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PubMed1998

The construction of the crack babies phenomenon as a social problem.

Early negative findings on cocaine-exposed newborns engendered widespread media and public perceptions of a causal link between poor mothers' substance use and serious problems in their offspring. Despite later research questioning the prevalence of the problems and implicating other environmental and economic factors, these mothers were stigmatized and criminalized, and their children precipitously removed from their care. This paper reviews the process by which this came about and urges a more balanced and complex view of the problem.

Cocaine-Related Disorders↗

PubMed2002

Perceived stigma and community integration among clients of assertive community treatment.

Facilitating the integration of persons with psychiatric disabilities is an important goal of community programs. In addition to limitations such as inadequate housing, poverty, and unemployment, a common barrier to community adjustment identified by people with psychiatric disabilities is their perception of being stigmatized. This study examined the relationships between perceived stigma and community integration in 95 clients of assertive community treatment (ACT) teams, using sequential multiple regression procedures. Findings indicate that despite their physical presence in the community and the intensive support they receive, ACT clients believe other community members will reject them. Moreover, this perception appears to interfere with their sense of belonging, particularly among those who also perceive less social support and who have greater psychosocial skill deficits. In the context of the present study, global self-esteem did not mediate this relationship. In addition to community focused antistigma campaigns, stigma-related issues should also be addressed with ACT clients themselves.

Adolescent↗

PubMed2000

Obesity in the new millennium.

Obesity has increased at an alarming rate in recent years and is now a worldwide public health problem. In addition to suffering poor health and an increased risk of illnesses such as hypertension and heart disease, obese people are often stigmatized socially. But major advances have now been made in identifying the components of the homeostatic system that regulates body weight, including several of the genes responsible for animal and human obesity. A key element of the physiological system is the hormone leptin, which acts on nerve cells in the brain (and elsewhere) to regulate food intake and body weight. The identification of additional molecules that comprise this homeostatic system will provide further insights into the molecular basis of obesity, and possibilities for new treatments.

Environment↗

PubMed2000

Medicinal strategies in the treatment of obesity.

When prevention fails, medicinal treatment of obesity may become a necessity. Any strategic medicinal development must recognize that obesity is a chronic, stigmatized and costly disease that is increasing in prevalence. Because obesity can rarely be cured, treatment strategies are effective only as long as they are used, and combined therapy may be more effective than monotherapy. For a drug to have significant impact on body weight it must ultimately reduce energy intake, increase energy expenditure, or both. Currently approved drugs for long-term treatment of obesity include sibutramine, which inhibits food intake, and orlistat, which blocks fat digestion.

Adipose Tissue↗

PubMed2001

The S-locus receptor kinase is inhibited by thioredoxins and activated by pollen coat proteins.

The self-incompatibility response in Brassica allows recognition and rejection of self-pollen by the stigmatic papillae. The transmembrane S-locus receptor kinase (SRK), a member of the receptor-like kinase superfamily in plants, mediates recognition of self-pollen on the female side, whereas the S-locus cysteine-rich protein (SCR) is the male component of the self-incompatibility response. SCR is presumably located in the pollen coat, and is thought to be the SRK ligand. Although many receptor-like kinases have been isolated in plants, the mechanisms of signal transduction mediated by these molecules remain largely unknown. Here we show that SRK is phosphorylated in vivo within one hour of self-pollination. We also show that, in vitro, autophosphorylation of SRK is prevented by the stigma thioredoxin THL1 in the absence of a ligand. This inhibition is released in a haplotype-specific manner by the addition of pollen coat proteins. Our data indicate that SRK is inhibited by thioredoxins and activated by pollen coat proteins.

Brassica↗

PubMed2001

Bias, discrimination, and obesity.

This article reviews information on discriminatory attitudes and behaviors against obese individuals, integrates this to show whether systematic discrimination occurs and why, and discusses needed work in the field. Clear and consistent stigmatization, and in some cases discrimination, can be documented in three important areas of living: employment, education, and health care. Among the findings are that 28% of teachers in one study said that becoming obese is the worst thing that can happen to a person; 24% of nurses said that they are "repulsed" by obese persons; and, controlling for income and grades, parents provide less college support for their overweight than for their thin children. There are also suggestions but not yet documentation of discrimination occurring in adoption proceedings, jury selection, housing, and other areas. Given the vast numbers of people potentially affected, it is important to consider the research-related, educational, and social policy implications of these findings.

Attitude of Health Personnel↗

PubMed2007

Internalization of weight bias: Implications for binge eating and emotional well-being.

OBJECTIVE: This study examined the relationship between internalization of negative weight-based stereotypes and indices of eating behaviors and emotional well-being in a sample of overweight and obese women. RESEARCH METHOD AND PROCEDURES: The sample was comprised of 1013 women who belonged to a national, non-profit weight loss organization. Participants completed an on-line battery of self-report questionnaires measuring frequency of weight stigmatization and coping responses to deal with bias and symptoms of depression and self-esteem, attitudes about weight and obesity, and binge eating behaviors. In addition, participants were asked to list the most common weight-based stereotypes and whether they believed them to be true or false. RESULTS: Participants who believed that weight-based stereotypes were true reported more frequent binge eating and refusal to diet in response to stigma experiences compared with those who reported stereotypes to be false. The degree to which participants believed stereotypes to be true or false was not related to types or amount of stigma experiences reported, self-esteem, depression, or attitudes toward obese persons. In addition, engaging in weight loss strategies as a response to bias was not predicted by stereotype beliefs or by actual stigma experiences, regardless of the amount or types of stigma reported. DISCUSSION: These findings suggest that obese individuals who internalize negative weight-based stereotypes may be particularly vulnerable to the negative impact of stigma on eating behaviors and also challenge the notion that stigma may motivate obese individuals to engage in efforts to lose weight. This study highlights a new area of research that warrants attention to better understand weight stigma and its potential consequences for health.

Adaptation, Psychological↗

PubMed2026

Genome-wide association meta-analysis of eating behavior traits revealed one susceptibility locus for emotional eating.

In order to identify new and genome-wide significant loci for eating behavior traits (cognitive restraint, uncontrolled eating and emotional eating), we conducted a meta-GWAS with seven studies of European ancestry (n = 11,250). Eating behavior was assessed using the Three-Factor Eating Questionnaire. Genotype effects of single studies were estimated using additive models adjusting for age, sex, BMI, and principal components and single study results were combined by fixed-effect meta-analysis.For cognitive restraint and uncontrolled eating, no genome-wide significant association could be detected. For emotional eating, one genomic region on chromosome 5 comprising two polymorphisms attained genome-wide significance (P = 4.0×10-8 for rs6877636 and P = 3.2×10-8 for rs6897090). The minor alleles were associated with higher emotional eating scores (β=0.093 ± 0.017), with a similar direction of effect in each study. Both SNPs, in near perfect linkage disequilibrium, mapped to RP11-24P24.1, a processed pseudogene of ornithine decarboxylase 1 (ODC1). Enrichment analysis revealed a significant overlap between genome-wide BMI-associated variants and nominal emotional eating variants, supporting the hypothesis that shared genetic factors may influence both eating behavior traits and obesity risk. Finally, we observed a number of interesting associations reaching suggestive significance (P < 10-6) involving BMI candidate genes, including a suggestive association between FTO variants and cognitive restraint (rs9922708, β = 0.069, P = 5.9×10-7).In conclusion, our meta-GWAS identified for the first time a robust chromosomal region associated with emotional eating in seven studies. Given that emotional eating strongly influences body weight but is often stigmatized, recognizing genetic susceptibility to certain eating behaviors may help reduce stigma and alleviate guilt.

Journal Article↗

PubMed2000

Epidemic obesity: are genetic factors involved via increased rates of assortative mating?

OBJECTIVE: Prevalence rates of obesity have been increasing in several countries over the past two decades. Mainly secular changes in energy intake and expenditure have been invoked to underly the increasing rates; genetic factors have not been considered because of the very recency of this phenomenon. We hypothesize that genetic factors might very well be involved via an increased rate of assortative mating between obese individuals. We speculate that the recent upsurge in social stigmatization of obese individuals underlies the hypothesized increase in assortative mating. DESIGN: To accumulate evidence for our hypothesis we analysed deduced rates of assortative mating among parents of extremely obese children and adolescents, who belonged to two different large study groups (n = 201 and n = 270). For this purpose we calculated parental body mass indices (BMIs) based on (a) measured current heights and weights, (b) self-reported current heights and weights, and finally (c) measured current heights and recalled weights at ages 20 and 30, respectively. BMI centiles were determined which in turn were attributed to the respective BMI decile. Deduced rates of assortative mating were evaluated in bivariate histograms of the paternal and maternal BMI deciles. RESULTS: High rates of assortative mating were observed as deduced from the bivariate histograms, which revealed a fairly consistent pattern. Thus, in the first study group almost 35% of the parental pairs had a BMI in the tenth decile; over 50% of the mothers and fathers had a BMI in this top decile. Recalled parental BMIs at ages 20 and 30 also clustered in the upper decile. These results were basically replicated in the second study group. In addition, parental loading on the tenth decile was shown to be higher for the subgroup of children and adolescents who had a BMI equal to or exceeding the highest BMI of the population-based age and gender matched control group. CONCLUSIONS: Our results indicate that assortative mating is common among parents of extremely obese children and adolescents, ascertained between 1995 and 1997. In addition, the parental loading on the tenth decile is most prominent for the most obese children. Whereas we are unable to document an increased rate of assortative mating, we interpret our results as being consistent with the hypothesis that an increased rate of assortative mating has contributed to the recent rise in obesity rates in several countries. Thus, assortative mating warrants further studies to assess its impact on obesity prevalence rates through both genetic and non-genetic mechanisms. Our results suggest that assortative mating might especially increase the rates for extreme obesity.

Adolescent↗

PubMed2005

The unhappy obese child.

OBJECTIVE: One of the most painful aspects of obesity may be the emotional suffering it causes. The paper discusses the psychological and social effects of obesity. METHOD: Current studies examining the psychosocial strains of obese children and adolescents are reported. The report especially focuses on stigmatization, mental health disorders, school performance and health-related quality of life. DISCUSSION: Research is showing that obesity is associated with poorer psychosocial functioning even compared with other chronic diseases. Future studies should further explicate the risk and protective factors for developing severe psychosocial strain.

Adolescent↗

PubMed2006

Assessing the impact of psoriasis and the relevance of qualitative research.

Living with psoriasis is a lifetime experience. The lack of a cure combines with a peculiar public response of disinterest if not prejudice and stigmatization. Various factors account for changes in quality of life measures that seem independent from disease severity and effectiveness of treatment. Merging a qualitative and individual case analysis with assessment of quality of life would represent a direction for future studies.

Chronic Disease↗

PubMed1997

Long-term adaptation to electrically induced cycle training in severe spinal cord injured individuals.

Spinal cord injured (SCI) individuals most often contract their injury at a young age and are deemed to a life of more or less physical inactivity. In addition to the primary implications of the SCI, severe SCI individuals are stigmatized by conditions related to their physically inactive lifestyle. It is unknown if these inactivity related conditions are potentially reversible and the aim of the present study was, therefore, to examine the effect of exercise on SCI individuals. Ten such individuals (six with tetraplegia and four with paraplegia; age 27-45 years; time since injury 3-23 years) were exercise trained for 1 year using an electrically induced computerized feedback controlled cycle ergometer. They trained for up to three times a week (mean 2.3 times), 30 min on each occasion. The gluteal, hamstring and quadriceps muscles were stimulated via electrodes placed on the skin over their motor points. During the first training bouts, a substantial variation in performance was seen between the subjects. A majority of them were capable of performing 30 min of exercise in the first bout; however, two individuals were only able to perform a few minutes of exercise. After training for 1 year all of the subjects were able to perform 30 min of continuous training and the work output had increased from 4 +/- 1 (mean +/- SE) to 17 +/- 2 Kilo Joules per training bout (P < 0.05). The maximal oxygen uptake during electrically induced exercise increased from 1.20 +/- 0.08 litres per minute measured after a few weeks habituation to the exercise to 1.43 +/- 0.09 litres per minute after training for 1 year (P < 0.05). Magnetic resonance cross sectional images of the thigh were performed to estimate muscle mass and an increase of 12% (mean, P < 0.05) was seen in response to 1 year of training. In biopsies taken before exercise various degrees of atrophy were observed in the individual muscle fibres, a phenomenon that was partially normalized in all subjects after training. The fibre type distribution in skeletal muscles is known to shift towards type IIB fibres (fast twitch, fast fatiguable, glycolytic fibres) within the first 2 years after the spinal cord injury. The muscle in the present investigation contained of 63% myosin heavy chain (MHC) isoform IIB, 33% MHC isoform IIA (fast twitch, fatigue resistant) and less than 5% MHC isoform I (slow twitch) before training. A shift towards more fatigue resistant contractile proteins was found after 1 year of training. The percentage of MHC isoform IIA increased to 61% of all contractile protein and a corresponding decrease to 32% was seen in the fast fatiguable MHC isoform IIB, whereas MHC isoform I only comprised 7% of the total amount of MHC. This shift was accompanied by a doubling of the enzymatic activity of citrate synthase, as an indicator of mitochondrial oxidative capacity. It is concluded that inactivity-associated changes in exercise performance capacity and skeletal muscle occurring in SCI individuals after injury are reversible, even up to over 20 years after the injury. It follows that electrically induced exercise training of the paralysed limbs is an effective rehabilitation tool that should be offered to SCI individuals in the future.

Adaptation, Physiological↗

PubMed1997

Endothelial fibrinolytic reactivity and the risk of deep venous thrombosis after spinal cord injury.

Deep vein thrombosis (DVT) is a frequent event in patients with spinal cord injury, even with prophylactic anticoagulant therapy. Lower limb paralysis is a known major risk factor for venous thrombosis, supposedly due to the venostasis in relation with total immobility. The main goal of this study was to evaluate the endothelial response to anoxia to determine whether recovery of fibrinolytic potential occurs in patients subjected to forced bedrest because of a spinal cord injury and whether this recovery is related to the incidence and/or evolution of DVT. We evaluated vascular endothelium reactivity in the lower limbs no longer submitted to the hydrostatic pressure of the erected position in 15 patients with paraplegia or tetraplegia and in 10 normal volunteers after venous occlusion produced by the application of 10 cm Hg pressure to the lower limb for 15 min comparatively to the upper limb used as reference. Among the 15 patients, 10 whose spinal cord injury had occurred 1 to 6 months earlier were still receiving prophylactic anticoagulant therapy, whereas the five other patients were not receiving prophylactic anticoagulants because the injury dated back 6 months or more. After venostasis, tissue plasminogen activator (tPA) increased significantly in both patients and controls in the upper limb (tPA levels twofold and threefold respectively in controls and patients) but showed no significant changes in the lower limb; prolonged immobility did not allow recovery in the lower limbs of a level of fibrinolytic responsiveness identical to that in the upper limbs. The plasminogen activator inhibitor (PAI1) remained unchanged after anoxia, although wide interindividual variations were seen. Natural coagulation inhibitors and circulating blood stigmates of hypercoagulability were measured. None of the patients had abnormally low levels of coagulation inhibitors (ie, antithrombin III, protein C and protein S levels were normal). Seventy-five per cent of patients (prophylactically anticoagulated or not) had very high levels of fibrin degradation products (D. Dimer levels sevenfold to eightfold those of the controls), but all patients had normal levels of thrombin-antithrombin complexes and prothrombin fragments 1 + 2. The permanence of the thrombotic process characterized by an increase in D. Dimer levels without recovery of fibrinolytic potential suggests a proposal for the patients an indefinite antithrombotic treatment at curative doses.

Adolescent↗

PubMed1986

Congruity and predictability between two measures of nonstandard dialect usage on four grammatical forms.

This study investigated whether Nonstandard English (NSE) dialect responses to an examiner-constructed sentence completion test were congruent with and predictive of use of NSE during spontaneous conversation. The sentence completion test was designed to evoke either NSE or Standard English (SE) dialect variants of four grammatical forms for which the NSE dialect variants are highly stigmatized. The 76 Black male subjects were between the ages of 15:8 and 23:5 years. The grammatical forms assessed were verb-subject agreement third person singular, negative concord, possessive suffix, and continuative be. A low but statistically significant correlation was found between the percentage of NSE usage on the test and during conversation when all four grammatical forms were combined (r = .2344, p less than .05). Only the possessive suffix form showed a statistically significant correlation between the two measures when correlations were computed for individual grammatical forms (r = .4341, p less than .05). Thus, congruency was interpreted to be highly variable and dependent on the particular grammatical form. To measure predictability, data were inspected for each grammatical form to determine the percentage of subjects who used at least one NSE dialect variant for sentence completion test items when at least one NSE variant of that form occurred during spontaneous conversation. Responses to the sentence completion test were predictive of NSE during conversation for more than 90% of the subjects only for the negative concord grammatical form. It was concluded that the sentence completion test is satisfactorily congruent with and predictive of patterns of dialect used in spontaneous conversation only for certain specific grammatical forms. Some possible reasons for these variable results and their implications for second dialect assessment are offered.

Adolescent↗

PubMed1998

Hearing loss, control, and demographic factors influencing hearing aid use among older adults.

Preference for non-use of hearing aids among older adults who are candidates for amplification remains to be explained. Clinical studies have examined the contribution of consumer attitudes, behaviors, and life circumstances to this phenomenon. The present study extends the interests of earlier investigators in that it examines psychological control tendencies in combination with hearing loss and demographic variables among older adults who elected to accept (adherents) or ignore (nonadherents) advice from hearing professionals to acquire and use hearing aids. One hundred thirty-one individuals participated by completing measures of hearing, hearing handicap, psychological control, depression, and ego strength. Participants were asked to provide demographic information and personal opinions regarding hearing aid use. Adherence group and gender differences were noted on measures of hearing sensitivity, psychological control, and demographic factors. Female adherents demonstrated greater hearing loss and poorer word recognition ability but less hearing handicap, higher internal locus of control, higher ego strength, and fewer depressive tendencies than female nonadherents. They reported demographic advantages. Female adherents assumed responsibility for effective communication. Although male adherents and nonadherents did not differ significantly demographically, male adherents were more accepting of their hearing loss, took responsibility for communication problems, and found hearing aids less stigmatizing. Implications for clinical practice and future clinical investigations are identified and discussed. Results are expected to be of interest to clinicians, clinical investigators, and health care policymakers.

Aged↗

PubMed2001

Candidate gene case-control association studies: advantages and potential pitfalls.

There is increasing information on the importance of genetic polymorphisms in human genes. Polymorphisms occur on average once every 500-1000 base pairs in the human genome and are useful in the identification of genes involved in human disease. Some genetic polymorphisms have functionally significant effects on the gene product and are the most useful type of polymorphism in disease association studies while others are simply useful markers. There are two main approaches using polymorphisms in the identification of genes involved in polygenic diseases. The first involves examining inheritance patterns for genetic polymorphisms in family studies and the second case-control studies which compare genotype frequencies for candidate disease genes in unrelated individuals with the disease and healthy controls. Use of family studies is generally the preferred approach but this is only feasible if the genetic component of the disease is relatively strong, DNA samples are available from other family members and the disease is relatively easy to diagnose and is not stigmatized. Population case-control studies are useful both as an alternative and an adjunct to family studies. When performing case-control studies factors such as study design, methods for recruitment of cases and controls, functional significance of polymorphisms chosen for study and statistical analysis of data require close attention to ensure that only genuine associations are detected. To illustrate some potential problems in the design and interpretation of association studies, some specific examples of association studies on drug response and on disease susceptibility involving receptor genes, cytochrome P450 and other xenobiotic metabolizing enzyme genes and immune system genes including TNF-alpha, IL-10 and the IL-4 receptor are discussed.

Case-Control Studies↗

PubMed2004

Medical practitioners and their families as patients.

OBJECTIVE: To explore diagnoses, treatment methods, compliance and outcome in a cohort of medical practitioners and their families seen in a private practice setting to identify characteristics of this group. METHODS: A systematic retrospective case-note review was conducted of all medical practitioners, their partners and children seen in a private practice setting over 15 years, documenting mode of referral, diagnosis, attendances, mode of treatment, and outcome. RESULTS: Seventy-seven medical families were identified, including 45 doctors, 21 partners and 11 offspring as the primary patient; 38 of the doctor group were self-referred. Doctors and their families were likely to accept treatment guidelines as recommended and to continue until a joint decision was made to terminate. CONCLUSIONS: Doctors presenting themselves for treatment in a private practice are a highly motivated and compliant group, who make significant changes in therapy. They defy directly the usual findings on "impaired physicians" who may be a different group, the latter generally being referred for psychiatric treatment as "impaired physicians" through statutory bodies such as medical boards. With increasing de-stigmatization and increasing education on the benefits of self-care, doctors may be seeking appropriate early intervention.

Adult↗

PubMed2002

Mass treatment with nevirapine to prevent mother-to-child transmission of HIV/AIDS in sub-Saharan African countries.

OBJECTIVE: In 2001, an estimated 800000 children were newly infected with HIV, almost all through mother-to-child transmission (MCTC), and 90% of these children were born in Africa. In such resource-poor settings, cheaper and more easily administered antiretroviral drugs should be available for use. Mass treatment of an intrapartum and neonatal single dose of nevirapine regimen has been suggested as an effective strategy to prevent MCTC, yet this strategy has never been conducted in clinical trials. By discussing the advantages and disadvantages of it, we analyze the possibility of implementing this regimen. METHODS: We reviewed public health strategies to prevent MCTC in resource-poor settings, and discuss whether or not mass treatment of an intrapartum and neonatal single dose of nevirapine regimen can be recommended as one therapy in sub-Saharan Africa due to its simplicity of distribution and use, long-term efficacy, and cost-effectiveness. RESULT: Recent studies in Uganda showed the high efficacy and cost-effectiveness of a single dose of nevirapine only to HIV/AIDS-positive pregnant women. The characteristics of nevirapine also meet the requirements of mass treatment. Mass treatment of nevirapine would increase access to antiretroviral drugs among pregnant women because they can access nevirapine without volunteer counseling and testing, which 31% of pregnant women in developing countries refused to accept due to the fear of stigmatization. No serious adverse effects or drug resistance to this regimen were reported through the studies in Uganda. CONCLUSION: Mass treatment of a single-dose nevirapine can be recommended as one alternative therapy, and further research is recommended to obtain more information about the efficacy, side-effects, drug resistance, and compliance of this strategy.

Adult↗