Social representations of intellectual disability; a comparison between cultures.

OBJECTIVES: People with Intellectual disability consistently appear to be one of the most looked-down upon and repressed subgroups of society in many cultures. The main aim of this study was to compare social representations of intellectual disability in its various aspects between different cultures. MATERIALS AND METHODS: The study was conducted in four different sites: Beirut-Lebanon, Algiers-Algeria, Tours-France and Namur-Belgium. Participants were asked to complete a questionnaire evaluating social representations of intellectual disability. RESULTS: A total of 755 participants consented to take part in the study. Gender only affected social representations in the Lebanese population. Overall, Algerians appeared to have the least positive social representations and Lebanon to have more positive attitudes, while France and Belgium tended to have the most favourable representations. DISCUSSION AND CONCLUSIONS: Findings highlight the imbalance between a European and a non-European country showing the importance of developing tailored interventions to improve general attitudes towards intellectual disability.

Improving interoception and self-disgust in the treatment of patients with anorexia nervosa.

Anorexia nervosa (AN) is a mental disorder in which sufficient evidence points towards the presence of a high level of disturbed interoception and self-disgust. High arousal mood induction is a therapeutic technique that helps improve a patient's interoceptive capacities. With some adjustments to this technique such as adding a challenging behavior that induces a "flow" state or a mindfulness component such as in mindful awareness in body-oriented therapy (MABT), it is expected that patients with AN may benefit from an integrative treatment strategy that helps them improve their symptoms of high self-disgust and low interoception.

[Treatment of nevus of Ota and Ito and epidermal nevus syndrome]. / Behandlung des Naevus Ota und Ito und des Pigmentnävussyndroms.

Nevus of Ota, nevus of Ito and nevus of Hori are special melanocytic nevi that have a slate-brown or blue/grey coloring. They are pigmented disorders characterized by its heterotopic melanocytic dermal location and by blue/brown unilateral and sometimes bilateral facial patch in case of nevus of Ota, and in the supraclavicular, scapular, and deltoid region in case of nevus of Ito. It is more common in patients with Asian and dark-skinned ethnic backgrounds. Histologically, elongated, dendritic melanocytes are seen scattered mainly throughout the upper third of reticular dermis. An acquired variant is called Hori's nevus with more bilateral facial distribution, similar to melasma. Dermal melanocytosis can also occur elsewhere on the body, including inside the mouth. Despite its benign nature, patients frequently seek therapy because of its facial involvement. QS lasers are used effectively to treat these lesions. The number of treatment sessions correlates with clinical improvement. Post laser hypo- and hyperpigmentation are common side effects mainly affecting patients with darker skin.

Influence of organic phosphorus on reproductive performance and metabolic profiles of anoestrous Farafra ewes in subtropics at the end of breeding season.

The effect of organic phosphorus on metabolic, haematological and hormonal status, restoration of ovarian functions and conception rate in anoestrous Farafra ewes in subtropics were evaluated. Anoestrous Farafra ewes (n = 24; 34.72 ± 0.52 kg body weight) were allocated into two equal groups: control and phosphorus groups. The ewes of phosphorus group were treated with sodium 4-dimethylamino-2-methyl-phenyl-phosphonate as an organic bound phosphorous twice a week for successive 3 weeks. Ovarian follicle development and corpora lutea were checked three times a week till occurrence of oestrus using ultrasonography while pregnancy was confirmed at 30 days post-service. Plasma metabolites, reproductive hormones, thyroid hormones and minerals were detected at weeks -2, -1, 0 (mating day) and + 4 weeks post-oestrus. Phosphorus group had significantly (p < .05) short interval to oestrous resumption if compared to control ewes (2.1 ± 0.8 weeks vs. 4.6 ± 1.1 weeks). In addition, phosphorous supplementation significantly (p < .05) increased the number of antral follicles (developed and their sizes in addition to sizes of corpora lutea (8.72 ± 0.3 mm vs. 7.46 ± 0.9 mm) as well. Number of services per conception (2.6 vs. 1.4; p < .01) was higher in control group than that of phosphorus group. Pregnancy rate (80 vs. 50%) was significantly (p < .01) higher in phosphorus group when compared to control. White blood cells in treated ewes (10.8 ± 0.44; p < .05) and monocytes (2.93 ± 0.13; p < .01) were higher than that of control group (white blood cells; 9.53 ± 0.50 and monocytes; 2.24 ± 0.14). Metabolic parameters did not differ between phosphorus and control groups during different times of treatment. It could be concluded that phosphorous administration to anoestrous Farafra ewes in subtropics could improve reproductive performance and restore ovarian activity at the end of spring and early summer.

CRP relevance in clinical assessment of chronic spontaneous urticaria Tunisian patients.

BACKGROUND: Chronic spontaneous urticaria (CSU) is a common dermatological condition defined by the sudden occurrence of daily wheals and pruritus for at least six weeks. Multifactorial origin is suggested such as oxidative stress. This latter may play a double role as a trigger and remnant agent. OBJECTIVES: The first aim of this study is to investigate antioxidant status, inflammatory proteins, hematologic counts and clinical assessment in CSU patients. The second aim is to evaluate the effect of a first-line treatment: desloratadine 5 mg/d on these different parameters. PATIENTS AND METHODS: This study enrolled 30 CSU patients and same number of controls. We assessed the urticaria activity score (UAS), total antioxidant status (TAS), glutathione S-transferase (GST), superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT), albumin, alpha1, alpha2, beta1 beta2, gamma globulins, c-reactive protein (CRP) and hematologic numeration. RESULTS: At baseline alpha1, alpha2, beta1, beta2, gamma globulins, CRP, SOD activity, leukocytes and basophils were significantly higher in patients versus controls (p < 0.05). TAS, GST, CAT, GPx and albumin were significantly low in patients versus controls (p < 0.05). After treatment, TAS, GST and GPx were significantly increased in patients versus patients before treatment (p < 0.001). SOD, alpha1, alpha2, beta1, beta2, gamma globulins, CRP, albumin, leukocytes and basophils were significantly decreased after treatment versus before treatment (p < 0.05). A significant correlation between CRP and UAS (r = 0.3; p = 0.011) was noted. UAS assessment revealed the efficacy of 30 d-antihistaminic treatment. CONCLUSIONS: Desloratadine exerted anti-inflammatory and antioxidant effects on CSU patients revealed by CRP. Patients' remission was synergistic to CRP attenuation emphasizing CRP relevance for CSU clinical assessment.

Occurrence of non-cerebral coenurosis in sheep.

This study reports seven rare cases of non-cerebral coenurosis in sheep. The sheep were slaughtered in abattoirs of Abu Dhabi (United Arab Emirates) but originated from India, Iran, Oman and Sudan. The prevalence of infection with non-cerebral coenurosis was 0.008%. The locations of the cysts were the triceps brachii muscle, the diaphragm, the infraspinatus muscle of the shoulder, the muscles of the thigh and the abdomen, and the ommentum. The Coenurus cysts were surrounded by a fibrous, semi-opaque membrane, cloudy white in colour. Altogether, 12 cysts were recovered and all contained a single bladderworm. Cysts had a volume of 7.3 ± 1.30 cm3 (ml), with 7.3 ± 4.0 clusters of scolices, and an average number of scolices 75.3 ± 24.4. These features in sheep were similar to those reported for non-cerebral Coenurus cysts in goats. No cysts were found in the brain or spinal cord of any of the infected sheep. No clinical evidence of non-cerebral coenurosis had been recorded during the antemortem veterinary inspection of the infected sheep.

Anatomy of the rabbit inner ear using computed tomography and magnetic resonance imaging.

Anatomically, the inner ear is a highly complex organ of intricate design, composed of a bony labyrinth that encases the same-shaped membranous labyrinth. It is difficult to study the three-dimensional anatomy of the inner ear because the relevant structures are very small and embedded within the petrous temporal bone, one of the densest bones in the body. The current study aimed to provide a detailed anatomic reference for the normal anatomy of the rabbit's inner ear. As a study model, ten healthy adults New Zealand White rabbit heads were used. Six heads were used for macroscopic evaluation of the bony and membranous labyrinths. The remaining four heads were evaluated radiographically, where 3D images were generated of the bony and membranous labyrinths using data sets from computed tomography (CT) and magnetic resonance imaging (MRI), respectively. The anatomical structures were identified and labelled according to NominaAnatomicaVeterinaria (NAV). Our study revealed that CT and MRI are the optimal cross-sectional imaging modalities for investigating such tiny and often inaccessible inner ear structures. As high-quality scanners are not readily available to veterinarians, the CT and MRI images generated by this research were of lower quality; therefore, high-quality dissections were used to identify/support structures seen in these images. In conclusion, this study provides one of the first investigations that uses multislice CT scans and MRI to study the rabbit's inner ear and its correlation with the corresponding anatomical images. Both anatomical, CT and MRI images will serve as a reference for interpreting pathologies relative to the rabbit's inner ear.

Comparison of two policies for induction of labour postdates.

The objective of this study was to compare maternal and midwifery manpower effects of policies for induction of labour (IOL) postdates, using a retrospective cohort design, in a level two maternity unit in a district hospital in South-West England. Primary outcome measures included mode of delivery, admission-delivery interval, midwifery manpower use. Group I consisted of 124 women who underwent IOL at 40+10. Group II were 104 women who underwent IOL at 42 weeks' gestation and 123 women who laboured spontaneously between 40+10 and 42 weeks' gestation. The nulliparous women had a shorter admission-delivery interval when induction was planned for 42 weeks, compared with 40+10 (p = 0.003), and required less frequent use of syntocinon (p = 0.04) and of continuous fetal monitoring (p = 0.02). The caesarean rate was higher in Group I than in Group II (p = 0.04) for nulliparous women only. The earlier induction policy was associated with a higher midwifery manpower requirement for nulliparae (p = 0.002). For parous women, the only difference was the greater use of oxytocin in labour. There was no difference between the groups in duration of labour, analgesia, Apgar scores, admission to neonatal care and meconium aspiration. In conclusion, delaying planned induction by three days was associated with lower medicalisation of labour and manpower needs for nulliparous women.

High-risk human papillomavirus infections in breast cancer in Syrian women and their association with Id-1 expression: a tissue microarray study.

High-risk human papillomaviruses (HPVs) could be important risk factors for breast carcinogenesis and metastasis. Based on this hypothesis, we recently studied the effect of E6/E7 onco-proteins of high-risk HPV type 16 in two non-invasive human breast cancer cell lines, BT20 and MCF7; we reported that E6/E7 converts these cell lines to invasive cells. This is accompanied by an overexpression of Id-1, which is an important regulator of breast metastasis. In this investigation, we examined the presence of high-risk HPVs (16, 18, 31, 33 and 35) and the expression of their E6 onco-protein as well as their correlation with Id-1 gene expression, using polymerase chain reaction (PCR) and tissue microarray (TMA) analysis, respectively, in a cohort of 113 Syrian breast cancer patients. We found that high-risk HPV types 16, 18, 31, 33 and 35 are present in 8.84, 9.73, 7.07, 55.75 and 37.16% of our samples, respectively, which represent invasive breast cancers. Overall, 69 (61.06%) of the 113 samples are HPV positive; among these specimens 24 tissues (34.78%) are coinfected with more than one HPV type. Furthermore, we report that the expression of the E6 onco-protein of these high-risk HPVs is correlated with Id-1 overexpression in the majority of invasive breast cancer tissue samples. Our data suggest that high-risk HPV infections are associated with human breast cancer progression in Syrian women.

Risk of cancer in symptomatic postmenopausal women with endometrial polyps at scan.

Postmenopausal bleeding is a common symptom accounting for about 10% of gynaecology referrals. Endometrial polyp formation is a frequent association and most can be identified at transvaginal scan using fluid-contrast endosonography. We undertook a study to find out what proportions of polyps are malignant or pre-malignant, and of those, what proportion could be identified on outpatient endometrial sampling. A consecutive series of 102 women were identified from theatre records and a cancer registry. The results suggest that about 10% of women with benign polyps get a further lesion. Overall, 11 (10.8%) had cancer and two (1.9%) had severe pre-malignant changes (complex endometrial hyperplasia with atypia). Of the 11 cancers, six (54.5%) were identified on endometrial sampling but five (45.5%) were only evident after inpatient hysteroscopic removal of the polyp. Four of these (80%) had had benign tissue on initial endometrial microscopy.

[Oxidant stress and cardiovascular absolute risk in Tunisian type 2 diabetes]. / Stress oxydant et risque cardiovasculaire absolu chez des diabétiques de type 2 du centre tunisien.

INTRODUCTION: cardiovascular diseases constitute the most hefty complications in diabetes. Absolute cardiovascular risk (ACVR) can be estimated by many equations that are continuously criticised. The aim is, in one hand, to evaluate ACVR in type 2 diabetes and, in the other hand, is to establish correlations between ACVR and oxidant-antioxidant status. MATERIAL AND METHODS: 183 type 2 diabetes and 200 controls were admitted. ACVR assessment was calculated following Laurier equation. Oxidant status was evaluated by the measure of homocysteine, hydrogen peroxide (H2O2) and LDL thiobarbituric reactive oxygen substances (LDL-TBARS). Antioxidant status was evaluated by the measure of superoxide dismutase (SOD) activity, glutathione peroxidase (GPx), total antioxidant status (TAS) vitamins A, E and zinc. Glycated haemoglobin (HbA1c) and microalbuminuria were assessed by turbidimetry. RESULTS: ninety percent of diabetes belonged to moderate and high ACVR groups. In diabetic men ACVR was doubled each elevation of 4 micromol/L homocysteine, of 50 micromol/L of H2O2 and of 20 mg/L of microalbuminuria. High risk ACVR group showed the lowest SOD activity, zincemia and the highest HbA1c. No significant difference was found in LDL-TBARS, TAS, GPx, vitamins A, E between the different ACVR groups. The strong relation between homocysteine and ACVR confirms homocysteine atherosclerotic role. Homocysteine auto-oxidation produces H2O2 leading to LDL-TBARS increase. Microalbuminuria-ACVR association verifies its vasculopathy predictor role. Urinary albumin leakage may be consequent to the hyperhomocysteinemia found in diabetes. CONCLUSION: homocysteine introduction in ACVR assessment equation may ameliorate this estimation.

[Clinical, biologic and molecular characteristics of two Tunisian MPS IV A patients]. / Etude de la maladie de Morquio A dans une famille tunisienne présentant deux enfants atteints.

Mucopolysaccharidosis type IV A (MPS IV A) is an autosomal recessive disorder resulting from the deficient activity of the lysosomal enzyme, N-acetylgalactosamine-6-sulfate sulfatase (GALNS) and the progressive lysosomal accumulation of keratane sulfate. Clinically, the MPS IV A differs from the other MPS by the localisation of the keratane sulfate in skelet and in eyes associated to the conservation of a normal intelligence. To date, the characterization and purification of the GALNS gene made a research for pathogenic mutations in patients with MPS IV A easier. These mutations are responsible of severe, intermediate or mild phenotype. The aim for this work was the research of clinical, biologic and molecular characteristics of two Tunisian MPS IV A patients who were offsprings of consanguineous mating. Enzymatic and urinary diagnostics suggested a MPS IV A phenotype. A novel homozygous mutation IVS1+1G-A was identified by direct sequencing in the GALNS gene of the two patients. Identification of GALNS mutations provide genotype/phenotype correlations and permit the precision of anomalies responsible of Morquio A phenotype in concerned families.

Effects of feeding green microalgae on ovarian activity, reproductive hormones and metabolic parameters of Boer goats in arid subtropics.

The present study aimed to improve ovarian follicle development and plasma metabolites and hormone concentrations upon supplementation of Boer goats with green microalga (Dunaliella salina; 10 g/head/day) (N = 20; MAT group) compared to control (N = 10; not receive microalgae) in subtropics. Estrus was synchronized in all animals by two intramuscular administration of 12.5 mg dinoprost 11 days a part. MAT group was supplemented with Dunaliella salina for 11 days (from the day of first injection of dinoprost till the second injection). Ovarian performance, steroids, LH, FSH and blood metabolites were assessed every three days during the estrous cycle. Numbers and sizes of ovarian follicles and corpora lutea were significantly (P < 0.05) increased in MAT group. Progesterone, estrogen, FSH and LH were higher in MAT group during estrous cycle. Blood metabolites including glucose, total cholesterol and blood urea nitrogen were significantly (P < 0.05) increased upon D. salina administration. On the other hand, supplementation of D. salina resulted in significant decrease of plasma total protein, albumin, aspartate aminotransferase and alanine aminotransferase. In conclusion, supplementation with D. salina could improve ovarian follicle development and concentrations of plasma metabolites and hormones which subsequently improves reproductive performance of Boer goats.

[Detection of EBV by PCR in fresh and paraffin embedded samples of cavum tumour]. / Détection de l'EBV par PCR dans des biopsies fraîches et enrobées en paraffine du cancer du cavum.

The nasopharyngeal carcinoma (NPC) is frequent in Tunisia. It's the second ORL cancer of men after the larynx one. To analyse the NPC characteristics in our population, we determined the frequency of EBV infection in 47 paraffin-embedded and 6 fresh NPC biopsies. We first extracted the DNA from tumoral tissus and then amplified viral sequences by PCR to detect and to type the infecting virus (EBV-A or ABV-B). Our results showed that amplifiable DNA has been obtained from 34/47 paraffin-embedded NPC biopsies while 13/47 of the others biopsies contained degraded and not amplifiable DNA. All the fresh biopsies allowed to obtain DNA with good quality. The EBV infection frequency in paraffin-embedded NPC biopsies is 35% while EBV is detected in all fresh biopsies (6/6). Our analyse also showed that the EBV-A is predominant in our population compared to EBV-B as it was shown in most countries of the world. This study clearly shows that PCR results obtained with paraffin-embedded NPC biopsies are divergeant from those obtained with fresh biopsies. Because of DNA degradation in paraffin-embedded NPC biopsies, the biology molecular results from that kind of samples is criticable. Moreover the results obtained from fresh NPC biopsies confirmed the quasi-constant association of EBV with undifferenciated carcinoma nasopharyngeal type.

Prevalence and health-care features of hyperglycemia in semiurban-rural communities in southern Saudi Arabia.

OBJECTIVE: To determine the prevalence of hyperglycemia in semiurban-rural Saudi Arabian communities and to assess some of its important health-care related aspects. RESEARCH DESIGN AND METHODS: A cluster of 12 villages near the city of Abha, the capital of the southern region in Saudi Arabia, with a total population of 2150 (290 families) has been included in this study. The family head was interviewed about diagnosed diabetes among family members. Also, the capillary blood glucose level was measured in subjects greater than or equal to 10 yr (the target population, n = 1419) with a reflectance meter after 2-h fasting after the main midday meal. RESULTS: The 87% of the target population who responded for screening showed a prevalence of 4.6% of diabetes, which was higher among men (5.5%, age adjusted, P less than 0.05) than among women (3.6%). Estimates were based on 57 cases ascertained by positive history of the disease (n = 49) or blood glucose level greater than 11.1 mM (200 mg/dl) without previous diagnosis of diabetes (n = 8). The prevalence of impaired glucose tolerance (blood glucose between 7.8 (140 mg/dl) and 11.0 mM (199 mg/dl) with no history of diabetes) was 3.7%, being higher among women than among men (P less than 0.01). Eighty-eight percent of the previously diagnosed cases were receiving treatment at the time of screening. However, in only 12.2% of those receiving treatment was glucose found to be controlled (level less than 7.8 mM [140 mg/dl]). CONCLUSIONS: Diabetes frequency in this Saudi community is relatively high. There is a pressing need to promote public awareness about the disease and to improve the competency of the health-care team for achieving better control and early detection of the disease.

Does microalbuminuria predict diabetic nephropathy?

OBJECTIVE: To describe risk factors associated with microalbuminuria (MA) in subjects with diabetes, investigate the predictive value of MA as a marker of risk for diabetic nephropathy (DN), and define risk factors associated with the development and progression of MA. RESEARCH DESIGN AND METHODS: We conducted a prospective longitudinal study of 23 diabetic subjects with persistent MA and 209 diabetic subjects without MA who attended diabetes clinics at the University of Michigan Medical Center in 1989 and 1990. Both groups were examined at baseline and after 7 years. At baseline, urinary albumin-to-creatinine ratios were studied in random, first morning, and 24-h urine samples. At follow-up, a 12-h overnight urine sample was collected and analyzed for albumin and creatinine. At baseline, MA was defined by at least two separate urine specimens with albumin-to-creatinine ratios between 30 and 299 microg albumin per milligram of creatinine. RESULTS: MA regressed in 56% of subjects with baseline MA without systematic application of corrective measures and developed in 16% of subjects without baseline MA. The predictive value positive of MA as a marker of risk for DN was 43%, and the predictive value negative was 77%. In the combined cohort, the incidence and progression of MA were significantly associated with poor glycemic control and duration of diabetes between 10 and 14 years. CONCLUSIONS: MA may not be as sensitive and specific a predictor of DN as previously suggested. Other markers of risk for DN are needed for optimal clinical management.

Characteristics of non-cerebral coenurosis in tropical goats.

The epidemiological, clinical, and biochemical profile of non-cerebral coenurosis in goats and the morphological characteristics of the responsible metacestodes (cysts) were examined in a cross-sectional survey of slaughtered goats in abattoirs of the United Arab Emirates (U.A.E.) originating from Abu Dhabi and various tropical countries. The age, country of origin, and location of each cyst in the body of goats were recorded. Blood samples collected from infected and matching healthy goats were subjected to biochemical analysis. Data on the morphological characteristics of the cysts as well as the clusters, scoleces, and rostellar hooks in one cyst from each affected carcass were collected. The data collected were subjected to statistical analysis. A total of 2,284 slaughtered goats were examined and 40 goats were diagnosed as infected with non-cerebral coenurus cysts. The prevalence of non-cerebral coenurosis was 1.75% and the degree of parasite aggregation (k) was 0.003, which is indicative of overdispersion (k<1). The only abnormalities observed in the infected goats were palpation of large single cysts in thigh muscles and higher serum aspartate aminotransferase (AST) value. A total of 76 non-cerebral coenurus cysts from 14 different body locations were collected. No cysts were found in the brain or spinal cord. Cysts located in psoas muscles had on average significantly bigger volumes and higher numbers of scoleces and clusters compared to cysts located in other body parts (P-value=0.000). Significant differences in the morphometric measurements of the rostellar hooks were observed between cysts found in goats from different countries of origin (P-value<0.05) perhaps due to initial steps of allopatric speciation by geographic isolation. A significant positive correlation was found between number of scoleces and volume of cysts (b=6.37>5; R-Sq=89.4%; P-value=0.000) and between number of clusters and number of scoleces (b=25.13>1; R-Sq=79.8%; P-value=0.000) indicative of following a positive allometric growth as well as between number of clusters and volume of cysts (b=0.25<0.5; R-Sq=69.4%; P-value=0.000) indicative of following a negative allometric growth. The biological significance of the observed allometries is not known, but perhaps for evolutionary reasons the parasite is investing its resources more on the growth of scoleces, less on the growth of cyst volume, and even less on the number of clusters.

Abnormalities of CD4+ T lymphocyte proliferative responses from patients with recently diagnosed insulin-dependent diabetes mellitus.

To investigate the abnormalities of cell-mediated immunity in patients with recently diagnosed insulin-dependent diabetes mellitus (IDDM), we studied the responses of the two major T lymphocyte subsets from peripheral blood lymphocytes (PBL) to mitogen stimulation. Samples for PBL were obtained from a group of IDDM patients and from a group of normal controls. CD4+ and CD8+ T cells were isolated and were subsequently stimulated with three specific lymphocyte mitogens, namely Phytohemagglutinin (PHA), Concanavalin A (Con A) and Pokeweek mitogen (PWM). The proliferative response was measured by incorporation of radioactive thymidine in lymphocyte cultures which were stimulated by the three mitogens. The responses of CD8+ T cells from IDDM patients and from controls were not significantly different. However, CD4+ T cells from IDDM patients showed significantly depressed responses to PHA and Con A and to a much lesser extent to PWM. These data provide new information regarding the CD4+ T lymphocyte abnormalities found in patients with IDDM.

Evaluation of the use of the reflectance meter by several operators in field screening for diabetes mellitus.

The performance of reflectance meters for measuring blood glucose concentrations was evaluated in other studies previously and was found to be satisfactory. In the present study, we have evaluated the reliability of one brand of such meters (Glucometer II), when used by several operators, for blood glucose measurements during an epidemiological survey. We have compared the results obtained by the meter with those obtained by a standard hospital laboratory procedure for the same samples. A high and statistically significant degree of correlation (r = 0.901) was observed between the two groups of measurements. The linear regression equation was Y = 0.9X + 13.4. We conclude that the Glucometer II is an accurate and practical instrument even when used by several operators in epidemiological surveys provided that adequate training is given to those operators prior to using the instrument. This is important since the use of reflectance meters in epidemiological surveys is becoming increasingly widespread especially in the third world countries.