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Objective: The objective of this study was to estimate and compare the distributions of body mass index (BMI: kg/m2) among individuals with and without schizophrenia, and, thereby, place the weight gain-inducing effects of antipsychotic drugs into context., Method: Data sources were (1) the mental health supplement of the 1989 National Health Interview Survey (NHIS; N = 80,130 nonschizophrenic and 150 self-reported schizophrenic individuals), (2) baseline BMI data from a drug trial of the anti-psychotic ziprasidone supplied by Pfizer Inc (420 noninstitutionalized individuals with chronic psychotic disorders [DSM-IV schizophrenia or schizoaffective disorder]) and (3) data from the National Health and Nutrition Examination Survey III (NHANES III; N = 17,689 nonschizophrenic individuals) to act as a control group for the ziprasidone trial data., Results: After age-adjusting BMI in each data set, the NHIS data revealed that men with schizophrenia have mean BMIs similar to those of men without schizophrenia (26.14 vs. 25.63, respectively). In contrast, women with schizophrenia in the NHIS data set had a significantly (p<.001) higher mean BMI than did women without schizophrenia (27.36 vs. 24.50, respectively). Moreover, each decile was higher for women with schizophrenia than for women without schizophrenia. Analysis of the ziprasidone and NHANES III data sets revealed that, on average, men with schizophrenia have mean BMIs comparable to those of men without schizophrenia (26.79 vs. 26.52, respectively). In these 2 data sets, women with schizophrenia also had a mean BMI similar to those of women without schizophrenia (27.29 vs. 27.39, respectively)., Conclusion: Although there may be a small subpopulation of schizophrenic individuals who are underweight, individuals with schizophrenia were, on the whole, as obese as or more obese than individuals without schizophrenia, suggesting that weight gain induced by antipsychotic agents is an important concern for many individuals.

To examine the ability of the personality dimension dispositional optimism to predict short-term obesity treatment outcomes (weeks of program attendance and weight loss), 177 consecutive persons seeking outpatient treatment at a university-based weight management center completed the revised Life Orientation Test (LOT-R; Scheier, Carver, & Bridges, 1994) and underwent a comprehensive medically monitored weight loss program. The overall LOT-R and optimism subscales did not correlate with either attendance or weight loss. However, the pessimism subscale was positively associated with weeks of attendance.

The relationship among body mass index (BMI, kg/m2), smoking status, and overall mortality remains controversial. To assess this relationship in a representative sample of older women, we used data from the Panel Study of Income Dynamics (PSID). The PSID (begun in 1968) is a prospective longitudinal cohort study designed to examine economic and demographic behavior. Respondents were 1355 women age > or = 50 when they initially completed the Self-Administered Health Questionnaire in 1990. Data collected included self-reported height and weight, years of completed education, smoking status (never versus ever), and responses to four health-related questions (e.g., retired due to ill health, difficulty eating). Respondents were followed, including the date of death if respondent died, through 1994. Cox proportional hazard regression revealed a U-shaped relationship irrespective of whether smoking was included in the model. The base of the curve was fairly wide, suggesting that a broad range of BMI is well tolerated by older women. The minimum mortality (estimated from fitted proportional hazard models) for both the smoking and nonsmoking models occurred at a BMI of approximately 34. When interactions between smoking status and BMI terms were added to the model, the interactions were not jointly significant (p = 0.071). Moreover an exploratory plot of the BMI-mortality curve among never smokers (n = 800) revealed a curve that moved away from being U-shaped toward being more monotonically decreasing. It is concluded that these data suggest that there is no evidence that the U-shaped BMI-mortality relationship observed is caused by confounding by smoking status.

Patients who report dysphagia, but have no detectable physical defect, have often been diagnosed as having an eating disorder. This diagnosis was evaluated by administering the Eating Disorders Inventory-2 (EDI-2) and a measure of distress, the Symptom Checklist-90 (SCL-90R), to a sample of 21 adult psychogenic dysphagia patients (PDPs). Their EDI-2 responses were then compared with samples of anorexics, college men, and college women, and their SCL-90R responses were compared with published data of patients with dysphagia due to a motility disorder, an obstruction, or neither. Relative to the anorexics, the PDPs scored significantly lower on all EDI-2 dimensions except maturity fears. For the SCL-90R, PDPs scored significantly higher on the interpersonal sensitivity, depression, anxiety, and general severity index than did the dysphagia comparison groups. Moreover, PDP scores on the anxiety and interpersonal sensitivity dimensions were indicative of clinically significant distress. These findings suggest that PDPs do not appear to have an eating disorder, but that they report clinically significant levels of psychological distress, particularly anxiety.

Background: The U.S. Surgeon General advocates the accumulation of moderate-intensity activity throughout the day to improve health., Objectives: To test the effectiveness of signs to encourage use of stairs instead of escalators., Design: Community intervention., Setting: Shopping center., Participants: 17901 shoppers., Intervention: Signs promoting the health and weight-control benefits of stair use were placed beside escalators with adjacent stairs., Measurements: The sex, age, race, weight classification, and use of stairs were observed., Results: Overall, stair use increased from 4.8% to 6.9% and 7.2% with the health and weight-control signs, respectively. Younger persons increase their stair use from 4.6% to 6.0% with the health sign and 6.1% with the weight-control sign. Older persons almost doubled their stair use from 5.1% to 8.1% with the health sign and increased use to 8.7% with the weight-control sign. Differential use of stairs was observed between ethnic groups. Among white persons, stair use increased from 5.1% to 7.5 and 7.8% with the health sign and weight-control signs. Among black persons, stair use decreased from 4.1% to 3.4% with the health sign and increased to 5.0% with the weight-control sign. At baseline, lean persons used the stairs more often than overweight persons (5.4% and 3.8%, respectively). The health sign increased stair use to 7.2% among normal-weight persons and 6.3% among overweight persons; the weight-control sign prompted stair use to increase to 6.9% among persons of normal weight and to 7.6% among overweight persons., Conclusions: Simple, inexpensive interventions can increase physical activity. Research is needed to identify effective motivators to promote activity among black persons.

Obesity is a major public health problem associated with increased health risks, chronic pain, and decrements in functional health status and subjective well-being. To examine the impact of pain on Health-Related Quality-of-Life (HRQL). 312 consecutive persons seeking medically-supervised weight loss treatment completed a sociodemographic questionnaire, the Medical Outcomes Study Short-Form Health Survey (SF-36), and underwent a series of clinical evaluations. Forty-eight percent of the patients when asked to rate "How much pain have you had in the last four weeks?" reported at least moderate pain in the four weeks prior to treatment. In analyses adjusted for sociodemographic factors, body-mass index (BMI) (kg/m2), and depression, obese patients reporting pain scored significantly lower on all SF-36 domains than those not reporting pain. Findings indicate that the pain itself is independently associated with impaired HRQL in nearly half of obese persons seeking treatment. These data demonstrate that pain is a strong covariate of obesity and, therefore, may need to be considered in the design and development of obesity treatments.

We compared health-related control perceptions in 115 HIV+ gay/ bisexual British men who were or were not members of an AIDS support group. Participants completed the Multidimensional Health Locus of Control Scale (MHLC). Compared to those who were not members of a support group, HIV+ men who belonged to a support group reported higher frequencies of perceptions that both oneself and powerful others (health professionals) are major determinants of one's health. Support group members also reported a lower frequency of perceptions that chance factors greatly influence one's health.

The relationships between dispositional optimism, social support, and mood and performance symptoms associated with the premenstrum were examined in a sample of 101 adult women. Optimism and satisfaction with one's level of social support were positively correlated. Optimism was related inversely to mood-related symptoms, even after controlling for the effects of social support. Optimism did not correlate with premenstrual performance impairment. Social support did not correlate with any premenstrual symptoms.

The Dieting Readiness Test (DRT) has been recommended by the Institute of Medicine as a measure of diet and exercise-related motivation and attitudes in those about to embark on a weight loss program. However, little research is available regarding the psychometric properties of this instrument. We conducted a study to assess the psychometric properties and predictive validity of the DRT. A group of 410 obese adults seeking outpatient treatment at a university-based weight management center completed the DRT prior to engaging in a comprehensive medically monitored program. Principal-components factor analysis indicated a five-factor solution and acceptable internal consistency for the resulting scales. The Bingeing and Eating cues scale was negatively associated with program attendance. None of the four remaining scales correlated with either attendance or weight loss. We conclude that although the DRT possesses a stable and interpretable structure and adequate internal consistency, it does not appear to be a strong predictor of weight loss or treatment attendance.

This study was conducted to assess the predictive utility of self-esteem and dispositional optimism to postpartum depression. Forty-five British women completed standard measures of self-esteem, optimism, and postpartum depression several weeks before childbirth. Depression was again measured at two and six weeks postpartum. Optimism was associated with less depressive symptoms during pregnancy and at two weeks postpartum, while self-esteem was associated with lower depression over all three administrations. After controlling for optimism and earlier levels of depressive symptoms, self-esteem remained associated with lower levels of depressive symptoms two weeks postpartum. This suggests that self-esteem and not optimism appears to be a reliable contributing factor to the differential susceptibility to depression in the early postpartum period.

Background: The relationship between obesity and increased risks of morbidity and mortality is well established. Less is known about the impact of obesity on functional health status and subjective well-being., Methods: We examined health-related quality of life (HRQL), measured by the Medical Outcomes Study Short Form-36 Health Survey (SF-36), and clinical characteristics of 312 consecutive persons seeking outpatient treatment for obesity at a university-based weight management center. SF-36 scores were adjusted for sociodemographic factors and various comorbidities, including depression, to better estimate the effect of obesity on HRQL. Health-related quality of life of the obese patients was then compared with that of the general population and with a sample of patients who have other chronic medical conditions., Results: Compared with general population norms, participants who had a mean body-mass index (BMI) of 38.1 reported significantly lower scores (i.e., more impairment) on all eight quality-of-life domains, especially bodily pain and vitality. The morbidly obese (mean BMI, 48.7) reported significantly worse physical, social, and role functioning, worse perceived general health, and greater bodily pain than did either the mildly (mean BMI, 29.2) or moderately to severely obese (mean BMI, 34.5). The obese also reported significantly greater disability due to bodily pain than did patients with other chronic medical conditions., Conclusions: Obesity profoundly affects quality of life. Bodily pain is a prevalent problem among obese persons seeking weight loss and may be an important consideration in the treatment of this population.

We examined the influence of a brief, small group teaching intervention, which used current patients as examples, on the detection of malnutrition by medical housestaff. We reviewed 100 consecutive patient admissions before and 61 admissions 1 month after the intervention for any mention of malnutrition in admitting, progress, or discharge notes and compared the result with the number of patients diagnosed as malnourished by dietitians. Before the intervention, interns correctly identified 4 (14%) of 28 malnourished patients. After the intervention, the same interns correctly identified 15 (94%) of 16 malnourished patients (p = .0004). We conclude that this brief teaching intervention was effective in increasing the awareness and detection of malnutrition by interns.

Background: Specific inhibition of target proteins by antisense oligodeoxynucleotides is an extensively studied experimental approach. This technique is currently being tested in clinical trials applying phosphorothioate-modified oligonucleotides as therapeutic agents. These polyanionic molecules, however, may also exert non-antisense-mediated effects., Materials and Methods: We examined the influence of oligonucleotides on lipopolysaccharide (LPS)-stimulated tumor necrosis factor alpha (TNF alpha) synthesis in freshly isolated human peripheral blood mononuclear cells. Oligonucleotides (18 mer) with different degrees of phosphorothioate modification were studied., Results: The addition of phosphorothioate oligonucleotides (5 microM) caused amplification of TNF synthesis of up to 410% compared with the control with LPS alone. Without LPS stimulation, phosphorothioate oligonucleotides did not induce TNF production. We demonstrate that the enhancement of LPS-stimulated TNF production by phosphorothioate oligonucleotides does not rely on the intracellular presence of oligonucleotides and is not mediated by LPS contamination. Partially phosphorothioate-modified oligonucleotides and unmodified oligonucleotides did not increase TNF synthesis. High concentrations of the polyanion heparin reversed the oligonucleotide-induced enhancement of TNF synthesis., Conclusions: The data suggest that amplification of TNF synthesis may be caused by binding of the polyanionic phosphorothioate oligonucleotide to cationic sites on the cell surface. Such binding sites have been proposed for polyanionic glycoaminoglycans of the extracellular matrix, which have also been described to augment LPS-stimulated TNF synthesis. The present results are relevant to all in vitro studies attempting to influence protein synthesis in monocytes by using phosphorothioate oligonucleotides. The significance of our findings for in vivo applications of phosphorothioates in situations where there is a stimulus for TNF synthesis, such as in sepsis, should be elucidated.

This study investigated the effects of generalized and domain-specific expectancies on participation in 8 weeks of step aerobic-exercise classes. 154 university students and staff who registered for step aerobic classes completed measures of aerobic self-efficacy and dispositional optimism prior to attending their first class. Attendance was taken at each session by the instructors. A split at the median on attendance classified participants as dropouts or adherers. Analysis indicated that adheres scored significantly higher on self-efficacy that did dropouts. Adherers and dropouts did not differ on dispositional optimism.

Results are presented from a pilot study in which risk perceptions for developing cancer in samples of American and British adults were compared. 61 American and 43 British people estimated the likelihood of cancer happening to themselves and the average person. As a group, participants tended to judge their personal likelihood of developing cancer as less than the average, supporting the presence of an optimistic bias. However, compared to the Americans, British respondents tended to perceive both themselves and the average person to be less likely to develop cancer. There were no gender differences or interactions between the variables. Discussion centered on possible variations between the two countries with respect to perceptions of control and responsibility for one's health status which may account for the findings.

The present study investigated the effects of individual differences along the dimension of dispositional optimism-pessimism on comparative risk perception in relation to the prospect of developing AIDS. 104 university students completed the Life Orientation Test of Scheier and Carver and estimated the likelihood of AIDS happening to themselves and the average university student. A split at the median on the Life Orientation Test divided subjects into optimists and pessimists. Dispositional optimists and pessimists rated their own likelihood of developing AIDS as less than that of the average student. Moreover, subjects classified as optimistic and pessismistic did not differ significantly in their ratings of comparative risk perception.

This article challenges nurses to rethink cultural values and ideals regarding beauty and body weight, respond appropriately to persons suffering from any of the eating disorders, and work together to change self-deprecation into a celebration of womanhood.

Providing truly holistic care means that nurses must recognize that their clients are sexual beings and that they often suffer from sexual concerns and problems related to their past history and their current medical problems. In addition to helping clients move toward physical wellness, nurses should intervene with intrapersonal and interpersonal problems affecting client's sexual feelings and behaviors.