A cross-cultural comparison of population gambling patterns and regulatory frameworks: France and Québec.

Few empirical studies have examined the relationships between differing regulatory approaches and patterns of gambling behaviors. This article reports on a correlational cross-cultural comparison of differences in the regulatory approaches and gambling behavior among general adult populations in France and Québec, Canada. We drew data from two large population surveys conducted in France and Québec (N=27 653 and N=11 888, respectively). We found diverging and converging aspects of government regulatory policies. Statistical analyses demonstrated significantly higher participation rates and prevalence of 'assiduous gamblers' in Québec. In France, among assiduous gamblers, the proportion of moderate-risk and probable pathological gamblers is significantly higher. Future research should examine environmental conditions and varying gambling offerings, as well as gambling regulation, to determine their potential influence on gambling behaviors.

Prenatal intestinal obstruction affects the myenteric plexus and causes functional bowel impairment in fetal rat experimental model of intestinal atresia.

BACKGROUND: Intestinal atresia is a rare congenital disorder with an incidence of 3/10,000 birth. About one-third of patients have severe intestinal dysfunction after surgical repair. We examined whether prenatal gastrointestinal obstruction might effect on the myenteric plexus and account for subsequent functional disorders. METHODOLOGY/PRINCIPAL FINDINGS: We studied a rat model of surgically induced antenatal atresia, comparing intestinal samples from both sides of the obstruction and with healthy rat pups controls. Whole-mount preparations of the myenteric plexus were stained for choline acetyltransferase (ChAT) and nitric oxide synthase (nNOS). Quantitative reverse transcription PCR was used to analyze mRNAs for inflammatory markers. Functional motility and permeability analyses were performed in vitro. Phenotypic studies were also performed in 8 newborns with intestinal atresia. In the experimental model, the proportion of nNOS-immunoreactive neurons was similar in proximal and distal segments (6.7±4.6% vs 5.6±4.2%, p = 0.25), but proximal segments contained a higher proportion of ChAT-immunoreactive neurons (13.2±6.2% vs 7.5±4.3%, p = 0.005). Phenotypic changes were associated with a 100-fold lower concentration-dependent contractile response to carbachol and a 1.6-fold higher EFS-induced contractile response in proximal compared to distal segments. Transcellular (p = 0.002) but not paracellular permeability was increased. Comparison with controls showed that modifications involved not only proximal but also distal segments. Phenotypic studies in human atresia confirmed the changes in ChAT expression. CONCLUSION: Experimental atresia in fetal rat induces differential myenteric plexus phenotypical as well as functional changes (motility and permeability) between the two sides of the obstruction. Delineating these changes might help to identify markers predictive of motility dysfunction and to define guidelines for post-surgical care.

Outcomes of empirical eating disorder phenotypes in a clinical female sample: results from a latent class analysis.

BACKGROUND/AIMS: To empirically classify phenotypes of eating disorders (ED) using latent class analysis (LCA), and to validate this classification based on clinical outcomes. METHODS: LCA was applied to 968 inpatients. The resultant classes were validated by clinical outcomes including mortality. RESULTS: A 5-class solution showed the best fit. The symptoms of latent class 1 (LC1; 26% of the sample) resembled anorexia nervosa (AN), bingeing-purging (AN-B/P) subtype; those of LC2 (23%) resembled bulimia nervosa; those of LC3 (11%) were close to AN-B/P without weight and body concerns; those of LC4 resembled restrictive anorexia nervosa (RAN) without weight and body concerns, and those of LC5 RAN. A history of hospitalization for ED was significantly more frequent for LC3 and LC4. The lowest BMI at admission were presented in LC4. LC1 showed the highest level of psychological disturbances and LC4 the lowest. LC3 and LC4 differed from LC1 and LC5 by higher percentages of treatment dropout (64.9 vs. 57.2 and 55.7 vs. 47.5%, respectively; overall p = 0.001). Survival rates tended to be different between the LC (p = 0.09). CONCLUSIONS: Subgroups of AN patients with low weight and body concerns seem more severe at hospitalization and more difficult to manage, with a higher rate of treatment dropout than the 'typical' AN patients.

Radiofrequency ablation of renal tumours: diagnostic accuracy of contrast-enhanced ultrasound for early detection of residual tumour.

OBJECTIVE: To evaluate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in the early detection of residual tumour after radiofrequency ablation (RFA) of renal tumours. METHODS: Patients referred to our institution for RFA of renal tumours prospectively underwent CEUS and computed tomography (CT) or magnetic resonance imaging (MRI) before, within 1 day and 6 weeks after treatment. Identification of residual tumour was assessed by three blinded radiologists. Reference standard was CT/MRI performed at least 1 year after RFA. RESULTS: A total of 66 renal tumours in 43 patients (median age 62 years; range 44-71.5) were studied. Inter-reader agreement (kappa value) was 0.84 for CEUS. Prevalence of residual disease was 19%. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), respectively, were as follows: 64% [confidence interval (CI) 39-84], 98% [CI 91-100], 82% [CI 52-95] and 92% [CI 83-97] on 24-h CEUS; 79% [CI 52-92], 100% [CI 94-100], 100% [CI 74-100] and 95% [CI 87-100] on 6-week CEUS; 79% [CI 52-92], 95% [CI 86-98], 79% [CI 52-92] and 95% [CI 86-98] on 24-h CT/MRI; and 100% [CI 72-100], 98% [CI 90-100], 91% [CI 62-98] and 100% [CI 93-100] on 6-week CT/MRI. CONCLUSION: CEUS has high specificity for the early diagnosis of residual tumour after renal RFA.

Association of arterial stiffness and endothelial dysfunction with metabolic syndrome in obese children.

OBJECTIVE: We investigated whether metabolic syndrome, defined in 3 different ways (2 commonly used and 1 novel) is associated with arterial alterations in obese children. STUDY DESIGN: The study group comprised 384 obese children age 2.5 to 18 years. Blood pressure, fasting blood glucose, blood insulin, plasma lipids, and body composition were measured. Noninvasive ultrasound measurements were obtained in 161 patients to investigate arterial mechanical properties and endothelial function. RESULTS: The prevalence of metabolic syndrome was 10.4%. Intima-media thickness correlated positively with low-density lipoprotein cholesterol (r = .21; P < .01) and negatively with high-density lipoprotein cholesterol (r = -.17; P < .05). In adolescents (11 to 18 years), cross-sectional vascular compliance correlated negatively with abdominal fat (r = -.22; P = .02). The only synergistic effects among individual metabolic syndrome components was an effect of insulinemia and systolic blood pressure on cross-sectional compliance (4.05; P < .05). No significant difference in vascular variables was found between the patients with and without metabolic syndrome using any of the 3 definitions. CONCLUSION: Metabolic syndrome in obese children is not related to arterial variables, whereas several of its individual components are associated with vascular alterations. These data suggest that the value of the metabolic syndrome as a predictor of future cardiovascular events in children remains to be prospectively evaluated. In the meantime, individual cardiovascular risk factors should be evaluated and controlled.

[Cochin Hospital Clinical Ethics Center: the first two years]. / Bilan d'activité du Centre d'éthique clinique de l'hôpital Cochin après deux ans de fonctionnement.

INTRODUCTION: In September 2002, Cochin Hospital (Paris, France) opened a Clinical Ethics Center for patients, health proxies and members of the healthcare staff to consult when they face medical decisions raising ethical issues, that is, presenting possible conflicts in values. Three years after the opening of this experimental center that remains unique in France, we evaluated its activities. OBJECTIVES: To describe and compare consultations in 2003 and 2004 and to compare our activity with that of similar units abroad. METHODS: The descriptive analysis is based on data routinely collected for all consultations. RESULTS: The Center received 47 calls in 2003 and 83 in 2004. The most frequent reasons for consultation were: end of life issues (28%), patients' rights (25%), and questions about assisted reproduction technologies (16%). Two factors explain the increase in activity between 2003 and 2004. First, patients and their proxies called much more often: 24 calls in 2004, compared with only 10 in 2003. Second, research protocols designed to focus on specific ethical questions faced by medical teams in their daily practice required them to call systematically in the relevant situations (39 calls in 2004, compared with 15 in 2003). Calls from healthcare workers about one-time or ad hoc ethics questions remained stable (22 in 2003 and 21 in 2004). DISCUSSION/CONCLUSION: Healthcare staff appear to need clinical ethics consultations less for help on ad hoc issues than for long-term collaboration on specific and frequent ethical issues that remain difficult, despite their familiarity. These findings refute earlier fears that healthcare personnel would use these consultations to avoid their own ethical responsibilities. The increasing direct demand from patients and proxies should continue during the next few years, for it corresponds to a profound social trend, to defend one's autonomy in the face of illness and to make decisions and take responsibility for oneself.