Ethical Issues Linked to the Development of Telerehabilitation: A Qualitative Study

While telerehabilitation (TR) makes it possible to respond to many significant health system problems, TR still gives rise to debates, particularly concerning ethical issues. This qualitative study collected the opinions of stakeholders with varied profiles. A guided interview focused on discerning strategies that might foster the ethical deployment of TR. Such strategies were found to be linked to the decision-making of the public authorities, the role of scientific and professional bodies, the training of health professionals, and the management of patient information. Ethical issues relating to the development of TR included universal accessibility, patients’ free choice, respect of privacy, and professional confidentiality. The ethical development of TR can be fostered by the provision of information to stakeholders as well as reminding practitioners of the ethical framework that regulates medical practice

COVID-19 vaccine acceptance, hesitancy and resistancy among university students in France

Clinical Investigation Center, CHU Rouen, Normandie University, Rouen, France, CHU Rouen, Normandie University, Rouen, France, Rouen University Hospital, Normandie University, Rouen, FranceIntroduction. Young adults, specifically college students, are at risk of being infected with COVID-19 and transmitting the infection to others owing to their sense of invulnerability and can be a source of transmission to at-risk populations and could be the public acceptance of a new vaccine for COVID-19 developed within a short period remains uncertain despite the forthcoming availability. The objectives were to explore, among university students, the level of COVID-19 vaccine acceptance, hesitancy and resistancy and to determine the motivations and barriers, and the reasons that may change student vaccination decision making. Material and methods. An online cross-sectional study was conducted among students of a French university in January 2021 with questions about the intention to be vaccinated against COVID-19, the motivations and the barriers: ”Do you intend to be vaccinated against COVID-19 (when it is possible for you to do so)?” with the choice answers of: “Yes, absolutely”; “Yes, probably”; “No, probably not”; “No, certainly not” and “I don’t know”. Students reported the motivations or the reasons of hesitations with several possible answers. Results. A total of 3089 students were included, with a mean of age of 20.3 (SD=1.9). A total of 3089 students were included, with a mean of age of 20.3 (SD=1.9), and 71.4% were female. The self-estimated knowledge of conventional vaccines and COVID-19 vaccines was 5.9/10 (2.3) and 4.9/10 (2.3), respectively. Confidence in the efficacy and safety of conventional vaccines (excluding COVID-19 vaccines) was 8.0/10 (2.3) and 7.7/10 (2.3), respectively. To the question on the intention to vaccinate against the COVID-19, 58.0% of students reported that they would choose to have a vaccination, 17.0% reported that they would not and 25.0% were not sure. The main motivation for vaccine acceptance were “I don't want to transmit COVID-19 to others”, the main barrier for vaccine resistance or hesitancy were “I prefer to wait until I have more experience with these new vaccines”. Age, female gender, being in first three years of study, studied sciences courses and neither sciences nor healthcare courses were significantly associated with a higher risk of vaccine hesitancy or resistancy. Self-estimated knowledge of conventional vaccines and COVID-19 vaccines, and confidence in efficiency and safety of conventional vaccination were associated with a lower risk of vaccine hesitancy or resistancy. Conclusions. Our study shows that, in January 2021, before students have the opportunity to be vaccinated against COVID-19 in France, more than half of the students were vaccine acceptance, a quarter were hesitant, and one in five students were resistant. It is relevant to disseminate evidence-based interventions to promote COVID-19 vaccine acceptability for college students, especially for the students in neither sciences nor healthcare, as college students will soon be eligible to receive a COVID-19 vaccine. Preventive university medicine, campus-based student organizations, and college students could be consider designing educational programs and messaging that promotes behavioral confidence among college students to receive the COVID-19 vaccine

Hypoxia-inducible factor-1 α/platelet derived growth factor axis in HIV-associated pulmonary vascular remodeling

<p>Abstract</p> <p>Background</p> <p>Human immunodeficiency virus (HIV) infected patients are at increased risk for the development of pulmonary arterial hypertension (PAH). Recent reports have demonstrated that HIV associated viral proteins induce reactive oxygen species (ROS) with resultant endothelial cell dysfunction and related vascular injury. In this study, we explored the impact of HIV protein induced oxidative stress on production of hypoxia inducible factor (HIF)-1α and platelet-derived growth factor (PDGF), critical mediators implicated in the pathogenesis of HIV-PAH.</p> <p>Methods</p> <p>The lungs from 4-5 months old HIV-1 transgenic (Tg) rats were assessed for the presence of pulmonary vascular remodeling and HIF-1α/PDGF-BB expression in comparison with wild type controls. Human primary pulmonary arterial endothelial cells (HPAEC) were treated with HIV-associated proteins in the presence or absence of pretreatment with antioxidants, for 24 hrs followed by estimation of ROS levels and western blot analysis of HIF-1α or PDGF-BB.</p> <p>Results</p> <p>HIV-Tg rats, a model with marked viral protein induced vascular oxidative stress in the absence of active HIV-1 replication demonstrated significant medial thickening of pulmonary vessels and increased right ventricular mass compared to wild-type controls, with increased expression of HIF-1α and PDGF-BB in HIV-Tg rats. The up-regulation of both HIF-1α and PDGF-B chain mRNA in each HIV-Tg rat was directly correlated with an increase in right ventricular/left ventricular+septum ratio. Supporting our <it>in-viv</it>o findings, HPAECs treated with HIV-proteins: Tat and gp120, demonstrated increased ROS and parallel increase of PDGF-BB expression with the maximum induction observed on treatment with R5 type gp-120_CM. Pre-treatment of endothelial cells with antioxidants or transfection of cells with HIF-1α small interfering RNA resulted in abrogation of gp-120_CMmediated induction of PDGF-BB, therefore, confirming that ROS generation and activation of HIF-1α plays critical role in gp120 mediated up-regulation of PDGF-BB.</p> <p>Conclusion</p> <p>In summary, these findings indicate that viral protein induced oxidative stress results in HIF-1α dependent up-regulation of PDGF-BB and suggests the possible involvement of this pathway in the development of HIV-PAH.</p

Attention-deficit hyperactivity disorder and addictions (substance and behavioral): Prevalence and characteristics in a multicenter study in France

Aim The aim of this study is to determine the possible links between attention-deficit hyperactivity disorder (ADHD) and the presence of concomitant addictions with or without substance use in a French student population. Measures A battery of questionnaire measuring socioeconomic characteristics, university curriculum, ADHD (Wender Utah Rating Scale and Adult ADHD Self-Report Scale), substance consumptions (alcohol, tobacco, and cannabis), and behavioral addictions [(eating disorders (SCOFF)], Internet addiction (Internet Addiction Test), food addiction (Yale Food Addiction Scale), compulsive buying (Echeburua’s), and problem gambling (The Canadian Problem Gambling Index)] and measures of physical activity (Godin’s Leisure Time Exercise Questionnaire) was filled up by university students in Rouen and Nanterre in France. Results A total of 1,517 students were included (472 from Paris Nanterre and 1,042 from Rouen). The mean age was 20.6 years (SD = 3.6) and the sex ratio male to female was 0.46. The prevalence of ADHD among the students (current ADHD with a history of ADHD in childhood) was 5.6%. A quarter (25.7%) of students had already repeated their university curriculum, compared to 42.2% among the students with ADHD. Students with possible ADHD had repeated classes more often and believed to have a lower academic level than the students without ADHD. Significant differences were found as students with ADHD were less likely to succeed in their studies (repeated classes more often) than non-ADHD students, and considered their academic level to be lower. They also had significantly higher scores on substance (alcohol, cannabis, and tobacco) as well as behavioral addictions (gambling, compulsive buying disorder, eating disorders, and Internet addiction). Conclusion It seems essential to determine students’ problems and propose interventions adapted to students’ needs, in order to reduce the negative impact on their future academic and global successes

Electoral Dioramas: On the Problem of Representation in Voting Advice Applications

Voting Advice Applications (VAAs) are online tools designed to help citizens decide how to vote. They typically offer their users a representation of what is at stake in an election by matching user preferences on issues with those of parties or candidates. While the use of VAAs has boomed in recent years in both established and new democracies, this new phenomenon in the electoral landscape has received little attention from political theorists. The current academic debate is focused on epistemic aspects of the question how a VAA can adequately represent electoral politics. We argue that conceptual and normative presuppositions at play in the background of the tool are at least as important. Even a well-developed VAA does not simply reflect what is at stake in the election by neutrally passing along information. Rather, it structures political information in a way that is informed by the developers’ presuppositions. Yet, these presuppositions remain hidden if we interpret the tool as a mirror that offers the user a reflection of him/herself situated within the political landscape. VAAs should therefore be understood as electoral dioramas, staged according to a contestable picture of politics

Depressive symptoms in higher education students during the COVID-19 pandemic: the role of containment measures

Background Students are a vulnerable group for the indirect impact of the COVID-19 pandemic, particularly their mental health. This paper examined the cross-national variation in students’ depressive symptoms and whether this can be related to the various protective measures implemented in response to the initial stage of the COVID-19 outbreak. Methods Student data stem from the COVID-19 International Student Well-being Study, covering 26 countries during the first wave of the COVID-19 pandemic. Country-level data on government responses to the COVID-19 pandemic were retrieved from the Oxford COVID-19 Tracker. Multilevel analyses were performed to estimate the impact of the containment and economic support measures on students’ depressive symptoms (n = 78 312). Results School and workplace closures, and stay-at-home restrictions were positively related to students’ depressive symptoms during the COVID-19 pandemic, while none of the economic support measures significantly related to depressive symptoms. Countries’ scores on the index of these containment measures explained 1.5% of the cross-national variation in students’ depressive symptoms (5.3%). This containment index’s effect was stable, even when controlling for the economic support index, students’ characteristics, and countries’ epidemiological context and economic conditions. Conclusions Our findings raise concerns about the potential adverse effects of existing containment measures (especially the closure of schools and workplaces and stay-at-home restrictions) on students’ mental health

Writing settlement after Idle No More: non-indigenous responses in Anglo-Canadian poetry

This article examines the representation of settlement in Canada in the wake of Idle No More in recent Anglo-Canadian literature. It argues that Idle No More engendered a new vocabulary for settler-invader citizens to position themselves in relation to this Indigenous movement, with non-Indigenous Canadians self-identifying as “settlers” and “allies” as a means of both orienting themselves with respect to Indigenous resistance to the settler-invader nation-state and signalling an attempted solidarity with Idle No More that would not lapse into appropriation. Four very different poetic texts by non-Indigenous authors demonstrate this reconsideration of settlement in the wake of Idle No More: Arleen Paré’s Lake of Two Mountains (2014); Rachel Zolf’s Janey’s Arcadia (2014); Rita Wong’s undercurrent (2015); and Shane Rhodes’s X (2013). Although only the latter two of these collections make explicit reference to Idle No More, all four of these texts engage with historical and current colonialisms, relationships to land and water, and relationships between Indigenous peoples and settler-invaders, providing examples of new understandings and representations of (neo)colonial settlement in post-Idle No More Canada

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes