Austerity and its implications for immigrant health in France.

The ongoing economic crisis in France increasingly has affected immigrant rights, including access to health care. Consistent with a 2014 League Against Cancer survey, we identify the ways in which sickness produces a "double penalty" for immigrants with serious illness. Immigrants with chronic illnesses such as cancer, diabetes, and other debilitating conditions divert vital funds from daily needs to deal with sickness and loss of work while at the same time national austerity measures shred the state's traditional safety net of social services and support. We examine how immigrants strategize to manage financial exigencies, therapeutic itineraries and social relations in the face of these converging pressures. We base our findings on two studies related by this theme: an investigation of health inequalities in the Médoc region, in which 88 women, 44 of North African and Eastern European origin, were interviewed over a three-year period (2010-2013); and a three-year study (2014-2017) of West African immigrant women with breast cancer seeking treatment in the greater Paris region, 70 members of immigrant associations, and clinical personnel in three hospitals.

Blending Western Biomedicine with Local Healing Practices.

Western allopathic physicians working internationally might encounter allopathic colleagues who endorse local healing practices that are not scientifically supported and, hence, might pose harm to patients. Respect for the autonomy of local physicians and patients thus can conflict with the ethical principles of beneficence and nonmaleficence. In such a situation, it is advisable for Western allopathic physicians to communicate their concerns to local colleagues as equal partners. Making an effort to understand local meanings associated with a traditional therapy demonstrates one's respect for local cultural ideas and practices, even if one disagrees with that therapy, and is crucial to tailoring messages about clinical practice change. A realistic approach to cross-cultural clinical practice change seeks to reduce, rather than eliminate, harm.

Disease, risk, and contagion: French colonial and postcolonial constructions of "African" bodies.

In this article, we explore how sub-Saharan African immigrant populations in France have been constructed as risk groups by media sources, in political rhetoric, and among medical professionals, drawing on constructs dating to the colonial period. We also examine how political and economic issues have been mirrored and advanced in media visibility and ask why particular populations and the diseases associated with them in the popular imagination have received more attention at certain historical moments. In the contemporary period we analyze how the bodies of West African women and men have become powerful metaphors in the politics of discrimination prevalent in France, in spite of Republican precepts that theoretically disavow cultural and social difference.

Temporal modulation of ß-catenin signaling by multicellular aggregation kinetics impacts embryonic stem cell cardiomyogenesis.

Pluripotent stem cell differentiation recapitulates aspects of embryonic development, including the regulation of morphogenesis and cell specification via precise spatiotemporal signaling. The assembly and reorganization of cadherins within multicellular aggregates may similarly influence ß-catenin signaling dynamics and the associated cardiomyogenic differentiation of pluripotent embryonic stem cells (ESCs). In this study, dynamic changes in ß-catenin expression and transcriptional activity were analyzed in response to altered cell adhesion kinetics during embryoid body (EB) formation and differentiation. Modulation of intercellular adhesion kinetics by rotary orbital mixing conditions led to temporal modulation of T-cell factor/lymphoid enhancer-binding factor activity, as well as changes in the spatial localization and phosphorylation state of ß-catenin expression. Slower rotary speeds, which promoted accelerated ESC aggregation, resulted in the early accumulation of nuclear dephosphorylated ß-catenin, which was followed by a decrease in ß-catenin transcriptional activity and an increase in the gene expression of Wnt inhibitors such as Dkk-1. In addition, EBs that exhibited increased ß-catenin transcriptional activity at early stages of differentiation subsequently demonstrated increased expression of genes related to cardiomyogenic phenotypes, and inhibition of the Wnt pathway during the initial 4 days of differentiation significantly decreased cardiomyogenic gene expression. Together, the results of this study indicate that the expression and transcriptional activity of ß-catenin are temporally regulated by multicellular aggregation kinetics of pluripotent ESCs and influence mesoderm and cardiomyocyte differentiation.

The multiparametric effects of hydrodynamic environments on stem cell culture.

Stem cells possess the unique capacity to differentiate into many clinically relevant somatic cell types, making them a promising cell source for tissue engineering applications and regenerative medicine therapies. However, in order for the therapeutic promise of stem cells to be fully realized, scalable approaches to efficiently direct differentiation must be developed. Traditionally, suspension culture systems are employed for the scale-up manufacturing of biologics via bioprocessing systems that heavily rely upon various types of bioreactors. However, in contrast to conventional bench-scale static cultures, large-scale suspension cultures impart complex hydrodynamic forces on cells and aggregates due to fluid mixing conditions. Stem cells are exquisitely sensitive to environmental perturbations, thus motivating the need for a more systematic understanding of the effects of hydrodynamic environments on stem cell expansion and differentiation. This article discusses the interdependent relationships between stem cell aggregation, metabolism, and phenotype in the context of hydrodynamic culture environments. Ultimately, an improved understanding of the multifactorial response of stem cells to mixed culture conditions will enable the design of bioreactors and bioprocessing systems for scalable directed differentiation approaches.

Hydrodynamic modulation of embryonic stem cell differentiation by rotary orbital suspension culture.

Embryonic stem cells (ESCs) can differentiate into all somatic cell types, but the development of effective strategies to direct ESC fate is dependent upon defining environmental parameters capable of influencing cell phenotype. ESCs are commonly differentiated via cell aggregates referred to as embryoid bodies (EBs), but current culture methods, such as hanging drop and static suspension, yield relatively few or heterogeneous populations of EBs. Alternatively, rotary orbital suspension culture enhances EB formation efficiency, cell yield, and homogeneity without adversely affecting differentiation. Thus, the objective of this study was to systematically examine the effects of hydrodynamic conditions created by rotary orbital shaking on EB formation, structure, and differentiation. Mouse ESCs introduced to suspension culture at a range of rotary orbital speeds (20-60 rpm) exhibited variable EB formation sizes and yields due to differences in the kinetics of cell aggregation. Computational fluid dynamic analyses indicated that rotary orbital shaking generated relatively uniform and mild shear stresses (< or =2.5 dyn/cm(2)) within the regions EBs occupied in culture dishes, at each of the orbital speeds examined. The hydrodynamic conditions modulated EB structure, indicated by differences in the cellular organization and morphology of the spheroids. Compared to static culture, exposure to hydrodynamic conditions significantly altered the gene expression profile of EBs. Moreover, varying rotary orbital speeds differentially modulated the kinetic profile of gene expression and relative percentages of differentiated cell types. Overall, this study demonstrates that manipulation of hydrodynamic environments modulates ESC differentiation, thus providing a novel, scalable approach to integrate into the development of directed stem cell differentiation strategies.

Cardiomyogenic differentiation of embryoid bodies is promoted by rotary orbital suspension culture.

Embryonic stem cells (ESCs) can differentiate into all somatic cell types, including cardiomyocytes, which may be used for regenerative cardiac cell therapies. ESCs are commonly differentiated via cell aggregates known as embryoid bodies (EBs), but current cardiomyogenic differentiation methods, such as formation via hanging drops, yield relatively small numbers of EBs and differentiated cells. On the other hand, batch culture methods, like static suspension, yield increased numbers of EBs and cells, but typically exhibit less overall cardiomyogenic differentiation. The objective of this study was to determine if rotary orbital suspension culture, which produces EBs resembling hanging drops, was capable of enhancing cardiomyogenic differentiation compared to static suspension culture. Similar to hanging drops, rotary suspension culture significantly increased the proportion of spontaneously contracting EBs compared to static suspension culture. The gene expression of mesoderm (Brachyury-T) and cardiac transcription factors (Gata4, Nkx2.5, and Mef2c), as well as sarcomeric muscle proteins (alpha-MHC and MLC-2v) was increased within EBs cultured in rotary suspension conditions. Rotary orbital culture also yielded a greater percentage of EBs that were immunoreactive for alpha-sarcomeric actin protein compared to static suspension, and augmented the average percentage of alpha-sarcomeric actin-positive cells detected via flow cytometry. These results demonstrate that rotary orbital suspension culture enhances endogenous cardiomyogenesis of EBs and therefore could benefit the development of regenerative cardiac therapies.

The construction of "cultural difference" and its therapeutic significance in immigrant mental health services in France.

Since the early 1970s, the French public health system has been accorded considerable responsibility for immigrants identified by the educational, judicial or social service authorities as psychologically distressed or socially disruptive. In this paper we discuss three models of healing embedded in constructs of "cultural difference" and addressed at specialized mental health-care centers catering to immigrants in Paris: "cultural mediation," transcultural psychiatry/ethnopsychiatry and clinical medical anthropology. Based on observations and interviews at three specialized mental health centers in Paris, we explore how these clinical approaches address migrant wellbeing and seek to resolve crises in migrant families, especially those of West African origin. We suggest that the prevalent approaches to therapy creatively blend concepts and practices of anthropology, psychiatry and psychology but, at the same time, confront challenges inherent in the use of a generic "African" healing modality. Cases studies demonstrate that in order for such interventions to be perceived as effective by patients, "cultural difference" must be acknowledged but also situated in broader social, political and economic contexts.

Rotary suspension culture enhances the efficiency, yield, and homogeneity of embryoid body differentiation.

Embryonic stem (ES) cells hold great promise as a robust cell source for cell-based therapies and as a model of early embryonic development. Current experimental methods for differentiation of ES cells via embryoid body (EB) formation are either inherently incapable of larger-scale production or exhibit limited control over cell aggregation during EB formation and subsequent EB agglomeration. This report describes and characterizes a novel method for formation of EBs using rotary orbital motion that simultaneously addresses both concerns. EBs formed under rotary suspension conditions were compared with hanging-drop and static EBs for efficiency of EB formation, cell and EB yield, homogeneity of EB size and shape, and gene expression. A 20-fold enhancement in the number of cells incorporated into primitive EBs in rotary versus static conditions was detected after the first 12 hours, and a fourfold increase in total cell yield was achieved by rotary culture after 7 days. Morphometric analysis of EBs demonstrated formation and maintenance of a more uniform EB population under rotary conditions compared with hanging-drop and static conditions. Quantitative gene expression analysis indicated that rotary EBs differentiated normally, on the basis of expression of ectoderm, endoderm, and mesoderm markers. Increased levels of endoderm gene expression, along with cystic EB formation, indicated by histological examination, suggested that differentiation was accelerated in rotary EBs. Thus, the rotary suspension culture method can produce a highly uniform population of efficiently differentiating EBs in large quantities in a manner that can be easily implemented by basic research laboratories conducting ES cell differentiation studies.

Differential effects on messenger ribonucleic acid expression by bone marrow-derived human mesenchymal stem cells seeded in agarose constructs due to ramped and steady applications of cyclic hydrostatic pressure.

This study investigated the differential effects of ramped and steady applications of cyclic hydrostatic pressure (CHP) on chondrogenic differentiation of bone marrow-derived human mesenchymal stem cells (hMSCs) in 3-dimensional culture in the absence of transforming growth factor-beta (TGF-beta). A custom hydrostatic pressure system was designed and manufactured. hMSCs were seeded in agarose and exposed to steady (7.5 MPa) or ramped (1 MPa to 7.5 MPa over a 14-day period) CHP for 4 h/d at f = 1 Hz for 14 days. Real-time reverse transcriptase polymerase chain reaction analysis was performed on days 0, 4, 9, and 14 to determine changes in messenger ribonucleic acid (mRNA) expression levels of Sox9, aggrecan, collagen I, and collagen II. Collagen II and aggrecan mRNA expression remained unchanged. Collagen I increased at day 4 in CHP specimens before decreasing to levels at or below same-day unloaded controls at days 9 and 14. On average, ramped and steady regimens of CHP increased Sox9, with the largest upregulation occurring at day 4 in response to steady pressure. These findings indicate that hydrostatic pressure may induce chondrogenesis in hMSC-seeded agarose constructs without TGF-beta, and that hMSCs are capable of withstanding high initial pressures that may initiate chondrogenesis faster than lower pressures.

Reproductive strategies and Islamic discourse: Malian migrants negotiate everyday life in Paris, France.

Approximately 37 thousand Malians currently reside in France as part of the West African diaspora. Primarily Muslim, both women and men confront challenges to their understandings of Islamic prohibitions and expectations, especially those addressing conjugal relations and reproduction. Biomedical policies generate marital conflicts and pose health dilemmas for women who face family and community pressures to reproduce but biomedical encouragement to limit childbearing. For many women, contraception represents a reprieve from repeated pregnancies and fatigue in spite of resistance from those who contest women's reproductive decisions as antithetical to Islam. French social workers play a particularly controversial role by introducing women to a discourse of women's rights that questions the authority of husbands and of religious doctrine. Women and men frame decisions and debate in diverse interpretations of Islam as they seek to manage the contradictions of everyday life and assert individual agency in the context of immigration and health politics.

Polygamy, disrupted reproduction, and the state: Malian migrants in Paris, France.

For Malian women, migration from West Africa to France has disrupted widely shared understandings of marriage and reproduction. In response to restrictive immigration policies, men and women routinely confront the challenges of polygamy, public disapproval of high fertility, and biomedical messages promoting contraception. Although many Malians continue to be strongly pronatalist, within a family, spouses may experience contradictory pressures and objectives regarding reproduction, particularly in polygamous marriages. Because women are more likely than men to interact with nurses and doctors in the context of maternity and child health care visits, they are systematically confronted by encouragement to contracept. French population policy is contradictory in this regard, as it has been strongly pronatalist throughout the 20th century, yet is equally strongly anti-natalist with regard to immigrant populations. Recent anti-immigrant policies such as the Pasqua law prohibiting polygamy have emerged as influences shaping men's and women's contested reproductive goals. Men tend to oppose contraception, citing Islamic doctrine while women increasingly justify contraceptive use in response to government policies and biomedical encouragement. In contrast, polygamy also may generate pregnancy rivalries as wives strategize to enhance their reproductive careers and thus to retain immigrant status.

Patient and physician explanatory models for acute bronchitis.

OBJECTIVES: Our goals were to develop explanatory models to better understand how physicians diagnose and treat acute bronchitis; to describe patient expectations and needs when experiencing an episode of acute bronchitis; and to enhance communication between physician and patient. STUDY DESIGN: We used qualitative, semi-structured, in-depth interviews to generate patient and physician explanatory models. POPULATION: We had a purposeful, homogeneous sample of 30 family physicians and 30 adult patients. OUTCOMES MEASURED: Our multidisciplinary team of investigators used an editing style of analysis to develop patient and physician explanatory models based on the following topics: (1) what caused my illness/etiology, (2) what symptoms I had/onset of symptoms, (3) what my sickness did to me/pathophysiology, (4) how severe is my sickness/course of illness, and (5) what kind of treatment should I receive/treatment. RESULTS: We found that patient and physician models were congruous for symptoms of acute bronchitis and incongruous for etiology and course of illness. Models were congruous for treatment, although for different reasons. CONCLUSIONS: Patients may have a very vague understanding of the process of infection and the difference between bacteria and viruses. Compounding this confusion is frequent miscommunication from physicians regarding the clinical course of untreated illness. These factors and non-communicated expectations from patients and fear of missing something on the part of physicians contribute to the decision to treat with antibiotics.