Pilot study of peer modeling with psychological inoculation to promote coronavirus vaccination.

Promoting coronavirus vaccination is deterred by misinformation, ranging from elaborate conspiracy theories about sinister purposes to exaggeration of side effects, largely promulgated by social media. In this pilot study, we tested the effects of different messages on actions leading to vaccination. Two theory-based advertisements were produced for Facebook, which provided video testimonials from peer role models recommending vaccination and its benefits while providing psychological inoculation through the models' acknowledging misinformation, rejecting it and receiving the vaccine. These ads were paid to appear on Facebook users' feeds in rural counties in South Texas, along with a generic vaccine promotion ad from the CDC without peer models or psychological inoculation. Ad viewers could click a link to 'find a vaccine near you'; these responses served as the outcome variable for assessing experimental effects. Ads featuring peer modeling with psychological inoculation yielded a significantly higher rate of positive responses than CDC ads (30.5 versus14.9/1000 people reached in English and 49.7 versus 31.5/1000 in Spanish; P < 0.001 for both English and Spanish rate comparisons). This provides useful pilot data supporting the hypothesis that theory-based communication, i.e. peer modeling with psychological inoculation, may be more effective than more traditional forms of advertising for promoting coronavirus vaccination.

[How information on a patient's social status is gathered. An anthropological analysis of the discourses employed in private medical practice]. / Les pratiques de repérage de la situation sociale des patients. Analyse anthropologique de discours de praticiens libéraux.

BACKGROUND: A number of studies have highlighted differences and even discrimination in health care offer according to social category, and shown that they contribute to the production of inequality. On the other hand, when the health care system treats every patient equally, and does not take personal difficulties into consideration, some authors have suggested inequality "by omission". That is why public health actors at different levels have recommended systematic collection of information on patients' social status. The objective of this article is to analyze data gathering on patients' socio-economic condition and its repercussions. METHODS: The survey is based on more than 50 semi-structured face-to-face interviews with doctors and dentists in private practice. Their answers were subjected to socio-anthropological analysis. RESULTS: While some practitioners collect information on patients' social status proactively by systematic interrogation, others proceed indirectly and in accordance with subjective criteria. Quite often, patient status remains ignored, usually due to lack of interest, and less frequently because practitioners wish to guard against any risk of stigmatizing underprivileged patients. Different rationales may explain these attitudes: need to prioritize relevant information, wish to observe equity and equality, determination to refrain from social labeling, desire to protect patient self-esteem and to reinforce the practitioner-patient relationship. When identification does occur, it is essentially justified by a desire to adapt the care pathway to potential socio-economic obstacles. CONCLUSION: When a patient's social situation is sought out by private doctors and dentists, they are mainly concerned with customizing care pathways by taking financial impediments into close consideration. In most cases, their justifications for asking questions are subjective; by doing so, they inadvertently introduce arbitrariness in an area where the French state endeavors to produce social justice via provisions such as "CMU" ("universal", across the board health coverage). Systematic questioning on a patient's social status can represent a form of supplementary if unconscious symbolic violence toward frequently disqualified persons; what is more, it runs the risk of inducing stereotypes and manifesting prejudice. Only when contextualized does such questioning seem appropriate. On the other hand, when a practitioner misses out on social issues liable to impede care and treatment, he will probably have no "second chance" to address these concerns. Some practitioners have emphasized a need for suitable timing and contextualizing of questions on a patient's social status, and for putting them forward in a climate of trust.

Situation testing: the case of health care refusal.

BACKGROUND: Situation testing to assess physicians' refusal to provide healthcare is increasingly used in research studies. This paper aims to explain the relevance and limits of this method. METHODS: Conducted in 2008-2009, this study was designed to assess the rate of healthcare refusal among several categories of private practitioners toward patients covered by the French public means-tested complementary health insurance (CMUc) when they requested a first appointment by phone. The other objectives were to study the determinants of healthcare refusal and assess the method. The study was conducted on a representative sample of Paris-based dentists and physicians in five categories: general practitioners, medical gynecologists, ophthalmologists, radiologists, and dentists. RESULTS: The method was based on two protocols. In the first scenario, an actor pretended to be a CMUc beneficiary and, in the second one, he did not give information about his health coverage but hinted at a low socioeconomic status. The two protocols were compared and procedures checking the relation between refusal and CMUc coverage were implemented in each of them. In the scenario in which the patient declared being a CMUc beneficiary, the results showed different refusal rates depending on the type of practitioner, physician, or dentist, their specialty, and whether or not, they charge more than the standard set fee. In the second scenario, refusal rates were much lower. The comparison of the two protocols seems to confirm the existence of discrimination based on CMUc affiliation rather than patients' socioeconomic status. DISCUSSION: The discussion presents the limits of situation testing, which remains an experimental instrument because it does not observe reality but reveals behaviors in situation. The findings cannot be extrapolated and are limited in time. The statistical analysis is only valid if the procedure followed is precise and applied consistently using a preset scenario. In addition, the discriminatory nature of the refusal (CMUc coverage) must be confirmed by a validation procedure (unless clearly stated by the interlocutor).

The relation of environmental contaminants exposure to behavioral indicators in Inuit preschoolers in Arctic Quebec.

Although lead (Pb) exposure has been identified as an important risk factor in child behavioral development, less is known regarding the relation between child behavior and exposure to polychlorinated biphenyls (PCBs) and mercury (Hg). Inuit children are particularly exposed to these chemicals and the aim of this study was to investigate the association between prenatal and postnatal exposure to Pb, PCBs, Hg and several aspects of behavioral function in Inuit preschoolers. The sample consisted of one hundred and ten 5-year-old Inuit children from Arctic Quebec. An umbilical cord blood sample was used to document prenatal exposure to Pb, PCBs and Hg. Child blood samples were collected at age 5 and the same contaminants were measured. A modified version of the Infant Behavior Rating Scale from the Bayley Scales of Infant Development-II was used to assess child behavior through examiners' ratings. Furthermore, attention, activity and emotional outcomes were assessed through behavioral coding of video recordings taken during fine motor testing. Pb exposure during childhood was associated with examiners ratings of greater impulsivity, irritability and with coding of observed inattention. Prenatal exposure to PCB 153 correlated with the examiners ratings of increased state of unhappiness and anxiety during the testing session, which was corroborated from video coding since cord PCB 153 was related to fewer manifestations of positive affects. No association was found with Hg exposure. These data corroborated those from previous Pb cohort studies and revealed an association between prenatal PCBs exposure and emotional outcomes in preschoolers.

The relationship between lead exposure, motor function and behaviour in Inuit preschool children.

The main focus of this study was to determine the role of behaviour in the relationship between postnatal lead exposure and motor function. The sample consisted of 110 preschoolers, of age 5, from Nunavik. Lead concentration was measured at birth and at testing time. Average lead levels were of 4.9 microg/dL (0.24 micromol/L) and 5.3 microg/dL (0.26 micromol/L) for cord and child blood, respectively. Children's balance and fine motor capacities were tested. A modified version of the IBR was used to assess behaviour. Postnatal blood lead concentrations correlated positively with both impulsivity and activity. Neither pre- nor postnatal blood lead concentration correlated with attention level. The children's scores on impulsivity (I) and activity (A) were summed to create the independent variable IA, which was tested as a potential mediator between lead exposure and two dependent variables: the coefficient of covariation in alternating hand movements and transversal sway in tandem position. Mediation was significant only for the latter variable. IA and attention were then tested as potential moderators in the relation between postnatal lead exposure and motor function. No significant interaction between independent variables could be observed. These results do not support the hypothesis that, at low levels of postnatal exposure, lead acts indirectly on motor function via behaviour. However, IA does act as a mediator in the relationship between postnatal blood lead concentration and transversal sway in tandem position.

Standardization of a neuromotor test battery: the CATSYS system.

Interindividual and intraindividual variability in neuromotor behaviors is expected and normal. Early changes in neuromotor behaviors associated with neurodegenerative disorders or neurotoxic effects are often subtle and fluctuating in their characteristics. Therefore, their detection at an early stage is particularly difficult without precise recording instruments. The CATSYS system developed by Danish Product Development (DPD) is a portable device recording four measures of neuromotor control including tremor, reaction time, hand coordination and postural sway. The aim of this study is to develop a set of normative data. One hundred and fifty healthy men and women were divided into five age groups: (1) 20 to 29 years (n=30); (2) 30 to 39 years (n=30); (3) 40 to 49 years (n=30); (4) 50 to 59 years (n=30); (5) 60 to 70 years (n=30). All participants were free of neurological deficits at the time of testing and they were tested individually for approximately 30 min. Hand coordination was measured with prono-supination and finger-tapping movements executed at constant and accelerated rhythms. Reaction time was assessed in both hands using a hand held switch activated by the thumb. Postural tremor was quantified in both hands during 24.6 sec. by asking the subject to hold a stylus horizontally at 10 cm in front of his/her navel. The stylus contained a biaxial accelerometer. Postural sway was tested by asking the subject to stand on a force platform for 75 sec. under four conditions: (1) eyes open; (2) eyes closed; (3) eyes open standing on a foam pad; and (4) eyes closed standing on a foam pad. ANOVAs and multiple comparison tests were performed and the results were examined taking into account age, gender and experimental condition effects.

PBF-2 is a novel single-stranded DNA binding factor implicated in PR-10a gene activation in potato.

Elicitor-induced activation of the potato pathogenesis-related gene PR-10a requires a 30-bp promoter sequence termed the ERE (elicitor response element) that is bound by the nuclear factor PBF-2 (PR-10a binding factor 2). In this study, PBF-2 has been purified to near homogeneity from elicited tubers through a combination of anion-exchange and DNA affinity chromatography. Evidence demonstrates that inactive PBF-2 is stored in the nuclei of fresh tubers and becomes available for binding to the ERE upon elicitation. A protein with an apparent molecular mass of 24 kD (p24) is a DNA binding component of PBF-2. A cDNA encoding p24 has been cloned and encodes a novel protein with a potential transcriptional activation domain that could also act as a single-stranded DNA binding domain. Both PBF-2 and the cDNA-encoded protein bind with high affinity to the single-stranded form of the ERE in a sequence-specific manner. The inverted repeat sequence of the ERE, TGACAnnnnTGTCA, is critical for binding of this factor in vitro and for PR-10a expression in vivo, supporting the role of PBF-2 as a transcriptional regulator.

Neuromotor microalterations in subjects with spasmophilia symptoms: a preliminary study.

Spasmophilia is a relatively unknown condition characterized by perturbations of the neuromuscular system. We hypothesized that spasmophilia may negatively affect neuromotor functions in subtle ways. Three tests including tremor, rapid pointing movements, and alternating movements were quantified in a group of subjects with spasmophilia symptoms (SS) (n = 10) and a healthy control group (n = 10). Most of the characteristics used to evaluate motor functions in these three tests revealed no significant differences between the two groups except for two characteristics in alternating movements and two characteristics in rapid pointing movements. In terms of variances, a dissociation between voluntary movements and involuntary movements was observed for the two groups. Control subjects had significantly higher variances in involuntary movements such as tremor, while subjects with SS had significantly higher variances in voluntary movements such as alternating and rapid pointing movements. A significant increase in asymmetry in hand laterality was also noted for some characteristics in subjects with SS.

The Arabidopsis NPR1/NIM1 protein enhances the DNA binding activity of a subgroup of the TGA family of bZIP transcription factors.

The Arabidopsis NPR1 gene is essential in activating systemic, inducible plant defense responses. To gain a better understanding of NPR1 function, we conducted a yeast two-hybrid screening procedure and identified a differential interaction between NPR1 and all known members of the Arabidopsis TGA family of basic leucine zipper transcription factors. In the electrophoretic mobility shift assay, NPR1 substantially increased the binding of TGA2 to its cognate promoter element (as-1) as well as to a positive salicylic acid-inducible element (LS7) and a negative element (LS5) in the promoter of the pathogenesis-related PR-1 gene. Proteins encoded by npr1 mutants interacted poorly with TGA2 and did not substantially increase TGA2 binding to the as-1, LS5, or LS7 elements, thus establishing a link between the loss of disease resistance and the loss of TGA2 interaction and NPR1-enhanced DNA binding. Coupled with observations that the DNA binding activity of TGA factors is deregulated in npr1 plants, the results suggest that NPR1-mediated DNA binding of TGA2 is critical for activation of defense genes.

Chronic intestinal pseudoobstruction syndrome: clinical analysis, outcome, and prognosis in 105 children. French-Speaking Group of Pediatric Gastroenterology.

Our aim was to collect a large number of cases to characterize clinical presentation, outcome, and prognosis of chronic intestinal pseusoobstruction in children. We conducted a retrospective multicenter study that included children treated for chronic intestinal pseusoobstruction defined as recurrent episodes of intestinal obstruction with no mechanical obstruction, excluding Hirschsprung's disease. In all, 105 children, 57 boys and 48 girls, were studied, including five familial forms. Prenatal diagnosis was made in 18 patients. Eighty patients were less than 12 months old at onset; the disease began at birth for 37 patients. The most frequent signs were abdominal distension, vomiting, and constipation. Megacystis was noted in myopathies (7 cases), neuropathies (10 cases) and unclassified forms (13 cases). For all but three cases (two patients with CMV infection, one with Munchhausen-by-proxy syndrome), the associated diseases and disorders could not account for chronic intestinal pseusoobstruction as a secondary disorder. At least one full-thickness biopsy from the digestive tract was studied for 99 patients. The diagnosis recorded was visceral neuropathy in 58 cases, visceral myopathy in 17 cases, and uncertain or normal biopsy results in 24 cases. Seventy-eight children were fed intravenously, and only 18 were able to be fed orally throughout their illness. Seventy-one patients underwent surgery during their illness, and 217 surgical procedures, a mean of 3 per patient, were performed. Ostomy was the most performed procedure. Follow-up continued in 89 patients for 3 months to 16 years (mean 85 months). Forty-two patients were still fed by parenteral (39 patients) or enteral nutrition (3 patients) at the time of the study. Eleven patients died between the age of 1 month and 14 years 7 months.

A functional homolog of mammalian protein kinase C participates in the elicitor-induced defense response in potato.

The elicitor-induced activation of the potato pathogenesis-related gene PR-10a is positively controlled by a protein kinase(s) that affects the binding of the nuclear factors PBF-1 (for PR-10a binding factor-1) and PBR-2 to an elicitor response element (ERE). In this study, we have identified a kinase that has properties similar to the conventional isoenzymes of the mammalian protein kinase C (PKC) family. the treatment of potato tuber discs with specific inhibitors of PKC abolished the elicitor-induced binding of the nuclear factor PBF-2 to the ERE. This correlated with a reduction in the accumulation of the PR-10a protein. In contrast, treatment of the tuber discs with 12-O-tetradecanoylphorbol 13-acetate (TPA), an activator of PKC, led to an increase in binding of PBF-2 to the ERE and the corresponding increase in the level of the PR-10a protein, mimicking the effect seen with the elicitor arachidonic acid. Biochemical characterization of proteins extracted from the particulate fraction of potato tubers demonstrated that a kinase belonging to the conventional isoforms of PKC is present. This was confirmed by immunoprecipitation with antibodies specific to the conventional isoforms of human PKC and in-gel kinase assays. The ability of the immunoprecipitates to phosphorylate the alpha-peptide (a PKC specific substrate) in the presence of the coactivators calcium, phosphatidylserine, and TPA strongly suggested that the immunoprecipitated kinase is similar to the kinase characterized biochemically. Finally, the similar effects of the various modulators of PKC activity on the elicitor-induced resistance against a compatible race of Phytophthora infestans implicate this kinase in the overall defense response in potato.

The Activation of the Potato PR-10a Gene Requires the Phosphorylation of the Nuclear Factor PBF-1.

The pathogenesis-related gene PR-10a (formerly STH[middot]2) is induced in various organs of potato after wounding, elicitor treatment, or infection by Phytophthora infestans. Deletion analysis of the promoter of the PR-10a gene enabled us to identify a 50-bp region, located between positions -155 and -105, necessary for the elicitor responsiveness of the [beta]-glucuronidase reporter gene in transgenic potato plants. Within this region, a 30-bp sequence, located between positions -135 and -105, was necessary for the activation of the promoter by the elicitor. However, strong promoter activity after elicitor treatment required the presence of a 20-bp sequence located between positions -155 and -135. The region between -135 and -105 was specifically recognized by two nuclear factors, PBF-1 (PR-10a Binding Factor 1) and PBF-2, and binding of PBF-1 was coordinated with the accumulation of the PR-10a mRNA. Gel shift assays using nuclear extracts pretreated with sodium deoxycholate or alkaline phosphatase suggested that PBF-1 is a multimeric factor in which at least one of the constituent proteins can be phosphorylated. Treatment with alkaline phosphatase also indicated that binding of PBF-1 is positively regulated by phosphorylation and that it is phosphorylated only in tissues in which PR-10a is expressed. The use of protein phosphatase and kinase inhibitors in vivo provided additional evidence that wounding and elicitor treatment induce the phosphorylation of PBF-1 and that this phosphorylation is associated with gene activation.

[The Pierre-Robin syndrome. Classification and new therapeutic approach]. / Le syndrome de Pierre Robin. Classification et nouvelle approche thérapeutique.

Rhombencephalic failure of the suction-swallowing, excess of central and obstructive ventilatory arrests with hypoxia and hypercapnia, vagal hypertonia and esophagogastric motor abnormalities are the new clinical signs observed in children presenting with the Pierre Robin's syndrome. A therapeutic management adapted to each of the types I, II, III of the syndrome were defined and a good nursery-nursing allowed a reduction in the mortality-rate from 27 to 5%. Still considered by some as a malformative and glossoptosing disorder whose etiology is only bucco-pharyngeal in origin, this syndrome, common to numerous embryopathies, is a precocious embryonal abnormality of the brain stem neurogenesis, expressed by the dramatic failure of the physiological oro-ventilation system. This syndrome appears to be a peculiar form of dysautonomia of the brain stem development with an uncertain future, often transitory, isolated or associated but in the heart of pediatric internal medicine and its multi-disciplinarity.