Reliability and validity of the cross-culturally adapted French version of the Core Outcome Measures Index (COMI) in patients with low back pain.

PURPOSE: To conduct a cross-cultural adaptation of the Core Outcome Measures Index (COMI) into French according to established guidelines. METHODS: Seventy outpatients with chronic low back pain were recruited from six spine centres in Switzerland and France. They completed the newly translated COMI, and the Roland Morris disability (RMQ), Dallas Pain (DPQ), adjectival pain rating scale, WHO Quality of Life, and EuroQoL-5D questionnaires. After ~14 days RMQ and COMI were completed again to assess reproducibility; a transition question (7-point Likert scale; "very much worse" through "no change" to "very much better") indicated any change in status since the first questionnaire. RESULTS: COMI whole scores displayed no floor effects and just 1.5% ceiling effects. The scores for the individual COMI items correlated with their corresponding full-length reference questionnaire with varying strengths of correlation (0.33-0.84, P < 0.05). COMI whole scores showed a very good correlation with the "multidimensional" DPQ global score (Rho = 0.71). 55 patients (79%) returned a second questionnaire with no/minimal change in their back status. The reproducibility of individual COMI 5-point items was good, with test-retest differences within one grade ranging from 89% for 'social/work disability' to 98% for 'symptom-specific well-being'. The intraclass correlation coefficient for the COMI whole score was 0.85 (95% CI 0.76-0.91). CONCLUSIONS: In conclusion, the French version of this short, multidimensional questionnaire showed good psychometric properties, comparable to those reported for German and Spanish versions. The French COMI represents a valuable tool for future multicentre clinical studies and surgical registries (e.g. SSE Spine Tango) in French-speaking countries.

Prise en charge du patient avec bronchopneumopathie obstructive: ambulatoire ou hospitalière [Management of the patient with COPD: home case or hospitalization].

Acute exacerbation of COPD is one of the most common causes of hospital admission in patients affected with this disease. In most cases, consideration of differential diagnoses and assessment of important comorbidities will allow to make the decision whether or not the patient needs to be hospitalized. A decision to hospitalize will be based on specific symptoms and signs, as well on the patient's history. Contrary to bronchial asthma, a systematic action plan strategy is lacking for COPD. However, a disease management plan involving all the health care providers may have the potential to improve the patient's well being and to decrease costs related to these exacerbations.

DIAfit, un programme suisse pour promouvoir l'activité physique chez les patients avec diabète de type 2 [DIAfit, a Swiss program encouraging physical activity in patients with type 2 diabetes].

Physical activity has a beneficial effect on the cardiovascular risk and the well-being in patients with type 2 diabetes. Thereby, both aerobic physical activities and resistance activities are recommended. DIAfit is a programm for patients with type 2 diabetes that is being implemented in Switzerland. Its objective is to allow the initiation of a structured physical activity in the setting of a pluridisciplinary team to promote a healthy lifestyle.

Research priorities for nursing care of infants, children and adolescents: a West Australian Delphi study.

This paper describes a study that aimed to identify research priorities for the care of infants, children and adolescents at the sole tertiary referral hospital for children in Western Australia. The secondary aim was to stimulate nurses to explore clinical problems that would require further inquiry. Background. Planning for research is an essential stage of research development; involving clinicians in this exercise is likely to foster research partnerships that are pertinent to clinical practice. Nursing research priorities for the paediatric population have not previously been reported in Australia. Design. Delphi study. Method. Over 12 months in 2005-2006, a three-round questionnaire, using the Delphi technique, was sent to a randomly selected sample of registered nurses. This method was used to identify and prioritise nursing research topics relevant to the patient and the family. Content analysis was used to analyse Round I data and descriptive statistics for Round II and III data. Results. In Round I, 280 statements were identified and reduced to 37 research priorities. Analysis of data in subsequent rounds identified the top two priority research areas as (1) identification of strategies to reduce medication incidents (Mean = 6 center dot 47; SD 0 center dot 88) and (2) improvement in pain assessment and management (Mean = 6; SD 1 center dot 38). Additional comments indicated few nurses access the scientific literature or use research findings because of a lack of time or electronic access. Conclusions. Thirty-seven research priorities were identified. The identification of research priorities by nurses provided research direction for the health service and potentially other similar health institutions for children and adolescents in Australia and internationally. Relevance to clinical practice. The nurse participants showed concern about the safety of care and the well-being of children and their families. This study also enabled the identification of potential collaborative research and development of pain management improvement initiatives.

Hypoxie-ischémie cérébrale néonatale : rôle de la voie de JNK et implication de l'autophagie dans la mort neuronale

Résumé : Malgré les immenses progrès réalisés depuis plusieurs années en médecine obstétricale ainsi qu'en réanimation néonatale et en recherche expérimentale, l'asphyxie périnatale, une situation de manque d'oxygène autour du moment de la naissance, reste une cause majeure de mortalité et de morbidité neurologique à long terme chez l'enfant (retard mental, paralysie cérébrale, épilepsie, problèmes d'apprentissages) sans toutefois de traitement pharmacologique réel. La nécessité de développer de nouvelles stratégies thérapeutiques pour les complications de l'asphyxie périnatale est donc aujourd'hui encore essentielle. Le but général de ce travail est l'identification de nouvelles cibles thérapeutiques impliquées dans des mécanismes moléculaires pathologiques induits par l'hypoxie-ischémie (HI) dans le cerveau immature. Pour cela, le modèle d'asphyxie périnatale (proche du terme) le plus reconnu chez le rongeur a été développé (modèle de Rice et Vannucci). Il consiste en la ligature permanente d'une artère carotide commune (ischémie) chez le raton de 7 jours combinée à une période d'hypoxie à 8% d'oxygène. Il permet ainsi d'étudier les lésions de type hypoxique-ischémique dans différentes régions cérébrales dont le cortex, l'hippocampe, le striatum et le thalamus. La première partie de ce travail a abordé le rôle de deux voies de MAPK, JNK et p38, après HI néonatale chez le raton à l'aide de peptides inhibiteurs. Tout d'abord, nous avons démontré que D-JNKI1, un peptide inhibiteur de la voie de JNK présentant de fortes propriétés neuroprotectrices dans des modèles d'ischémie cérébrale adulte ainsi que chez le jeune raton, peut intervenir sur différentes voies de mort dont l'activation des calpaïnes (marqueur de la nécrose précoce), l'activation de la caspase-3 (marqueur de l'apoptose) et l'expression de LC3-II (marqueur de macroautophagie). Malgré ces effets positifs le traitement au D-JNKI1 ne modifie pas l'étendue de la lésion cérébrale. L'action limitée de D-JNKI1 peut s'expliquer par une implication modérée des JNKs (faiblement activées et principalement l'isotype JNK3) après HI néonatale sévère. Au contraire, l'inhibition de la voie de nNOS/p38 par le peptide DTAT-GESV permet une augmentation de 20% du volume du tissu sain à court et long terme. Le second projet a étudié les effets de l'HI néonatale sur l'autophagie neuronale. En effet, l'autophagie est un processus catabolique essentiel au bien-être de la cellule. Le type principal d'autophagie (« macroautophagie » , que nous appellerons par la suite « autophagie ») consiste en la séquestration d'éléments à dégrader (protéines ou organelles déficients) dans un compartiment spécialisé, l'autophagosome, qui fusionne avec un lysosome pour former un autolysosome où le contenu est dégradé par les hydrolases lysosomales. Depuis peu, l'excès ou la dérégulation de l'autoptiagie a pu être impliqué dans la mort cellulaire en certaines conditions de stress. Ce travail démontre que l'HI néonatale chez le raton active fortement le flux autophagique, c'est-à-dire augmente la formation des autophagosomes et des autolysosomes, dans les neurones en souffrance. De plus, la relation entre l'autophagie et l'apoptose varie selon la région cérébrale. En effet, alors que dans le cortex les neurones en voie de mort présentent des caractéristiques mixtes apoptotiques et autophagiques, ceux du CA3 sont essentiellement autophagiques et ceux du CA1 sont principalement apoptotiques. L'induction de l'autophagie après HI néonatale semble donc participer à la mort neuronale soit par l'enclenchement de l'apoptose soit comme mécanisme de mort en soi. Afin de comprendre la relation pouvant exister entre autophagie et apoptase un troisième projet a été réalisé sur des cultures primaires de neurones corticaux exposés à un stimulus apoptotique classique, la staurosporine (STS). Nous avons démontré que l'apoptose induite par la STS était précédée et accompagnée par une forte activation du flux autophagique neuronal. L'inhibition de l'autophagie de manière pharmacologique (3-MA) ou plus spécifiquement par ARNs d'interférence dirigés contre deux protéines autophagiques importantes (Atg7 et Atg5) a permis de mettre en évidence des rôles multiples de l'autophagie dans la mort neuronale. En effet, l'autophagie prend non seulement part à une voie de mort parallèle à l'apoptose pouvant être impliquée dans l'activation des calpaïnes, mais est également partiellement responsable de l'induction des voies apoptotiques (activation de la caspase-3 et translocation nucléaire d'AIF). En conclusion, ce travail a montré que l'inhibition de JNK par D-JNKI1 n'est pas un outil neuroprotecteur efficace pour diminuer la mort neuronale provoquée par l'asphyxie périnatalé sévère, et met en lumière deux autres voies thérapeutiques beaucoup plus prometteuses, l'inhibition de nNOS/p38 ou de l'autophagie. ABSTRACT : Despite enormous progress over the last«decades in obstetrical and neonatal medicine and experimental research, perinatal asphyxia, a situation of lack of oxygen around the time of the birth, remains a major cause of mortality and long term neurological morbidity in children (mental retardation, cerebral palsy, epilepsy, learning difficulties) without any effective treatment. It is therefore essential to develop new therapeutic strategies for the complications of perinatal asphyxia. The overall aim of this work was to identify new therapeutic targets involved in pathological molecular mechanisms induced by hypoxia-ischemia (HI) in the immature brain. For this purpose, the most relevant model of perinatal asphyxia (near term) in rodents has been developed (model of Rice and Vannucci). It consists in the permanent ligation of one common carotid artery (ischemia) in the 7-day-old rat combined with a period of hypoxia at 8% oxygen. This model allows the study of the hypoxic-ischemic lesion in different brain regions including the cortex, hippocampus, striatum and thalamus. The first part of this work addressed the role of two MAPK pathways (JNK and p38) after rat neonatal HI using inhibitory peptides. First, we demonstrated that D-JNKI1, a JNK peptide inhibitor presenting strong neuroprotective properties in models of cerebral ischemia in adult and young rats, could affect different cell death mechanisms including the activation of calpain (a marker of necrosis) and caspase-3 (a marker of apoptosis), and the expression of LC3-II (a marker of macroautophagy). Despite these positive effects, D-JNKI1 did not modify the extent of brain damage. The limited action of D-JNKI1 can be explained by the fact that JNKs were only moderately involved (weakly activated and principally the JNK3 isotype) after severe neonatal HI. In contrast, inhibition of nNOS/p38 by the peptide D-TAT-GESV increased the surviving tissue volume by around 20% at short and long term. The second project investigated the effects of neonatal HI on neuronal autophagy. Indeed, autophagy is a catabolic process essential to the well-being of the cell. The principal type of autophagy ("macroautophagy", that we shall henceforth call "autophagy") involves the sequestration of elements to be degraded (deficient proteins or organelles) in a specialized compartment, the autophagosome, which fuses with a lysosome to form an autolysosome where the content is degraded by lysosomal hydrolases. Recently, an excess or deregulation of autophagy has been implicated in cell death in some stress conditions. The present study demonstrated that rat neonatal HI highly enhanced autophagic flux, i.e. increased autophagosome and autolysosome formation, in stressed neurons. Moreover, the relationship between autophagy and apoptosis varies according to the brain region. Indeed, whereas dying neurons in the cortex exhibited mixed features of apoptosis and autophagy, those in CA3 were primarily autophagíc and those in CA1 were mainly apoptotic. The induction of autophagy after neonatal HI seems to participate in neuronal death either by triggering apoptosis or as a death mechanism per se. To understand the relationships that may exist between autophagy and apoptosis, a third project has been conducted using primary cortical neuronal cultures exposed to a classical apoptotic stimulus, staurosporine (STS). We demonstrated that STS-induced apoptosis was preceded and accompanied by a strong activation of neuronal autophagic flux. Inhibition of autophagy pharmacologically (3-MA) or more specifically by RNA interference directed against two important autophagic proteins (Atg7 and AtgS) showed multiple roles of autophagy in neuronal death. Indeed, autophagy was not only involved in a death pathway parallel to apoptosis possibly involved in the activation of calpains, but was also partially responsible for the induction of apoptotic pathways (caspase-3 activation and AIF nuclear translocation). In conclusion, this study showed that JNK inhibition by D-JNKI1 is not an effective neuroprotective tool for decreasing neuronal death following severe perinatal asphyxia, but highlighted two more promising therapeutic approaches, inhibition of the nNOSlp38 pathway or of autophagy.

CRIMINAL JUSTICE, VICTIM SUPPORT CENTERS, AND THE EMOTIONAL WELLBEING OF CRIME VICTIMS

SUMMARY (Français au-dessous)After the Second World War, the role of the victim in criminal conflict became an objectof interest for academics. But it was only in the 1960s that the importance of providingprotection and assistance to crime victims was highlighted in particular by the victims'movement, which inaugurated a new era of criminal justice in systems throughout the world.Moving beyond just the role of controlling crime and punishing the offender, the criminaljustice system also began to contribute to the victims' rehabilitation and to help the victim tomove on from the event psychologically and emotionally.Although some criminological research has been conducted, to date the effect that thecriminal justice system and victim support services have on the well-being of crime victims isstill uncertain.The current study sought to understand better the healing process of victims of crime, thepotential consequences of their participation on the criminal justice system, and the supportof victim centers. Moreover, it aimed to find out whether the existence of a Victim SupportAct would change the treatment that the victim receives in the criminal justice system. Thusthis research was conducted based in two countries - Switzerland and Brazil - where theoutcome of the victims' movement on the criminal justice system was different, as was theparticipation of the victim in the criminal justice system and the government's provision ofsupport.In order to conduct this research we employed the qualitative method, which is the mostefficient to gather sensitive information. Interviews with crime victims were the main sourceof information. Hearing observation and document research were used as complementarysources.The results of this research show that victims who have contact with the criminal justicesystem and victim services are not more likely to recover than those who had no contact. Thisis to say, the support offered has no major effects; the influence of the criminal justice systemand the victim support services in the emotional well-being of crime victims is rather neutral.However, considering that the sample is not representative, findings are not expected to begeneralized. Instead, findings may give insight to practitioners or to future criminal justicepolicy makers, suggesting what may work to improve the emotional well-being of crimevictims, as well as suggesting further studies.________________________________________________________________________________RÉSUMÉAprès la deuxième guerre mondiale, le rôle de la victime est devenu un objet d'intérêtpour les académiciens. Par contre, c'est seulement dans les années 60 que l'importance defournir de la protection et de l'appui aux victimes d'infractions a été accentuée, en particulierpar un mouvement ― victims' mouvement ―, qui a inauguré un nouveau temps dans lajustice pénale des systèmes juridiques du monde entier. A part la fonction de contrôler lecrime et de punir le délinquant, le système de justice pénale joue également un rôle dans laréhabilitation des victimes.Malgré la réalisation de plusieurs recherches criminologiques sur ce sujet, les effets que lesystème de la justice pénale et les centres d'aides aux victimes ont sur le bien-être desvictimes d'infractions est encore incertain.Ainsi cette étude cherche à mieux comprendre le processus de réhabilitation des victimesd'infraction, les conséquences de leur participation dans le système de justice pénale ainsique la portée de l'appui des centres d'aide. De plus, l'étude vise à découvrir si l'existenced'une loi d'aide aux victimes, particulièrement la Loi d'Aide aux Victimes d'InfractionsLAVI, est susceptible de changer le traitement que la victime reçoit dans le système de lajustice pénale. Pour cela, elle a été conduite dans deux pays - la Suisse et le Brésil - où lesconséquences du mouvement des victimes sur le système de la justice pénale a eu undéveloppement différent; il en va de même pour la participation de la victime dans laprocédure pénale et pour l'appui offert par l'Etat.Cette étude utilise la méthode qualitative qui est la plus efficace pour le recueild'informations sensibles. La plus importante source des données sont les interviews avec lesvictimes. L'observation des audiences et l'analyse de documents ont été utilisés en tant quesources d'information complementáire.Les résultats de cette recherche montrent que les victimes qui ont porté plainte et qui ontreçu l'appui des centres d'aides ne sont pas mieux rétablies que celles qui n'ont rien fait. C'estainsi que nous avons conclu que les services offerts n'ont aucune influence dans ce processus.Cependant, considérant que notre échantillon n'est pas représentatif, il n'est pas possible degénéraliser nos résultats. Néanmoins, ceux-ci peuvent éclairer les praticiens ou les futursdécideurs politiques de la justice pénale, suggérant ce qui peut fonctionner pour lerétablissement des victimes d'infraction, aussi bien que suggérer d'autres études.

Training in flexible intensive insulin therapy improves quality of life, decreases the risk of hypoglycaemia and ameliorates poor metabolic control in patients with type 1 diabetes.

AIM: Intensified insulin therapy has evolved to be the standard treatment of type 1 diabetes. However, it has been reported to increase significantly the risk of hypoglycaemia. We studied the effect of structured group teaching courses in flexible insulin therapy (FIT) on psychological and metabolic parameters in patients with type 1 diabetes. METHODS: We prospectively followed 45 type 1 diabetic patients of our outpatient clinic participating in 5 consecutive FIT teaching courses at the University Hospital of Basel. These courses consist of 7 weekly ambulatory evening group sessions. Patients were studied before and 1, 6, and 18 months after the course. Main outcome measures were glycated haemoglobin (HbA1c), severe hypoglycaemic events, quality of life (DQoL), diabetes self-control (IPC-9) and diabetes knowledge (DWT). RESULTS: Quality of life, self-control and diabetes knowledge improved after the FIT courses (all p<0.001). The frequency of severe hypoglycaemic events decreased ten-fold from 0.33 episodes/6 months at baseline to 0.03 episodes/6 months after 18 months (p<0.05). Baseline HbA1c was 7.2+/-1.1% and decreased in the subgroup with HbA1c > or = 8% from 8.4% to 7.8% (p<0.05). CONCLUSIONS: In an unselected, but relatively well-controlled population of type 1 diabetes, a structured, but not very time consuming FIT teaching programme in the outpatient setting improves psychological well-being and metabolic parameters.

Non-traumatic spinal cord ischaemia in childhood - clinical manifestation, neuroimaging and outcome.

BACKGROUND: Spinal cord ischaemia is rare in childhood and information on clinical presentation and outcome is scarce. METHODS: This is a retrospective analysis of eight patients and 75 additional cases from the literature. Data search included: patient's age, primary manifestation, risk factors, neuroimaging and outcome. RESULTS: Five female and three male patients gave consent to participate. Mean age was 12.5 years (10-15 years). Six patients presented with paraplegia; this was preceded by pain in four. Brown Sequard syndrome and quadriparesis were the two others' presenting condition. Sensation levels were thoracolumbar in seven cases. Bladder dysfunction only or bladder and bowel dysfunction were reported in eight and five patients respectively. Time to maximal symptom manifestation was <12 h in 7/8. Risk factors included surgery, minor trauma, recent infection, and thrombophilia. Mean follow-up was 3.3 years (0.25-6.3 years). Three patients remained wheelchair-dependent and three patients were ambulatory without aid. Bladder function recovered fully in five children. Most affected aspects of quality of life were physical and mental well-being and self-perception. T2-weighted-MR images showed pencil-like hyperintensity (8/8) in sagittal and H-shaped or snake-eyes-like lesion (6/8) in axial views. Analyses of all 83 patients were in congruence with the above results of the study group. CONCLUSION: Spinal cord ischaemia in childhood presenting with pain, paraplegia, and bladder dysfunction has high morbidity concerning motor problems and quality of life. Acute arterial ischaemic event in children seems similar to adult events with respect to clinical presentation and, surprisingly, also in outcome.

Le regard d'un psychiatre sur les écrits de la folie : la carrière de Hans Steck à l'Asile psychiatrique de Cery (1920-1960)

Quelles représentations de la schizophrénie les psychiatres vont-ils construire à travers l'étude des écrits asilaires des patients et des scientifiques dans la première moitié du XXème siècle? Le psychiatre helvétique Hans Steck (1891-1980), qui a travaillé à l'Asile psychiatrique de Cery de 1920 à 1960 et qui s'est fait connaître du public grâce à l'oeuvre d'Aloïse Corbaz, reconnue comme auteure d'art brut par Jean Dubuffet en 1945, constitue le fil rouge de la thèse. Dans le contexte des mouvements tels que Γ "art psychopathologique" et Γ "art brut", Steck étudie les théories de "la mentalité primitive et les peintures magiques des schizophrènes". En 1927, il se tourne vers les théories évolutionnistes de la régression et les premières études de Lévy-Bruhl pour avancer l'idée qu'il existe un "parallélisme schizo-primitif'. Puis il développe des explications de la pensée délirante, à partir des théories exposées lors du Premier Congrès International de Psychiatrie en 1950. Enfin, adoptant la perspective phénoménologique, il explique que "la fonction de l'art et la fonction du délire visent à reconstituer un monde viable pour le malade". En ce sens, l'expression artistique, bien que n'entrant pas dans le champ de la psychothérapie, fournit des indicateurs de l'état psychique du malade en même temps qu'elle contribue à son bien-être. Sont abordés les problèmes concernant la reconnaissance de Γ "auteur" interné, dont les oeuvres appartiennent soit aux archives médicales, soit au musée. La pérennité des critères qui définissent les oeuvres d'"art psychopathologique" ou d'"art brut" est également mise en question. Enfin, le rôle essentiel de l'écriture à l'hôpital, tant pour les patients que pour les soignants, fait l'objet de nombreux développements. - What representations of schizophrenia have psychiatrists been constructing when studying writings by patients and scientists in mental asylums in the first half of the 20th century? The Swiss psychiatrist Hans Steck (1891-1980) is the protagonist of this dissertation. From 1920 to 1960, he has been working at the "Asile psychiatrique de Cery" near Lausanne. Steck is known thanks to the paintings of Aloïse Corbaz, an artist recognized by Jean Dubuffet as belonging to the "art brut" movement in 1945. In the context of movements like "art psychopathologique" and "art brut," Steck studies theories of "primitive character and magic paintings of schizophrenics." In 1927, Steck engages with theories of regression and Lévy-Bruhl's early studies in order to push the idea of a "parallelism schizo-primitif." On the occasion of the First International Congress of psychiatry held in Paris in 1950, Steck develops explanations for the "pensée délirante." Finally, turning to a phenomenological point of view, he explains, "the function of art and the function of the delusion help the patient to reconstruct a viable environment for the sick person." In this way, artistic expression is not thought of as a psychotherapeutical means, but provides insight into the state of mind of a mentally sick person at the same time as contributing to his well-being. The dissertation discusses whether the "author's" work belongs in medical archives or museums. The continuity of "psychopathological art" and "art brut" criteria will be discussed. Finally, the essential role that writing played in the hospital for the patients as well as for the medical staff is presented.

Chronic illness, life style and emotional health in adolescence: results of a cross-sectional survey on the health of 15-20-year-olds in Switzerland.

The objective was to evaluate the prevalence of chronic conditions (CC) in adolescents in Switzerland; to describe their behaviour (leisure, sexuality, risk taking behaviour) and to compare them to those in adolescents who do not have CC in order to evaluate the impact of those conditions on their well-being. The data were obtained from the Swiss Multicentre Adolescent Survey on Health, targeting a sample of 9268 in-school adolescents aged 15 to 20 years, who answered a self-administered questionnaire. Some 11.4% of girls and 9.6% of boys declared themselves carriers of a CC. Of girls suffering from a CC, 25% (versus 13% of non carriers; P=0.007) and 38% of boys (versus 25%; P=0.002) proclaimed not to wear a seatbelt whilst driving. Of CC girls, 6.3% (versus 2.7%; P=0.000) reported within the last 12 months to have driven whilst drunk. Of the girls, 43% (versus 36%; P=0.004) and 47% (versus 39%; P=0.001) were cigarette smokers. Over 32% of boys (versus 27%; P=0.02) reported having ever used cannabis and 17% of girls (versus 13%; P=0.013) and 43% of boys (versus 36%; P=0.002) admitted drinking alcohol. The burden of their illness had important psychological consequences: 7.7% of girls (versus 3.4%; P=0.000) and 4.9% of boys (versus 2.0%; P=0.000) had attempted suicide during the previous 12 months. CONCLUSION: experimental behaviours are not rarer in adolescents with a chronic condition and might be explained by a need to test their limits both in terms of consumption and behaviour. Prevention and specific attention from the health caring team is necessary.

Acknowledgment and health in police officers

The way colleagues and supervisors acknowledge specific contribution and efforts of individuals is crucial for occupational mental health and well being. It contributes to improve the self image of employees and it gives a sense to the activities performed. We carried out a study about occupational health in police officers with a special emphasis on acknowledgment and reward. A questionnaire was sent to 1000 police officers working for a cantonal administration in Switzerland. In total, 695 participants answered the questionnaire. We used the French version of the Langner's questionnaire on psychiatric symptoms to identify cases characterized by potential mental health problems. Multiple choice items (6 modalities ranging from "not at all" to "tremendously") to measure acknowledgment were used. Answers were later dichotomized (low annoyance- high annoyance). Questions we used are: "Do you feel annoyed due to a lack of support and attention from your supervisors?" "Do you feel annoyed because the authorities (politics, judges, etc.) have a low consideration of your occupation?" "Do you feel annoyed due to a low appreciation by the public?" and "Do you feel annoyed due to a lack of acknowledgment by the hierarchy?". The score for psychiatric symptoms was high for 86 police officers for whom health might be at risk. Acknowledgment aspects associated with a high score for psychiatric symptoms are : high annoyance due to a lack of support and attention from supervisors (odds ratio [OR] 3.2, 95% confidence interval [CI] 2.0 to 5.1), high annoyance because authorities seems to have a low consideration for police officers (OR 2.7, 95% CI 1.7 to 4.3), high annoyance due to a low appreciation by the public (OR 1.8, 95% CI 1.2 to 2.9), and high annoyance due to a lack of acknowledgment by the hierarchy (OR 3.0, 95% CI 1.9 to 4.8). Preserving mental health in occupations characterized by high emotional demand is challenging. The results from our study suggest that appropriate acknowledgment might contribute to the prevention of mental health problems. Further research should address a potential causal relation of acknowledgment on mental health.

Physical activity and pregnancy: cardiovascular adaptations, recommendations and pregnancy outcomes.

Regular physical activity is associated with improved physiological, metabolic and psychological parameters, and with reduced risk of morbidity and mortality. Current recommendations aimed at improving the health and well-being of nonpregnant subjects advise that an accumulation of > or =30 minutes of moderate physical activity should occur on most, if not all, days of the week. Regardless of the specific physiological changes induced by pregnancy, which are primarily developed to meet the increased metabolic demands of mother and fetus, pregnant women benefit from regular physical activity the same way as nonpregnant subjects. Changes in submaximal oxygen uptake (VO(2)) during pregnancy depend on the type of exercise performed. During maternal rest or submaximal weight-bearing exercise (e.g. walking, stepping, treadmill exercise), absolute maternal VO(2) is significantly increased compared with the nonpregnant state. The magnitude of change is approximately proportional to maternal weight gain. When pregnant women perform submaximal weight-supported exercise on land (e.g. level cycling), the findings are contradictory. Some studies reported significantly increased absolute VO(2), while many others reported unchanged or only slightly increased absolute VO(2) compared with the nonpregnant state. The latter findings may be explained by the fact that the metabolic demand of cycle exercise is largely independent of the maternal body mass, resulting in no absolute VO(2) alteration. Few studies that directly measured changes in maternal maximal VO(2) (VO(2max)) showed no difference in the absolute VO(2max) between pregnant and nonpregnant subjects in cycling, swimming or weight-bearing exercise. Efficiency of work during exercise appears to be unchanged during pregnancy in non-weight-bearing exercise. During weight-bearing exercise, the work efficiency was shown to be improved in athletic women who continue exercising and those who stop exercising during pregnancy. When adjusted for weight gain, the increased efficiency is maintained throughout the pregnancy, with the improvement being greater in exercising women. Regular physical activity has been proven to result in marked benefits for mother and fetus. Maternal benefits include improved cardiovascular function, limited pregnancy weight gain, decreased musculoskeletal discomfort, reduced incidence of muscle cramps and lower limb oedema, mood stability, attenuation of gestational diabetes mellitus and gestational hypertension. Fetal benefits include decreased fat mass, improved stress tolerance, and advanced neurobehavioural maturation. In addition, few studies that have directly examined the effects of physical activity on labour and delivery indicate that, for women with normal pregnancies, physical activity is accompanied with shorter labour and decreased incidence of operative delivery. However, a substantial proportion of women stop exercising after they discover they are pregnant, and only few begin participating in exercise activities during pregnancy. The adoption or continuation of a sedentary lifestyle during pregnancy may contribute to the development of certain disorders such as hypertension, maternal and childhood obesity, gestational diabetes, dyspnoea, and pre-eclampsia. In view of the global epidemic of sedentary behaviour and obesity-related pathology, prenatal physical activity was shown to be useful for the prevention and treatment of these conditions. Further studies with larger sample sizes are required to confirm the association between physical activity and outcomes of labour and delivery.

Wage cuts and managers' empathy: How a positive emotion can contribute to positive organizational ethics in difficult times

Using the lens of positive organizational ethics, we theorized that empathy affects decisions in ethical dilemmas that concern the well-being of not only the organization but also other stakeholders. We hypothesized and found that empathetic managers were less likely to comply with requests by an authority figure to cut the wages of their employees than were non-empathetic managers. However, when an authority figure requested to hold wages constant, empathy did not affect wage cut decisions. These findings imply that empathy can serve as a safeguard for ethical decision making in organizations during trying times without generally undermining organizational effectiveness. We conclude by discussing the implications of our research.