The reception of public health messages during the COVID-19 pandemic.

Understanding the reception of public health messages in public-facing communications is of key importance to health agencies in managing crises, pandemics, and other health threats. Established public health communications strategies including self-efficacy messaging, fear appeals, and moralising messaging were all used during the Coronavirus pandemic. We explore the reception of public health messages to understand the efficacy of these established messaging strategies in the COVID-19 context. Taking a community-focussed approach, we combine a corpus linguistic analysis with methods of wider engagement, namely, a public survey and interactions with a Public Involvement Panel to analyse this type of real-world public health discourse. Our findings indicate that effective health messaging content provides manageable instructions, which inspire public confidence that following the guidance is worthwhile. Messaging that appeals to the audience's morals or fears in order to provide a rationale for compliance can be polarising and divisive, producing a strongly negative emotional response from the public and potentially undermining social cohesion. Provenance of the messaging alongside text-external political factors also have an influence on messaging uptake. In addition, our findings highlight key differences in messaging uptake by audience age, which demonstrates the importance of tailored communications and the need to seek public feedback to test the efficacy of messaging with the relevant demographics. Our study illustrates the value of corpus linguistics to public health agencies and health communications professionals, and we share our recommendations for improving the public health messaging both in the context of the ongoing pandemic and for future novel and re-emerging infectious disease outbreaks.

The language of vaccination campaigns during COVID-19.

Understanding what makes communication effective when designing public health messages is of key importance. This applies in particular to vaccination campaigns, which aim to encourage vaccine uptake and respond to vaccine hesitancy and dispel any myth or misinformation. This paper explores the ways in which the governments of Great Britain (England, Scotland and Wales) promoted COVID-19 vaccination as a first-line strategy and studies health message effectiveness by examining the language of official vaccination campaigns, vaccine uptake across the different nations and the health message preferences of unvaccinated and vaccine sceptic individuals. The study considers communications beginning at the first lockdown until the point when daily COVID-19 updates ended for each nation. A corpus linguistic analysis of official government COVID-19 updates is combined with a qualitative examination of the expression of evaluation in governmental discourses, feedback from a Public Involvement Panel and insights from a nationally representative survey of adults in Great Britain to explore message production and reception. Fully vaccinated, unvaccinated and sceptic respondents showed similar health messaging preferences and perceptions of health communication efficacy, but unvaccinated and sceptic participants reported lower levels of compliance for all health messages considered. These results suggest that issues in health communication are not limited to vaccination hesitancy, and that in the future, successful vaccination campaigns need to address the determining factors of public attitudes and beliefs besides communication strategies.

Representing Behavioral Pathology: The Importance of Modality in Medical Descriptions of Conduct, ADHD as Case Study.

This paper examines the role of modality resources (e.g. "may," "often") in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in representing behavioral pathology focusing, in particular, on Attention Deficit Hyperactivity Disorder (ADHD). ADHD diagnosis requires reports of non-practitioners (e.g. carers and teachers); an effective understanding of behavioral descriptors by the lay community is thus of paramount importance. The study combines qualitative linguistic discourse analysis and a corpus approach to study the presence and functions of modality, adopting a Systemic Functional perspective toward language. The study argues that in the DSM-5 modality is an important linguistic resource for conveying clinical significance, inferred from graduations of recurrence and probability. However, adopting features of professional discourse in representing behavioral pathology for non-experts, especially when those resources are inherently evaluative, stresses the need of health literacy among the lay social community and accessibility in health communication materials, particularly when non-practitioners are involved in the diagnosis practice.

What biomarkers explain about pterygium OCT pattern.

BACKGROUND: Optical coherence tomography (OCT) has become a very useful tool to study in vivo different ocular structures and to improve differential diagnosis and management of many ocular pathologies. This study aims to identify pterygium alterations that trigger characteristic OCT images, and analyze if this pattern correctly demarcates lesion boundary. METHODS: Thirty-two patients, 22 men, and ten women, aged between 26 and 56 (mean age 40.5 ± 6.9) with symptomatic primary pterygium were recruited. After excision, lesion images were obtained by high-definition OCT. Specimens were stained with hematoxylin­eosin (H&E), antivimentin for all mesenchymal origin cells and altered limbal basal cells, CD45 for lymphocyte and macrophage cells, CD1a for Langerhans cells, and S100 for melanocyte and Langerhans cells. RESULTS: The typical OCT wedge-shape hyperreflective mass was evident only by vimentin antibody and included, mainly, fibroblasts but also immune cells (verified by CD45) in a rich network of collagen fibers. The mass apex, often extended centripetally as a thin subepithelial line, hyperreflective by OCT, was formed by a row of fibroblasts under an apparently intact Bowman's layer, as vimentin samples revealed. Hyperreflective epithelium overlying the mass showed a great number of vimentin-positive infiltrated cells such as melanocytes, Langerhans cells, and lymphocytes (identified by the other biomarkers). H&E staining revealed the presence of goblet cells. Nevertheless, only vimentin staining revealed the presence of altered basal cells above partially dissolved or apparently intact Bowman's layer, coinciding in this last case with the fibroblast subepithelial line. In most of the cases (72 %), the altered cells occupied a basal segment shorter than the fibroblast subepithelial line but in some specimens, these cells exceeded the fibroblast line length. CONCLUSIONS: This study demonstrated the great visual accordance between pterygium OCT images and vimentin staining. Alteration in collagen arrangement, infiltration of inflammatory cells, and fibroblast subepithelial line in the lesion apex were the main histological changes responsible for the anomalous hyperreflectivity of the OCT pattern. By contrast, altered basal cells located in the basal epithelial layer of the pterygium head could not be detected by OCT, which might generate lesion size underestimation.

Conjunctival Short-term Evolution after Pterygium Excision.

PURPOSE: To analyze conjunctival cytological features 1 month after pterygium excision using limbo-conjunctival autograft (LCA) with and without intraoperative mitomycin C and to assess tissue short-term evolution in both situations. METHODS: Fifty-nine primary nasal pterygia from 59 patients were excised with LCA. Twenty-nine were treated with intraoperative mitomycin C 0.02% (MMC+) and 30 were treated without it (MMC-). Impression cytology was performed in nasal and temporal conjunctiva before and 1 month after the excision. Goblet cell density (GCD) and nucleus-to-cytoplasm nongoblet epithelial cell ratio were quantified. RESULTS: Surgical strategy comparisons (intergroup comparisons): All the preoperative data were, in mean, within the reference range, except for a slight goblet cell hyperplasia in the area of the lesion in MMC+ but no significant differences were found between the groups (p = 0.079 for GCD and p = 0.245 for nucleus-to-cytoplasm ratio; analysis of variance). Clinically relevant differences after surgery were only shown in nasal GCD that was significantly lower in MMC+ than in MMC- (p = 0.000; analysis of variance), with the mean value in MMC+ slightly below normal values whereas that in MMC- remained normal. Tissue evolution (intragroup comparisons): No clinically relevant changes were found in MMC-. Data from MMC+ displayed no changes 1 month after surgery, except for nasal GCD that showed a significant reduction (p = 0.000; paired t test). Nevertheless, this GCD decrease was more modest than that previously described using mitomycin C without autograft, because in the present study, nasal GCD was not lower but similar to postoperative temporal data of the same eye (p = 0.164; paired t test). CONCLUSIONS: Limbo-conjunctival autograft is a good technique for conjunctiva early recovery. When mitomycin C was added, the GCD reduction was lower than described using other surgical techniques. Mitomycin C, in optimal concentration and exposure, associated with LCA could be a good clinical option to minimize pterygium recurrence.

Ocular discomfort in pterygium patients.

PURPOSE: To evaluate the relationship between ocular discomfort and pterygium clinical characteristics. METHODS: The ocular comfort index test was self-completed by 25 men and 15 women (age [mean ± SD], 43 ± 11 years) with primary pterygium. Pterygium corneal area (PCA) and limbal perimeter, course and bilaterality of the lesion, visibility of episcleral vessels, conjunctival hyperemia, and exposure to dry or dusty environments were assessed. Spearman correlation and multiple linear regression were performed to evaluate the relationship between ocular discomfort and pterygium clinical characteristics. RESULTS: Ocular discomfort was inversely correlated with PCA (ρ = -0.447, p < 0.01) and directly correlated with the exposure to dry or dusty environments (ρ = 0.324, p < 0.05). The other studied factors did not show any significant relationship with discomfort symptoms. The linear regression analysis identified PCA as the only factor that significantly influenced ocular discomfort (R = -0.404, p < 0.01). CONCLUSIONS: The findings confirm an inverse linear relationship between ocular discomfort and PCA, providing evidence of corneal sensitivity loss in these patients.

Tear osmolarity and ocular changes in pterygium.

PURPOSE: To determine abnormalities in tear osmolarity (TO), tear function, and impression cytology in patients with pterygium and to assess the relationship between the variables. METHODS: Thirty eyes from 30 patients with primary nasal pterygium and 30 eyes from 30 volunteers without ocular pathologies or dry eye symptoms were enrolled in the present study. TO test, tear ferning test, fluorescein tear breakup time, Schirmer test, and impression cytology of the conjunctiva were performed. Analysis of variance was applied for intergroup comparisons, and Pearson correlation was used to calculate the strength of relationships between the variables. A statistical significance level of P<0.05 was considered. RESULTS: Pterygium patients had significantly higher TO, lower crystallization percentage, and lower goblet cell density (GCD) than control patients. A weak but significant negative correlation seems to exist between TO and crystallization percentage (r=-0.425, P<0.01) and between TO and GCD (r=-0.295, P<0.05). CONCLUSION: There is evidence to suggest that pterygium appears to induce unfavorable conditions of increasing TO that could trigger alterations in tear crystallization and GCD. Being aware of TO changes seems essential to understand the complex relationship among pterygium, tear film functions, and ocular surface changes.

Effects of tear hyperosmolarity on conjunctival cells in mild to moderate dry eye.

PURPOSE: To analyze the effects of tear hyperosmolarity on conjunctival cells in mild to moderate dry eye. METHODS: Sixty-eight subjects (35 females and 33 males, mean age 43, S.D. 20.3, range 18-87 years) with symptoms of dry eye were enrolled in the study. Patients with severe dry eye or any other condition that induces ocular inflammation were excluded. The sample was divided into two groups according to the tear osmolarity cut-off value of 308 mOsmol L(-1) measured in the right eye of each patient. Impression cytology of the temporal interpalpebral conjunctiva was performed and goblet cell density, nucleus diameter, cytoplasm diameter and nucleus/cytoplasm ratio of epithelial cells quantitatively assessed. A battery of tear tests (ferning test, tear break-up time and Schirmer I test) was also carried out in order to more completely describe the groups and understand the process. Analysis of variance (anova) was applied to establish cytological and tear differences between hyperosmolar and normal tear osmolarity eyes. Pearson's correlation was calculated between the cytological variables and tear osmolarity. RESULTS: The normal tear osmolarity group included patients with symptoms of dry eye, grade 1-2 of squamous metaplasia, and a number of positive tear signs of dry eye ranging between 0 and 3. The hyperosmolar tear group included patients with symptoms of dry eye, grade 1-2 of squamous metaplasia with significantly lower values of nucleus diameter (F(1,66) = 4.3, p = 0.040), and a number of positive tear signs of dry eye ranging between 1 (hyperosmolar tear) and 4. Mean reflex secretion of tears was clearly normal in both groups but significantly lower (F(1,66) = 7.2, p = 0.009) in the hyperosmolar tear group. Significant correlations were established for tear osmolarity and goblet cell density (r(33) = 0.45, p = 0.006) and nucleus/cytoplasm ratio (r(33) = -0.44, p = 0.009) in the normal tear osmolarity group but not in the hyperosmolar tear group. CONCLUSIONS: Mild to moderate hyperosmolar tear conditions seem to lead to an initial reduction of the conjunctival cell nucleus before the cytoplasm diameter showed a clear tendency to enlarge. The relationship between tear osmolarity and conjunctival cell characteristics seems to be linear only in the normal tear osmolarity group. These results also provide a plausible link between lower reflex secretion of tears and hyperosmolarity.

Item by item analysis strategy of the relationship between symptoms and signs in early dry eye.

PURPOSE: The present study aimed at analyzing the relationship between several particular symptoms, risk factors or global questionnaire scores and some tear clinical signs in early dry eye patients. MATERIAL AND METHODS: A total of 77 volunteers were enrolled in the study without any prior classification, although patients with severe dry eye were excluded. Two questionnaires were used to assess ocular symptoms and risk factors, and clinical tear signs were evaluated with four tests (osmolarity, ferning, break-up time and the phenol red thread test). Multiple linear regression analysis was performed to determine the relative predictive value of each particular ocular symptom and risk factor, for each clinical sign. This analysis was repeated using symptoms and risk factors global scores. RESULTS: The symptom "eyes stuck shut in the morning" was the only predictor variable for the sign "ferning crystallization" (R = 0.228, p < 0.05) and "dryness" for "break-up time" (R = -0.315, p < 0.01). "Burning sensation" and "computer use for more than 3 h" were predictor variables for "tear osmolarity" (R = 0.342, p < 0.01), while "itching" and "female gender" were found to predict the outcomes of the "phenol red thread test" (R = -0.462, p < 0.05). Global questionnaire scores were not found to predict any tear clinical sign. CONCLUSIONS: The present findings support the informative value of exploring the associations between clinical signs, ocular symptoms and risk factors by following an item by item strategy rather than opting for global questionnaire scores.

Cornea, retina, and lens morphology in five Soricidae species (Soricomorpha: Mammalia).

We analyzed the cornea, retina, and lens of five species of Soricidae (pygmy shrew, Sorex minutus; common shrew, Sorex araneus; Millet's shrew, Sorex coronatus; water shrew, Neomys fodiens; greater white-toothed shrew, Crocidura russula) by light and electron microscopy. In all of these species, the corneal epithelium showed a dead cell layer, which may increase the refractive power of the cornea, thereby reducing the hypermetropy that would be expected in a small eye. Moreover, the anterior surface of the lens was more curved than the posterior, thus minimizing spherical aberrations. The thicker lens and its smaller radii of curvature indicated that Sorex species and N. fodiens have a higher refractive lens power than the most nocturnal species, C. russula. In addition, only in the retina cone inner segments of the most diurnal species (genus Sorex) did we find megamitochondria that might act as microlenses to enhance the efficiency of cones. In C. russula, the scarcity of cones and the relatively small yet abundant rod nuclei were found to be consistent with its habits. The flat lens and its more anterior arrangement, together with the lack of megamitochondria in the retina of C. russula, indicated that this species has less visual acuity than the other shrews studied here.

Giant mitochondria in the retina cone inner segments of shrews of genus Sorex (Insectivora, Soricidae).

The retinas of three species of shrews (Sorex araneus, S. coronatus, and S. minutus) were analyzed. Two kinds of photoreceptors were identified according to (among other characteristics) the traits of the mitochondria of their inner segments. The rod inner segments contained several round or oval mitochondria distributed longitudinally inside the ellipsoid. The cone inner segment showed a few mitochondria, which we classified as megamitochondria (maximum length = 4.22 microm in S. araneus, 5.68 microm in S. coronatus, and 2.42 microm in S. minutus). An analysis of serial thin sections in S. coronatus showed that these large organelles occurred in the apical and central portions of the ellipsoid. In the peripheral and basal regions of the ellipsoid, megamitochondria were frequently accompanied by smaller mitochondria. The giant mitochondria were irregular in form and densely packed, and a reduced cytosol was observed between each mitochondria. In general, they exhibited an electron-dense matrix and a complex system of cristae, which varied in length and array. In mammalian retina, megamitochondria have only been described in the ellipsoid of the tree shrews Tupaia glis and T. belangeri, two diurnal Scandentia with a rich-cone retina. In general terms, Sorex megamitochondria are morphologically very similar to those reported for Tupaia, especially in their arrangement in the cone ellipsoid. However, they differ in the orientation of the cristae. We propose that the ellipsoid of Sorex may serve two functions: as a source of energy for receptor cells, and as a device for improving the cone outer segment optics.