Traditional healers or bonesetters ("rebouteux") in France: A survey of their practice, profile, and customers.

BACKGROUND: In France, many people consult "bonesetters" for several medical reasons. Little is known about them. We aimed to investigate the practices of traditional healers in France as well as their profile and that of their customers. METHODS: This was a survey carried out in Metropolitan France. A 33-item questionnaire developed by a multidisciplinary group was sent to a sample of 148 traditional healers found on the Internet and by word of mouth. RESULTS: Of the 148 questionnaires sent, 89 (60.1 %) were returned and 67 (45.3 %) were analyzed: 51.5 % (n = 34) of respondents were men, and the mean (±standard deviation) age was 51.6 ±â€¯11.6 years. The respondents considered that they had received a gift of healing and were mainly magnetic healers (68.2 %). They became aware of this gift at a mean age of 19.9 ±â€¯14.1 years. The traditional healers practiced mainly in rural areas (54.5 %), at home (59.1 %), and used their hands to transmit energy (95.5 %). They advertised their practice mainly by word of mouth (89.4 %) and had a predominantly female clientele (78.1 %). Various diseases were treated, with the most frequent being subjective complaints (pain, stress, fatigue, insomnia) and dermatological complaints (eczema, accidental and post-herpes-zoster burns, psoriasis, and warts). Most respondents considered their activities to be complementary to conventional medicine, and 10.9 % considered them more effective. Some indicated that they did not consider themselves "healers" but rather "providers of relief". DISCUSSION: The results of this survey provide a better understanding of this network of local care that revolves around medicine.

[Ethnicity and immigration status: How are they associated with work and depressive symptoms?] / Ethnicité et statut d'immigrant : quelle association avec le travail et les symptômes dépressifs ?

BACKGROUND: The purpose of this research is to determine whether, in the Canadian workforce, cultural identity traits, particularly ethnicity and immigrant status, might modify the association of work with depressive symptoms. METHOD: Data were derived from the nine cycles of the National Population Health Survey (NPHS) conducted by Statistics Canada. Based on a sample of 6477 workers, multilevel regression models were brought into being. Analyses were adjusted for family-related factors, non-work social support, and personal characteristics. RESULTS: After accounting for potential confounders, ethnicity and work-related factors were distinctly and directly associated with depressive symptoms. Workers belonging to visible minorities had significantly fewer depressive symptoms than their Caucasian counterparts. Unlike Caucasians, they were more often overqualified, less in a position to use their skills, and largely without decision-making authority. On the other hand, all analyses having to do with immigrant status led to inconclusive results. CONCLUSION: Ethnicity seems to have some bearing on the association of work with depressive symptoms among members of the Canadian workforce. It might be beneficial to carry out targeted interventions aimed at improving working conditions according to ethnicity and situations involving professional overqualification.

[Work, family, resources and unequal levels of psychological distress between working men and working women : vulnerability or gendered expression of stress?] / Inégalité de détresse psychologique entre les hommes et les femmes en emploi : vulnérabilité ou expression genrée du stress?

INTRODUCTION: This study aims to compare the vulnerability hypothesis and the expression hypothesis to explain a greater level of psychological distress among working women than among working men. METHOD: The two hypotheses were contrasted by integrating work stressors, family stressors, work-family conflicts and psychosocial resources. The conceptual models were tested by using multilevel path analyses on 2026 employees in Quebec (Canada) based in 63 work establishments. RESULTS: Results partially supported both hypotheses. According to the vulnerability hypothesis, single parenting, child-related problems and self-esteem were indirectly involved in the variation of psychological distress among women through family-to-work, otherwise known as work-family conflict. According to the expression hypothesis, although family-to-work conflict was closely associated with more psychological distress among women, this stressor was also closely associated with higher at-risk alcohol consumption among men. Couple-related problems and a sense of control likewise played a role in the expression mechanism through family-to-work conflict. CONCLUSION: These results underline the importance of considering that gender contributes to mental health inequalities through multiple mechanisms. They also call for a distinction between the two directions of work-family conflict as gendered mediators.

Do age and gender contribute to workers' burnout symptoms?

BACKGROUND: Despite mounting evidence on the association between work stress and burnout, there is limited knowledge about the extent to which workers' age and gender are associated with burnout. AIMS: To evaluate the relationship between age, gender and their interaction with burnout in a sample of Canadian workers. METHODS: Data were collected in 2009-12 from a sample of 2073 Canadian workers from 63 workplaces in the province of Quebec. Data were analysed with multilevel regression models to test for linear and non-linear relationships between age and burnout. Analyses adjusted for marital status, parental status, educational level and number of working hours were conducted on the total sample and stratified by gender. RESULTS: Data were collected from a sample of 2073 Canadian workers (response rate 73%). Age followed a non-linear relationship with emotional exhaustion and total burnout, while it was linearly related to cynicism and reduced professional efficacy. Burnout level reduced with increasing age in men, but the association was bimodal in women, with women aged between 20-35 and over 55 years showing the highest burnout level. CONCLUSIONS: These results suggest that burnout symptoms varied greatly according to different life stages of working men and women. Younger men, and women aged between 20-35 and 55 years and over are particularly susceptible and should be targeted for programmes to reduce risk of burnout.

A calcium-sensitive promoter construct for gene therapy.

Targeting diseased cells is a challenging issue in both pharmacological and biological therapeutics. Gene therapy is emerging as a novel approach for treating rare diseases and for illnesses for which there is no other alternative. An important limitation of gene therapy has been the off-target effects and therefore efforts have been focused on increasing the specificity of gene transfer to the targeted organ. Here, we describe a promoter containing six nuclear factor of activated T cells (NFAT) consensus sequences, which is as efficient as the cytomegalovirus (CMV) promoter to drive expression in vascular smooth muscle cells both in vitro and in vivo. In contrast to the CMV promoter it is activated in a Ca(2+)-dependent manner after endoplasmic reticulum depletion and allows the transgene expression only in proliferative/diseased cells. Overexpression of sarco/endoplasmic reticulum (SR/ER) Ca(2+) ATPase 2a under the control of this NFAT promoter inhibits restenosis after angioplasty in rats. In conclusion, this promoter may be useful for gene therapy in vascular proliferative diseases and other diseases involving upregulation of the NFAT pathway.

Efficient transduction of vascular smooth muscle cells with a translational AAV2.5 vector: a new perspective for in-stent restenosis gene therapy.

Coronary artery disease represents the leading cause of mortality in the developed world. Percutaneous coronary intervention involving stent placement remains disadvantaged by restenosis or thrombosis. Vascular gene therapy-based methods may be approached, but lack a vascular gene delivery vector. We report a safe and efficient long-term transduction of rat carotid vessels after balloon injury intervention with a translational optimized AAV2.5 vector. Compared with other known adeno-associated virus (AAV) serotypes, AAV2.5 demonstrated the highest transduction efficiency of human coronary artery vascular smooth muscle cells (VSMCs) in vitro. Local delivery of AAV2.5-driven transgenes in injured carotid arteries resulted in transduction as soon as day 2 after surgery and persisted for at least 30 days. In contrast to adenovirus 5 vector, inflammation was not detected in AAV2.5-transduced vessels. The functional effects of AAV2.5-mediated gene transfer on neointimal thickening were assessed using the sarco/endoplasmic reticulum Ca(2+) ATPase isoform 2a (SERCA2a) human gene, known to inhibit VSMC proliferation. At 30 days, human SERCA2a messenger RNA was detected in transduced arteries. Morphometric analysis revealed a significant decrease in neointimal hyperplasia in AAV2.5-SERCA2a-transduced arteries: 28.36±11.30 (n=8) vs 77.96±24.60 (n=10) µm(2), in AAV2.5-green fluorescent protein-infected, P<0.05. In conclusion, AAV2.5 vector can be considered as a promising safe and effective vector for vascular gene therapy.

Topical sirolimus solution for lingual microcystic lymphatic malformations in children and adults (TOPGUN): study protocol for a multicenter, randomized, assessor-blinded, controlled, stepped-wedge clinical trial.

BACKGROUND: Lingual microcystic lymphatic malformations (LMLMs) are rare congenital vascular malformations presenting as clusters of cysts filled with lymph fluid or blood. Even small well-limited lesions can be responsible for a heavy burden, inducing pain, aesthetic prejudice, or oozing, bleeding, infections. The natural history of LMLMs is progressive worsening punctuated by acute flares. Therapeutic options include surgery, laser excision, and radiofrequency ablation but all are potentially detrimental and expose to local relapse. Therefore, the management frequently relies on a "watchful waiting" approach. In complicated LMLMs, treatment with oral sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, is often used. Topical applications of sirolimus on the buccal mucosae have been reported in other oral diseases with good tolerance and none to slight detectable blood sirolimus concentrations. We aim to evaluate the efficacy and safety of a 1 mg/mL sirolimus solution applied once daily on LMLM of any stage in children and adults after 4, 8, 12, 16, 20, and 24 weeks of treatment compared to usual care (no treatment). METHODS: This is a randomized, multicentric study using an individually randomized stepped-wedge design over 24 weeks to evaluate topical application of a 1 mg/mL sirolimus solution once daily, on LMLM, versus usual care (no treatment), the control condition. Participants begin with an observational period and later switch to the intervention at a randomized time (week 0, 4, 8, or 12). Visits occur every 4 weeks, either in the study center or by teleconsulting. The primary outcome will be the evaluation of global severity of the LMLM on monthly standardized photographs by 3 independent blinded experts using the physical global assessment (PGA) 0 to 5 scale. Secondary outcomes will include lesion size measurement and quality of life assessment, investigator, and patient-assessed global disease and specific symptoms (oozing, bleeding, sialorrhea, eating impairment, taste modification, aesthetic impairment, pain, and global discomfort) assessment. A biological monitoring will be performed including residual blood sirolimus concentration and usual laboratory parameters. DISCUSSION: Given the disappointing state of current treatment options in LMLMs, topical sirolimus could become firstline therapy in treating LMLMs if its efficacy and safety were to be demonstrated. TRIAL REGISTRATION: ClinicalTrials.gov NCT04128722 . Registered on 24 September 2019. EudraCT: EUCTR2019-001530-33-FR Sponsor (University Hospital Center of Tours - CHRU Tours): DR190041-TOPGUN French regulatory authorities: ID RCB: 2019-001530-33.

Short course of immune-suppressive doses of prednisolone, evaluated through a prospective double-masked placebo-controlled clinical trial in healthy Beagles, is associated with sustained modifications in renal, hydration, and electrolytic status.

OBJECTIVE: To investigate the effects and duration of orally administered prednisolone on renal function evaluated by glomerular filtration rate (GFR) determination and creatinine (Cr) and symmetric dimethylarginine (SDMA) concentrations as well as on urinalysis, electrolytes, and hydric status in healthy dogs. ANIMALS: 14 healthy Beagles. PROCEDURES: In this prospective double-masked placebo-controlled study, dogs were randomized after baseline evaluation to receive a 7-day course of either prednisolone (1.5 to 2.0 mg/kg, PO, q 12 h) or a placebo. A repeated-measure design was performed, each dog participating in 4 successive sampling sessions. Clinical data, systolic blood pressure, CBC, and biochemical analyses including serum SDMA concentration, GFR determination, urine output quantification, and complete urinalysis were performed for all dogs the day before (D0) and at the end of steroid administration (D7) as well as 2 weeks (D21) and 4 weeks (D35) after the end of treatment. RESULTS: At D7, when compared with baseline, GFR increased significantly in treated dogs, whereas creatinine and SDMA concentrations decreased significantly. GFR and Cr but not SDMA modifications persisted significantly at D21. None of the variables differed significantly from baseline at D35. The OR of presenting an albumin band on urine electrophoresis was 2.4 times as high in treated versus control dogs (OR, 36; 95% CI, 1.8 to 719.4; P = 0.02). CLINICAL RELEVANCE: A short-term course of immune-suppressive prednisolone treatment in healthy dogs leads to a sustained but reversible renal hyperfiltration state. Modification in electrolytic variables can affect the clinical interpretation of blood work in such patients.