Residents' knowledge in transfusion medicine and educational programs: A pilot study.

BACKGROUND: Residents' knowledge in transfusion medicine significantly impacts the optimal use of blood and patient safety. Little is known regarding this topic in France in particular. The objectives were to evaluate their basic knowledge, to determine whether the objectives of the curricula were attained and subsequently to suggest ways for improvement. METHODS: A cross-sectional study was conducted on 50 first year medical and surgical specialty residents rotating in a French university hospital. RESULTS: Major gaps in the knowledge were noted among residents of various specialties, equally between those with low and sustained transfusion practice. The majority of these young doctors expressed difficulties in prescribing and handling transfusions, identifying and managing its complications and understanding their responsibilities. The roles of hemovigilance practitioners were further somehow unclear for participants. CONCLUSION: Given these results, action plans appear needed to limit consequences. A special transfusion medicine educational program should be added to the currently available medical education curriculum in order to ensure physicians have adequate knowledge of transfusion basics; at least a practical assisted situation during residency would be of valuable interest.

[The global cardiovascular risk of patients with schizophrenia hospitalized in psychiatry at the university hospital of Saint-Étienne]. / Le risque cardiovasculaire global des patients atteints de schizophrénie hospitalisés en psychiatrie au CHU de Saint-Étienne.

CONTEXT: Patients suffering from schizophrenia present with a risk of cardiovascular death which is two to three times as high as the general population. OBJECTIVES: Our study aims to evaluate the global cardiovascular risk according to SCORE and Framingham on patients suffering from schizophrenia who have been hospitalized in psychiatric institutions and also to assess whether being under the care of a physician affects that risk. METHODS: A prospective descriptive epidemiologic study was conducted from April 2005 to March 2016. The study population consisted of adult patients suffering from schizophrenia who were hospitalized in the psychiatric unit of the CHU de Saint-Étienne. The data was collected during the clinical admission examination. The software CARDIORISK was used to compute the global cardiovascular risk according to SCORE and Framingham. RESULTS: The average cardiovascular risk was about four times as high for males as it was for females according to the SCORE model and twice as high according to the Framingham model. According to the SCORE model, 16.5 % of the patients presented a high cardiovascular risk versus 6.6 % according to the Framingham model. There was no statistically significant difference between patients who were under the care of a physician and those who were not, both in terms of the prevalence of the risk factors and in terms of the global cardiovascular risk. CONCLUSION: Using the global cardiovascular risk approach as a primary prevention measure could allow patients suffering from schizophrenia to be admitted earlier. Also, regularly reevaluating that risk could allow initiation of behavioral changes and/or important cardiovascular treatments.

Polygenic risk for schizophrenia, transition and cortical gyrification: a high-risk study.

BACKGROUND: Schizophrenia is a highly heritable disorder, linked to several structural abnormalities of the brain. More specifically, previous findings have suggested that increased gyrification in frontal and temporal regions are implicated in the pathogenesis of schizophrenia. METHODS: The current study included participants at high familial risk of schizophrenia who remained well (n = 31), who developed sub-diagnostic symptoms (n = 28) and who developed schizophrenia (n = 9) as well as healthy controls (HC) (n = 16). We first tested whether individuals at high familial risk of schizophrenia carried an increased burden of trait-associated alleles using polygenic risk score analysis. We then assessed the extent to which polygenic risk was associated with gyral folding in the frontal and temporal lobes. RESULTS: We found that individuals at high familial risk of schizophrenia who developed schizophrenia carried a significantly greater burden of risk-conferring variants for the disorder compared to those at high risk (HR) who developed sub-diagnostic symptoms or remained well and HC. Furthermore, within the HR cohort, there was a significant and positive association between schizophrenia polygenic risk score and bilateral frontal gyrification. CONCLUSIONS: These results suggest that polygenic risk for schizophrenia impacts upon early neurodevelopment to confer greater gyral folding in adulthood and an increased risk of developing the disorder.

[Vaccination coverage and socioeconomic determinants of BCG vaccination in children before 3 months: Results of the Elfe cohort study, 2011]. / Couverture vaccinale et déterminants socioéconomiques de la vaccination BCG chez l'enfant avant 3 mois : résultats de la cohorte Elfe, 2011.

BACKGROUND: In 2007, French authorities changed mandatory BCG vaccination for all children into a strong recommendation to vaccinate only children considered at high risk of tuberculosis. Vaccination coverage (VC) data are insufficient in France. We estimated VC at approximately two months of age and identified socioeconomic factors associated with BCG vaccination. METHODS: The Elfe study (Étude Longitudinale Française depuis l'Enfance) included a random sample of about 18 000 children born in 2011 selected at birth from 320 maternity wards from mainland France. Information was collected through questionnaires and telephone interviews conducted approximately two months after delivery. Because BCG recommendations are different in the Paris region (Île-de-France [IDF]) and outside this region, VC was estimated separately in these two regions. We estimated VC for different levels of tuberculosis risk, approached by the geographical origin of the parents. Poisson regression was performed to analyze the association between socioeconomic factors and BCG vaccination status, and results expressed by prevalence ratios (PR). RESULTS: CV was higher in IDF (59.5%) compared to at-risk children outside IDF (46.7%) (p<0.001). VC in children with two parents from a tuberculosis highly endemic country was 80.5% in IDF and 60.4% outside IDF. In the multivariable model, having one or two parents from a tuberculosis highly endemic country (PR around 1.40) or consulting a private pediatrician (PR around 1.15) or a maternal and child health (MCH) center (PR around 1.40) after leaving the maternity ward were associated with a higher VC, whereas a university educational level in mothers was associated with a lower VC (PR=0.80). CONCLUSION: In France, BCG vaccination in infants is performed early after discharge from the maternity ward. A first consultation with a pediatrician or in a MCH center is associated with better vaccination coverage. Children at higher risk are probably well identified by physicians and better vaccinated.

Childhood adversity and hippocampal and amygdala volumes in a population at familial high risk of schizophrenia.

BACKGROUND: There is an established link between childhood adversity (CA) and schizophrenia. Hippocampus and amygdala abnormalities pre-date onset in those at high familial risk (fHR) of schizophrenia, but it is not clear whether these alterations are associated with CA in those at elevated risk of schizophrenia. METHODS: We examined hippocampal and amygdala volumes in those at fHR who had been referred to a social worker or the Children's Panel compared to those who had not. RESULTS: The right hippocampus and left amygdala were significantly smaller in those that had been referred to social work and Children's Panel. CONCLUSIONS: Our findings suggest that CA can influence structural changes in the brain in a cohort at fHR of schizophrenia. These findings provide further evidence that while genetic factors contribute to the structural changes found in schizophrenia, environmental factors such as CA can have a lasting impact on specific brain regions.

Longitudinal changes in hippocampal volume in the Edinburgh High Risk Study of Schizophrenia.

Schizophrenia is associated with structural brain abnormalities that are likely to be present before disease onset. It remains unclear to what extent these represent general vulnerability indicators or are associated with the developing clinical state itself. It also remains unclear whether such state or trait alterations may be evident at any given time-point, or whether they progress over time. To investigate this, structural brain scans were acquired at two time-points (mean scan-interval 1.87years) in a cohort of young unaffected individuals at high familial risk of schizophrenia (baseline, n=142; follow-up, n=64) and healthy controls (baseline, n=36; follow-up, n=18). Sub-cortical reconstructions of the hippocampus and amygdala were generated using the longitudinal pipeline available with Freesurfer. The high risk cohort was subdivided into individuals that remained well during the study (HR[well], baseline, n=68; follow-up, n=30), transient and/or partial symptoms that were insufficient to support a formal diagnosis (HR[symp], baseline, n=57; follow-up, n=26) and individuals that subsequently developed schizophrenia according to ICD-10 criteria (HR[ill], baseline, n=17; follow-up, n=8). Longitudinal change in the hippocampus and amygdala was compared, focusing first on overall differences between high-risk individuals and controls and then on sub-group differences within the high-risk cohort. We found a significantly altered developmental trajectory for all high risk individuals compared to controls, with controls showing a significant increase in hippocampal volume over time compared to those at high risk. We did not find evidence of altered longitudinal trajectories based on clinical outcome within the high risk cohort. These results suggest that an altered developmental trajectory of hippocampal volume is associated with a general familial predisposition to develop schizophrenia, as this alteration was not related to subsequent clinical outcome.

Childhood adversity and cortical thickness and surface area in a population at familial high risk of schizophrenia.

BACKGROUND: There is now a well-established link between childhood adversity (CA) and schizophrenia. Similar structural abnormalities to those found in schizophrenia including alterations in grey-matter volume have also been shown in those who experience CA. METHOD: We examined whether global estimates of cortical thickness or surface area were altered in those familial high-risk subjects who had been referred to a social worker or the Children's Panel compared to those who had not. RESULTS: We found that the cortical surface area of those who were referred to the Children's Panel was significantly smaller than those who had not been referred, but cortical thickness was not significantly altered. There was also an effect of social work referral on cortical surface area but not on thickness. CONCLUSIONS: Cortical surface area increases post-natally more than cortical thickness. Our findings suggest that CA can influence structural changes in the brain and it is likely to have a greater impact on cortical surface area than on cortical thickness.

[Early prenatal interview and antenatal education for childbirth and parenthood: Associated psychosocial and obstetric characteristics in women of the ELFE cohort]. / Entretien prénatal précoce et séances de préparation à la naissance et à la parentalité : caractéristiques psychosociales et obstétricales associées chez les femmes de la cohorte ELFE.

OBJECTIVES: Early prenatal interview (Entretien prénatal précoce [EPP]) is aimed at defining with couples their physical, psychological and social needs during perinatal period. Antenatal education for childbirth and parenthood (Préparation à la naissance et à la parentalité [PNP]) is aimed at promoting global perinatal health. The objective was to identify the psychological, demographic and obstetrical characteristics independently associated with participation in: (i) an EPP; (ii) a PNP. MATERIALS AND METHODS: Multivariate analyses were applied to data collected during the maternity stay of mothers whose children were included in the French cohort French Longitudinal Study since the Childhood (ELFE), a nationally representative cohort of children followed-up from birth to adulthood. RESULTS: Among the 14,595 mothers of the sample, 33% had an EPP and 52% a PNP. Primiparous mothers, born in France, with high educational level, employed or unemployed, with psychological difficulties more often benefit from EPP and/or PNP. Women who were young, benefiting from free health insurance (Couverture Maladie Universelle [CMU]), with unplanned pregnancy, with less antenatal care and obstetrical complications less often benefit from PNP. CONCLUSION: The EPP and the PNP reach high sociodemographic level populations. They should be integrated into a wider system of prevention and care, in order to reach the most vulnerable populations and to contribute to the improvement of the psychological and social environment of all the women during the perinatal period.

Structural magnetic resonance imaging markers of susceptibility and transition to schizophrenia: a review of familial and clinical high risk population studies.

There is a growing consensus that a symptomatology as complex and heterogeneous as schizophrenia is likely to be produced by widespread perturbations of brain structure, as opposed to isolated deficits in specific brain regions. Structural brain-imaging studies have shown that several features of the brain, such as grey matter, white matter integrity and the morphology of the cortex differ in individuals at high risk of the disorder compared to controls, but to a lesser extent than in patients, suggesting that structural abnormalities may form markers of vulnerability to the disorder. Research has had some success in delineating abnormalities specific to those individuals that transition to psychosis, compared to those at high risk that do not, suggesting that a general risk for the disorder can be distinguished from alterations specific to frank psychosis. In this paper, we review cross-sectional and longitudinal studies of individuals at familial or clinical high risk of the disorder. We conclude that the search for reliable markers of schizophrenia is likely to be enhanced by methods which amalgamate structural neuroimaging data into a coherent framework that takes into account the widespread distribution of brain alterations, and relates this to leading hypotheses of schizophrenia.

[Social inequalities in health in 4 year-old children in the Hauts-de-Seine (France)]. / Inégalités sociales de santé à quatre ans dans les Hauts-de-Seine (France).

The social effects on health described in France on newborn and 5- to 6-year-old children suggest the existence of a social gradient among the youngest children. The favoured, though unequal, social situation of the department of the Hauts-de-Seine (France), makes it particularly adapted to this study. A survey, conducted in 2010 by the departmental service of maternal and infantile protection (PMI) on a representative sample of 1227 children, who received check-ups in their first or second year of nursery school, reveals a significant increase of overweight (from 4.6 to 16.5%), of language disorders (from 8.3 to 25.3%), of the orientations to specialized consultations (from 20.6 to 36.6%), according to the socioprofessional category of the father or the social affiliation of the children in the following subgroups: children speaking or understanding a foreign language (36.6% of the sample), children schooled in priority educational zones (equivalent to education achievement zones in UK, 13.6%), children with limited social health coverage (13.4%). In contrast, the BCG and hepatitis B vaccinal coverage is systematically higher in these various groups. The multivariate analysis investigates for each health problem its links with these various subgroups, and with previous child care experiences, and PMI medical consultations. This study suggests therefore further prospects for different actions according to health problems or regarding vaccinal strategy. The development of such routine indicators of disadvantage should allow territorial health services to target their actions towards the decrease of social disparities in health and to check a posteriori the efficiency of the public systems, which have been implemented.

Estrogen signaling in testicular cells.

Aromatase transforms irreversibly androgens into estrogens and is present in the endoplasmic reticulum of various tissues including the mammalian testis. In rat all testicular cells except peritubular cells express aromatase. Indeed in adult rat germ cells (pachytene spermatocytes and round spermatids) we have demonstrated the presence of a functional aromatase (transcript, protein and biological activity) and the estrogen output is equivalent to that of Leydig cells. In addition in the adult rat, transcripts of aromatase vary according to the germ cell type and to the stages of seminiferous epithelium. By contrast with the androgen receptors mainly localized in somatic cells, estrogen receptors (ERs) are described in most of the testicular cells including germ cells. Moreover, besides the presence of high affinity ERα and/or ERß, a rapid membrane effect has been recently reported and we demonstrated that GPR30 (a transmembrane intracellular estrogen receptor) is expressed in adult rat pachytene spermatocytes. Therefore estrogens through both GPR30 and ERα are able to activate the rapid EGFR/ERK/c-jun signaling cascade, which in turn triggers an apoptotic mitochondrial pathway involving an increase in Bax expression and a concomitant reduction of cyclin A1 and B1 gene levels. In another study in round spermatids of adult rat we have shown that the rapid membrane effect of estradiol is also efficient in controlling apoptosis and maturation / differentiation of these haploid germ cells. In man the presence of a biologically active aromatase and of estrogen receptors has been reported in Leydig cells, but also in immature germ cells and ejaculated spermatozoa. Thus the role of estrogen (intracrine, autocrine and / or paracrine) in spermatogenesis (proliferation, apoptosis, survival and maturation) and more generally, in male reproduction is now evidenced taking into account the simultaneous presence of a biologically active aromatase and the widespread distribution of estrogen receptors especially in haploid germ cells.

Gper and ESRs are expressed in rat round spermatids and mediate oestrogen-dependent rapid pathways modulating expression of cyclin B1 and Bax.

Spermatogenesis is a precisely controlled and timed process, comprising mitotic divisions of spermatogonia, meiotic divisions of spermatocytes, maturation and differentiation of haploid spermatids giving rise to spermatozoa. It is well known that the maintenance of spermatogenesis is controlled by gonadotrophins and testosterone, the effects of which are modulated by a complex network of locally produced factors, including oestrogens. However, it remains uncertain whether oestrogens are able to activate rapid signalling pathways directly in male germ cells. Classically, oestrogens act by binding to oestrogen receptors (ESRs) 1 and 2. Recently, it has been demonstrated that rapid oestrogen action can also be mediated by the G-protein-coupled oestrogen receptor 1 (Gper). The aim of the present study was to investigate ESRs and Gper expression in primary cultures of adult rat round spermatids (RS) and define if oestradiol (E2) is able to activate, through these receptors, pathways involved in the regulation of genes controlling rat RS apoptosis and/or maturation. In this study, we demonstrated that rat RS express ESR1, ESR2 and Gper. Short-time treatment of RS with E2, the selective Gper agonist G1 and the selective ESR1 and ERß agonists, 4,4',4"-(4-propyl-[1H]pyrazole-1,3,5-triyl) trisphenol (PPT) and 2,3-bis(4-hydroxyphenyl)-propionitrile (DPN), respectively, determined activation of Extra-cellular signal-regulated kinase (ERK1/2) through the involvement of epidermal growth factor receptor transactivation. In addition, we investigated the effects of ESRs and Gper pathway activation on factors involved in RS maturation. Expression of cyclin B1 mRNA was downregulated by E2, G1 and PPT, but not by DPN. A concomitant and inverse regulation of the pro-apoptotic factor Bax mRNA expression was observed in the same conditions, with DPN being the only one determining an increase in this factor expression. Collectively, these data demonstrate that E2 activates, through ESRs and Gper, pathways involved in the regulation of genes controlling rat RS apoptosis and differentiation such as cyclin B1 and Bax.

Age- and cell-related gene expression of aromatase and estrogen receptors in the rat testis.

Spermatogenesis is a complex and coordinated process leading to the formation of spermatozoa. This event, which is under the control of numerous endocrine and paracrine factors, seems to also be controlled by estrogens which exert their effects via nuclear estrogen receptors (ESRs) ESR1 and ESR2. Estrogens are synthesized by aromatase which is biologically expressed in the rat testis. The objective of our study was to clarify the gene expression patterns of aromatase and ESRs according to age and in the two compartments of the adult rat testis. In the adult, transcripts of aromatase vary according to the germ cell type and to the stages of seminiferous epithelium, a maximum being observed at stage I. The ESR1 gene is highly expressed in the adult testis and in stages from VIIc-d to XIV. Moreover, both ESR mRNA levels are higher in purified round spermatids than in pachytene spermatocytes, suggesting a putative role of estrogens in the haploid steps of spermatogenesis. The variability of the results in the expression of both ESRs led us to explore the putative presence of variants in the rat testis. Concerning ESR1, we have shown the presence of the full-length form and of one isoform with exon 4 deleted. For ESR2, besides the wild type, three isoforms were observed: one with exon 3 deleted, another with an insertion of 54 nucleotides, and the last one with both modifications. Therefore, the stage-regulated expression of aromatase and ESR1 genes in the rat testis suggests a likely role of estrogens in spermatogenesis.

[Monitoring infant growth: comparative use of WHO standards and French national reference curves]. / Usage comparé des courbes de l'Organisation mondiale de la santé et des courbes françaises dans le suivi de la croissance pondérale des jeunes nourrissons.

The WHO curves published in 2006 reflect the exact growth of infants who are exclusively breast-fed for at least 4 months. These curves are universal but not widely used in France. At 2-3 months, they have a much higher level than the curves of the Personal Child Health Record. The aim of our study was to evaluate whether the choice of the type of curve influenced the interpretation of infant growth and the advice given, and whether WHO curves could be used for all infants. Initially, 22 physicians retrospectively interpreted the WHO and Personal Child Health Record weight gain curves of 20 infants who were exclusively breast-fed. All of the curves were interpreted twice. In a second step, we drew the WHO curves from 0 to 3 months for the 151 infants monitored by the consultation. At 2 months, there is a very clear discordance in the interpretations of the French and WHO curves (weighted kappa = -0.26 CI 95% [-0.62; 0.18]), contrasting with the satisfactory concordance of the WHO interpretations (weighted kappa = 0.71 CI 95% [0.25; 0.89]) and Personal Child Health Record (weighted kappa = 0.58 CI 95% [0.09; 0.81]) curves. By overestimating the weight gain during the first weeks, in one-third of the infants use of the French curves leads to either inappropriate suggestions of restrictions or their insufficient weight not being taken into account. Moreover, the weight gain at 2-3 months for 151 infants of all categories is within the limits of the WHO curves, without going below the percentile lines for the non-breast-fed infants, except premature babies. Broader use of the WHO curves could be proposed in order to optimize the care of infants, regardless of how they are fed.

[Health checkups for children of 3-4 years of age in the Hauts-de-Seine department (France): results and prospects]. / Bilans de santé à 3-4 ans dans le département des Hauts-de-Seine (France) : résultats et perspectives.

INTRODUCTION: A mission of the department's State Maternal and Child Welfare Service is to organize the first checkups for children attending nursery schools. Here, we present the data of the Hauts-de-Seine department (France). PATIENTS AND METHOD: All of the PMI physicians who carry out checkups of children aged 3 to 4 years in the nursery schools of the department, contributed in this study by random drawing a sample of 1914 children, born in 2001, who were in the 1st year of nursery school in 2004-2005. The data gathered concern the children's way of living, their personal and family antecedents, vaccinations, the results of the clinical examination, tests of hearing, vision, and language, the existence of special health or educational programs for children with handicaps or illnesses (PPS and PAI), as well as the types of health insurance coverage the children have. RESULTS: The median age of the children at the time of the checkups was 3 years and 8 months. Half of the children had had some kind of childcare from before the age of 1 year. Two-thirds of the children spend more than 25h a week at school. Twenty-seven percent of the children had already been hospitalized, due to accidents in 5 % of the cases. One child out of 20 lives in a nuclear family that has experienced a serious familial disease. Thirty percent of the children speak or understand a second language. Fifteen percent of the children have poor health insurance coverage. 8.5 % of the children were overweight, 1.6 % were obese, 3.9 % were too thin. 2.5 % were in school with PAI programs,and 0.4 % with PPS programs. As a result of the checkups, 30.1 % of the children were referred (28.3 % for children who have both social security and mutual insurance), including 4.7 % for hearing tests, 13.7 % for vision, 4.4 % for dental checkups, 6.3 % for anomalies of the general examination, 2.7 % for psychological difficulties, 2.6 % for serious language difficulties. 28.9 % of the parents received advice (26.4 % for children who have both social security and mutual insurance) for psychological difficulties, language issues, DTCPH (diphtheria, tetanus, whooping cough, poliomyelitis and hemophilus) and Measles, Mumps, Rubella (MMR) vaccination boosters, and 56.1 % when we add the recommended hepatitis B vaccination. Children who are in schools in priority education zones represent 12.1 % of them. These 2 subgroups are distinguished for a large number of variables, which reflect the very early appearance of social inequalities in terms of health care. Children who went to the Child Welfare Service represented 35 % of the sample, children who are in schools in priority education zones represent 12.1 % of them. CONCLUSION: The complete and systematic medical exam for children in nursery school at the age of 3-4 years old, the key age for screening, give occasion to appreciate global children's health. There should be thinking on the national level about how to group the results of the departments.

[Early visual screening appears essential to detect complete amblyopia risk and to treat strabismus earlier]. / Dépistage précoce des troubles visuels : expérience du service départemental de la Protection maternelle et infantile dans les Hauts-de-Seine.

INTRODUCTION: Early medical examinations performed in 2-, 4-, 9-, and 24-month-olds need to set up a technique adapted to infants and children. The aim of this study was to describe the technique and the results of screening performed by physicians of the Hauts-de-Seine district in 2004. PATIENTS AND METHODS: Over 1 year, 17 participating centers of the Maternal and Infant Welfare department of the Hauts-de-Seine district (France) included 1366 children at the 9- and 24-month medical consultation. This standardized procedure looked for personal and family risk factors and sought to detect ocular anomalies, strabismus, and amblyopia. Depending on the results, the patient was oriented toward appropriate care. RESULTS: At inclusion, only 10% of the children had already consulted an ophthalmologist with insufficient numbers in the risk groups although the difference between groups was significant. Of the children included, 30.2% had a family history of visual impairment and 7% a personal risk. During the examination, a risk of visual impairment was suspected for 12.5% of the children. At the end of the consultation, 39.7% of the children were oriented to an ophthalmic consultation, with the history or the results of the examination. One of these children out of two underwent a consultation. Finally, 31 children were prescribed corrective glasses compared to only eight wearing glasses initially and 65 children were followed up as opposed to only seven children before the study. CONCLUSION: This screening has led to quadrupling the number of children wearing corrective lenses and monitoring the others presenting visual abnormalities, confirming the advantages of early visual screening for children under 3 years of age.

[Visual screening in 3- to 5-year-old preschool children: Maternal and Infant Welfare evaluation program in the Hauts-de-Seine district, France]. / Dépistage des troubles visuels entre 3 et 5 ans: expérience du service départemental de la Protection Maternelle et Infantile dans les Hauts-de-Seine.

INTRODUCTION: Prevalence of visual impairment is estimated at 15% at the age of 5 years. Early visual screening is essential to prevent the risk of amblyopia and treat strabismus. The Maternal and Infant Welfare department of the Hauts-de-Seine district (France) organized a systematic visual screening during a routine health check-up in 3- to 4-year-old preschool children. In this population, 4% of children were wearing corrected lenses before check-up and 12% of children were referred to an ophthalmic consultant. The aim of this study was to document the performance and limitations of two visual acuity measurement tests: the Stycar test (separated presentation of letters) and Cadet letters test (grouped presentation). PATIENTS AND METHODS: Twelve physicians conducting check-ups in 56 of the department's preschools constituted two random samples of representative children. The first sample of 201 children included 3- to 4-year-olds with a positive visual screening on the Cadet or Stycar test and the results and recommendations were collected. The second sample included 238 children who had a first negative visual screening at 3-4 years old with the Stycar test. We then conducted a second visual screening at 4-5 years-old with the Cadet letters test and collected results. RESULTS: In the first sample of 201 children, 73 were lost to follow-up, 40 had a normal documented ophthalmic examination, 63 needed glasses and 25 needed follow-up. The positive predictive value (PPV) of the Stycar test was much higher than the PPV of the Cadet test (79% versus 48%, p<10-4). After this first screening, prevalence of visual impairment at 3-4 years old was estimated at 8%. In the second sample of 238 children, four children were recently lens adapted and 36 were referred to an ophthalmic consultant. Of these 36 children, 11 were lost to follow-up (of these children, two had a very low visual acuity (2/10 and 3/10), four had a normal ophthalmic examination, 13 needed glasses, and eight needed a follow-up. Of the total sample, 10.5% of the children had a documented visual insufficiency on the primary Stycar test screening. The PPV of the Cadet letters test was 84% (IC95%[70%; 98%]). Results of the Cadet letters test was independent of the delay between the two tests. CONCLUSION: Although one-third of the children did not follow the recommendations for follow-up consultation, we demonstrate that visual acuity evaluation was insufficient at 3-4 years of age, and the problems were caught at 4-5 years of age with the Cadet test. Physicians must be aware of the difficulty of the Cadet test at 3-4 years of age but also that screening is inadequate when the Stycar test is normal. A second visual screening, taking into account separating problems on the Cadet test is justified at 4-5 years of age The Stycar test must be discontinued after 4-5 years of age when compliance and the predictive value of the Cadet letters test become excellent.

Dimensionality of the Pay Satisfaction Questionnaire: a validation study in Belgium.

This study examined the underlying dimensions of the Pay Satisfaction Questionnaire to test whether the robust 4-factor structure (Pay Level, Benefits, Raises, and Structure or Administration) often established in the United States can be generalized to other countries and cultures as well. Data of 4 samples (for-profit employees, nonprofit nurses, cultural centre employees, and nonprofit teachers) were analysed with confirmatory factor analyses. The results for the first 3 samples yielded support for the original 4-factor structure of the Pay Satisfaction Questionnaire. In the teachers' sample, the irrelevant Benefits items were excluded from the analysis, resulting in a 3-factor structure of pay satisfaction.

Interleukin-6 expression after repeated bouts of eccentric exercise.

Plasma interleukin-6 (IL-6) is known to increase in response to eccentric exercise due to an acute-phase immune response. However, the severity of muscle injury is reduced with repeated bouts of eccentric exercise, possibly as a result of decreases in plasma IL-6. This study determined the response of IL-6 mRNA and IL-6, troponin-I (sTnI), muscle strength, and soreness as a result of repeated bouts of eccentric exercise. Eight males underwent two eccentric exercise bouts (3 wk apart) involving 7 sets of 10 repetitions at 150 % of the isotonic 1-RM of the dominant knee extensors. Blood samples were taken before, after and 2, 4, 6, 24, 48 and 96 h post-exercise. Strength and soreness ratings were assessed before and at 24, 48 and 96 h-post. Data were analyzed with 2 x 4 and 2 x 8 ANOVAs and the non-parametric Friedman test (p < 0.05). Both IL-6 mRNA and IL-6 underwent peak increases (p < 0.05) at 4 h-post and 6 h-post, respectively, but were not different between bouts. However, there were significant changes (p < 0.05) in sTnI, strength, and soreness that were greater after the first bout than the second, characteristic of the repeated bout effect. These results indicate that changes in sTnI, strength and soreness were less with the second eccentric exercise bout whereas the changes in both IL-6 mRNA and protein were not effected between bouts.