What are key factors influencing malnutrition screening in community-dwelling elderly populations by general practitioners? A large cross-sectional survey in two areas of France

BACKGROUND/OBJECTIVES

Malnutrition is associated with a high morbi-mortality in elderly populations and their institutionalization at an early stage. The incidence is well known despite being often under-diagnosed in primary care. General practitioners (GPs) have a key role in home care. What are the factors affecting malnutrition-screening implementation by French GPs?

SUBJECTS/METHODS

We conducted a cross-sectional survey in two areas in the southeast of France (Savoie and Isère). In May 2008, an anonymized survey was sent by e-mail and/or post to all GPs with a large clinical practice. Two months later, reminder letters were sent. Potential barriers were measured by dichotomous scale. On GPs' characteristics (socio-demographic, medical training, geriatric practice and knowledge), multiple regression logistic was performed to identify others factors affecting malnutrition screening.

RESULTS

In all, 493 GPs (26.85%) answered and 72.2% felt that malnutrition screening was useful although only 26.6% implemented it each year and 11.9% every 2-5 years. The main barriers to the implementation were patient selection (60.4%) and forgetting to screen (26.6%). Minor barriers were lack of knowledge (19.5%) or time (15%). New factors were identified: unsuitable working conditions (19.1%), insufficient motivation (6.8%) or technical support (7.2%). The quality of malnutrition information received was found to be the only promoter of annual screening (odds ratio=1.44 (1.087-1.919); P=0.011).

CONCLUSIONS

This survey is the first in France to reveal GPs' factors affecting malnutrition implementation. New obstacles were identified in this survey. The hope of implementing regular malnutrition screening by GPs seems to lie with the quality of malnutrition information received.

Unexpected novel relational links uncovered by extensive developmental profiling of nuclear receptor expression

Nuclear receptors (NRs) are transcription factors that are implicated in several biological processes such as embryonic development, homeostasis, and metabolic diseases. To study the role of NRs in development, it is critically important to know when and where individual genes are expressed. Although systematic expression studies using reverse transcriptase PCR and/or DNA microarrays have been performed in classical model systems such as Drosophila and mouse, no systematic atlas describing NR involvement during embryonic development on a global scale has been assembled. Adopting a systems biology approach, we conducted a systematic analysis of the dynamic spatiotemporal expression of all NR genes as well as their main transcriptional coregulators during zebrafish development (101 genes) using whole-mount in situ hybridization. This extensive dataset establishes overlapping expression patterns among NRs and coregulators, indicating hierarchical transcriptional networks. This complete developmental profiling provides an unprecedented examination of expression of NRs during embryogenesis, uncovering their potential function during central nervous system and retina formation. Moreover, our study reveals that tissue specificity of hormone action is conferred more by the receptors than by their coregulators. Finally, further evolutionary analyses of this global resource led us to propose that neofunctionalization of duplicated genes occurs at the levels of both protein sequence and RNA expression patterns. Altogether, this expression database of NRs provides novel routes for leading investigation into the biological function of each individual NR as well as for the study of their combinatorial regulatory circuitry within the superfamily.

NRs are key molecules controlling development, metabolism, and reproduction in metazoans. Since NRs are implicated in many human diseases such as cancer, metabolic syndrome, and hormone resistance, they are important pharmaceutical targets and are under intense scrutiny to better understand their biological functions. In the present study, we determined the expression patterns of all NR genes as well as their main transcriptional coregulators during zebrafish development. We used zebrafish because the transparency of its embryo allows us to perform whole-mount in situ hybridization from early development to late organogenesis. This complete developmental profiling offers an unprecedented view of NR expression during embryogenesis, uncovering their potential function during central nervous system and retina formation. We observed that in contrast to NR genes, only a few coregulators exhibit a restricted expression pattern, suggesting that tissue specificity of hormone action is conferred more by the receptors than by their coregulators. Lastly, by evolutionary analysis of expression pattern divergence of duplicated genes, we observed that neofunctionalization occurs at the levels of both protein sequence and mRNA expression patterns. Taken together, our data provide the starting point for functional analysis of an entire gene family during development and call for the study of the intersection between metabolism and development.

Glypicans shunt the Wingless signal between local signalling and further transport

The two glypicans Dally and Dally-like have been implicated in modulating the activity of Wingless, a member of the Wnt family of secreted glycoprotein. So far, the lack of null mutants has prevented a rigorous assessment of their roles. We have created a small deletion in the two loci. Our analysis of single and double mutant embryos suggests that both glypicans participate in normal Wingless function, although embryos lacking maternal and zygotic activity of both genes are still capable of transducing the signal from overexpressed Wingless. Genetic analysis of dally-like in wing imaginal discs leads us to a model whereby, at the surface of any given cell of the epithelium, Dally-like captures Wingless but instead of presenting it to signalling receptors expressed in this cell, it passes it on to neighbouring cells, either for paracrine signalling or for further transport. In the absence of dally-like, short-range signalling is increased at the expense of long-range signalling (reported by the expression of the target gene distalless) while the reverse is caused by Dally-like overexpression. Thus, Dally-like act as a gatekeeper, ensuring the sharing of Wingless among cells along the dorsoventral axis. Our analysis suggests that the other glypican, Dally, could act as a classical co-receptor.

The axolotl (Ambystoma mexicanum), a neotenic amphibian, expresses functional thyroid hormone receptors

Neotenic amphibians such as the axolotl (Ambystoma mexicanum) are often unable to undergo metamorphosis under natural conditions. It is thought that neoteny represents a deviation from the standard course of amphibian ontogeny, affecting the thyroid axis at different levels from the central nervous system to peripheral organs. Thyroid hormone receptors (TRs) that bind the thyroid hormone (TH) T(3) have been described in axolotl. However, the full sequences of TR were needed to better characterize the TH response and to be able to assess their functional capacity at the molecular level. We report that each of the alpha and beta axolotl TRs bind both DNA and TH, and they activate transcription in response to TH in a mammalian cell-based transient transfection assay. Moreover, both TRs are expressed in axolotl tissues. Interestingly, each TR gene generates alternatively spliced isoforms, harboring partial or total deletions of the ligand-binding domain, which are expressed in vivo. Further, we found that in the axolotl, TH regulates the expression of stromelysin 3 and collagenase 3, which are TH target genes in Xenopus. Taken together, these results suggest that axolotl TRs are functional and that the molecular basis of neoteny in the axolotl is not linked to a major defect in TH response in peripheral tissues.

Molecular cloning and developmental expression patterns of thyroid hormone receptors and T3 target genes in the turbot (Scophtalmus maximus) during post-embryonic development

Thyroid hormones (TH) are pleiotropic factors important for many developmental and physiological functions in vertebrates and particularly in amphibian metamorphosis. Their effects are mediated by two specific receptors (TRalpha and TRbeta), which are ligand-dependent transcription factors, members of the nuclear hormone receptor superfamily. Besides their pivotal role in amphibian metamorphosis, TH are also critical for fish metamorphosis. As this later role of TH is less studied, we analyzed their action in the turbot (Scophtalmus maximus), a metamorphosing flat fish. We describe the isolation of sequences for the turbot orthologs of a number of Xenopus genes, which are induced during amphibian metamorphosis. Developmental expression of these genes during turbot metamorphosis was studied by several methods and the expression patterns of these genes compared with those in Xenopus and flounder. We find that the period between the onset and the end of eye migration (day 22 to day 30 post-hatching) most likely corresponds to the metamorphic climax with either high TRalpha or high TH levels. Our results show that in contrast to amphibians, it is TRalpha and not TRbeta mRNA that is up-regulated during metamorphosis. Our results highlight the notion that TH regulates, through a rise of TR expression, a genetic cascade during turbot metamorphosis. The fact that TH regulates metamorphosis in amphibian and teleost fishes suggests that TH-regulated metamorphosis is a post-embryonic process conserved in most vertebrates.

Euteleost fish genomes are characterized by expansion of gene families

The presence of additional hox clusters in the zebrafish has led to the hypothesis that there was a whole genome duplication at the origin of modern fish. To investigate the generality of this assumption, we analyzed all available actinopterygian fish gene families, and sequenced nuclear receptors from diverse teleost fish. The origin and timing of duplications was systematically determined by phylogenetic analysis. More genes are indeed found in zebrafish than in mouse. This abundance is shared by all major groups of euteleost fish, but not by eels. Phylogenetic analysis shows that it may result from frequent independent duplications, rather than from an ancestral genome duplication. We predict two zebrafish paralogs for most mouse or human genes, thus expressing a note of caution in functional comparison of fish and mammalian genomes. Redundancy appears to be the rule in fish developmental genetics. Finally, our results imply that the outcome of genome projects cannot be extrapolated easily between fish species.

Molecular cloning and characterization of thyroid hormone receptors in teleost fish

Thyroid hormones are pleiotropic factors important for many developmental and physiological functions in vertebrates. Their effects are mediated by two specific receptors (TRalpha and TRbeta) which are members of the nuclear hormone receptor superfamily. To clarify the function of these receptors, our laboratory has started a comparative study of their role in teleost fish. This type of approach has been hampered by the isolation of specific clones for each fish species studied. In this report, we describe an efficient reverse transcription/PCR procedure that allows the isolation of large fragments corresponding to TRalpha and TRbeta of a wide range of teleost fish. Phylogenetic analysis of these receptors revealed a placement consistent with their origin, sequences from teleost fish being clearly monophyletic for both TRalpha and TRbeta. Interestingly, this approach allowed us to isolate (from tilapia and salmon) several new TRalpha or TRbeta isoforms resulting from alternative splicing. These isoforms correspond to expressed transcripts and thus may have an important physiological function. In addition, we isolated a cDNA encoding TRbeta in the Atlantic salmon (Salmo salar) encoding a functional thyroid hormone receptor which binds specific thyroid hormone response elements and regulates transcription in response to thyroid hormones.

Molecular characterization of the prolactin receptor in two fish species, tilapia Oreochromis niloticus and rainbow trout, Oncorhynchus mykiss: A comparative approach

We present recent information on the molecular characterization of the prolactin receptor (PRL-R) in two teleost species, tilapia (Oreochromis niloticus) and rainbow trout (Oncorhynchus mykiss), in the perspective of improved understanding of the physiological differences in the control of osmoregulatory function between these two fish species. Although our interest will mainly focus on osmoregulatory organs, we will also discuss evidence of the presence of PRL-R in other tissues such as gonads and hematopoietic organs. The first fish PRL-R was characterized in tilapia. This receptor is similar to that of the long form of mammalian PRL-R, but the most conserved region (extracellular domain) has only 53% identity with mammalian PRL-R. A rainbow trout PRL-R cDNA has been also isolated and appeared very similar in structure to tilapia PRL-R. Expression of the PRL-R gene was studied by Northern blotting for various tissues from tilapia and trout, and a unique transcript size of 3.2-3.4 kb was observed in all tissues studied (including male and female gonads, skin, brain, spleen, head, kidney, and circulating lymphocytes). Osmoregulatory organs (gills, kidney, intestine) were the richest tissues. Using in situ hybridization, PRL-R transcripts were localized in gill chloride cells, both in trout and tilapia. Analysis of PRL-R transcript levels in gills, kidney, and intestine indicated the maintenance of a high level of expression during adaptation to a hyperosmotic environment. These results support PRL being a pleiotropic hormone in fish and suggest the presence of a unique PRL-R form in tilapia and in trout. Finally, characterization of hormone receptor binding has been carried out in both species using a radioreceptor assay (in tilapia) or surface plasmon resonance (SPR) technology (in trout). These studies indicated the presence of a stable hormone-receptor complex in tilapia, while PRL binds to its receptor through an unstable homodimeric complex in trout. Thus, the characteristics of PRL binding on its receptor appear to be significantly different in tilapia and trout. Whether such differences may lead to different signal transduction mechanisms and osmoregulatory actions of PRL in these two euryhaline species merits further investigation.Key words: prolactin receptor, genetic expression, hormone-receptor interaction, surface plasmon resonance, fish osmoregulation.

Molecular characterization of the prolactin receptor in two fish species, tilapia Oreochromis niloticus and rainbow trout, Oncorhynchus mykiss: a comparative approach

We present recent information on the molecular characterization of the prolactin receptor (PRL-R) in two teleost species, tilapia (Oreochromis niloticus) and rainbow trout (Oncorhynchus mykiss), in the perspective of improved understanding of the physiological differences in the control of osmoregulatory function between these two fish species. Although our interest will mainly focus on osmoregulatory organs, we will also discuss evidence of the presence of PRL-R in other tissues such as gonads and hematopoietic organs. The first fish PRL-R was characterized in tilapia. This receptor is similar to that of the long form of mammalian PRL-R, but the most conserved region (extracellular domain) has only 53% identity with mammalian PRL-R. A rainbow trout PRL-R cDNA has been also isolated and appeared very similar in structure to tilapia PRL-R. Expression of the PRL-R gene was studied by Northern blotting for various tissues from tilapia and trout, and a unique transcript size of 3.2-3.4 kb was observed in all tissues studied (including male and female gonads, skin, brain, spleen, head, kidney, and circulating lymphocytes). Osmoregulatory organs (gills, kidney, intestine) were the richest tissues. Using in situ hybridization, PRL-R transcripts were localized in gill chloride cells, both in trout and tilapia. Analysis of PRL-R transcript levels in gills, kidney, and intestine indicated the maintenance of a high level of expression during adaptation to a hyperosmotic environment. These results support PRL being a pleiotropic hormone in fish and suggest the presence of a unique PRL-R form in tilapia and in trout. Finally, characterization of hormone receptor binding has been carried out in both species using a radioreceptor assay (in tilapia) or surface plasmon resonance (SPR) technology (in trout). These studies indicated the presence of a stable hormone-receptor complex in tilapia, while PRL binds to its receptor through an unstable homodimeric complex in trout. Thus, the characteristics of PRL binding on its receptor appear to be significantly different in tilapia and trout. Whether such differences may lead to different signal transduction mechanisms and osmoregulatory actions of PRL in these two euryhaline species merits further investigation.

DMRT1 expression during gonadal differentiation and spermatogenesis in the rainbow trout, Oncorhynchus mykiss

DMRT1 has been suggested to be the first conserved gene involved in sex differentiation found from invertebrates to human. To gain insight on its implication for fish gonadal differentiation, we cloned a DMRT1 homologue in the rainbow trout, Oncorhynchus mykiss (rtDMRT1), and showed that this gene is expressed during testicular differentiation, but not during ovarian differentiation. After 10 days of steroid treatment, expression was shown to be decreased in estrogen-treated male differentiating gonads but not to be restored in androgen-treated differentiating female gonads. This clearly reinforces the hypothesis of an important implication for DMRT1 in testicular differentiation in all vertebrates. In the adults a single 1.5 kb transcript was detected by Northern blot analysis in the testis, and its expression was found to be sustained throughout spermatogenesis and declined at the end of spermatogenesis (stage VI). Along with this expression in the testis we also detected by reverse transcriptase-polymerase chain reaction a slight expression in the ovary. We also obtained new DM-domain homologous sequences in fish, and their analysis suggest that at least four different genes bearing 'DM-domain' (DMRT genes) exist in fish just as in all vertebrate genomes.

An inherited functional circadian clock in zebrafish embryos

Circadian clocks are time-keeping systems found in most organisms. In zebrafish, expression of the clock gene Period3 (Per3) oscillates throughout embryogenesis in the central nervous system and the retina. Per3 rhythmic expression was free-running and was reset by light but not by the developmental delays caused by low temperature. The time of fertilization had no effect on Per3 expression. Per3 messenger RNA accumulates rhythmically in oocytes and persists in embryos. Our results establish that the circadian clock functions during early embryogenesis in zebrafish. Inheritance of maternal clock gene products suggests a mechanism of phase inheritance through ovogenesis.

[Family characteristics and the labor market in developed countries: a clear distinction between north and south]

The relationship between family characteristics and the labor market is explored using data concerning 15 OECD countries. Several distinct geographical groupings are identified, including the Mediterranean countries, Scandinavia, North America, and Japan and West Germany. Belgium, France, the Netherlands, and the United Kingdom occupy a middle ground and are less specifically defined. Furthermore, "the statistical map shows a strong relationship which manifests itself in two opposite ways. On the one hand, it shows the link between a traditional family structure and a weak integration of women in the working population (Spain, Ireland), and, on the other hand, it shows a close link between a divided family and the fact women have a paying job, often just part time (Sweden, Denmark)." (SUMMARY IN ENG AND SPA)