Social stigma in diabetes : a framework to understand a growing problem for an increasing epidemic

A comprehensive understanding of the social and psychological impact of diabetes mellitus is important for informing policy and practice. One potentially significant, yet under-researched, issue is the social stigma surrounding diabetes. This narrative review draws on literature about health-related stigma in diabetes and other chronic conditions in order to develop a framework for understanding diabetes-related stigma. Our review of the literature found that people who do not have diabetes assume that diabetes is not a stigmatized condition. In contrast, people with diabetes report that stigma is a significant concern to them, experienced across many life domains, e.g., in the workplace, in relationships. The experience of diabetes-related stigma has a significant negative impact on many aspects of psychological well-being and may also result in sub-optimal clinical outcomes for people with diabetes. We propose a framework that highlights the causes (attitudes of blame, feelings of fear and disgust, and the felt need to enforce social norms and avoid disease), experiences (being judged, rejected, and discriminated against), and consequences (e.g., distress, poorer psychological well-being, and sub-optimal self-care) of diabetes-related stigma and also identifies potential mitigating strategies to reduce diabetes-related stigma and/or enhance coping and resilience amongst people with diabetes. The systematic investigation of the experiences, causes, and consequences of diabetes-related stigma is an urgent research priority.

Children's content regulation and the 'obesity epidemic'

Some 30 years ago, Australia introduced the Children's Television Standards (CTS) with the twin goals of providing children with high-quality local programs and offering some protection from the perceived harms of television. The most recent review of the CTS occurred in the context of a decade of increasing international concern at rising levels of overweight and obesity, especially in very young children. Overlapping regulatory jurisdictions and co-regulatory frameworks complicate the process of addressing pressing issues of child health, while rapid changes to the media ecology have both extended the amount of programming for children and increased the economic challenges for producers. Our article begins with an overview of the conceptual shifts in priorities articulated in the CTS over time. Using the 2007-09 Review of the CTS as a case study, it then examines the role of research and stakeholder discourses in the CTS review process and critiques the effectiveness of existing regulatory regimes, both in providing access to dedicated children's content and in addressing the problem of escalating obesity levels in the population.

Links between pollen, atopy and the asthma epidemic

Pollen allergy has been found in 80–90% of childhood asthmatics and 40–50% of adult-onset asthmatics. Despite the high prevalence of atopy in asthmatics, a causal relationship between the allergic response and asthma has not been clearly established. Pollen grains are too large to penetrate the small airways where asthma occurs. Yet pollen cytoplasmic fragments are respirable and are likely correlated with the asthmatic response in allergic asthmatics. In this review, we outline the mechanism of pollen fragmentation and possible pathophysiology of pollen fragment-induced asthma. Pollen grains rupture within the male flowers and emit cytoplasmic debris when winds or other disturbances disperse the pollen. Peak levels of grass and birch pollen allergens in the atmosphere correlated with the occurrence of moist weather conditions during the flowering period. Thunderstorm asthma epidemics may be triggered by grass pollen rupture in the atmosphere and the entrainment of respirable-sized particles in the outflows of air masses at ground level. Pollen contains nicotinamide adenine dinucleotide phosphate (reduced) oxidases and bioactive lipid mediators which likely contribute to the inflammatory response. Several studies have examined synergistic effects and enhanced immune response from interaction in the atmosphere, or from co-deposition in the airways, of pollen allergens, endogenous pro-inflammatory agents, and the particulate and gaseous fraction of combustion products. Pollen and fungal fragments also contain compounds that can suppress reactive oxidants and quench free radicals. It is important to know more about how these substances interact to potentially enhance, or even ameliorate, allergic asthma.

An ICT enabled conceptual framework for determining epidemic susceptibility and acute type response : an exemplar from India

In a developing nation such as India, the national government is pursuing the pathway of ICT supported decentralized programs, to combat endemics, in the social contexts of each State. The State of Kerala, which has been an exemplar for development, has become susceptible to endemics, brought in by urbanization and non-resident Indian population and compounded by environmental disasters. In this paper, the authors contend that the psyche of the community which has changed from social amity to self-interest need to be re-awakened with the power of ICTs and Internet, so as to efficiently combat endemics. The authors also propose a preliminary framework for emergency responses based on existing ICT systems, recommended by the national government, to fit the context.

Community views on responding to a local asbestos disease epidemic : implications for policy and practice

The Latrobe Valley region of Victoria, Australia, has the highest rate of asbestos disease in the state due to extensive past use of asbestos in the power industry. Current responses to asbestos disease epidemics in Australia and internationally are dominated by medical, scientific, legal and government perspectives. The voices and perspectives of those most directly affected – exposed and diseased workers, their families and communities – are relatively rarely heard.A qualitative interview study was conducted to determine what people in the Latrobe Valley community think could or should be done following their own asbestos disease epidemic. Analysis identified several themes. Notably, these represent a sophisticated community understanding of issues that is largely consistent with state-of-the-art occupational health and public health knowledge.Some themes are well known already, eg the need for fair and timely compensation, adequate healthcare facilities and services, and more education. Others point to neglected possibilities, such as the need for reconciliation and social healing to complement the dominant individual medico-legal focus. Employer suppression of hazard information and denial of asbestos-related disease in past decades continues to have a profound effect on people's views in the present. Reconciliation in some form, eg acknowledgement of or apology for past wrongs, was identified as a necessary first step in developing new and better policy and practice responses; action in this regard has important implications for the implementation and effectiveness of other policy and practice interventions. Further, a need for substantive community participation in the development of policy and practice responses – currently lacking – was identified. Findings suggest that community is an under-recognised and under-utilised resource in responding to a local asbestos disease epidemic.The Latrobe Valley situation is a microcosm of the broader Australian and international story. It offers insights on the perspectives of those most affected by asbestos issues, how such people and their views can be used to strengthen current policy and practice responses, and how their participation is essential to building comprehensive public and social health responses to this global problem.

The first case of porcine epidemic diarrhea in Canada

In January, 2014, increased mortality was reported in piglets with acute diarrhea on an Ontario farm. Villus atrophy in affected piglets was confined to the small intestine. Samples of colon content were PCR-positive for porcine epidemic diarrhea virus (PEDV). Other laboratory tests did not detect significant pathogens, confirming this was the first case of PED in Canada.

Investigation into the role of potentially contaminated feed as a source of the first-detected outbreaks of porcine epidemic diarrhea in Canada

In January 2014, approximately 9 months following the initial detection of porcine epidemic diarrhea (PED) in the USA, the first case of PED was confirmed in a swine herd in south-western Ontario. A follow-up epidemiological investigation carried out on the initial and 10 subsequent Ontario PED cases pointed to feed as a common risk factor. As a result, several lots of feed and spray-dried porcine plasma (SDPP) used as a feed supplement were tested for the presence of PEDV genome by real-time RT-PCR assay. Several of these tested positive, supporting the notion that contaminated feed may have been responsible for the introduction of PEDV into Canada. These findings led us to conduct a bioassay experiment in which three PEDV-positive SDPP samples (from a single lot) and two PEDV-positive feed samples supplemented with this SDPP were used to orally inoculate 3-week-old piglets. Although the feed-inoculated piglets did not show any significant excretion of PEDV, the SDPP-inoculated piglets shed PEDV at a relatively high level for ≥9 days. Despite the fact that the tested PEDV genome positive feed did not result in obvious piglet infection in our bioassay experiment, contaminated feed cannot be ruled out as a likely source of this introduction in the field where many other variables may play a contributing role.

Empowering primary care to tackle the obesity epidemic: the Counterweight Programme

Subjects: Obese patients (body mass index greater than or equal to30 kg/m2) or BMIgreater than or equal to28 kg/m2 with obesity-related comorbidities in 80 general practices.

Intervention: The model consists of four phases: (1) audit and project development, (2) practice training and support, (3) nurse-led patient intervention, and (4) evaluation. The intervention programme used evidence-based pathways, which included strategies to empower clinicians and patients. Weight Management Advisers who are specialist obesity dietitians facilitated programme implementation.

Main outcome measures: Proportion of practices trained and recruiting patients, and weight change at 12 months.

Results: By March 2004, 58 of the 62 (93.5%) intervention practices had been trained, 47 (75.8%) practices were active in implementing the model and 1549 patients had been recruited. At 12 months, 33% of patients achieved a clinically meaningful weight loss of 5% or more. A total of 49% of patients were classed as 'completers' in that they attended the requisite number of appointments in 3, 6 and 12 months. 'Completers' achieved more successful weight loss with 40% achieving a weight loss of 5% or more at 12 months.

Conclusion: The Counterweight programme provides a promising model to improve the management of obesity in primary care.

Sponsorship: Educational grant-in-aid from Roche Products Ltd.

An epidemic model based temporal violation prediction strategy for large batch of parallel business cloud workflows

Temporal violations often take place during the running of large batch of parallel business cloud workflow, which have a serious impact on the on-time completion of massive concurrent user requests. Existing studies have shown that local temporal violations (namely the delays of workflow activities) occurring during cloud workflow execution are the fundamental causes for failed on-time completion. Therefore, accurate prediction of temporal violations is a very important yet challenging task for business cloud workflows. In this paper, based on an epidemic model, a novel temporal violation prediction strategy is proposed to estimate the number of local temporal violations and the number of violations that must be handled so as to achieve a certain on-time completion rate before the execution of workflows. The prediction result can be served as an important reference for temporal violation prevention and handling strategies such as static resource reservation and dynamic provision. Specifically, we first analyze the queuing process of the parallel workflow activities, then we predict the number of potential temporal violations based on a novel temporal violation transmission model inspired by an epidemic model. Comprehensive experimental results demonstrate that our strategy can achieve very high prediction accuracy under different situations.

Beliefs about the causes of weight change in the Australian population

OBJECTIVE: To describe self-reported weight change and beliefs about the causes of weight change and to examine whether these vary by sex and weight status.
DESIGN: This cross-sectional population study examined data from the 1995 Australian National Health and Nutrition Surveys.
SUBJECTS: A total of 10 624 randomly-selected adults provided data.
MEASURES: Objectively measured height and weight, perceptions of current weight status, self-reported weight change over the past year, and reasons for weight change.
RESULTS: Thirty-five percent of participants reported a weight gain in the last 12 months, with females, and those already overweight more likely to report a recent increase in weight. Approximately one in five participants reported a recent weight loss. Those who had recently gained weight were more likely to perceive themselves as overweight regardless of actual weight status. Commonly reported reasons for weight gain included a change in physical activity level (52% males and 35% females) and a change in the amount of food/drink consumed (30% males, 27% females). Similar reasons were given for weight loss.
CONCLUSIONS: Findings of widespread reported weight gain, particularly among those already overweight, suggest Australia's obesity epidemic may be worsening. Strategies are urgently required to better inform individuals about the factors impacting on their weight in order to prevent further weight gain.

Preventive strategies against weight gain and obesity

A well-resourced, comprehensive, population-based set of strategies is needed to
attenuate and eventually reverse the current trends of increasing obesity prevalence
now apparent in most countries. The Epidemiological Triad (host, vector,
environment) has proven to be a robust model for other epidemics and is applied
to obesity. Host-based strategies are primarily educational and these tend to
be most effective among people with higher incomes and higher educational
attainment. The main vectors for a high-energy intake are energy-dense foods and
drinks and large portion sizes and, for low energy expenditure, machines that
promote physical inactivity. Vector-based strategies that alter food formulation
can have a significant impact, particularly through influencing common, highvolume
foods. The increasingly ‘obesogenic’ environments are probably the main
driving forces for the obesity epidemic. There are many environmental strategies
that can influence the physical, economic, policy or socio-cultural environments,
but the evidence base for these potentially powerful interventions is small.
Children should be the priority population for interventions, and improving the
general socio-economic conditions for disadvantaged, marginalized or poor population
sectors is also a central strategy for obesity prevention. The key settings
for interventions are schools, homes, neighbourhoods, primary health care services
and communities. The key macroenvironments for interventions are the
transport and infrastructure sector, the media and the food sector.