Influencing weight bias: The impact of biased questionnaire anchors on stereotype beliefs and judgments.

OBJECTIVES: In this investigation, biased questionnaire response anchors were designed to indirectly manipulate respondents' estimates of their peers' stereotypic beliefs or the estimates of scientific research findings about individuals with obesity. The current study tested the hypothesis that biased response anchors could influence personal beliefs about obesity. METHODS: Two-hundred adults participated in the study. A simple manipulation of questionnaire items (i.e., asking respondents to estimate peers' beliefs or scientific research findings) using biased response scale anchors was designed to subtly relay information about certain personality traits of individuals with obesity. RESULTS: The anchor manipulation significantly influenced participants' immediate and follow-up weight biased beliefs as well as participants' evaluation of an obese job applicant's potential for employment. CONCLUSION: Social judgments about obese individuals may be susceptible to subtle manipulation of response anchors and may be impacted by the source of comparison information (e.g., peers; scientific research).

Coping responses as mediators in the relationship between perceived weight stigma and depression.

The prejudice and discrimination that overweight and obese individuals experience as a result of their weight (i.e. weight stigma) often leads to psychological consequences, such as depression. The present study examined whether coping with stigmatizing experiences mediated the relationship between perceived weight stigma and depression among overweight/obese treatment seeking adults. Fifty-four overweight and obese (mean BMI=37.2) weight loss treatment seeking participants (87.3% Caucasian, 79.6% female) participated in the study. Results from this study indicate that greater stigmatizing experiences were significantly related to depression. Both adaptive and maladaptive coping significantly mediated the relationship between weight stigma and depression. Surprisingly however, greater adaptive coping was positively related to depression. Coping responses appear to mediate the association between experiencing bias and discrimination because of one's weight and adverse psychological outcomes. Results suggest that obese individuals are at considerable risk for psychological complications secondary to weight-based mistreatment by others and their responses to cope with the mistreatment.

Implicit, explicit, and internalized weight bias and psychosocial maladjustment among treatment-seeking adults.

OBJECTIVE: Weight bias among weight loss treatment-seeking adults has been understudied. This investigation examined the 1) levels of implicit, explicit, and internalized weight bias among overweight/obese treatment-seeking adults, 2) association between weight bias and psychosocial maladjustment (binge eating, body image, depression), and 3) association between participation in weight loss treatment and changes in weight bias. METHODS: Fifty-four overweight and obese individuals (BMI > or = 27) recruited for a weight loss intervention completed measures of depression, body image, binge eating, and implicit, explicit, and internalized weight bias. RESULTS: Participants evidenced significant implicit, explicit, and internalized weight bias. Greater weight bias was associated with greater depression, poorer body image, and increased binge eating. Despite significant reductions in negative internalized and explicit weight bias following treatment, weight bias remained strong. CONCLUSIONS: Weight bias among treatment-seeking adults is associated with greater psychological maladjustment and may interfere with their ability to achieve optimal health and well-being.

Internalized weight stigma and its ideological correlates among weight loss treatment seeking adults.

There are significant economic and psychological costs associated with the negative weight-based social stigma that exists in American society. This pervasive anti-fat bias has been strongly internalized among the overweight/obese. While the etiology of weight stigma is complex, research suggests that it is often greater among individuals who embrace certain etiological views of obesity or ideological views of the world. This investigation examined 1) the level of internalized weight stigma among overweight/obese treatment seeking adults, and 2) the association between internalized weight stigma and perceived weight controllability and ideological beliefs about the world ('just world beliefs', Protestant work ethic). Forty-six overweight or obese adults (BMI >or=27 kg/m2) participating in an 18- week behavioral weight loss program completed implicit (Implicit Associations Test) and explicit (Obese Person's Trait Survey) measures of weight stigma. Participants also completed two measures of ideological beliefs about the world ("Just World Beliefs", Protestant Ethic Scale) and one measure of beliefs about weight controllability (Beliefs about Obese Persons). Significant implicit and explicit weight bias was observed. Greater weight stigma was consistently associated with greater endorsement of just world beliefs, Protestant ethic beliefs and beliefs about weight controllability. Results suggest that the overweight/obese treatment seeking adults have internalized the negative weight-based social stigma that exists in American society. Internalized weight stigma may be greater among those holding specific etiological and ideological beliefs about weight and the world.

Metabolic and psychological changes during refeeding in anorexia nervosa.

OBJECTIVE: This study aimed to examine resting metabolic rate (RMR) and psychological changes during refeeding in 10 women with anorexia nervosa participating in a partial hospitalization eating disorder program. RESULTS: Participants' admission RMRs, as assessed by the MedGem Analyzer, were below their RMRs predicted by the Harris- Benedict equation, t(1,9)=5.77, p<0.01. Correlational analyses revealed a trend toward smaller increases in RMR being associated with higher admission BMI (r=-0.49, p=0.08), but not with highest lifetime BMI. Over the course of treatment, RMR per pound of Fat-Free Mass (FFM) increased from the beginning to the middle, t(1,9)=-3.02, p<0.05, and to the end stage of treatment, t(1,9)=-2.53, p<0.05. Scores on the Eating Attitudes Test-26, Eating Disorder Inventory-2, Brief Symptom Inventory (BSI), BSI Depression subscale, and Mizes Anorectic Cognitions scale significantly improved throughout treatment (all p<0.05); however, body dissatisfaction did not improve. DISCUSSION: Results suggest that weight restoration programs for anorexia nervosa cannot rely on FFM or standard formulas to predict caloric needs throughout refeeding, and that admission BMI is one factor to be considered in predicting caloric needs during refeeding. Furthermore, ways to improve body dissatisfaction during refeeding needs to be more of a treatment focus.

Ruptured giant liver cyst: a rare cause of acute abdomen in a haemodialysis patient with autosomal dominant polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary disorder. Although liver involvement is the most frequent extra-renal manifestation, serious complications due to liver cysts are very rare. We report the occurrence of an acute abdomen caused by massive haemoperitoneum resulting from rupture of a giant liver cyst in ADPKD. Data suggest that chronic anticoagulation therapy should be avoided where possible in the presence of a giant liver cyst.

Ecological momentary assessment of temptation and lapse in dieting.

Although some research attention has been given to the factors associated with temptation and lapse in dieting, the majority of research has focused on individuals in weight loss clinical trials and relied heavily on retrospective self-report data. The present study sought to overcome these limitations by using ecological momentary assessment (EMA) techniques to examine situations of dietary temptation, lapse, and minimal dietary consequence with a sample of overweight dieters (N=30) attempting to lose weight on their own. Results support and extend previous research findings on dietary temptation and lapse. In general, results indicate that recent consumptive activity, location, mood state, type of activity, and abstinence violation effects were related to moments of temptation and/or lapse. Education on the factors associated with dietary temptation and lapse and strategies for addressing these factors is imperative for both dieters in formal programs and those attempting to lose or maintain weight on their own.

Quality of life in patients awaiting lung transplant: cystic fibrosis versus other end-stage lung diseases.

The symptoms associated with chronic lung disease can impair quality of life and psychosocial functioning. The purpose of the present study was to provide a thorough baseline assessment of quality of life in patients with end-stage lung disease and being evaluated for transplant; and to assess potential differences in quality of life between patients with cystic fibrosis (CF) and those with other types of end-stage lung disease (e.g., chronic obstructive pulmonary disease (COPD), interstitial pulmonary fibrosis (IPF)). We evaluated 58 patients with CF and 52 patients with other types of end-stage lung disease who were recruited for this study during an assessment of their candidacy for lung transplant. Subjects completed a battery of questionnaires that assessed demographic factors (including work and educational status), the presence of psychological distress (anxiety and depression), availability of social support, coping styles, and physical functioning. Despite significant impairment in physical functioning in the areas of recreation, household activities, sleep, and ambulation, other indices of life quality suggested good adaptation in the majority of patients. Also, quality of life differed for patients with CF and for those with other types of end-stage lung disease. Patients with CF were more likely to be working, had lower levels of anxiety and higher levels of social support, and used more functional coping strategies than did patients with other end-stage lung disease. These results highlight the fact that patients with different types of lung disease may require different psychosocial services as they await transplant. These findings also raise the question of whether there is a difference in quality of life after transplant between patients with CF and those with other types of lung disease.

Emotional responsivity during daily life: relationship to psychosocial functioning and ambulatory blood pressure.

Emotional responsivity refers to acute changes in affective states. This study examined the relationship of emotional responsivity during daily life with ambulatory blood pressure (ABP) and psychosocial functioning. Subjects were 162 employed men and women, aged 25-45 years. Subjects underwent 24-h ABP monitoring in which they completed a behavioral diary with each cuff inflation. On a separate day, subjects completed a psychometric test battery including measures of depression, trait anxiety, and social support. Emotional Responsivity, an index of negative emotional variability during waking hours, was operationalized as the standard deviation of each individual's negative emotions scores throughout the day. Individuals with high levels of emotional responsivity showed greater increases in ABP and heart rate (HR) associated with negative emotions. Emotionally responsive individuals also reported less satisfaction with social support and higher levels of perceived daily stress, trait anxiety, and depressive symptoms. These findings suggest that psychosocial traits that have been linked to cardiovascular disease may be associated with more marked cardiovascular activation occurring in response to negative emotions experienced throughout the day.

Ambulatory blood pressure and marital distress in employed women.

In this investigation, the relationship between marital distress and blood pressure during daily life in a sample of married employed women was examined. It was hypothesized that greater marital distress would be associated with elevated blood pressure in the home environment, but not in the workplace. Participants were 50 married employed women, aged 25 to 45 years. Participants underwent ambulatory blood pressure monitoring on a typical workday. The women with higher levels of marital distress exhibited greater negative emotions and higher levels of blood pressure at home. These results suggest that the physiological concomitants of stress and emotional upset associated with marital distress are manifest in elevated blood pressure that is most pronounced in the home environment.

Emotional responsivity and transient myocardial ischemia.

This study examined the relationship between "emotional responsivity" (i.e., individuals who exhibit relatively large variations of self-reported tension levels) and myocardial ischemia. One hundred thirty-six patients with coronary artery disease underwent 48 hr ambulatory electrocardiographic (ECG) monitoring and laboratory mental stress testing using radionuclide angiocardiography. Compared with individuals characterized as low emotional responders, a higher proportion of individuals characterized as high emotional responders exhibited wall motion abnormalities in response to laboratory mental stress testing and were more likely to exhibit ECG ST-segment depression (> or = 1 mm for > or = 1 min) during routine daily activities. These results suggest that emotional responsivity may represent an individual difference characteristic that is associated with an increased likelihood of exhibiting myocardial ischemia in both the laboratory and the real-world setting.

Blood pressure reactivity and marital distress in employed women.

OBJECTIVE: The impact of marital distress on cardiovascular responses to an "ecologically valid" laboratory stressor (a marital conflict recall task) was examined in maritally distressed and non-distressed women. It was hypothesized that the presence of high levels of marital distress would be associated with elevated blood pressure and heart rate responses to a marital conflict task. METHOD: Fifty married, employed women, aged 25-45, were recruited into high and low marital distress groups, based on total scores on the Dyadic Adjustment Scale. Subjects participated in three laboratory stress tasks: a marital conflict recall task, a work conflict recall task, and a serial subtraction task. RESULTS: During the marital conflict recall task, women characterized as high in marital distress exhibited higher systolic blood pressure (M = 21.4 +/- 9.1 vs. 17.3 +/- 7.7) (p < .05) and heart rate (M = 13.6 +/- 9.5 vs. 10.9 +/- 6.5) (p < .01) responses, compared with low-distress women. However, the association between marital distress and cardiovascular response was statistically significant only after aggregate responses to the control stressors were used as covariates. CONCLUSION: These data indicate that the stress associated with recalling a marital conflict was manifest in elevated blood pressure and heart rate, particularly among women characterized as experiencing high levels of distress in their marriage. Future research is needed to determine whether the blood pressure differences between women who are satisfied with their marriage, versus those that are chronically distressed are clinically meaningful. In addition, examination of the "ecological validity" of laboratory stressors suggests that a useful methodology may be to assess task responses, while controlling for nonspecific individual differences in cardiovascular reactivity.

Psychosocial influences on blood pressure during daily life.

Ambulatory blood pressure (ABP) monitoring allows frequent non-invasive blood pressure (BP) recordings in a variety of settings. Emerging evidence suggests that ABP is a better predictor of cardiovascular morbidity than clinic BP. Ambulatory blood pressure is influenced by a variety of physical, psychological and behavioral factors that comprise an individual's daily life. The present article reviews psychosocial research relating ABP to psychological factors (e.g. Type A behavior pattern, anger/hostility) and environmental influences (e.g. job strain). Psychological factors and environmental factors alone and in interaction with each other appear to substantially influence ABP. Interacting physical, psychosocial and behavioral factors that comprise daily life provide unique methodological challenges to ABP research. Methodological considerations (e.g. activity patterns, caffeine and alcohol consumption) for performing ABP research are discussed. Evidence outlined in this review suggests that psychosocial factors contribute to ABP level. To the extent that psychosocial factors contribute to ABP cardiac disease, it will be important to analyze their effects on underlying disease processes.

[Acute management of patients bitten by poisonous snakes]. / Acute opvang van patiënten gebeten door een gifslang.

The management of poisonous snake bites includes first aid and clinical medical treatment. First aid consists of reassurement of the patient, immobilisation of the bitten limb and rapid transport to the nearest hospital to monitor the vital functions. In no case suction, incision or tight bandages should be applied. The degree of envenomation can be classified in three categories depending on the spread of the symptoms: no symptoms, only local non-progressive symptoms, and systemic or local rapidly progressive symptoms (severe envenomation). Antivenin therapy is indicated in severe envenomation. Because of the risk of anaphylactic reactions or serum sickness, antivenin should be given with great caution. Antibiotic therapy and tetanus prophylaxis are advised in all cases. Immediate consultation with the National Intoxication Centre of the Rijksinstitut voor Volksgezondheid en Milieu (RIVM) is always warranted; telephone: 030-2748888. In a national protocol, which is available at the RIVM, the Harbour Hospital Rotterdam, the Academic Medical Centre and Artis Zoo Amsterdam, the correct management of snake bites is described. An overview of all antivenins available in the Netherlands is also given in this protocol.

Effect of satisfaction with social support on blood pressure in normotensive and borderline hypertensive men and women.

The relation between blood pressure (BP) and two aspects of social support, perceived satisfaction and structural social support network characteristics, were examined in adults classified as having normal BP or borderline hypertension. Causal BPs were taken by a trained technician on 3 separate visits, each approximately 1 week apart. Participants were categorized as borderline hypertensive if screening systolic blood pressure (SBP) fell in the range 130-160 mmHG and/or diastolic blood pressure (DBP) fell in the range 85-100 mmHg; BPs below these ranges were considered normotensive. Participants underwent ambulatory BP monitoring. Individuals classified as normotensive reported significantly greater support satisfaction than individuals with borderline hypertension. Social network characteristics were not associated with BP. During 24 hr of ambulatory BP monitoring, high perceived support satisfaction was associated with lower SBP and DBP at work, home, and during sleep. These data suggest that perceived satisfaction with social support is associated with lower BP. The presence of social support also may reduce BP levels during daily life.

[Invagination in adults]. / Invaginatie bij volwassenen.

Two adult patients with intussusception were both diagnosed by colonoscopic investigation. The first patient, a woman aged 39, suffered from persisting abdominal discomfort with nausea and vomiting. Ultimately an ileo-ileocolic intussusception caused by an inflammatory fibroid polyp of the ileum was found. The other patient, a man of 79 years, complained of subacute cramping pain in the right lower abdomen. This was due to an ileocolic intussusception caused by an adenocarcinoma of the cecum. Both patients underwent an ileocecal resection; their postoperative courses were uneventful.