En France, les malades infectes par le virus de l’immunodeficience humaine (VIH) sont frequemment co-infectes par le virus de l’hepatite B (VHB). Les medecins et les malades devraient etre particulierement attentifs a la prevention de la contamination par ce virus. Objectifs Evaluer l’attitude vis-a-vis du VHB et de la pratique de la vaccination chez les medecins et les malades infectes par le VIH de la cohorte Aquitaine. Methodes Une enquete transversale, basee sur deux auto-questionnaires, a ete menee entre novembre 2002 et juin 2003. Cent quatre vingt dix huit medecins du Groupe d’Epidemiologie Clinique du SIDA en Aquitaine (GECSA) et des reseaux VIH de la region ont ete interroges ainsi que 512 malades de la cohorte. Les questionnaires exploraient pour les medecins, la determination du statut VHB, la prescription de la serologie et de la vaccination (frequence, type de vaccin, schema), et pour les malades, le statut VHB, l’information recue, les facteurs de risque de contamination, l’attitude vis-a-vis de la vaccination. Resultats 93 % des medecins et 22 % des malades declaraient etre vaccines. 75 % des medecins disaient evaluer le statut serologique des malades au moins une fois, mais 23 % d’entre eux seulement disaient avoir prescrit un dosage post-vaccinal des anticorps. Les principales raisons invoquees pour ne pas davantage pratiquer cette vaccination etaient: l’oubli (79 %), la difficulte a identifier les malades a risque (44 %), et la crainte d’effets secondaires (32 %). Parmi les malades, 30 % n’avaient pas recu d’information sur le vaccin contre le VHB. Globalement, 44 % ne se consideraient pas a risque, alors que 82 % avaient ete exposes a au moins un facteur de risque. Les principales raisons invoquees pour l’absence de vaccination etaient la preoccupation plus importante pour l’infection par le VIH (70 %), la non proposition par leur medecin (65 %) ou la crainte d’effets secondaires (58 %). Cependant, parmi ceux qui se disaient non vaccines, 42 % accepteraient de l’etre. Conclusion Des campagnes d’information et de sensibilisation ciblees sont necessaires chez les malades infectes par le VIH ainsi que chez leurs medecins.

Background Childhood autoimmune hemolytic anemia (AIHA) is a rare and severe disease characterized by hemolysis and positive direct antiglobulin test (DAT). Few epidemiologic indicators are available for the pediatric population. The objective of our study was to reliably estimate the number of AIHA cases in the French Aquitaine region and the incidence of AIHA in patients under 18 years old. Procedure In this retrospective study, the capture–recapture method and log-linear model were used for the period 2000–2008 in the Aquitaine region from the following three data sources for the diagnosis of AIHA: the OBS'CEREVANCE database cohort, positive DAT collected from the regional blood bank database, and the French medico-economic information system. Results A list of 281 different patients was obtained after cross-matching the three databases; 44 AIHA cases were identified in the period 2000–2008; and the total number of cases was estimated to be 48 (95% confidence interval [CI]: 45–55). The calculated incidence of the disease was 0.81/100,000 children under 18 years old per year (95% CI 0.76–0.92). Conclusion Accurate methods are required for estimating the incidence of AIHA in children. Capture–recapture analysis corrects underreporting and provides optimal completeness. This study highlights a possible under diagnosis of this potentially severe disease in various pediatric settings. AIHA incidence may now be compared with the incidences of other hematological diseases and used for clinical or research purposes.

Background More than 80% of mesothelioma cases in men are attributable to occupational asbestos exposure compared to only 40% in women. The objective of the study was to characterize a series of female pleural mesotheliomas according to known and suspected risk factors. Methods From the exhaustive recording of 318 female mesothelioma cases in the French National Mesothelioma Surveillance Program between 1998 and 2009, multiple correspondence analysis and hybrid clustering were performed to characterize these cases according to expert assessed occupational and non-occupational exposure to asbestos and man-made vitreous fibers, X-ray exposure, and history of cancer and non-malignant respiratory diseases. Results Four clusters were identified: (1) occupational exposure to asbestos and man-made vitreous fibers (7.9% of subjects); (2) radiation exposure during radiotherapy (12.9%); (3) increased asbestos exposure (19.8%); and (4) “non-exposure” characteristics (59.4%). Conclusion These results will allow hypotheses to be generated about associations between mesothelioma and non-occupational asbestos exposure, X-ray exposure and history of respiratory disease. Am. J. Ind. Med. 56:1307–1316, 2013. © 2013 Wiley Periodicals, Inc.

More than 80% of mesothelioma cases in men are attributable to occupational asbestos exposure compared to only 40% in women. The objective of the study was to characterize a series of female pleural mesotheliomas according to known and suspected risk factors.From the exhaustive recording of 318 female mesothelioma cases in the French National Mesothelioma Surveillance Program between 1998 and 2009, multiple correspondence analysis and hybrid clustering were performed to characterize these cases according to expert assessed occupational and non-occupational exposure to asbestos and man-made vitreous fibers, X-ray exposure, and history of cancer and non-malignant respiratory diseases.Four clusters were identified: (1) occupational exposure to asbestos and man-made vitreous fibers (7.9% of subjects); (2) radiation exposure during radiotherapy (12.9%); (3) increased asbestos exposure (19.8%); and (4) "non-exposure" characteristics (59.4%).These results will allow hypotheses to be generated about associations between mesothelioma and non-occupational asbestos exposure, X-ray exposure and history of respiratory disease.

Background The heterogeneity of hepatitis C virus (HCV) infection cannot always be explained by HCV genotypes or host genetic factors, raising the issue of possible cofactors. A new form of hepatitis leading to liver cancer was discovered in 1992 in mice, owing to an infection by Helicobacter hepaticus. Moreover, several studies showed an association between the presence of HCV and Helicobacter in the liver of patients with severe liver diseases suggesting a possible synergism between the two pathogens. In an HCV transgenic mouse model with a B6C3F1 background, the combination of H. hepaticus infection and the HCV transgene resulted in a significantly greater incidence and multiplicity of preneoplastic and neoplastic liver foci in males. Objectives Because the mouse genetic background is a major determinant in the development of liver disease, our aim was to test the synergism between HCV and H. hepaticus infection using transgenic mice with a more sensitive genetic background to H. hepaticus infection. Methods For this purpose, four groups of mice were followed up to 14 months, the presence of H. hepaticus was monitored by PCR and hepatic lesions were looked for. Results We found that H. hepaticus, but not the HCV transgene, increased the number of hepatic lesions. The presence of carcinoma was more likely to occur on a background of hepatitis, and the overall lesions were more frequent in the presence of steatosis. The effect of the mouse genetic background was greater than the effect of the HCV transgene and was sufficient to promote lesions particularly via its sensitivity to H. hepaticus infection. Conclusions Genetic susceptibility may be a more important factor than expected. Indeed, the synergism between HCV and H. hepaticus infection involved in liver disease may be highly host dependent.

Due to the high burden of pneumonia in Indonesia, the inclusion of pneumococcal conjugate vaccine (PCV) into Indonesia's National Immunization Program (NIP) is recommended by World Health Organization. Prior to the introduction of new vaccines, it is imperative to assess the perceptions of the public and medical community about the disease and the vaccine. The purpose of this qualitative study was to explore the knowledge, perceptions, and attitudes of mothers and health care providers (HCPs) toward PCV in Bandung, West Java, Indonesia. Methodology Fifty-five respondents (26 mothers and 29 HCPs) were interviewed at public and private health care facilities in Bandung using semi-structured interviews in May–June 2011. Data were analyzed manually according to pre-defined themes. Results Although most mothers had low knowledge about PCV, did not perceive themselves as susceptible to the disease, perceived that cost was the main barrier to PCV access, and obtained little information on PCV, they considered pneumonia as a severe disease and a priority health problem, perceived benefits of the vaccine, and were likely to adopt it. Similarly, knowledge about PCV among most HCPs was limited. Despite perceiving cost as the main barrier, most HCPs perceived benefits of the vaccine, susceptibility and severity of the disease, regarded pneumonia as a priority health problem, and were likely to suggest the new vaccination. Discussion/Conclusions Despite the poor knowledge of mothers and HCPs about PCV, they are aware of the high burden of pneumonia and the need for a vaccine in the NIP. Perceived severity and benefits among mothers, and, additionally, perceived susceptibility among HCPs were manifested in the willingness to accept PCV. The findings would contribute to better understanding the factors, which could support decision-making about vaccine introduction, and be utilized for developing suitable messages for mothers and HCPs.

Cognitive decline may lead to dementia whose most frequent cause is Alzheimer's disease (AD). Among the many potential risk factors of cognitive decline and AD, diet raises increasing interest. Most studies considered diet in the frame of a single nutrient approach with inconsistent results. A novel approach to examine the link between nutrition and cognitive function is the use of dietary patterns. The aim of the present review was to update and complete the body of knowledge about dietary patterns in relationship with various cognitive outcomes in the elderly. Two approaches can be used: a priori and a posteriori patterns. A priori patterns are defined by the adhesion to a pre-defined healthy diet using a score such as the Mediterranean diet (MeDi) score, the Healthy Eating Index, the Canadian Healthy Eating Index, the French National Nutrition and Health Programme (Programme National Nutrition Santé) Guideline Score (PNNS-GS), the Recommended Food Score (RFS) and Dietary Approaches to Stop Hypertension (DASH). MeDi score, RFS, PNNS-GS and DASH have been associated with lower risks of cognitive impairment, cognitive decline, and dementia or AD. Principal components analysis, reduced rank regression and clustering methods allow the identification of ‘healthy’ patterns associated with lower risk of cognitive decline. However, some studies did not report any associations with cognitive outcomes and results are discordant especially regarding MeDi and the risk of dementia. Several methodological challenges should be overcome to provide a higher level of evidence supporting the development of nutritional policies to prevent cognitive decline and AD.

Background: HIV screening in a labour ward is the last opportunity to initiate an antiretroviral prophylaxis among pregnant women living with HIV to prevent mother-to-child HIV transmission. Little is known about the feasibility and acceptability of HIV screening during labour in West Africa. Findings: A cross-sectional survey was conducted in the labour ward at the Tokoin Teaching Hospital in Lome (Togo) between May and August 2010. Pregnant women admitted for labour were randomly selected to enter the study and were interviewed on the knowledge of their HIV status. Clinical and biological data were collected from the individual maternal health chart. HIV testing or re-testing was systematically proposed to all pregnant women. Among 1530 pregnant women admitted for labour, 508 (32.2%) were included in the study. Information on HIV screening was available in the charts of 359 women (71%). Overall, 467 women accepted HIV testing in the labour ward (92%). The HIV prevalence was 8.8% (95% confidence interval: 6.4 to 11.7%). Among the 41 women diagnosed as living with HIV during labour, 34% had not been tested for HIV during pregnancy and were missed opportunities. Antiretroviral prophylaxis had been initiated antenatally for 24 women living with HIV and 17 in the labour room. Conclusions: This study is the first to show in West Africa that HIV testing in a labour room is feasible and well accepted by pregnant women. HIV screening in labour rooms needs to be routinely implemented to reduce missed opportunities for intervention aimed at HIV care and prevention, especially PMTCT. Keywords: HIV; mother-to-child transmission; acceptance; labour; Africa. (Published: 18 July 2012) Citation: Ekouevi DK et al. Journal of the International AIDS Society 2012, 15 :17380 http://www.jiasociety.org/index.php/jias/article/view/17380 | http://dx.doi.org/10.7448/IAS.15.2.17380

Objectives: The use of psychoactive substances in response to psychological distress is not well documented in the general population and has never been studied in combination with health care use. This study estimated the frequency of health care and substance use in response to anxiety or depressive disorders and determined factors associated with these behaviors. Methods: From a large survey of adults from four French regions, the authors selected those with a 12-month probable anxiety or depressive disorder without a substance use disorder (N=4,071). These disorders were determined with the Composite International Diagnostic Interview Short Form, and participants were asked whether they used substances or health care in response to each disorder. Results: The use of substances in response to anxiety or depressive disorders was 12.9% among men and 5.2% among women. Compared with those who used health care only, those who used substances (with or without health care) were more likely to be men, single, and young. Those who used both substances and health care were also less likely to have a depressive disorder. Conclusions: This study shows that a sizeable portion of the general population uses substances in response to anxiety or depressive disorders. It also shows that these substance users have distinctive sociodemographic characteristics and can thus be targeted by prevention programs. Strategies to reach substance users with depressive or anxiety disorders who do not use health care remain to be elaborated. (Psychiatric Services 60:351–357, 2009)

International audience; BACKGROUND: Several nutritional factors, including dietary fatty acids, antioxidants, and folates, have been related to pathological brain aging. Dietary patterns that represent a combination of foods may better predict disease risk than single foods or nutrients. OBJECTIVE: To identify dietary patterns by a mixed clustering method and to analyze their relationship with cognitive function, depressive symptoms, and self-rated health in older people. DESIGN: Cross-sectional population-based study. SUBJECTS/SETTING: Subjects included 1,724 elderly community dwellers living in Bordeaux, France from 2001 to 2002. STATISTICAL ANALYSIS: Cluster analysis, combining hybrid clustering, and research for stable groups during the k-means step on mean number of weekly servings of 20 predetermined food groups, separately in men and women. RESULTS: Five dietary clusters were identified in each sex. A "healthy" cluster characterized by higher consumption of fish in men (n=157; 24.3%) and fruits and vegetables in women (n=267; 24.8%) had significantly lower mean number of errors to Mini Mental State score after adjustment for socio-demographic variables (beta=-0.11; 95% confidence interval [CI], -0.22 to -0.004 in men; beta=-0.13; 95% CI, -0.22 to -0.04 in women). The same cluster was associated with borderline significance with lower depressive symptoms in women (beta=-0.16; 95% CI, -0.33 to 0.007). Men in the "pasta eaters" cluster (n=136; 21%) had higher depressive symptoms (beta=0.26; 95% CI, 0.06 to 0.46) and higher risk to report poor health (polytomous regression, odds ratio [OR]=1.91; 95% CI, 1.21 to 3.01) than the "healthy" cluster. Women in the "biscuits and snacking" cluster (n=162; 15%) had greater risk of poor perceived health (OR=1.69; 95% CI, 1.15 to 2.48) compared to "healthy" eaters. Additional adjustment for body mass index and medication use strengthened these associations. CONCLUSIONS: Sex-specific dietary patterns derived by hybrid clustering method are associated with fewer cognitive and depressive symptoms and better perceived health in older people.

Contains fulltext : 69187.pdf (Publisher’s version ) (Closed access) OBJECTIVES: To explore and determine the clinical figures of behavioral syndromes from the factor structure of the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) in demented and psychotic patients. SETTING: Two nursing homes and two long-term care homes. DESIGN: Observational, cross-sectional. PARTICIPANTS: One hundred and sixty-three institutionalized elderly with dementia or psychosis (66.9% female), mean age 80.9 +/- 9.1 years. MEASUREMENTS: The NPI-NH includes 12 neuropsychiatric symptoms and a distress scale. The product score of frequency (F) and severity (S) ratings provides an overall score for each of the 12 items. An exploratory principal component analysis with Varimax rotation was performed on the F x S scores according to patients' diagnosis. RESULTS: High internal consistency of the NPI-NH was found (alpha = 0.8). In demented patients a 4-factor solution was found that explained 63.9% of the variance, with the syndromes: (a) 'hyperactivity'; (b) 'affective'; (c) 'psychosis'; and (d) 'Hallucinations'. A four-factor solution was also found in psychotic patients, explaining 61.3% of variance, with syndromes: (a) 'affective'; (b) 'frontal lobe symptoms'; (c) 'sundowning'; and (d) 'psychomotor agitation'. A syndrome was unlikely to appear alone but was most likely to occur with other syndromes. A specific pattern of syndrome co-occurrence were found in demented (a + b + c in 30.5% of cases) and psychotic patients (a + b + c + d in 35.2% of cases). CONCLUSION: The syndrome taxonomies are consistent with the diagnostic criteria. The clinical use of syndrome co-occurrence could help to further understand and evaluate behavioral changes in pharmacological and non-pharmacological treatments.

A longitudinal study enrolled 75 women with primary breast cancer. Before the confirmation of diagnosis, authors measured trait-anxiety and body satisfaction. Three weeks after diagnosis, coping strategies and state-anxiety were evaluated. The number of days of survival was measured 10 years after diagnosis. In Cox proportional-hazards models adjusting for severity of disease and age, high social support and low state-anxiety predicted an increased risk of death from breast cancer. A significant increased risk of death in women with low scores on the Body Image Questionnaire appeared only in the univariate model.

Since 1993, many studies on the health of Persian Gulf War Veterans (PGWV) have been undertaken. These studies have concluded that there has been an increased mortality due to external causes, no excess of recognized diseases, and no effect on PGWV children. When compared with the non-deployed, PGWV have reported a higher frequency of infertility as well as different symptoms, but a specific Gulf War syndrome was not identified. In October 2000, the French government asked an independent working group to analyse the scientific literature on PGWV health. The group concluded that an exhaustive study of French PGWV was to be undertaken. The objectives of this study were to describe the exposures of PGWV in the operations theatre, to report on the symptoms and diseases that occurred in PGWV and their children during and after the military campaign, and to explore the possibility of a Gulf War syndrome. This exhaustive cross-sectional study, which included all civilians and troops who served in the Gulf from August 1990 to July 1991, began in January 2002. Data were collected by postal self-administered questionnaires. A standardized clinical evaluation was performed by 27 clinics of occupational diseases and nine military hospitals. Symptoms and diseases which appeared after the campaign are described. To date, among 20,261 PGWV, 5,666 participated in the study (28%). The most frequent symptoms described since the return from the Gulf were headaches (83%), neurological or psychological symptoms, and back pain. Apart from well-known symptoms associations (respiratory, neurocognitive, psychological and musculo-skeletal syndromes), no other cluster was highlighted by our analysis.

Several studies have found an inverse association between fish consumption and risk of dementia. The objective of this study was to describe the characteristics of older fish consumers, in order to identify potential confounders in this relationship. Cross-sectional analysis of the baseline data of a prospective cohort study. Bordeaux, Dijon, and Montpellier (France) in 1999–2000. A total of 9280 community dwellers aged 65 y and above participating in the baseline examination of the Three-City Study. All participants answered a face-to-face interview and underwent a physical examination. Cross-sectional analyses were performed by logistic regressions. Regular fish consumers (at least weekly) had a higher education (OR from 1.19 to 1.65, P=0.0003) and income (OR from 1.37 to 1.89, P

Lot quality assurance sampling (LQAS) was evaluated for rapid low cost identification of communities where Schistosoma mansoni infection was hyperendemic in southern Madagascar. In the study area, S. mansoni infection shows very focused and heterogeneous distribution requiring multifariousness of local surveys. One sampling plan was tested in the field with schoolchildren and several others were simulated in the laboratory. Randomization and stool specimen collection were performed by voluntary teachers under direct supervision of the study staff and no significant problem occurred. As expected from Receiver Operating Characteristic (ROC) curves, all sampling plans allowed correct identification of hyperendemic communities and of most of the hypoendemic ones. Frequent misclassifications occurred for communities with intermediate prevalence and the cheapest plans had very low specificity. The study confirmed that LQAS would be a valuable tool for large scale screening in a country with scarce financial and staff resources. Involving teachers, appeared to be quite feasible and should not lower the reliability of surveys. We recommend that the national schistosomiasis control programme systematically uses LQAS for identification of communities, provided that sample sizes are adapted to the specific epidemiological patterns of S. mansoni infection in the main regions.

OBJECTIVES. This project aimed to compare the independent and combined effectiveness of two implementation interventions of guidelines for ordering thyroid function tests: a Memorandum Pocket Card (MPC) and a Test RequestForm (TRF). RESEARCH DESIGN. Intervention groups were wards. The study used an experimental 2*2 factorial design with matching hospitals according to size and activity and wards according to preintervention appropriateness for test ordering. Four ward groups were established: the dual intervention group, the order form group, the pocket card group and the control group. Physicians in all groups received guidelines and were invited to a local information meeting. MEASURES. The main outcome measure of effectiveness was the Guideline Conformity Rate (GCR). RESULTS. Six hospitals participated in the study (two middle-sized hospitals, two small-sized hospitals and two psychiatric hospitals). A total of 1412 orders for thyroid function tests were collected. GCR was 78% in the dual intervention group, 83% in the order form group, 73% in the pocket card group and 62% in the control group. The interaction between TRF and MPC was not significant (β = -0.70; P = 0.21). Compared with simple information, TRF was effective in increasing GCR (OR, 2.65; 95% CI, 1.52-4.62), unlike MPC (OR, 1.28; CI, 0.75-2.19). CONCLUSIONS. Using a robust design, our study shows the greater effectiveness of TRF than MPC and their association in implementing thyroid function test guidelines.

AIM: To design a classification tool for the histological assessment of hepatocellular carcinoma (HCC), dysplastic nodules (DN), and macroregenerative nodules (MRN) in cirrhotic liver. METHODS: Two hundred and twelve hepatocellular nodules (106 HCC; 74 MRN; 32 DN) were assessed systematically, quantitatively, and semiquantitatively as appropriate for 10 histological features that have been described as helpful in distinguishing small HCC, DN, and MRN in cirrhotic livers. The data were analyzed by multiple correspondence analysis (MCA). RESULTS: MCA distributed HCC, DN, and MRN as defined by traditional histological evaluation as well as the individual histological variables, in a “malignancy scale”. Based on the MCA data representation, we created a classification tool, which categorizes an individual nodular lesion as MRN, DN, or HCC based on the balance of all histological features (i.e., vascular invasion, capsular invasion, tumor necrosis, tumor heterogeneity, reticulin loss, capillarization of sinusoids, trabecular thickness, nuclear atypia, and mitotic activity). The classification tool classified most (83%) of a validation set of 47 nodules in the same way as the routine histological assessment. No discrepancies were present for DN and MRN between the routine histological assignment and the classification tool. Of 25 HCC assigned by routine assessment in the validation set, 8 were assigned to the DN category by the classification tool. CONCLUSION: We have designed a classification tool for the histological assessment of HCC and its putative precursors in cirrhotic liver. Application of this tool systematically records histological features of diagnostic importance in the evaluation of small HCC.

Something as basic as the arithmetic mean can produce errors and cause difficulties with students in the humanities and social sciences. It is recognized this public feels aversion with statistics and has gained a negative opinion against this discipline (Gordon, 2004 p.46-47). So what are the recurring errors and the main difficulties encountered by students ? To answer this question we start from a broader survey questionnaire developed by Jean-Claude Régnier. In this work we restrict ourselves to responses collected during three academic years (2009-2011) with students enrolled in Learning sciences Master 2. We extrapolate a situation that describes an event of daily life and assess procedural knowledge (Anderson, 1976, 1990; Tardif, 1992) by calculating a weighted arithmetic mean. This study therefore aims to characterize the mistakes made by students. The analysis of the responses identifies a wide variety of errors. Students acknowledge awareness of the method of averaging, but when it comes to applying less than half of them succeeds.Errors found are of various kinds, they range from misunderstanding of the statement to surface errors like wrong reporting of data. It appears that the competence to read a statement or to extract the relevant information may not be sufficiently controlled, even in subjects who have reached university 5th year., Une notion aussi élémentaire que la moyenne arithmétique peut produire des erreurs et engendrer des difficultés auprès d'étudiants de sciences humaines et sociales. Il est admis que ce public dans sa majorité s’est forgé une opinion négative à l'encontre de la statistique et peut éprouver jusqu’à de l’aversion envers cette discipline (Gordon, 2004 p.46-47). Quelles sont alors les erreurs récurrentes et les principales difficultés rencontrées par les étudiants ? Pour répondre à cette question nous partons d’une enquête plus ample par questionnaire mise au point par Jean-Claude Régnier. De ces travaux nous nous limitons aux réponses récoltées durant trois années universitaires (2009 à 2011) auprès d'étudiants de Master 2 inscrits en sciences de l’éducation. Nous en extrapolons une situation qui décrit un événement de la vie quotidienne et évalue des connaissances procédurales (Anderson, 1976, 1990 ; Tardif, 1992) à travers le calcul d’une moyenne arithmétique pondérée. Cette étude a donc pour objectif de caractériser les erreurs commises par les étudiants. L’analyse des réponses obtenues permet d’identifier des erreurs très variées. Les étudiants attestent qu’ils connaissent la méthode de calcul de la moyenne mais lorsqu’il s’agit de l’appliquer moins de la moitié d’entre eux y parvient. Les erreurs relevées sont de divers ordres, elles vont de l’incompréhension de l’énoncé à des erreurs de surface comme le report erroné des données. Il apparait que la compétence de savoir lire un énoncé comme celle d’en extraire l’information pertinente ne soient pas suffisamment maîtrisées, même chez des sujets ayant atteint la 5ème année d’études universitaires.

International audience; SThis is an issue that discuss statistic knowledges and your insertion in the Brazilian school curriculum of mathematics. First, we use the concept of "numeramentality" to express an analytical perspective that allows the study of knowledges which produce, organize and regulate the ways of thinking and acting in the contemporary and are based on the action to quantify, measure. Then we wonder about the risk as contemporary value to exercise the government of populations and individuals, and how it became a school curriculum component, which chooses the school theme and therefore the most appropriate knowledge. In this context, we note as the Brazilian curriculum agrees to demands and practices of the governmental order even though its knowledges have an epistemological importance. Finally, in our point of view, the use of themes such as inflation, growth, life expectancy for teaching Statistics provides the most political and social urgency in relation to ways of behaving face of the the risks and uncertainty. Finally, what is taught as statistical knowledge in school is only a form to be socially desirable subject.; Il s’agit d’une discussion sur les savoirs statistiques et leur insertion dans le curriculum scolaire brésilien des mathématiques. En premier lieu, nous utilisons le concept de « numéramentalité » pour exprimer une perspective analytique adéquate à l’étude des savoirs capables de produire, organiser et régulariser des façons de penser et d’agir dans la contemporanéité basées sur la quantification, la codification, la mesure. Ensuite, nous nous interrogeons sur le risque comme question contemporaine de l’exercice de gouvernement des populations et des individus et sur comment cette notion devient une composante curriculaire scolaire qui orientent les thématiques et par conséquent, les savoirs choisis comme les plus adéquats. Dans ce cadre, nous remarquons que le curriculum scolaire brésilien est en accord avec les demandes et pratiques d’ordre gouvernemental même si ces savoirs revêtent une importance épistémologique. Enfin, à notre avis, l’usage de thématiques comme l’inflation, la croissance, l’espérance de vie pour l’enseignement de la Statistique répondent à une urgence politique et sociale en rapport avec les façons de se conduire devant les risques et les incertitudes. Pour ainsi dire, ce qui s’enseigne comme connaissance statistique à l’école n’est peut-être qu’une forme socialement souhaitable d’être sujet

In this research, we analyzed the use of central tendency and dispersion measures as tools to compare one or more sets of data in the books of mathematical didactics in high schools in Brazil and France. We considered that one way of developing the concept of central tendency measure and dispersion is to use these measures as a comparison tool. We used the theoretical contribution of the conceptual fields theory. Despite the importance of these measures as comparison tools, the results have shown limits in the didactical books selected both in Brazil and France. Considering that these measures might be used in various situations in the area of work or of citizenship formation, among others, the limitations found could have repercussions in the student’s training., Dans cette recherche, nous avons analysé l’utilisation des mesures de tendance centrale et de dispersion comme outil de comparaison d’un ou plusieurs ensembles de données dans les manuels scolaires du lycée au Brésil et en France. Nous avons considéré que l’usage des mesures comme un outil de comparaison constituait une manière de développer le concept de mesure de tendance centrale et de dispersion. Nous nous sommes appuyés sur l’apport théorique de la théorie des champs conceptuels. Malgré l’importance de ces mesures comme outils de comparaison, les résultats ont montré l’existence de limites dans les manuels sélectionnés en France et au Brésil. Dans la mesure où ces mesures sont susceptibles d’être utilisées dans de nombreuses stations dans le domaine du travail ou de la formation à la citoyenneté, entre autres, les limites mises en évidence peuvent avoir des répercussions sur la formation des élèves.