Dépistage: principes et méthodes. [Screening: principles and methods].

The concept of early detection to then intervene and improve the prognostic seems straightforward. Applied to asymptomatic subjects, this concept--screening--is rather complex. This review presents the rational and fundamental principles of screening. It underscores the fundamental principles related to the disease and to the screening test considered, the importance of considering screening as a program rather than a test only, and the validity of measures used to evaluate the efficacy of screening. Lastly, it reviews the most frequently bias encountered in screening studies and interpretations.

Effects of a 5-h hilly running on ankle plantar and dorsal flexor force and fatigability.

This study aimed to examine the effects of a 5-h hilly run on ankle plantar (PF) and dorsal flexor (DF) force and fatigability. It was hypothesised that DF fatigue/fatigability would be greater than PF fatigue/fatigability. Eight male trail long distance runners (42.5 ± 5.9 years) were tested for ankle PF and DF maximal voluntary isokinetic contraction strength and fatigue resistance tests (percent decrement score), maximal voluntary and electrically evoked isometric contraction strength before and after the run. Maximal EMG root mean square (RMS(max)) and mean power frequency (MPF) values of the tibialis anterior (TA), gastrocnemius lateralis (GL) and soleus (SOL) EMG activity were calculated. The peak torque of the potentiated high- and low-frequency doublets and the ratio of paired stimulation peak torques at 10 Hz over 100 Hz (Db10:100) were analysed for PF. Maximal voluntary isometric contraction strength of PF decreased from pre- to post-run (-17.0 ± 6.2%; P < 0.05), but no significant decrease was evident for DF (-7.9 ± 6.2%). Maximal voluntary isokinetic contraction strength and fatigue resistance remained unchanged for both PF and DF. RMS(max) SOL during maximal voluntary isometric contraction and RMS(max) TA during maximal voluntary isokinetic contraction were decreased (P < 0.05) after the run. For MPF, a significant decrease for TA (P < 0.05) was found and the ratio Db10:100 decreased for PF (-6.5 ± 6.0%; P < 0.05). In conclusion, significant isometric strength loss was only detected for PF after a 5-h hilly run and was partly due to low-frequency fatigue. This study contradicted the hypothesis that neuromuscular alterations due to prolonged hilly running are predominant for DF.

Oui à la chasse au dopage pour la santé des athlètes et du sport [Sports and athletes deserve doping runting].

Cet article se veut une revue des effets ergogéniques et potentiellement délétères des principaux compléments alimentaires consommés par les sportifs populaires ou d'élite. De nombreux produits sont proposés sur le marché avec des allégations prometteuses, le plus souvent sans preuve scientifique sur leur validité ou leur innocuité. Les antioxydants n'augmentent ni la force ni l'endurance. La créatine améliore la capacité de récupération pour les exercices en intervalle anaérobie mais pas en course à pied ni en natation. L'hormone de croissance et les stéroïdes anabolisants augmentent la synthèse protéique et la masse maigre mais comportent des effets secondaires graves et souvent irréversibles. Les médecins, les diététiciens et les fédérations sportives ont un rôle important à jouer dans l'information et la prévention, afin d'éviter des attitudes néfastes pour la santé, pouvant même créer des addictions. This article reviews the evidence-based ergogenic potential adverse effects of the most common products in use by recreational and elite athletes today. This is an aggressively marketed and controversial area of sports medicine wordwide. It is therefore important for the scientific societies, clinicians, dieticians sports federations to be well versed in the more popular supplements and drugs in order to have an important role in information and prevention attitudes that can lead to health risks or addictions!

Roadway Lighting and Safety: Phase II – Monitoring Quality, Durability and Efficiency, November 2011

This Phase II project follows a previous project titled Strategies to Address Nighttime Crashes at Rural, Unsignalized Intersections. Based on the results of the previous study, the Iowa Highway Research Board (IHRB) indicated interest in pursuing further research to address the quality of lighting, rather than just the presence of light, with respect to safety. The research team supplemented the literature review from the previous study, specifically addressing lighting level in terms of measurement, the relationship between light levels and safety, and lamp durability and efficiency. The Center for Transportation Research and Education (CTRE) teamed with a national research leader in roadway lighting, Virginia Tech Transportation Institute (VTTI) to collect the data. An integral instrument to the data collection efforts was the creation of the Roadway Monitoring System (RMS). The RMS allowed the research team to collect lighting data and approach information for each rural intersection identified in the previous phase. After data cleanup, the final data set contained illuminance data for 101 lighted intersections (of 137 lighted intersections in the first study). Data analysis included a robust statistical analysis based on Bayesian techniques. Average illuminance, average glare, and average uniformity ratio values were used to classify quality of lighting at the intersections.

Penser la médecine communautaire s'apprend avec les pairs. [The spirit of community medicine: students learning from students].

At the University of Lausanne third-year medical students are given the task of spending a month investigating a question of community medicine. In 2009, four students evaluated the legitimacy of health insurers intervening in the management of depression. They found that health insurers put pressure on public authorities during the development of legislation governing the health system and reimbursement for treatment. This fact emerged during the scientific investigation led jointly by the team in the course of the "module of immersion in community medicine." This paper presents each step of their study. The example chosen illustrates the learning objectives covered by the module.

Promotion de l'activité physique au cabinet médical: où en sommes- nous en Suisse [Promotion of physical activity in the primary care setting: what is the situation in Switzerland?]

If many harmful effects of a sedentary lifestyle on health are well known, we still need to better understand how effectively promoting regular physical activity in the general population. Among the currently explored strategies, screening for sedentary lifestyle and promoting physical activity in the primary care setting seem promising. Despite recommendations from governmental agencies and professional associations in favor of physical activity counseling, this approach has not been widely adopted so far. This article summarizes the steps taken in Switzerland with an aim of developing physical activity counseling in the primary care setting. It describes how the early implication of primary care physicians influenced in a concrete way the development of a project dedicated to that task.

Measurement of multi-segment foot joint angles during gait using a wearable system.

Usually the measurement of multi-segment foot and ankle complex kinematics is done with stationary motion capture devices which are limited to use in a gait laboratory. This study aimed to propose and validate a wearable system to measure the foot and ankle complex joint angles during gait in daily conditions, and then to investigate its suitability for clinical evaluations. The foot and ankle complex consisted of four segments (shank, hindfoot, forefoot, and toes), with an inertial measurement unit (3D gyroscopes and 3D accelerometers) attached to each segment. The angles between the four segments were calculated in the sagittal, coronal, and transverse planes using a new algorithm combining strap-down integration and detection of low-acceleration instants. To validate the joint angles measured by the wearable system, three subjects walked on a treadmill for five minutes at three different speeds. A camera-based stationary system that used a cluster of markers on each segment was used as a reference. To test the suitability of the system for clinical evaluation, the joint angle ranges were compared between a group of 10 healthy subjects and a group of 12 patients with ankle osteoarthritis, during two 50-m walking trials where the wearable system was attached to each subject. On average, over all joints and walking speeds, the RMS differences and correlation coefficients between the angular curves obtained using the wearable system and the stationary system were 1 deg and 0.93, respectively. Moreover, this system was able to detect significant alteration of foot and ankle function between the group of patients with ankle osteoarthritis and the group of healthy subjects. In conclusion, this wearable system was accurate and suitable for clinical evaluation when used to measure the multi-segment foot and ankle complex kinematics during long-distance walks in daily life conditions.

Produção de cordeiros em pastagem de azevém e trevo-branco sob diferentes níveis de resíduos de forragem

Na presente pesquisa, objetivou-se analisar os efeitos de diferentes níveis de resíduos de forragem na produção de cordeiros. O experimento foi estabelecido em Tupanciretã, região do Planalto Médio do Estado do Rio Grande do Sul, em uma pastagem de azevém cv. Estanzuela 284 (Lolium multiflorum Lam) + trevo-branco cv. Yi (Trifolium repens L.), submetida a diferentes níveis de resíduo de matéria seca (RMS). O delineamento experimental utilizado foi o completamente casualizado, estudando-se os níveis de RMS mantidos na pastagem de 1.119, 1.320, 1.477, 1.695, 2.146, 2.166, 2.410 e 2.483 kg de matéria seca por hectare (MS/ha). O período experimental foi de 30/09 a 08/12/1992 e os animais utilizados foram cordeiros cruza Ile de France x Corriedale desmamados aos 80 dias. Foram avaliados o ganho de peso médio diário (GMD), ganho de peso vivo/ha (GPV/ha), carga animal, animais dia/ha e a eficiência de conversão de MS em kg de peso vivo de cordeiros. Os resultados obtidos mostraram uma relação linear positiva entre o GMD e GPV/ha com o aumento nos níveis de RMS/ha, observando-se nos níveis de RMS superiores a 2.400 kg um GMD de 0,12 kg/cordeiro/dia e um GPV/ha médio de 497 kg. Não houve relação quanto à carga animal e animais.dia/ha; verificou-se uma relação linear negativa entre a eficiência de conversão de MS com os níveis de RMS estudados. Os resultados demonstram o efeito dos níveis de RMS na resposta animal.

Comment tes médecins de famille prennent-ils en charge l'hypothyroïdie infraclinique [How do Swiss family physicians treat subclinical hypothyroidism?].

L'hypothyroïdie infraclinique est fréquemment rencontrée et sa prévalence augmente avec l'âge. Les recommandations relatives au dépistage et au traitement de l'hypothyroïdie infraclinique sont controversées. Une enquête internationale auprès des médecins de famille, à laquelle la Suisse a participé, a mis en évidence de fortes variations dans la prise en charge de l'hypothyroïdie infraclinique entre les pays. Ces différences de traitement traduisent avant tout le manque de données fiables quant à la prise en charge de cette condition. L'essai clinique randomisé européen TRUST devrait permettre de clarifier les indications pour le dépistage et la substitution par thyroxine. Une collaboration avec les médecins de famille et le soutien des Instituts universitaires de médecine générale à Lausanne et à Berne pour le recrutement des patients devraient permettre d'obtenir des données directement applicables à une population représentative de la médecine ambulatoire. Subclinical hypothyroidism is a common condition, and its prevalence increases with age. Currently, guidelines regarding the screening and treatment of subclinical hypothyroidism are controversial. An international survey of general practitioners (GPs), to which Swiss GPs also contributed, showed large inter-country variations in treatment strategies for subclinical hypothyroidism. These differences are mainly explained by the lack of strong evidence for the management of this condition. The European randomized-controlled clinical trial TRUST should help clarify recommendations for screening and thyroxin replacement for the elderly with subclinical hypothyroidism. Working in close collaboration with GPs in Switzerland for the recruitment of patients will ensure that the findings from this study will be applicable to primary care settings.

Dépistage et intervention brève par internet pour la consommation d'alcool a risque: www.alcooquizz.ch [Web-based screening and brief intervention for unhealthy alcohol use: www.alcooquizz.ch].

Many individuals with unhealthy alcohol use have few or no contact with the health care system and are therefore unlikely to receive information or a brief intervention from a health care professional. Consequently, many Internet-based interventions have been developed. These interventions can reach a large population. We present in this report www.alcooquizz.ch, a website providing tailored feedback and information on alcohol use and its consequences. In six months and a half, more than 15000 individuals visited the website. It appropriately targets individuals with unhealthy alcohol use and users' satisfaction was high. Internet is a valuable option to provide health related information and secondary prevention interventions for unhealthy alcohol use.

Utilité des outils d'aide à la prise médicamenteuse pour améliorer l'adhésion au traitement: revue Cochrane pour le praticien

Cet article présente les résultats de la revue systématique: Mahtani KR, Heneghan CJ, Glasziou PP, Perera R. Reminder packaging for improving adherence to self-administered long-term medications.Cochrane Database Syst Rev. 2011 Sep 7;(9):CD005025. PMID 21901694

Effects of prior repeated-sprints with different recovery duration on oxygen uptake kinetics during subsequent heavy-exercise

Introduction: Prior repeated-sprints (6) has become an interesting method to resolve the debate surrounding the principal factors that limits the oxygen uptake (V'O2) kinetics at the onset of exercise [i.e., muscle O2 delivery (5) or metabolic inertia (3)]. The aim of this study was to compare the effects of two repeated-sprints sets of 6x6s separated by different recovery duration between the sprints on V'O2 and muscular de-oxygenation [HHb] kinetics during a subsequent heavy-intensity exercise. Methods: 10 male subjects performed a 6-min constant-load cycling test (T50) at intensity corresponding to half of the difference between V'O2max and the ventilatory threshold. Then, they performed two repeated-sprints sets of 6x6s all-out separated by different recovery duration between the sprints (S1:30s and S2:3min) followed, after 7-min-recovery, by the T50 (S1T50 and S2T50, respectively). V'O2, [HHb] of the vastus lateralis (VL) and surface electromyography activity [i.e., root-mean-square (RMS) and the median frequency of the power density spectrum (MDF)] from VL and vastus medialis (VM) were recorded throughout T50. Models using a bi-exponential function for the overall T50 and a mono-exponential for the first 90s of T50 were used to define V'O2 and [HHb] kinetics respectively. Results: V'O2 mean value was higher in S1 (2.9±0.3l.min-1) than in S2 (1.2±0.3l.min-1); (p<0.001). The peripheral blood flow was increased after sprints as attested by a higher basal heart rate (HRbaseline) (S1T50: +22%; S2T50: +17%; p≤0.008). Time delay [HHb] was shorter for S1T50 and S2T50 than for T50 (-22% for both; p≤0.007) whereas the mean response time of V'O2 was accelerated only after S1 (S1T50: 32.3±2.5s; S2T50: 34.4±2.6s; T50: 35.7±5.4s; p=0.031). There were no significant differences in RMS between the three conditions (p>0.05). MDF of VM was higher during the first 3-min in S1T50 than in T50 (+6%; p≤0.05). Conclusion: The study show that V'O2 kinetics was speeded by prior repeated-sprints with a short (30s) but not a long (3min) inter-sprints-recovery even though the [HHb] kinetics was accelerated and the peripheral blood flow was enhanced after both sprints. S1, inducing a greater PCr depletion (1) and change in the pattern of the fibres recruitment (increase in MDF) compared with S2, may decrease metabolic inertia (2), stimulate the oxidative phosphorylation activation (4) and accelerate V'O2 kinetics at the beginning of the subsequent high-intensity exercise.

Evaluation of errors in alpine skiing video analysis

INTRODUCTION: Video records are widely used to analyze performance in alpine skiing at professional or amateur level. Parts of these analyses require the labeling of some movements (i.e. determining when specific events occur). If differences among coaches and differences for the same coach between different dates are expected, they have never been quantified. Moreover, knowing these differences is essential to determine which parameters reliable should be used. This study aimed to quantify the precision and the repeatability for alpine skiing coaches of various levels, as it is done in other fields (Koo et al, 2005). METHODS: A software similar to commercialized products was designed to allow video analyses. 15 coaches divided into 3 groups (5 amateur coaches (G1), 5 professional instructors (G2) and 5 semi-professional coaches (G3)) were enrolled. They were asked to label 15 timing parameters (TP) according to the Swiss ski manual (Terribilini et al, 2001) for each curve. TP included phases (initiation, steering I-II), body and ski movements (e.g. rotation, weighting, extension, balance). Three video sequences sampled at 25 Hz were used and one curve per video was labeled. The first video was used to familiarize the analyzer to the software. The two other videos, corresponding to slalom and giant slalom, were considered for the analysis. G1 realized twice the analysis (A1 and A2) at different dates and TP were randomized between both analyses. Reference TP were considered as the median of G2 and G3 at A1. The precision was defined as the RMS difference between individual TP and reference TP, whereas the repeatability was calculated as the RMS difference between individual TP at A1 and at A2. RESULTS AND DISCUSSION: For G1, G2 and G3, a precision of +/-5.6 frames, +/-3.0 and +/-2.0 frames, was respectively obtained. These results showed that G2 was more precise than G1, and G3 more precise than G2, were in accordance with group levels. The repeatability for G1 was +/-3.1 frames. Furthermore, differences among TP precision were observed, considering G2 and G3, with largest differences of +/-5.9 frames for "body counter rotation movement in steering phase II", and of 0.8 frame for "ski unweighting in initiation phase". CONCLUSION: This study quantified coach ability to label video in term of precision and repeatability. The best precision was obtained for G3 and was of +/-0.08s, which corresponds to +/-6.5% of the curve cycle. Regarding the repeatability, we obtained a result of +/-0.12s for G1, corresponding to +/-12% of the curve cycle. The repeatability of G2 and G3 are expected to be lower than the precision of G1 and the corresponding repeatability will be assessed soon. In conclusion, our results indicate that the labeling of video records is reliable for some TP, whereas caution is required for others. REFERENCES Koo S, Gold MD, Andriacchi TP. (2005). Osteoarthritis, 13, 782-789. Terribilini M, et al. (2001). Swiss Ski manual, 29-46. IASS, Lucerne.