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PurposeThe use of over-the-top (OTT) platforms grew substantially after the declaration of the COVID-19 pandemic in 2020. With the pandemic receding, there is a concern that users may not continue with their subscriptions. To counter this, OTT service providers must strategize proactively to retain and acquire new users once the pandemic abates. Positing that understanding the consumption values that users ascribe to OTT platform usage can provide useful customer retention insights, the purpose of this paper is to use the theory of consumption value (TCV) to study the values that users derived from their use of OTT following the onset of the pandemic.Design/methodology/approachThe mixed-method approach is used to collect qualitative and quantitative data. Analysis of qualitative responses collected through interviews of 12 current OTT platform users helped identify two categories of OTT platform-specific values: attribute-level and benefit-based. Next, the study examined the association of values thus identified with one another, as well as with continued intentions to use OTT platforms, by analyzing data collected from 371 existing users.FindingsThe findings indicated that functional value quality and social value, representing the attribute-level values, were positively associated with two benefit-based values – functional value price and emotional value (EMV). Next, EMV was not only associated with intentions but also partially mediated the association of attribute-level values with intentions. Premium subscription purchased and increased viewing time were confirmed to have moderating effects on the association between attribute-level and benefit-based values.Originality/valueThe study is amongst the foremost research initiatives to examine consumption values derived from OTT platform usage after the onset of the pandemic. Its novelty also comes from its identifying OTT platform-specific consumption values for the first time and adding a new dimension to the TCV by examining the interplay of these values in the OTT platform context.

PurposeThis paper studies the sociocultural drivers of materialism cross-culturally. Research in this area is scarce, even though rapid social transformations worldwide, fueled by globalization, make it imperative to identify the conditions under which commonalities and differences in materialistic tendencies are most likely to evidence among consumers as they seek to assert, restore, or enhance their self-concept and status in the context of global consumption trends.Design/methodology/approachThe psychographic determinants of materialism were rigorously validated across a diverse set of eight countries, by investigating which facets of acculturation to global consumer culture and national ethnic identity, along with consumer ethnocentrism, encourage or repel materialism. Using multigroup SEM and other analyses, the authors confirmed construct dimensionality and ascertained the stability of the relationships.FindingsThe most consistent positive drivers of materialism were self-identification with global consumer culture and exposure to American-based global mass media. The results demonstrated the compatibility of national identity and traditions with materialistic tendencies. Materialism was positively related to or independent of consumer ethnocentrism.Research limitations/implicationsThe findings offer consequential insights for both research and practice, although the cross-sectional character of survey research and certain sampling characteristics limit their generalizability.Practical implicationsThe results pinpoint segments that spill over national boundaries, and those that remain geographically constrained, thus providing guidance for marketing and communication strategies to practitioners.Social implicationsThe authors shed light on two widely held yet insufficiently researched assumptions: that the homogenizing effect of global consumer culture may be fomenting materialism worldwide, and that nationalistic, parochially oriented consumers may be more capable of resisting materialistic values.Originality/valueThe study design addresses several shortcomings of prior research, and its findings advance the understanding of materialism and its antecedents by identifying the conditions driving materialistic tendencies.

Purpose This study aims to investigate how consumers respond to global brands adapting to local elements. Specifically, this study identified three factors (i.e., cultural compatibility, cultural elements authenticity and cultural pride) affecting the purchase intentions (PIs) toward global brands using Chinese elements among Chinese consumers in China and Chinese immigrants in North America. Another aim is to examine the moderating role of acculturation in the relationship between cultural pride and PIs among Chinese immigrants. Design/methodology/approach Three studies were conducted to test the hypotheses in China and North America. Confirmatory factor analysis was used to confirm the factor structure. Hierarchical regression was used to test the main effects and moderated regression analysis was used to test the moderation effect. Findings Results show that cultural compatibility, cultural elements authenticity (CEA) and cultural pride positively affect the PIs toward global brands with Chinese elements for both Chinese consumers and Chinese immigrants. Further, among Chinese immigrants, acculturation moderates the relationship between cultural pride and PIs. Originality/value This study explored the factors influencing the PIs toward global brands using Chinese elements, filling a research gap. To the best of the authors’ knowledge, this study is the first to examine how perceived CEA affects consumers’ PIs toward global brands with Chinese elements. Further, the findings have implications for global brands that want to target Chinese consumers and Chinese immigrants in overseas markets.

Firms increasingly use ubiquitous technology in marketing to interact with consumers, locate and identify them, push promotions, and gather detailed purchasing data. This increased connectivity through ubiquitous technology creates a new bond between consumers and firms. Although most consumers willingly accept this connection, some perceive it as unwanted proximity, qualify it as intrusive, and consequently refuse to engage with firms. This research is intended to support firms that are interested in implementing ubiquitous technology in their marketing activities. We propose a new consumer response model, confirm a good fit with the data, and its stability in the presence of socio-demographic moderators using structural equations and multi-group analyses. This model is a tool that accurately captures the optimal settings of ubiquitous technology use and enables firms to efficiently predict consumer reactions to this technology, handily design implementation, and provide an improved customer experience.

Purpose This study aims to examine the emotional components of brand hate and the variation of emotions across different levels of brand hate. Design/methodology/approach Study 1 uses in-depth interviews and data triangulation. Studies 2-5 make use of quantitative methods to test and validate the multidimensional structure of brand hate and the variation of its composing emotions. Findings Study 1 suggests that brand hate is a multidimensional construct comprised of anger-, sadness- and fear-related emotions; possible antecedents and consequences are discussed. The quantitative results from Studies 2-5 confirm the findings in Study 1. A three-factor scale consisting of nine items is developed. The proposed model is tested among different samples and is compared with the currently available brand hate models. In addition, the findings show that emotions weigh differently for different brand hate levels. Research limitations/implications This study contributes to the brand hate literature and provides a structure to understand brand hate more thoroughly. Practical implications Companies can benefit from the research through a better knowledge of brand hate. Managers can use the multidimensional measurement to detect brand hate and better cope with it. Originality/value This study is among the first few attempts to examine the multidimensionality of brand hate and to investigate the variation of emotions in different brand hate levels. This study contributes to a more precise description of the brand hate construct and improves understanding of consumer-brand relationships.

BACKGROUND Whipple's disease is a very rare disease needing a long-term treatment. The most frequent symptoms are recurrent arthralgia or arthritis, chronic diarrhea, abdominal pain, and weight loss. OBJECTIVES In this article, we have highlighted the main clinical features and diagnostic procedures that lead to the diagnosis and comment on the clinical response, treatment, and the factors of relapse. METHODS Subjects were recruited from the Internal Medicine and Rheumatologic Departments of an University Hospital from November 1997 to January 2016. Overall, 12 subjects were finally diagnosed. RESULTS Mean age was 54.3 years (age range: 30-81), with more male patients (58.3%). Almost all patients had articular symptoms and impaired general condition (91.7%); and a majority had digestive symptoms (75%). Regardless of the symptoms, the most efficient diagnostic tools were the PCR screening on the gastrointestinal biopsies and saliva (83.3 and 72.7% positive results, respectively). More than half of the patients relapsed (55.6%). The relapsing patients were older [63.2 (44-81)] and mostly male with a majority (60%) of digestive symptoms and a delayed diagnosis. CONCLUSIONS In current practice, it is highly difficult to diagnose Whipple's disease. In order to decrease the delay between the first symptoms and the diagnosis, effective tools such as saliva and stools PCR should be used because higher delays of diagnosis lead to a higher number of relapses.

10% of rheumatoid arthritis (RA) cases are associated to so-called secondary Sjögren's syndrome (SS). These RA cases have higher DAS, fewer remissions. Is this linked to a poor response to DMARDs (disease-modifying anti-rheumatic drugs)? No study has addressed this question to date. Does the association between secondary Sjögren's syndrome (SS) and rheumatoid arthritis (RA) affect the therapeutic response to DMARDs and long-term prognosis? We conducted a retrospective case-control study: 39 RA associated with SS was (anti-SSA antibodies and/or Chisolm stage III or IV) were compared to 39 isolated cases of erosive RA matched by age, duration of progression and gender. The DAS CRP was higher in the RA + SS group in patients with disease progression of 16 years: 2.6 (1.5-4.5) compared to the RA group: 1.6 (1.3-2.8) (p = 0.0001) while fewer patients were in remission: 61 vs. 92% (p = 0.002). A higher number of B DMARDs have been prescribed: RA + SS = 3.04 (1-7); RA = 1.7 (1-5) (p = 0.004). Anti-TNFs are less effective when RA is associated with SS: 30 vs. 70%. Conversely, Rituximab is more effective when RA is associated with SS: 80 vs. 30%. Erosive RA-related SS exacerbates the clinical course of the condition: higher DAS, fewer remissions. This is linked to reduced treatment efficacy: higher number of DMARDs prescribed, reduced efficacy of anti-TNF drugs. RA-related SS could modify sensitivity to biotherapies: lower percentage of remissions and resistance to anti-TNF drugs.

Background Pregnancy and breastfeeding are associated with bone density loss. Fracture occurrence during pregnancy and post-partum, and its determinants, remain poorly known in Osteogenesis Imperfecta (OI). The aim of this study was to characterize fractures that occurred during pregnancy and post-partum in OI patients. Results We conducted a retrospective multicentric study including a total of 50 previously pregnant OI women from 10 Bone Centers in France. Among these patients, 12 (24%) patients experienced fractures during pregnancy or in the 6 months following delivery, and 38 (76%) did not experience any fracture. The most frequent localizations were: proximal femur (25%), spine (25%), distal femur (12.5%), and pelvis (12.5%). Fractures during pregnancy occurred during the third trimester and post-partum fractures occurred with a mean delay of 2 months following delivery. No fractures occurred during childbirth. We next compared the 12 patients with pregnancy or post-partum fractures with the 38 patients without fractures. Mean age at pregnancy was 32.7 ± 3.1 years-old in the fractured group, vs 29.3 ± 5.0 years-old in the non-fractured group (p = 0.002). Breastfeeding was reported in 85.7% of patients in the fractured group, vs 47.1% in the non-fractured group (p = 0.03). All patients with post-partum fractures were breastfeeding. Bone mineral density was significantly lower in patients with pregnancy-related fractures compared with other patients: spine Z-score − 2.9 ± 1.6DS vs − 1.5 ± 1.7DS (p = 0.03), and total hip Z-score − 2.0 ± 0.7DS vs − 0.5 ± 1.4DS (p = 0.04). At least one osteoporosis-inducing risk factor or disease other than OI was identified in 81.8% vs 58.6% of fractured vs non-fractured patients (not significant). Fracture during pregnancy or post-partum was not associated with the severity of OI. Bisphosphonates before pregnancy were reported in 16.7% and 21.1% of patients with pregnancy-related fractures and non-fractured patients, respectively (not significant). Conclusions OI management during pregnancy and post-partum should aim for optimal control of modifiable osteoporosis risk factors, particularly in patients with low BMD. Breastfeeding should be avoided.

International audience; We content analyzed 4155 Chinese, French, and Canadian print ads to examine how fear advertising differsacross countries or cultures. Findings show that advertisers use fear appeals more frequently in Canada andChina than in France. Moreover, fear appeals appear in all three countries more frequently for convenience thanfor shopping-type products, and more frequently for shopping than for search-type products. Beauty and personalcare products, as well as drugs and medical products are more prone to fear appeals than all other productcategories. However, the frequency of fear appeals in relation to the product category varies across countries. Wealso find variations in relation to types of fear appeals. Social and self-esteem fear appeals appear most frequentlyin China, while physical fear appeals are most dominant in France and Canada, and economic fearappeals most frequent in France.

Physical attractiveness is an essential factor in consumers' evaluation processes during a service encounter. Using both experimental and field study designs, we demonstrate that a service representative's physical attractiveness affects consumer response (i.e., customer satisfaction, service quality perception, and likability of the service representative). Also, we find that a consumer's social distance perception between themselves and a service representative mediates the physical attractiveness effect on consumer response. Thus, this article is the first to demonstrate that social distance perception is an underlining mechanism of the physical attractiveness effect. Furthermore, findings from Studies 2 and 3 show that consumers' physical attractiveness and their attractiveness-ability belief moderate the physical attractiveness effect. Although contentious to some, our findings indicate that the recruitment of attractive representatives may be an effective business practice in service settings. However, managers should not regard consumers as a homogeneous group; self-perceived unattractive consumers may respond negatively to their service representative's physical attractiveness.

Background Mastocytosis is characterized by the accumulation/proliferation of abnormal mast cells. The frequency of isolated cutaneous involvement in adults with mastocytosis has not been fully determined. The main objective of our study was to assess the frequency of isolated cutaneous mastocytosis (CM) in adults with mastocytosis skin lesions. The second objective was to compare the clinical, histological, biological and imaging features in patients with isolated CM and patients with systemic mastocytosis (SM). Methods We included all patients with histology-proven mastocytosis skin lesions between January 2009 and December 2017. The mastocytosis diagnosis was made according to the international diagnostic criteria. All data were collected from a dedicated specific case report. Results Among 160 patients with mastocytosis skin lesions, 25 patients had isolated CM (15.6%), 105 had SM and 30 (18.7%) patients had undetermined mastocytosis. Skin KIT mutation (OR: 51.9, 95% CI: 3.9-678, P = 0.001) and high bone marrow tryptase (OR: 97.4, 95% CI: 10.3-915, P = 0.001) were strong predictors of SM. The prevalence of osteoporosis was higher in the SM population than in the isolated CM population. Moreover, a decrease in bone mineral density over a short period of follow-up (1-2 years) was associated with SM. There were no differences between the two groups regarding the frequency of mast cell activation symptoms, the presentation of skin lesions, the number of mast cells in the dermis and the level of serum tryptase. We propose considering the KIT mutation status and bone marrow tryptase levels to aid the diagnosis of isolated CM in adult mastocytosis patients. Conclusion Only a small minority of adults with mastocytosis skin lesions has isolated cutaneous involvement. In 18.7% of mastocytosis cases, even complete workup does not allow for a precise classification of patients.

When consumers view a sales promotion in a store or online, they have the ability to disseminate it online and inform others. This dissemination may be beneficial to firms because promotion...

International audience; Little is known about osteoporosis in mast cell disorders (MCDs) not related to systemic mastocytosis. We described osteoporosis and fractures in MCDs and showed that systemic mastocytosis was the only studied MCDs associated with osteoporotic vertebral fractures. Introduction : To describe osteoporosis (OP) and fragility fractures in mast cell disorders (MCDs). Methods : We retrospectively analyzed data concerning all successive patients with systemic mastocytosis (SM), cutaneous mastocytosis (CM), and mast cell activation syndromes (MCAS) diagnosed in our mastocytosis expert center between 2004 and 2015. We collected data concerning demographic profiles, clinical signs of MCD, osteoporosis, fractures, densitometry, and biological assessment of MCD. We compared CM and MCAS patients with SM patients with regard to the characteristics of OP and fragility fractures. Results : We assessed 89 SM patients, 20 CM patients, and 20 MCAS patients. Osteoporosis was less frequent in CM (15.0%) and MCAS (10.0%) than in SM (44.9%). Similarly, fractures were less frequent in non-SM MCDs, respectively 5.0%, 5.0%, and 28.1%. SM patients displayed high prevalence of vertebral fractures (22.5%), mostly multiple. Conversely, in non-SM patients, vertebral fractures appeared to be uncommon (5%) and more frequently associated with risk factors for osteoporosis. Conclusions : SM is associated with multiple vertebral osteoporotic fractures, whereas CM and MCAS do not appear to be associated with this phenotype.

Treatment with asfotase alfa has transformed the prognosis of hypophosphatasia in children and improves the bone and muscle signs in adults. The doses used in adults are the same as in children, whereas bone remodeling is different between them. We report on the cases of two patients treated with 1 mg/kg/day of asfotase alfa who developed spinal cord compression from spinal ossifications during treatment. The first patient, 50 years old, presented after 2 years of treatment with quadraparesis secondary to an increase in ossifications of the cervical vertebral ligaments. The neurological damage was resolved after laminectomy, and the patient was then treated for 18 months with doses of 80 mg per week, without recurrence of the bone and muscle signs. The second patient, 26 years old, 78 kg, developed pain and cervical stiffness with pyramidal tract irritation secondary to ossifications of the vertebral ligaments. This improved with a reduction of doses to 80 mg/week, which then, after 6 months of follow‐up, enabled maintained improvement of the bone and muscle pain that was initially obtained. To our knowledge, these are the first reported cases of increased spinal ligamentous ossifications with neurological complications. Biological monitoring in adults does not seem to enable asfotase alfa doses to be adjusted. The levels of serum alkaline phosphatase (ALP) while on the recommended treatment of 1 mg/kg/day are significantly supraphysiological (5000 to 20,000 IU) and the assays of pyrophosphate and pyridoxal phosphate are not correlated with clinical efficacy. In both of our patients, the treatment with 80 mg of asfotase alfa per week, which was proposed after the occurrence of spinal complications, seemed as effective, after a follow‐up of 18 months and 6 months, as the initial treatment for improving the bone and muscle signs, and could be provided as “attack” doses after healing of the pseudoarthroses. © 2021 American Society for Bone and Mineral Research © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

Nowadays, global brands often use Chinese elements in their products to attract consumers and increase market share. However, research on this topic is still in its infancy. This article aims to investigate the relationship between three independent variables (cultural pride, cultural compatibility, and Chinese elements authenticity), and a dependent variable (purchase intentions) toward the global brands using Chinese elements in their products, both in the Chinese and North American markets. Another aim is to understand how acculturation moderates the relationship between cultural pride and purchase intentions, and the relationship between cultural elements authenticity and purchase intentions.

Despite the important role of culture in consumer behavior studies, there has been no study of effect of indulgence vs. restraint, the sixth and last dimension of Hofstede’s cultural framework, at the individual-level in consumer behavior. This is mainly because there has been no scale yet developed to measure indulgence vs. restraint at the individual-level. Given that ascribing national-level cultural scores to individuals causes an ecological fallacy, the four studies of this research conceptualize and develop a measure for individual-level indulgence and establish the reliability, convergent and discriminant validity, as well as the nomological validity of this new scale.

While prior research shows that atmospheric cues such as visual design trigger customers' cognition and emotions, thus leading to approach-avoidance responses, this article proposes self-congruity as a mediator, paralleling cognitive evaluation (i.e., perceived quality). More specifically, this article, situated in the context of the coffee shop industry in China, investigates how perceived luxuriousness, reflected from the service provider's visual design, affects customers' willingness to pay a price premium (WTPP). The findings show that perceived luxuriousness leads to customers' inferences of high quality of the coffee and high self-congruity, thus increasing WTPP. Further, cosmopolitanism moderates the effect of perceived luxuriousness only via self-congruity, but not via perceived quality. This article contributes to the existing literature on atmospherics, self-congruity, brand equity, and cosmopolitanism. More importantly, this article provides managerial implications for global coffee/food brands that aim to set up their chain outlets and expand rapidly in China, one of the largest emerging markets.

Recent studies have shown that Dickkopf-related protein (DKK1) and sclerostin decrease when a complete response (CR) is obtained after chemotherapy in myeloma multiple (MM). To study variations in DKK1, sclerostin and P1NP in patients treated for MM, between complete response (CR) and relapse, we carried out a prospective study ancillary to the IFM 2009 protocol (IFM). The aim of IFM was to compare progression-free survival between patients treated with chemotherapy with or without transplantation. We selected 69 patients who reached CR and relapsed. We assayed by ELISA: DKK1, sclerostin and P1NP at 3 end points T1: CR, T2: 4 months before relapse and T3: relapse. There was a significant increase in DKK1 and sclerostin between T1, T2 and T3. (DKK1 medians (IQR): T1 = 30 pmol/l (20.4-41.1), T2 = 37.4 pmol/l (29.8-49.4), p 0.0001, T3 = 42 pmol/l (33.8-55.5), p 0.0001 sclerostin medians (IQR): T1 = 0.57 (0.47-0.69), T2 = 0.62 ng/ml (0.53-0.79), p 0.0001, T3 = n0.64 ng/ml (0.56-0.79), p = 0.005). No significant variation was detected in the levels of P1NP. No association was observed between the characteristics of the MM, or the treatment received and the variation between T1-T3 for DKK1, sclerostin or P1NP. A significant increase in DKK1 and sclerostin was observed four months before relapse.

The objective of our prospective study is to specify the variability of densitometric response to Denosumab, given in the second line, and to try to understand the reasons. All menopausal patients with primary osteoporosis, treated by Denosumab in our centre from 2014 to 2015, were included in this open prospective work. At T0, the patient's age, type of fracture, and previous treatments were collated. At T0 and T1, after 1 year of treatment by Dmab, a DXA of the spine and the hip and a determination of CTX were performed. Sixty-three patients aged 68.8 ± 8.3 years were included. The median number of treatments prescribed for osteoporosis before switch to Denosumab was 2.4. The median duration of these treatments was 7.2 years. At T1, CTX was less than 33 pg/ml (minimum threshold for our assay kit) in all patients. The median BMD in the spine increased by + 5.44% compared to T0. 14 patients in the upper quartile had a median BMD gain in the spine of + 11.07%. Fourteen patients in the lower quartile had a median BMD gain in the spine of + 0.6%. Only the duration of previous treatments, which was greater in the non-responder group, differed between these two groups. In the total cohort, the spinal densitometric gain was negatively correlated with the age of the patient at baseline (p = 0.04), the duration of previous treatment (p = 0.02), and positively with the CTX level (p = 0.05). The Dmab densitometric response is highly variable, partly explained by the duration of previous treatments and the level of bone resorption at initiation of treatment.