Gut Microbiota and Nutrition: Strategies for the Prevention and Treatment of Type 2 Diabetes.

The prevalence of diabetes has increased in last decades worldwide and is expected to continue to do so in the coming years, reaching alarming figures. Evidence have shown that patients with type 2 diabetes (T2D) have intestinal microbial dysbiosis. Moreover, several mechanisms link the microbiota with the appearance of insulin resistance and diabetes. Diet is a crucial factor related to changes in the composition, diversity, and activity of gut microbiota (GM). In this review, the current and future possibilities of nutrient-GM interactions as a strategy to alleviate T2D are discussed, as well as the mechanisms related to decreased low-grade inflammation and insulin resistance. A bibliographic search of clinical trials in Pubmed, Web of Science, and Scopus was carried out, using the terms "gut microbiota, diet and diabetes." The data analyzed in this review support the idea that dietary interventions targeting changes in the microbiota, including the use of prebiotics and probiotics, can improve glycemic parameters. However, these strategies should be individualized taking into account other internal and external factors. Advances in the understanding of the role of the microbiota in the development of metabolic diseases such as T2D, and its translation into a therapeutic approach for the management of diabetes, are necessary to allow a comprehensive approach.

Efficacy of the use of video games on mood, anxiety and depression in stroke patients: preliminary findings of a randomised controlled trial.

BACKGROUND: In the different published studies, there is no consensus on the efficacy of virtual reality as an adjuvant treatment of mood states. AIM: The aim of this study is to evaluate the impact of no immersive virtual reality with the Nintendo Switch device in rehabilitation treatment on mood, anxiety and depression in stroke patients admitted to neurorehabilitation units. METHODS: Fifty-eight patients admitted to neurorehabilitation units underwent a 1:3 multicentre randomised clinical trial. The intervention group consisted of 17 patients and the control group of 41 patients. The intervention group performed 6 virtual reality sessions together with the conventional treatment, and the control group performed only the conventional rehabilitation sessions. Primary and secondary clinical outcomes were measured before and six weeks after the intervention. RESULTS: Comparing the intervention group and control group, the anxiety levels of the intervention group decreased compared to the results observed in the control group (p = 0.01), as did the dependence of the intervention group (0.015). On the other hand, the results obtained after the intervention by the control group for anxiety (0.479) and depression (0.292) were not statistically significant. CONCLUSION: Rehabilitation VR used as an adjuvant treatment to conventional treatment has a beneficial impact on the neurological status and state of anxiety of stroke patients admitted to neurorehabilitation units. TRIAL REGISTRATION: Registered in the https://clinicaltrials.gov/ repository (NTC NCT05143385). Protocol registration date 7 October 2021, retrospectively registered.

Psychotherapeutic nursing as Advanced Clinical Practice for the promotion of mental health in Spain.

OBJECTIVE: To contribute to the recognition of psychotherapeutic nursing (PTN) as a regulated advanced clinical practice (ACP) in Spain, as is the case in other countries. BACKGROUND: Nurses are continually evolving to improve overall health outcomes. PTN has become a reality, with several authors describing it as an ACP. In Spain, psychotherapy is not officially regulated, which has led to a significant number of psychiatric nurses adopting an important ACP in this area without recognition. SOURCES OF EVIDENCE: Evidence confirms that PTN possesses the attributes necessary to be considered an ACP. Nurses, like psychotherapists, independently address the complex needs of individuals and families within the context of therapeutic relationships, and there is a pressing need to advance formal processes of regulation and certification. DISCUSSION: PTN has evolved at different rates depending on local initiatives, policies and various professional interests. In Spain, it is crucial to evaluate its outcomes, recognise it as an ACP and develop training plans for its regulation and accreditation. CONCLUSIONS: Mental health nurses in Spain have a strong interest in PTN being recognised as an ACP. To this end, they should join forces with other partners, scientific associations and international bodies such as the International Council of Nurses (ICN) to make PTN an internationally recognised ACP. IMPLICATIONS FOR NURSING PRACTICE: Psychotherapeutic nurses could contribute to improving mental health outcomes, client satisfaction and health system efficiency, and their formal recognition is an opportunity to enhance their professional identity, competence and autonomy. IMPLICATIONS FOR NURSING POLICY: Nursing policy needs to be reoriented towards strengthening psychotherapy as an ACP. Synergies and alliances between international nursing associations and the ICN can promote its development and implementation, while research, education and leadership are essential to achieving official regulation and accreditation.

The willingness to forgive among the Wayuu and among people from other indigenous communities in Colombia

Introduction/Objectives: Willingness to forgive has been studied in different situations, however, there are no published studies in Colombia with indigenous populations and taking into account their worldview. The present research was aimed at examining the willingness to forgive of people from various ethnic minorities in Colombia such as the Embera, Nasa, Pijao and Kaamash-Hu communities and focusing in particular on the Wayuu community. Method: An experimental design was used and a cluster analysis was performed. The sample was composed of 159 indigenous adults (30% male) between the ages of 18 and 76, who were shown a series of scenarios describing a common situation in which an orchard was damaged by domestic animals belonging to a neighbour. Three factors were manipulated in the scenario: the severity of the damage, the level of carelessness of the animals' owner, and the animals' owner's explanations and apologetic behaviour. Results: Cluster analysis yielded five qualitatively different positions: Never forgive under any circumstances (6% of the sample, primarily participants from the Embera community), Depends on apology and neglect (15%), Depends on apology, consequences, and neglect (30%, primarily participants from the Kaamash-Hu community), and Almost always forgive (36%, primarily people from the Wayuu community). Conclusion: Thus, there is a convergence between the results of this study and the anthropological observations of the participating ethnic communities. Forgiveness is closely linked to the cosmovision of each indigenous group.

Introducción/Objetivos: La voluntad de perdonar ha sido estudiada en diferentes situaciones, sin embargo, no existen estudios publicados en Colombia con población indígena y teniendo en cuenta su cosmovisión. La presente investigación tuvo como objetivo examinar la voluntad a perdonar de personas de diversas minorías étnicas en Colombia como la comunidad Embera, Nasa, Pijao, Kaamash-Hu y centrándose en particular en la comunidad Wayuu. Método: Se presentaron una serie de escenarios a una muestra de 159 adultos indígenas (30% hombres) de entre 18 y 76 años. Dichos escenarios describían una situación común en la que una huerta era dañada por animales domésticos de un vecino. Se manipularon tres factores en cada escenario: la gravedad del daño, el nivel de descuido del dueño de los animales y, las explicaciones y el comportamiento de disculpa del dueño de los animales. Resultados: El análisis de clústeres arrojó cinco posiciones cualitativamente diferentes: Nunca perdona bajo ninguna circunstancia (6% de la muestra, principalmente participantes de la comunidad Embera), Depende de las disculpas y del descuido (15%), Depende de las disculpas, las consecuencias y el descuido (30%, principalmente participantes de la comunidad Kaamash-Hu), y Casi siempre perdona (36%, principalmente personas de la comunidad Wayuu). Conclusiones: Por tanto, existe una convergencia entre los resultados de este estudio y las observaciones antropológicas que condujeron a la decisión de la Unesco de considerar el sistema de justicia restaurativa de la comunidad Wayuu como un patrimonio inalterable.

Chapitre 8. Annoncer ou pas la découverte d'anomalies non sollicitées lors d'un test génétique à séquençage haut débit ?

OBJECTIVE: New genome sequencing techniques allow new approaches in medical genetics, in particular by facilitating the diagnosis of genetic diseases. However, their use also leads to unsolicited genetic findings being uncovered. This type of discovery raises ethical, legal and psychological considerations. The objective of this psychological research was to study the different positions of patients, health professionals and general public regarding the acceptability of the announcement of unsolicited findings revealed during a high-throughput sequencing genetic test. METHOD: the first exploratory study aimed, through non-directive research interviews conducted with 13 patients of a medical genetics service, to understand the psychological repercussions linked to the announcement of a result of a targeted genetic test and to know the patients’ desires regarding the announcement of unsolicited findings if the test had been a high-throughput genetic test. The second study, using a quantitative methodology, aimed to identify the judgment policies of 144 patients, 94 healthcare professionals and 211 people from the general public concerning the acceptability of this type of disclosure. RESULTS: The cluster analyses highlighted six judgment policies as to whether or not to disclose the discovery of unsolicited anomalies: “Tell everything”, “Tell even in part”, “Tell everything unless desperate”, “Undecided”, “Do not tell” and “Do not tell if no prevention”. The participants positioned themselves differently, in particular according to the patient’s consent. CONCLUSION: This research shows the variability of positioning and the importance of consent in the acceptability of the disclosure of unsolicited findings. However, one of the limitations of the study lies in the fact that in medical clinic, acceptability and acceptance may vary over time. A longitudinal study would undoubtedly afford a better understanding of the psychological progress of patients in this type of care pathway..

French lay Persons' judgments of the possibility of a heart attack when experiencing various physical manifestations.

Background: The aim of the study was to characterize the different ways in which, based on certain physical manifestations that an individual suddenly experiences, people judge the possibility that these manifestations indicate the onset of a heart attack. Methods: One hundred ninety-four French adults--plus six physicians--were presented with a set of realistic vignettes composed by orthogonally crossing the levels of four factors: the type of pain felt, and the presence or absence of nausea, excess sweating, and of difficulty breathing. Results: Four qualitatively different reactions were found among the lay people. The majority reaction (54%) was close to the physicians' reaction. It consisted of suspecting a heart attack as soon as intense pain occurs in the chest or back. The second reaction (25%) retained from the first one only the idea that a heart attack should be suspected if the pain is localized to the chest. The third reaction (14%) reflected some people's uncertainty in the face of disturbing manifestations that they find difficult to interpret. The fourth reaction (7%) was that no set of symptoms could mean, for them, the onset of a heart attack. Conclusion: Only about half of the participants appeared to be able to consider unpleasant physical manifestations as a whole and integrate that information into an overall warning judgment that can lead into prompt life-saving actions. We recommend that judgment training on warning symptoms and signs be performed, especially for high-risk patients, in the offices of primary care providers and specialists.

Patients' Positions on the Degree of Trust to be Placed in Physicians.

Patient-physician relationship is ideally based on mutual trust. Trust usually takes times to build but can quite instantaneously be destroyed as a result of a single action or a single misperception. This study examined the way patients conceptualize the relationship between trust in a physician and perceived competency, honesty and openness, and personal involvement in care. One hundred sixty-seven patients aged 18-85 years were presented with a set of 27 three-item realistic vignettes that described situations in which participants could find themselves if hospitalized because of illness or accident. These scenarios resulted from the complete crossing of the three factors mentioned above. Participants were asked to assess the level of trust they would feel in each case. Through cluster analysis, three positions were found. For a minority of participants, trust was either unconditionally high (4%) or always quite low (8%). For a majority (75%), however, trust depended interactively on competency and honesty, on the one hand, and involvement, on the other hand; that is, the impact of competency and honesty on trust always depended on the level of involvement in care. In particular, when involvement had a low level, trust was always quite low, irrespective of the levels of both other factors. These findings are fully consistent with the view that, for a majority of patients, trust is inherently brittle: A breach in any one of participants' expectations regarding physicians' professionalism is enough to result in a more than proportional reduction in trust level.

Estimates of mpox effective reproduction number in Spain, April-August 2022.

We analysed the transmission of the human mpox virus in Spain by estimating the effective reproduction number of the disease from official surveillance data. Our computations show that this decreased steadily after an initial burst phase, dropping below 1 on July 12, and thus the outbreak was expected to reduce in the following weeks. Differences in trends were found across geographical regions of the country and across MSM and heterosexual populations.

Judging the possibility of the onset of diabetes mellitus type 2 from reported behavioral changes and from family history.

BACKGROUND: Undiagnosed type 2 diabetes is common and can lead to unrecognized health complications. Given that earlier detection can reduce the damage to vital organs, it is important for all persons to be able to make the connection between certain new manifestations in their bodies and the possibility of diabetes. This study examined the extent to which people use the behavioral changes they observe in others (or in themselves), as well as relevant family history, to judge the possibility of the onset of diabetes. METHODS: One hundred and fifty-six adults living in France examined a set of realistic vignettes describing a person with (or without) signs suggestive of diabetes (e.g., increased thirst, family antecedents) and judged the possibility of the disease in each case. RESULTS: Overall, 36% of participants focused on reported symptoms when judging the possibility of diabetes, 37% focused on family history, and 29% were not able to use the information or tended systematically to minimize the possibility of diabetes. CONCLUSIONS: People in France and probably around the world need a greater awareness not only of the factors putting them at risk of diabetes, but also of the specific signs and symptoms suggesting that they might be developing it.

LESS-PHARMA Study: Identifying and Deprescribing Potentially Inappropriate Medication in the Elderly Population with Excessive Polypharmacy in Primary Care.

Potentially inappropriate medication (PIM) increases adverse drug reactions and mortality, especially in excessively polymedicated patients. General practitioners are often in charge of this process. Some tools have been created to support them in this matter. This study aimed to measure the amount of potentially inappropriate medication among excessively polymedicated patients using several supporting tools and assess the feasibility of these tools in primary care. Several explicit deprescribing criteria were used to identify potentially inappropriate medications. The level of agreement between all the criteria and the acceptance by the general practitioner (GP) was also measured. We analysed whether the drugs proposed for deprescribing were eventually withdrawn after twelve months. The total number of drugs prescribed was 2038. Six hundred and forty-nine drugs (31.8%) were considered potentially inappropriate by at least one of the tools. GPs agreed with the tools in 56.7% of the cases. In a 12-month period, 109 drugs, representing 29.6% of the drugs that GPs agreed to deprescribe, were withdrawn. Elderly excessively polymedicated patients accumulated a great number of PIMs. The use of deprescribing supporting tools, such as explicit criteria, is feasible in primary care, and these tools are well accepted by the GPs. However, eventual withdrawal was carried out in less than half of the cases.

Mapping Colombians' positions on sentencing for substance offenses.

BACKGROUND: In Colombia, a person caught in possession of an illicit substance is not judicially sanctioned as long as the quantity does not exceed the maximum allowable amounts. Given that the public is divided on the appropriateness of this policy, an examination of the various public positions was undertaken. METHOD: A convenience sample of 302 adults were presented with 48 vignettes depicting a situation of everyday life easily recognizable by all in Colombia; that of a male person who is apprehended in the street by the police because he is suspected of illicit trafficking. These vignettes were created by orthogonal variation of four factors: Type of substance, amount of substance, type of charge against the offender, and offender's age. RESULTS: Through cluster analysis, six qualitatively different positions were found. These positions corresponded to three distinct, classical philosophies (a) a libertarian, free-market philosophy - punishment should never be extremely severe because the trade in psychotropic substances is a trade like any other (6%), (b) a moralistic, conservative philosophy - punishment should always be extremely severe except perhaps in certain cases (52%), and (c) a progressive, human rights-inspired philosophy - punishment should always be proportional to the seriousness of the facts (42%). CONCLUSION: Half of Colombian people supported a control policy according to which the use of psychotropic substances is considered profoundly immoral. Most of the other segment of the population express views similar to those of international organizations. It is therefore desirable that legislators rely on progressive international legislation to support domestic policies that are not strictly moralistic and conservative.

Generation of subharmonics in acoustic resonators containing bubbly liquids: A numerical study of the excitation threshold and hysteretic behavior.

In this paper we study the generation and behavior of subharmonics in a bubbly liquid confined in an acoustic resonator, through numerical simulations carried out at finite-amplitude acoustic pressure. Several configurations in terms of resonator length and driving frequency are considered here. Our results show that these frequency components, created from a higher-frequency signal at the source (ultrasound), are due to the nonlinearity of the medium at high acoustic-pressure amplitude and to the configuration of the resonator (geometry and boundaries). We also show that they have an amplitude-threshold dependence, which is in concordance with the literature. The response of these subharmonics to different sequences of pressure amplitudes also reveals the hysteretic nature of the bubbly liquid.

Impact of Greater Occipital Nerve Block on Photophobia Levels in Migraine Patients.

BACKGROUND: To study the effect of greater occipital nerve (GON) block on migraine-associated photophobia levels. Photophobia is one of the most bothersome symptoms reported by migraine patients. Studies investigating the impact of migraine treatment on this symptom are scarce. METHODS: This is an observational prospective case-control study. Patients with migraine and photophobia attending a Headache Clinic were recruited. Cases were defined as patients in whom GON block was performed, following usual clinical practice guidelines. All patients were evaluated with the Hospital Anxiety and Depression Scale, the Migraine Specific Quality of Life Questionnaire, the Utah Photophobia Symptom Impact Scale (UPSIS-12), and the Korean Photophobia Questionnaire (KUMC-8); both in the first visit (V1) and one week after (V2). RESULTS: Forty-one patients were recruited, 28 (68.3%) cases and 13 (31.7%) controls. At V1, there were no significant differences in the median [p25-p75] score of UPSIS-12 in cases vs controls (32.0 [21.0-34.0] vs 30.5 [22.0-37.0], P = 0.497) or KUMC-8 (6.5 [5.5-7.0] vs 7.0 [6.0-8.0], P = 0.463). At V2, cases experimented a significant improvement in UPSIS-12 of -5.5 [-8.8 to -1.3] and in KUMC-8 of -0.5 [-2.0 to 0], whereas there were no significant changes in the control group. Migraine with aura patients presented higher UPSIS-12 score at V1 (33.5 [24.5-37.0] vs 26.0 [16.0-35.0]) and lesser improvement at V2 after GON block compared with migraine without aura patients (-4.0 [-6.0 to -1.0] vs -8.0 [-17.0 to -2.0]), although statistical significance was not achieved ( P = 0.643 and P = 0.122, respectively). There was no significant variation in the remaining scales. CONCLUSIONS: Greater occipital nerve block improves migraine-associated photophobia, measured with UPSIS-12 and KUMC-8. Patients without aura may exhibit a greater improvement. Physicians could consider GON block for management of photophobia in migraine patients.

Young Indians' Willingness to Make a Living Organ Donation.

BACKGROUND: The large unmet need in India for organs to transplant calls for an increase in living organ donations. This study examined the positions of Indian university students on making a living organ donation. METHODS: A convenience sample of 339 students from Karnatak University rated willingness to be a living donor in 48 scenarios consisting of all combinations of 5 factors: recipient's identity (close family member vs stranger), level of surgical risk for the donor, possible long-term health consequences for the donor, probability of transplant success, and likelihood of finding other donors (the subject is one of the rare compatible donors or one donor among others). RESULTS: Cluster analyses showed the existence of 4 qualitatively distinct positions called nondonors (9%); family donors (21%), for whom willingness was very high when recipients were family members and very low when they were strangers; universal donors (30%), for whom willingness was also quite high when a stranger was involved; and conditional donors (23%), who took a risk-benefit perspective. CONCLUSIONS: These finding suggest that the fundamental reason for the current shortage of organs in India is neither psychological nor cultural but more likely organizational.

Positions of French Nurses Regarding the use of Hypnotherapy to Relieve Pain in Postoperative Settings.

The objective of this study was to carry out a detailed mapping of the different personal positions of French nurses concerning the practice of hypnotherapy. Factorial design was used to assess the impact of 4 situational factors: type of postoperative care and degree of pain associated with it (chemotherapy, wound cleansing and bandaging, or body grooming that leads to pain on mobilization); whether paracetamol (also known as acetaminophen) was administrated along with hypnosis or not; professional credentials of the hypnotherapist; and patient's identity (adult, young person, elderly person, or young person with learning difficulties). A combination of scenario technique and cluster analysis was implemented. Participants were 91 registered nurses and, for comparison, 19 nurse's aides, 9 physicians, 5 psychologists, and 77 laypersons. Seven qualitatively different positions were found. Only a minority of French nurses were convinced that hypnotherapy is an indisputably acceptable practice in postoperative care. Most of them were indifferent to the issue as long as pain medication was used. Nurses' views appeared to be similar to physicians' views.

Medición funcional en el dominio de la ética empírica / Functional Measurement in the Field of Empirical Ethics / Medição funcional no domínio da ética empírica

El presente artículo propone un enfoque empírico de la ética derivado de la teoría psicológica del juicio humano propuesta por Norman Anderson. Muestra cómo la metodología de esta teoría ­denominada medición funcional­ puede utilizarse para caracterizar las diversas posiciones personales que existen en todas las sociedades respecto a los problemas de salud pública. Los principales resultados de tres estudios realizados en tres países diferentes (Guinea, Francia y Colombia) se presentan como ilustración de lo que puede aportar este enfoque. Dichos análisis se centraron en tres problemas deliberadamente muy diferentes: (a) el deber de atender a los pacientes infectados, en caso de una epidemia que ponga en peligro la vida de los cuidadores; (b) la aceptabilidad de la reproducción postmortem, en el caso de los soldados que mueren en combate, y (c) la aceptabilidad del suicidio asistido por un médico

This paper presents the proposal of an empirical ap-proach to ethics derived from a psychological theory of human judgment proposed by Norman Anderson. It shows how the methodology specific to this theory ­functional measurement­ makes it possible to char-acterize the various personal positions that exist in all societies regarding public health problems. The main results of three studies carried out in three different countries (Guinea, France, and Colombia) on various problems are presented as an illustration of what this approach can offer. These analyses focused on three deliberately very different problems: (a) the duty to care for infected patients in the event of a pandemic that puts at risk the lives of the health professionals, (b) the acceptability of postmortem reproduction in the specific context of fallen soldiers, and (c) the accept-ability of physicianassisted suicide

Este artigo propõe uma abordagem empírica da ética derivada da teoria psicológica do julgamento humano proposta por Norman Anderson. Mostra como a metodo-logia dessa teoria ­ denominada medição funcional­ pode ser utilizada para caracterizar as diversas posições pessoais que existem em todas as sociedades em relação aos problemas de saúde pública. Os principais resulta-dos de três estudos, realizados em três países diferentes (Guiné, França e Colômbia), são apresentados como uma ilustração do que esta abordagem pode contribuir. Esses estudos se concentraram em três problemas de-liberadamente muito diferentes: (a) o dever de cuidar de pacientes infectados no caso de uma epidemia que ponha em risco a vida dos cuidadores, (b) a aceitabilida-de da reprodução postmortem no caso de soldados que morrem em combate, e (c) a aceitabilidade do suicídio assistido por médicos

Assessing hospitalized patients' quality of life from external indices: the perspectives of lay people and health professionals.

PURPOSE: We examined the way people assess hospitalized patients' quality of life from what they immediately observe when entering the patient's room, from what they learn by conversing with the patient, and from what they know about the patient's social life. METHODS: A sample of 474 adults (among them 7 physicians, 57 nurses, and 42 nurse's aides) aged 18-90 years was presented with 54 realistic scenarios depicting the situation of a terminally ill patient, and created by orthogonally combining the levels of four factors: chronic pain (e.g., requiring powerful painkillers), social support (e.g., some visits), mental status (e.g., alterations of consciousness), and physical autonomy. In each case, they assessed the patient's health-related quality of life. RESULTS: Through cluster analysis, three different positions related to what is important when judging the quality of life of a hospitalized patient were found. They were labeled Almost Always Low (40%), Depends on Personal and Social Circumstances (49%), and Depends Mainly on Social Support (11%). Health professionals did not differ fundamentally from lay people in their positions regarding what determines the health-related quality of life of their patients. CONCLUSION: Many people take a particularly pessimistic view of the quality of life of people whose health is unlikely to improve. Others think that, in certain circumstances, a certain quality of life can be preserved but for this to happen, the situation must be nearly ideal. A minority expressed a position consistent with the insistence of voluntary patient-visiting associations on the importance of providing hospitalized patients with social support.

Attitudes of French populations towards the disclosure of unsolicited findings in medical genetics.

Next-generation sequencing techniques enable unsolicited findings to be detected. This discovery raises ethical questions concerning the return of these findings. Our study aimed to highlight the views of the general public, patients under supervision and health professionals concerning the acceptability of disclosing unsolicited results to patients. In total, 449 participants assessed scenarios, consisted of all combinations of three factors (patient's information and consent, prevention and treatment of the unsolicited disease and doctor's decision). The response profiles were grouped into six clusters. The participants took ethical aspects into account, but health professionals also considered the medical aspects to a greater extent.

French People's Views on the Allocation of Organs for Transplantation.

BACKGROUND: French laypeople's views on the allocation of organs for transplantation were examined. METHODS: A total of 199 adults make judgments of priority for a liver transplant in 48 realistic scenarios composed of all combinations of 4 factors: 1. probability of success, 2. life expectancy without transplant, 3. level of responsibility for liver failure (eg, substance abuse in the past), and 4. social situation (eg, young mother with 2 young children). In all scenarios, the patients were in need of liver transplant. The ratings were subjected to cluster analysis and analyses of variance. RESULTS: Six qualitatively different positions were found that were termed Probability of Success and Life Expectancy (6%), Family Responsibilities (8%), Family Responsibilities and Risky Behavior (28%), Risky Behavior and Family Responsibilities (22%), Risky Behavior (11%), and Always a Priority (25%). Regular church attendees expressed more often the Risky Behavior and Family Responsibilities position and less often the Always a Priority position than atheists. Female participants expressed more often the Risky Behavior position than male participants. CONCLUSIONS: The French laypeople in our sample think that when assessing priority for transplant, criteria additional to medical urgency or the estimated utility in terms of expected life span after transplant should be taken into account. These criteria are the patient's lack of responsibility for the liver failure (ie, not causing it by drinking or using drugs) and the extent of the patient's social responsibilities (with active employment and dependents to care for).

French People's Views Regarding Xenotransplantation.

BACKGROUND: French laypeople's views on xenotransplantation were examined. METHODS: A convenience sample of 224 adults (among them, 37 nurses) judged of the acceptability of xenotransplantation in 50 realistic scenarios composed of various combinations of 4 factors: 1. the type of graft (eg, pig cardiac valve), 2. the level of urgency (eg, critical condition with very high risk of death in the short term), 3. the patient's or the family's level of consent (eg, the members of the family are divided on the issue), and 4. whether the transplantation was temporary or definitive. The ratings were subjected to cluster analysis and analyses of variance. RESULTS: Seven qualitatively different positions were found that were termed Never acceptable (12%), Urgency (4%), Family consent (33%), Religious concerns (15%), Family consent and urgency (10%), Depends on all circumstances (4%), and Always acceptable (11%). Vegans and vegetarians expressed the Never acceptable position more often than nonvegetarians. Health professionals expressed the Family consent position more often than the public. Regular church attendees expressed the Religious concerns position more often than atheists did. CONCLUSIONS: Few participants, mostly vegetarians, were opposed to xenotransplantation on principle. About one-third expressed positive views regarding xenotransplantation, either irrespective of circumstances or at least in those cases in which the patient's death is imminent and the family is not opposed for religious reasons. About one-half expressed positive views but deferred to the wishes of the family. The type of xenograft proposed had practically no effect on participants' views.