Participatory destigmatization strategies among Palestinian citizens,Ethiopian Jews and Mizrahi Jews in Israel

Abstract

This study examines how members of minority groups in Israel cope with stigmatization in everyday life. It focuses on working-class members of three minority groups: Palestinian Arabs or Palestinian citizens of Israel, Mizrahim (Jews of Middle Eastern and North African origin) and Ethiopian Jews. It reveals the use of racial, ethnic and national markers in daily processes of social inclusion and exclusion in one sociopolitical context. Palestinians, a group with a fixed external identity and a limited sphere of participation, were found to use the language of race and racism when describing stigmatizing encounters. Ethiopian Jews, the most phenotypically marked group, strictly avoided this language. For their part, Mizrahi Jews perceived the very discussion of stigmatization as stigmatizing, while often using ‘contingent detachment’ to distance themselves from negative group identities. Despite differences between the communities and the powerful role of the state in establishing symbolic and social boundaries, members of all three groups expressed their intention to achieve or retain avenues for participation in the larger society.     

Obese Children,Adults and Senior Citizens in the Eyes of the General Public: Results of a Representative Study on Stigma and Causation of Obesity

Obese individuals are blamed for their excess weight based on causal attribution to the individual. It is unclear whether obese individuals of different age groups and gender are faced with the same amount of stigmatization. This information is important in order to identify groups of individuals at risk for higher stigmatization and discrimination. A telephone interview was conducted in a representative sample of 3,003 participants. Experimental manipulation was realized by vignettes describing obese and normal-weight children, adults and senior citizens. Stigmatizing attitudes were measured by semantic differential. Causal attribution was assessed. Internal factors were rated with highest agreement rates as a cause for the vignette''s obesity. Lack of activity behavior and eating too much are the most supported causes. Importance of causes differed for the different vignettes. For the child, external causes were considered more important. The overweight vignette was rated consistently more negatively. Higher educational attainment and personal obesity were associated with lower stigmatizing attitudes. The vignette of the obese child was rated more negatively compared to that of an adult or senior citizen. Obesity is seen as a controllable condition, but for children external factors are seen as well. Despite this finding, they are faced with higher stigmatizing attitudes in the general public, contradicting attribution theory assumptions. Internal and external attribution were found to be inter-correlated. Obese children are the population most at risk for being confronted with stigmatization, making them a target point in stigma-reduction campaigns.     

支气管哮喘患儿病情控制的影响因素及其家长知信行问卷调查分析

摘要 目的：调查支气管哮喘患儿家长知信行情况,并分析支气管哮喘患儿病情控制的影响因素。方法：于2016年7月~2020年7月期间,选取我院收治的500例支气管哮喘患儿及其家长作为研究对象。患儿家长知信行情况采用《哮喘患儿家长知信行问卷》调查。患儿近4周的病情控制水平参照《诸福棠实用儿科学(第8版)》中的相关标准进行确定,病情控制水平包括良好控制、部分控制和未控制。将良好控制、部分控制的患儿纳为哮喘控制组,将未控制的患儿纳为哮喘未控制组。采用本院自制的调查量表调查患儿及其家长的信息,分析支气管哮喘患儿病情控制的影响因素。结果：支气管哮喘儿童家长知信行情况不容乐观。支气管哮喘患儿病情控制率为38.06%（187/491）。单因素分析结果表明,支气管哮喘患儿病情控制与家庭人均月收入、患儿个人过敏史、家长受教育程度、哮喘家族史、是否坚持长期用药、是否定期复诊有关（P<0.05）。多因素Logistic回归分析结果显示,家长受教育程度、家庭人均月收入、患儿个人过敏史、哮喘家族史、是否坚持长期用药、是否定期复诊均是支气管哮喘患儿病情控制的影响因素（P<0.05）。结论：本研究中支气管哮喘患儿病情控制水平一般,且支气管哮喘儿童家长知信行情况不容乐观,其中家长受教育程度、家庭人均月收入、患儿个人过敏史等均是支气管哮喘患儿病情控制的影响因素,临床中应结合相关因素进行针对性的干预或治疗,以期实现对支气管哮喘患儿病情的良好控制。     

Elevated asthma morbidity in Puerto Rican children: a review of possible risk and prognostic factors

Latino children represent a significant proportion of all US children, and asthma is the most common chronic illness affecting them. Previous research has revealed surprising differences in health among Latino children with asthma of varying countries of family origin. For instance, Puerto Rican children have a higher prevalence of asthma than Mexican American or Cuban American children. In addition, there are important differences in family structure and socioeconomic status among these Latino populations: Cuban Americans have higher levels of education and family income than Mexican-Americans and Puerto Ricans; mainland Puerto Rican children have the highest proportion of households led by a single mother. Our review of past research documents differences in asthma outcomes among Latino children and identifies the possible genetic, environmental, and health care factors associated with these differences. Based on this review, we propose research studies designed to differentiate between mutable and immutable risk and prognostic factors. We also propose that the sociocultural milieus of Latino subgroups of different ethnic and geographic origin are associated with varying patterns of risk factors that in turn lead to different morbidity patterns. Our analysis provides a blue-print for future research, policy development, and the evaluation of multifactorial interventions involving the collaboration of multiple social sectors, such as health care, public health, education, and public and private agencies.     

Updated Prevalences of Asthma,Allergy, and Airway Symptoms,and a Systematic Review of Trends over Time for Childhood Asthma in Shanghai,China

Background

The prevalence of asthma among Shanghai children has increased over time. This increase might be associated with changes in environmental exposures. Investigation of the time-trend of asthma and current prevalences is essential to understanding the causes.

Objective

To estimate the current prevalences of asthma, allergies and other respiratory symptoms among Shanghai preschool children, and to investigate the time-trend of childhood asthma prevalence of from 1990 to 2011.

Methods

From April 2011 to April 2012, the CCHH (China, Children, Homes, Health) cross-sectional study was conducted in Shanghai. Questionnaires were distributed to 17,898 parents or guardians of preschool children from 72 kindergartens in 5 districts. Previous similar studies were also summarized by a systematic literature review.

Results

From a total of 14,884 questionnaires for 3–7 year old children, prevalences of the following diseases and symptoms were calculated: asthma 10.2%, wheeze (ever) 28.1%, pneumonia (ever) 33.5%, otitis media 11.0%, rhinitis (ever) 54.1%, hay fever 12.2%, eczema (ever) 22.7%, and food allergy 15.7%. Urban children had higher prevalences of most symptoms than suburban children. The prevalence of asthma has increased significantly, almost five-fold, from 2.1% in 1990 to 10.2% in the present study. The prevalence of asthma in boys was higher than in girls in the present study and in all reviewed studies.

Conclusions

Asthma, allergy and airway symptoms are common among preschool children in Shanghai. The prevalence of childhood asthma in Shanghai has increased rapidly from 1990 to 2011.     

Stigmatized Students: Age,Sex, and Ethnicity Effects in the Stigmatization of Obesity

Objective: To assess the stigmatization of obesity relative to the stigmatization of various disabilities among young men and women. Attitudes across ethnic groups were compared. In addition, these findings were compared with data showing severe stigmatization of obesity among children. Research Methods and Procedures: Participants included 356 university students (56% women; mean age, 20.6 years; mean BMI, 23.3 kg/m²; range, 14.4 to 45.0 kg/m²) who ranked six drawings of same‐sex peers in order of how well they liked each person. The drawings showed adults with obesity, various disabilities, or no disability. These rankings were compared with those obtained through a similar procedure with 458 fifth‐ and sixth‐grade children. Results: Obesity was highly stigmatized relative to physical disabilities. African‐American women liked obese peers more than did African‐American men, white men, or white women [F (1, 216) = 4.02, p < 0.05]. Overweight and obese participants were no less stigmatizing of obesity than normal weight participants. Adults were more accepting than children of their obese peers [t (761) = 9.16, p < 0.001]. Discussion: Although the stigmatization of obesity was high among participants overall, African‐American women seemed to have more positive attitudes toward obesity than did white women, white men, or African‐American men. Participants’ weight did not affect their stigmatization of obesity: obese and overweight adults were as highly stigmatizing of obesity as non‐overweight adults. Such internalized stigmatization could help to explain the low self‐esteem and poor body image among obese young adults. However, adults seemed to have more positive attitudes about obesity than children. An understanding of the factors that limit the stigma of obesity among African‐American women could help efforts to reduce stigma.     

哮喘儿童父母知识知晓率、用药依从性及影响因素分析

目的:了解哮喘儿童父母的对疾病知识的掌握情况以及儿童的服药依从情况和影响因素,为提高哮喘儿童的控制率提供参考依据。方法:选择2015年1月-2015年12月于上海市第十人民医院儿科门诊诊治的支气管哮喘儿童93例,调查其哮喘控制情况、哮喘服药依从性和父母基本情况与相关知识。依从性与知识知晓率的比较采用双向有序的检验,影响因素采用有序结果的累积优势Logistic回归分析。结果:本次调查93例哮喘儿童中,哮喘完全控制率为23.7%,儿童服药依从性好的比率为25.8%,哮喘儿童父母相关知识知晓率高的比率为25.8%,儿童哮喘控制率与服药依从性之间存在相关性(P=0.029),哮喘儿童服药依从性与哮喘儿童父母相关知识知晓率之间存在相关性(P=0.035)。哮喘儿童的服药依从性受到儿童性别(OR=1.153,95%CI:1.04-1.96)、家族史(OR=1.402,95%CI:1.20-2.33)、知识知晓率(OR=1.828,95%CI:1.05-3.17)和病程(OR=0.758,95%CI:0.35-0.97)等因素的影响(P0.05)。结论:哮喘儿童的服药依从性受到儿童性别、家族史、知识知晓率和病程等因素的影响,要充分发挥儿童父母的作用,从医院内干预逐渐进入家庭干预,通过对父母或者监护人的认知或用药知识的提高,切实提高哮喘儿童的用药依从性和哮喘的控制率。     

Can morbidity associated with untreated asthma in primary school children be reduced?: a controlled intervention study.

OBJECTIVE--To determine whether an intervention programme based on existing school and community resources can reduce school absence and improve participation in games lessons and sport in children with unrecognised or undertreated asthma. DESIGN--Parallel group controlled intervention study. SETTING--102 primary schools in Nottingham: 49 were randomised to receive the intervention and 53 to be control schools. SUBJECTS--All children aged 5 to 10 years with parent reported absence from school because of wheezing in the previous year and taking no treatment or beta agonists only. INTERVENTIONS--Children with asthma were referred to their general practitioner for assessment of symptoms and treatment. Teachers were given education on asthma by the school nurse in 44 of the 49 intervention schools. MAIN OUTCOME MEASURES--Changes in school absence and missed games and swimming lessons because of wheezing, and schools'' policy towards management of asthma in school. RESULTS--Of 17,432 children screened, 451 met the entry criteria--228 in intervention schools and 223 in control schools. 152 (67%) children in intervention schools visited their general practitioner, of whom 39 (26%) were given a new diagnosis of asthma and 58 (38%) had treatment for asthma increased or changed. Over the next academic year mean (SE) parent reported school absence due to wheezing fell significantly, but to a similar extent, in both intervention and control schools (0.82 (0.11) and 1.09 (0.21) weeks respectively). There was little change in school recorded absence or participation in games lessons and swimming lessons in either group. At the end of the study intervention schools were more likely to have improved aspects of management of asthma in school. CONCLUSION--The intervention resulted in a majority of children being assessed by their general practitioner and improved teachers'' understanding and management of asthma, but it did not result in any appreciable reduction in morbidity.     

Leptin, adiponectin and pulmonary diseases

Adipose tissue produces leptin and adiponectin - energy-regulating adipokines that may also play a role in inflammatory pulmonary conditions, as suggested by some murine studies. Leptin and adiponectin and their respective receptors are expressed in the human lung. The association between systemic or airway leptin and asthma in humans is currently controversial, particularly among adults. The majority of the evidence among children however suggests that systemic leptin may be associated with greater asthma prevalence and severity, particularly among prepubertal boys and peripubertal/postpubertal girls. Systemic and airway leptin concentrations may also be disproportionately higher in chronic obstructive pulmonary disease (COPD) patients, particularly among women, and reflect greater airway inflammation and disease severity. Quite like leptin, the association between systemic and airway adiponectin and asthma in humans is also controversial. Some but not all studies, demonstrate that serum adiponectin concentrations are protective against asthma among premenopausal women and peripubertal girls. On the other hand, serum adiponectin concentrations are inversely associated with asthma severity among boys but positively associated among men. Further, systemic and airway adiponectin concentrations are higher in COPD patients than controls, as demonstrated by case-control studies of men. Systemic adiponectin is also positively associated with lung function in healthy adults but inversely associated with lung function in subjects with COPD. It is therefore possible that pro-inflammatory effects of adiponectin dominate under certain physiologic conditions and anti-inflammatory effects under others. The adipokine-lung disease literature has critical gaps that include a lack of adequately powered longitudinal or weight-intervention studies; inadequate adjustment for confounding effect of obesity; and unclear understanding of potential sex interactions. It is also uncertain whether adipokine derangements precede pulmonary disease or are a consequence of it. Future research will determine whether modulation of adipokines, independent of BMI, may allow novel ways to prevent or treat inflammatory pulmonary conditions.     

呼出气一氧化氮浓度与儿童哮喘病情控制及不同哮喘亚型的相关性研究

目的:探讨呼出气一氧化氮(FeNO)浓度与儿童哮喘病情控制及不同哮喘亚型的相关性。方法:选取2017年1月至2018年1月期间于我院确诊为支气管哮喘及毛细支气管炎的患儿各60例,分别设为哮喘组与毛细支气管炎组,另选取同期于我院进行体检的健康儿童40例作为对照组。哮喘组与毛细支气管炎组分别在治疗前、治疗后1 h及治疗后4周测定FeNO,对照组在体检时测定FeNO。对比对照组体检时以及哮喘组、毛细支气管炎组患儿不同治疗时期的FeNO浓度变化;哮喘组患儿根据不同病情控制情况分为哮喘控制组、哮喘部分控制组与哮喘未控制组,根据不同哮喘亚型分为咳嗽变异性组与非咳嗽变异性组,分析FeNO与哮喘患儿疾病控制情况、哮喘亚型的相关性。结果:哮喘组治疗前的FeNO浓度高于毛细支气管炎组治疗前和对照组体检时的FeNO浓度(P0.05);与治疗前与治疗后1 h比较,治疗4周后哮喘组与毛细支气管炎组患儿FeNO浓度降低(P0.05),治疗后1 h及治疗4周后哮喘组FeNO浓度高于毛细支气管炎组(P0.05)。哮喘控制组FeNO浓度低于部分控制组与哮喘未控制组,哮喘部分控制组FeNO浓度低于哮喘未控制组,咳嗽变异性组FeNO浓度高于非咳嗽变异性组(P0.05)。FeNO浓度与病情控制呈负相关,FeNO浓度越低,病情控制程度越好(r=-0.512,P=0.034)。结论:哮喘患儿的FeNO浓度高于毛细支气管炎患儿、健康儿童,且与患儿哮喘的病情控制存在相关性,可作为哮喘患儿的辅助诊断指标。     

Growth during early childhood in asthmatic children: relation to inhalation steroid dose and clinical severity score

BACKGROUND/AIM: While short-term studies reported a growth retardation in children with asthma treated with inhaled steroids, long-term studies described attainment of adult heights within the target height range. In the present work, we describe the growth pattern of children with asthma. METHODS: In 58 children with asthma, we compared the height at age 3 years with the height at a mean age of 7.5 years during a 12-month study period. RESULTS: No differences in growth could be detected within the study year. Children in the lowest tertile but not in other tertiles for asthma severity score and inhaled steroid dose showed a significant decrease in height standard deviation scores from age 3 to age 7.5 years. CONCLUSION: The decrease in height standard deviation scores might be explained by undertreatment or an individual sensitivity to inhaled steroids.     

Salbutamol: tablets,inhalational powder,or nebuliser?

A study was carried out to ascertain the most effective method of giving salbutamol. Seventeen children with severe asthma received active salbutamol (4 mg via a nebuliser, 400 micrograms as an inhalational powder, or a 4 mg tablet) together with complementary placebos on a double-blind, triple-dummy randomly allocated basis. The bronchodilatation effect was assessed by measuring the peak expiratory flow rate. The bronchodilatation effect was greatest when patients received nebulised salbutamol (p less than 0.05) but lasted longest when they received the tablet (p less than 0.0001); the onset of the effect was rapid with all forms of administration. These results indicate that nebulised salbutamol gives the best relief in severe asthma; in less severe cases, however, a regimen combining the inhalational powder and tablets is sufficient and more convenient.     

冬季肺炎和哮喘急性加重患儿呼吸道微生物多样性

目的 研究冬季肺炎和哮喘患儿呼吸道微生物的多样性。方法 选择2017年11月至2018年1月在我院急诊科治疗的确诊为肺炎和哮喘急性加重的患儿159例,其中肺炎患儿102例,哮喘急性加重患儿57例。选择同时期在本院就诊的无呼吸道疾病患儿88例,设为对照组。检测患儿呼吸道微生物分布情况。结果 肺炎和哮喘患儿呼吸道微生物多样性增加。肺炎患儿菌群丰度前3位的菌属分别是链球菌属、不动杆菌属、克雷伯菌属。哮喘患儿菌群丰度前3位的分别是嗜血杆菌属、莫拉氏菌属、葡萄球菌属。呼吸道病毒检测结果显示,肺炎患儿检出率前3位的病毒分别是肺炎支原体、呼吸道合胞病毒和副流感病毒3型。哮喘患儿病毒检出率前3位的是柯萨奇病毒、呼吸道合胞病毒和肺炎支原体。肺炎患儿肺炎支原体检出率明显高于哮喘患儿,柯萨奇病毒检出率明显低于哮喘患儿。结论 冬季肺炎和哮喘患儿的临床表现和体征较为相似,但是病原微生物检出情况有所不同。病原微生物检出的差异性有助于正确诊断和鉴别儿童肺炎和哮喘。     

Poverty,dirt, infections and non-atopic wheezing in children from a Brazilian urban center

Background

The causation of asthma is poorly understood. Risk factors for atopic and non-atopic asthma may be different. This study aimed to analyze the associations between markers of poverty, dirt and infections and wheezing in atopic and non-atopic children.

Methods

1445 children were recruited from a population-based cohort in Salvador, Brazil. Wheezing was assessed using the ISAAC questionnaire and atopy defined as allergen-specific IgE ≥0.70 kU/L. Relevant social factors, environmental exposures and serological markers for childhood infections were investigated as risk factors using multivariate multinomial logistic regression.

Results

Common risk factors for wheezing in atopic and non-atopic children, respectively, were parental asthma and respiratory infection in early childhood. No other factor was associated with wheezing in atopic children. Factors associated with wheezing in non-atopics were low maternal educational level (OR 1.49, 95% CI 0.98-2.38), low frequency of room cleaning (OR 2.49, 95% CI 1.27-4.90), presence of rodents in the house (OR 1.48, 95% CI 1.06-2.09), and day care attendance (OR 1.52, 95% CI 1.01-2.29).

Conclusions

Non-atopic wheezing was associated with risk factors indicative of poverty, dirt and infections. Further research is required to more precisely define the mediating exposures and the mechanisms by which they may cause non-atopic wheeze.     

Spectrum of Asthma in Children—III,Psychological and Social Components

Behavioural disturbances in the child, the mother-child and family relationships, and the family social structure were studied in a representative sample of the whole range of asthmatic children and compared with a control group of normal children. Behavioural disturbances occurred more often and at a statistically significant level only in the small group of children with severe and continuing asthma. These children were those with severe chronic airways obstruction as assessed physiologically and also with the most severe allergic manifestations.Predominant in the mother-child relations was an over-concern to protect the child''s health in those children with continuing asthma at 14 years of age. The families of the very severely affected group of children showed evidence of more stress than other families. Socioeconomic conditions were not significantly different in any group of asthmatic children compared with the control group.     

Psychological Stress and Hospitalization for Childhood Asthma-a Nationwide Cohort Study in Two Nordic Countries

Objective

Exposures to psychological stress in early life may contribute to the development or exacerbation of asthma. We undertook a cohort study based on data from several population-based registers in Denmark and Sweden to examine whether bereavement in childhood led to increased asthma hospitalization.

Methods

All singleton children born in Denmark during 1977-2008 and in Sweden during 1973-2006 were included in the study (N=5,202,576). The children were followed from birth to the date of first asthma hospitalization, emigration, death, their 18^th birthday, or the end of study (31 December 2007 in Sweden and 31 December 2008 in Denmark), whichever came first. All the children were assigned to the non-bereaved group until they lost a close relative (mother, father or a sibling), from when they were included in the bereaved group. We evaluated the hazard ratio (HR) of first hospitalization for asthma in bereaved children using Cox proportional hazards regression models, compared to those who were in the non-bereaved group. We also did a sub-analysis on the association between bereavement and first asthma medication.

Results

A total of 147,829 children were hospitalized for asthma. The overall adjusted HR of asthma hospitalization in bereaved children was 1.10 (95% confidence interval (CI): 1.04-1.16), compared to non-bereaved children. The risk of asthma hospitalization was increased in those who lost a close relative at age of 14-17 years (HR=1.54, 95% CI: 1.23-1.92), but not in younger age groups. The association between bereavement and asthma hospitalization did not change over time since bereavement. In the sub-analysis in singleton live births during 1996-2008 recorded in the DMBR, bereavement was associated with a lower use of asthma medication (HR=0.87, 95% CI: 0.80-0.95).

Conclusions

Our data suggests that psychological stress following bereavement in late adolescence is associated with an increased risk of asthma hospitalization or lowers the threshold for asthma hospitalization.     

The Urban Environment and Childhood Asthma (URECA) birth cohort study: design, methods, and study population

Background

The incidence and morbidity of wheezing illnesses and childhood asthma is especially high in poor urban areas. This paper describes the study design, methods, and population of the Urban Environment and Childhood Asthma (URECA) study, which was established to investigate the immunologic causes of asthma among inner-city children.

Methods and Results

URECA is an observational prospective study that enrolled pregnant women in central urban areas of Baltimore, Boston, New York City, and St. Louis and is following their offspring from birth through age 7 years. The birth cohort consists of 560 inner-city children who have at least one parent with an allergic disease or asthma, and all families live in areas in which at least 20% of the population has incomes below the poverty line. In addition, 49 inner-city children with no parental history of allergies or asthma were enrolled. The primary hypothesis is that specific urban exposures in early life promote a unique pattern of immune development (impaired antiviral and increased Th2 responses) that increases the risk of recurrent wheezing and allergic sensitization in early childhood, and of asthma by age 7 years. To track immune development, cytokine responses of blood mononuclear cells stimulated ex vivo are measured at birth and then annually. Environmental assessments include allergen and endotoxin levels in house dust, pre- and postnatal maternal stress, and indoor air nicotine and nitrogen dioxide. Nasal mucous samples are collected from the children during respiratory illnesses and analyzed for respiratory viruses. The complex interactions between environmental exposures and immune development will be assessed with respect to recurrent wheeze at age 3 years and asthma at age 7 years.

Conclusion

The overall goal of the URECA study is to develop a better understanding of how specific urban exposures affect immune development to promote wheezing illnesses and asthma.     

The parahippocampal place area: recognition, navigation, or encoding?

The parahippocampal place area (PPA) has been demonstrated to respond more strongly in fMRI to scenes depicting places than to other kinds of visual stimuli. Here, we test several hypotheses about the function of the PPA. We find that PPA activity (1) is not affected by the subjects' familiarity with the place depicted, (2) does not increase when subjects experience a sense of motion through the scene, and (3) is greater when viewing novel versus repeated scenes but not novel versus repeated faces. Thus, we find no evidence that the PPA is involved in matching perceptual information to stored representations in memory, in planning routes, or in monitoring locomotion through the local or distal environment but some evidence that it is involved in encoding new perceptual information about the appearance and layout of scenes.     

Controlled trial of slow-release aminophylline in childhood asthma: are short-term trials valid?

Slow-release aminophylline, although widely used for the prophylaxis of childhood asthma, has had only limited formal assessment. A four-month double-blind cross-over trial of slow-release aminophylline (14 mg/kg twice daily) was carried out in 24 children with perennial asthma. Satisfactory serum theophylline concentrations were obtained in 17 children, with few side effects. There was a significant improvement in mild daytime and night-time symptoms. The incidence of more severe symptoms was unaffected. Treatment did not improve the mean peak expiratory flow or reduce the incidence of use of bronchodilators. It is concluded that slow-release aminophylline has a place in the prophylaxis of perennial childhood asthma but is unsuitable for children who suffer from severe attacks. The cross-over trial design has severe limitations.