Public perception of dermatologists in France: results from a population-based national survey.

BACKGROUND: The public perception of dermatologists, highly relevant for implementing strategies to improve dermatological care, has been scarcely investigated in France, in regard to the background where the number of active dermatologists is continuously decreasing. OBJECTIVE: This study sought to investigate the French public's perception of dermatologists, as well as the physician-patient relationship in dermatology area. METHODS: A sample of 5000 inhabitants (aged ≥15-80 years) of Metropolitan France, seeking medical advice for a skin condition, were invited in July 2018 to fill in a digital structured questionnaire. RESULTS: The sample's gender ratio and geographical distribution proved representative of the French general population. Compared to 33.2% of respondents having consulted a general practitioner (GP), 20.6% had consulted a dermatologist over the past 12 months, the main reasons being a chronic skin condition (37%), surgical intervention (18%) and naevi check-up (15%). When confronted with acute skin problems, survey participants stated their GP was the first healthcare reference (54% of cases). This may be explained by two distinct phenomena: the declining demography of dermatologists and specific peculiarities of the French healthcare system. Contrarily, the dermatologist was the first care provider for chronic skin problems (47% of cases). On answering the question whether they were satisfied with their last dermatological consultation, 76% declared to be very satisfied/satisfied, vs. 24% dissatisfied/very dissatisfied. Some 78% were given a prescription at consultation end, considered efficacious by 91% and well tolerated by 98%. CONCLUSION: Our study findings underline the central role of dermatologists in skin care as valued and trusted care providers in France. Further educational and political strategies appear warranted to improve patient referral to dermatologists and decrease waiting times, thereby improving patients' well-being and satisfaction, as well as care quality provided.

Enhanced brain expression of genes related to cell proliferation and neural differentiation is associated with cortisol receptor expression in fishes.

Stress enhances or inhibits neurogenesis in mammals and some fish species. The link between the two processes is still unclear. Most studies have been performed in very specific stressful or altered environments. Despite the known inter-individual divergence in coping abilities within populations, the relationship between the stress axis and neurogenesis has never been addressed in unstressed individuals. Here we correlate brain expression of the pcna (proliferating cell nuclear antigen) and neurod1 (neurogenic differentiation factor 1) genes, two markers of neurogenesis, with transcripts of cortisol receptors in three fish species living in very distinct environments. Within the three species, individuals with the highest expression of neurogenesis genes were also those that expressed the high levels of cortisol receptors. Based on these correlations and the hypothesis that mRNA levels are proxies of protein levels, we hypothesize that within unstressed animals, individuals sensitive to cortisol perceive a similar environment to be more stimulating, leading to increased neurogenesis. Although it is difficult to determine whether it is sensitivity to cortisol that affects neurogenesis capacities or the opposite, the proposed pathway is a potentially fruitful avenue that warrants further mechanistic experiments.

Sex- and age-adjusted prevalence estimates of five chronic inflammatory skin diseases in France: results of the « OBJECTIFS PEAU ¼ study.

BACKGROUND: There are few population-based studies assessing the prevalence of skin diseases. OBJECTIVES: To estimate the prevalence of five chronic skin inflammatory diseases, i.e. atopic dermatitis (AD), psoriasis, alopecia areata (AA), vitiligo and hidradenitis suppurativa (HS) in France, using validated self-diagnostic questionnaires. METHODS: Population-based study using a representative sample of the French general population aged more than 15 years and sampling with replacement design. All participants were asked (ii) to fill in a specific questionnaire including socio-demographic characteristics, (ii) to declare if they have been diagnosed with one or more skin problem or skin diseases during their life, and (iii) to fill in five validated self-reported questionnaires for AD, psoriasis, AA, vitiligo and HS. RESULTS: A total of 20.012 adult participants responded to the questionnaire of whom 9760 were men (48.8%) and 10.252 (51.2%) were women. We identified a prevalence of 4.65% for AD (931 individuals), 4.42% for psoriasis (885 individuals), 1.04% for AA (210 individuals), 0.46% for vitiligo (93 individuals) and 0.15% for HS (29 individuals), respectively. LIMITATIONS: Questionnaire-based study and possible disease misclassifications. CONCLUSION: This is the largest population-based study aiming to estimate the prevalence of five chronic skin inflammatory diseases.

Inkjet Printing NiO-Based p-Type Dye-Sensitized Solar Cells.

Fabrication at low cost of transparent p-type semiconductors with suitable electronic properties is essential toward the scalability of many electronic devices, especially for photovoltaic and photocatalytic applications. In this context, the synthesis of mesoporous NiO films through inkjet printing of a sol-gel ink was investigated for the first time. Nickel chloride and Pluronic F-127, used as nickel oxide precursor and pore-forming agent, respectively, were formulated in a water/ethanol mixture to prepare a jettable ink for Dimatix printer. Multilayer NiO films were formed, and different morphologies could be obtained by playing on the interlayer thermal treatment. At low temperature (30 °C), a porous nanoparticulate-nanofiber dual-pore structure was observed. On the other hand, with a high temperature treatment (450 °C), nanoparticulate denser films without any dual structure were obtained. The mechanism for NiO formation during the final sintering step, investigated by means of X-ray photolectron spectroscopy, shows that a Ni(OH)2 species is an intermediate between NiCl2 and NiO. The different morphologies and thicknesses of the NiO films were correlated to their performance in a p-DSSC configuration, using a new push-pull dye (so-called "RBG-174") and an iodine-based electrolyte. Moreover, the positive impact of a nanometric NiOx layer deposited by spin-coating and introduced between FTO and the NiO mesoporous network is highlighted in the present work. The best results were obtained with NiOx/four layer-NiO mesoporous photocathodes of 860 nm, with a current density at the short circuit of 3.42 mA cm-2 (irradiance of 100 mW cm-2 spectroscopically distributed following AM 1.5).

Noble metal-free hydrogen-evolving photocathodes based on small molecule organic semiconductors.

Organic semiconductors have great potential for producing hydrogen in a sustainable and economically-viable manner because they rely on readily available materials with highly tunable properties. We demonstrate here the relevance of heterojunctions to the construction of H2-evolving photocathodes, exclusively based on earth-abundant elements. Boron subnaphthalocyanine chloride proved a very promising acceptor in that perspective. It absorbs a part of the solar spectrum complementary to α-sexithiophene as a donor, thus generating large photocurrents and providing a record onset potential for light-driven H2 evolution under acidic aqueous conditions using a nanoparticulate amorphous molybdenum sulfide catalyst.

Dermatosurgery: total quality management in a dermatology department.

BACKGROUND: Dermatosurgery (DS) is a growing sector in dermatology. Performance measurement is organized worldwide to improve the quality of health care. Clinical audit relies on self-assessment, comparison with guidelines, frames of references and implementation of improvement actions. OBJECTIVE: To assess the efficiency of our DS department. METHODS: A clinical audit focusing on the organization of the DS unit, patient routing, continuing medical education and training for students was conducted by two external auditors. After an initial evaluation, improvements were implemented and reassessed 1 year later by the same auditors. RESULTS: The audit resulted in the implementation of preoperative consultation, improved pre- and postoperative information leaflets for patients, standardizing of surgery reports, earmarking of funds for materials, and patient satisfaction survey. The training of residents was organized. CONCLUSION: This audit was a driving force for communication among the medical and paramedical teams and helped improve patient care and training of residents in DS. It also highlighted areas needing further improvement.

Unusual cases of adult intersexuality in the European eel Anguilla anguilla.

Two cases of intersexuality are reported for the first time in European eel, Anguilla anguilla (at the beginning of the silver eel stage), within 140 fish caught as glass eels in the south-west of France and reared in tanks at 17°C. Cysts containing spermatozoa were observed in ovaries with pre-vitellogenic oocytes. This feature is very uncommon, especially owing to the fact that male cells do not normally reach this stage in captivity, and an environmentally controlled transdifferentation process may not be excluded. Besides, the expression of the gonadal aromatase gene (cyp19a1a) was found to be higher in these 2 intersexual fish compared to normal females, although these results must be considered with caution since only 2 intersexual fish were available. A possible feminizing effect of this 'abnormal' upregulation of aromatase is discussed.

Experimental optimization of the optical and electrical properties of a half-wavelength-thick organic hetero-structure in a Micro-cavity.

In the context of progress towards the organic laser diode, we experimentally investigate the optical and electrical optimization of an OLED in a vertical λ/2 microcavity. The microcavity consists of a quarter-wavelength TiO2/SiO2 multilayer mirror, a half-wavelength-thick OLED and a semitransparent aluminum cathode. The Alq3/DCM2 guest-host system is used as the emitting layer. This study focuses on the design and the fabrication of a half-wavelength thick organic hetero-structure exhibiting a high current density despite both the thickness increase and the cathode thickness reduction. The emission wavelength, the line-width narrowing and the current-density are studied as a function of two key parameters: the hetero-structure optical thickness and the aluminum cathode thickness. The experimental results show that a 125 nm thick cavity OLED ended by a 20 nm thick aluminum cathode exhibits a resonance at 606 nm with a full width at half maximum of 11 nm, and with current-densities exceeding 0.5 A/cm². We show that even without a top high-quality-mirror the incomplete microcavity λ/2 OLED hetero-structure exhibits a clear modification of the spontaneous emission at normal incidence.

Effect of eucapnic hypoxia on bronchomotor tone and on the bronchomotor response to dry air in asthmatic subjects.

Because hypoxia has been shown to cause bronchoconstriction and to potentiate bronchomotor responsiveness in animals, we investigated whether hypoxia has similar effects in subjects with asthma. We measured specific airway resistance (SRaw; the mean of 5 sequential readings taken 30 s apart) before and immediately after each of 15 asthmatic subjects breathed a mixture of 8% O2 in N2 until hemoglobin saturation (SaO2; by ear oximetry) fell to 80% or less for at least 2 min. We maintained end-tidal CO2 at resting levels, the temperature of the inspirate at 22.0 +/- 1.1 degrees C, and the dew point at 18.5 +/- 1.6 degrees C (mean +/- SD). The SaO2 fell to 70 +/- 8%; minute ventilation rose to 28.4 +/- 8.5 L/min, and heart rate rose by 27 +/- 6 beats/min. The SRaw did not increase significantly in the group (baseline SRaw, 6.61 +/- 2.36; posthypoxia SRaw, 6.69 +/- 2.21 L X cm H2O/L/s) or in any subject. To determine if hypoxia increases bronchomotor responsiveness, we also compared the responses to eucapnic hyperpnea with dry air and with dry gas mixtures of 7 to 10% O2 in N2 in a randomized, double-blind sequence in 9 of the subjects. We measured SRaw in each subject before and after stepwise increases in minute ventilation, for 3 min at each level, until SRaw doubled or until the subject's maximal voluntary ventilation was achieved. The SaO2 fell to 82% or less at each level of ventilation with the hypoxic gas mixture. The 2 stimulus-response curves thus obtained did not differ in any subject.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of 0.25 ppm sulfur dioxide on airway resistance in freely breathing, heavily exercising, asthmatic subjects.

We sought to determine whether 0.25 ppm sulfur dioxide in filtered air causes bronchoconstriction when inhaled by freely breathing, heavily exercising, asthmatic subjects. Nineteen asthmatic volunteers exercised at 750 kilogram meters/min for 5 min in an exposure chamber that contained filtered air at ambient temperature and humidity or, on another day, filtered air plus 0.25 ppm sulfur dioxide. The order of exposure to sulfur dioxide and to filtered air alone was randomized, and the experiments were double-blinded. Specific airway resistance, measured by constant-volume, whole-body plethysmography, increased from 6.38 +/- 2.07 cm H2O X s (mean +/- SD) before exercise to 11.32 +/- 8.97 after exercise on days when subjects breathed filtered air alone and from 5.70 +/- 1.93 to 13.33 +/- 7.54 on days when subjects breathed 0.25 ppm sulfur dioxide in filtered air. The increase in specific airway resistance on days when subjects breathed 0.25 ppm sulfur dioxide was only slightly greater than on days when they breathed filtered air, but the difference was significant. To determine whether 0.25 ppm sulfur dioxide causes greater bronchoconstriction in asthmatic subjects exercising more vigorously, 9 subjects then repeated the experiment exercising at 1,000 instead of 750 kilogram meters/min. Specific airway resistance increased from 6.71 +/- 2.25 to 13.59 +/- 7.57 on days when subjects breathed filtered air alone and from 5.23 +/- 1.23 to 12.54 +/- 6.17 on days they breathed 0.25 ppm sulfur dioxide in filtered air. The increase in specific airway resistance on the 2 days was not significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

High-frequency ventilation lengthens expiration in the anesthetized dog.

We tested the response of nine barbiturate-anesthetized dogs to high-frequency ventilation (HFV) (40-55 ml tidal volumes at 15 Hz) while measuring and controlling lung volume and blood gases. When lung volume and PCO2 were held constant, six of the nine responded to HFV by lengthening expiration. In each of these six dogs the maximal response was apnea. The response was immediate. In submaximal responses only expiration was changed; inspiratory time and peak diaphragmatic electrical activity were unaffected. There was a variable effect on abdominal muscle activity. If mean expiratory lung volume was allowed to increase at the onset of HFV, the Hering-Breuer inflation reflex added to the response. The strength of the response depended on level of anesthesia and arterial PO2. Vagotomy abolished the response in all cases. We conclude that oscillation of the respiratory system reflexly prolongs expiration via mechanoreceptors, perhaps those in the lungs.

Effect of transrespiratory pressure on PETCO2-PaCO2 and ventilatory reflexes in humans.

Inspiratory muscle activity increases when lung volume is increased by continuous positive-pressure breathing in conscious human subjects (Green et al., Respir. Physiol. 35: 283-300, 1978). Because end-tidal CO2 pressure (PETCO2) does not change, these increases have not been attributed to chemoreflexes. However, continuous positive-pressure breathing at 20 cmH2O influences the end-tidal to arterial CO2 pressure differences (Folkow and Pappenheimer, J. Appl. Physiol. 8: 102-110, 1955). We have compared PETCO2 with arterial CO2 pressure (PaCO2). We have compared PETCO2 with arterial CO2 pressure (PaCO2) in healthy human subjects exposed to continuous positive airway pressure (10 cmH2O) or continuous negative pressure around the torso (-15 cmH2O) sufficient to increase mean lung volume by about 650 ml. The difference between PETCO2 and PaCO2 was not decreased, and we conclude that PETCO2 is a valid measure of chemical drive to ventilation in such circumstances. We observed substantial increases in respiratory muscle electromyograms during pressure breathing as seen previously and conclude this response must originate by proprioception. On average, the compensation of tidal volume thus afforded was complete, but the wide variability of individual responses suggests that there was a large cerebral cortical component in the responses seen here.