Stigmatizing Diagnoses in Neurosurgery: A Narrative Review

Understanding the Intersectional Relationship of Pain Stigma, Weight Bias Internalization, and Clinical Indicators in a Rural Population with Back Pain: A Survey-Based Study

BACKGROUND

Stigma is understood to be intersectional, meaning multiple characteristics can be stigmatizing, and they may be both overlapping and coconstitutive. Chronic pain and overweight are common complaints in the spinal surgery clinic. Since being overweight may relate to back pain in a complex fashion, we sought to understand if there is a moderating effect between weight bias and pain stigma.

METHODS

This study involves a survey-based, quantitative, cross-sectional, observational design using previously validated measures and demographic and clinical information. There were 192 participants. Statistical calculations were done with statistical package for the social sciences.

RESULTS

Pain stigma was not significantly correlated with BMI (body mass index), and weight bias was not significantly correlated with back pain. There was a strong positive correlation between weight bias and pain stigma. There was a strong positive correlation between weight bias and BMI when pain stigma was also high.

CONCLUSIONS

Given the relationship between weight stigma and pain, the intersection of weight and pain stigma is important because it indicates the vulnerability of patients with higher BMI to other forms of stigma, such as stigma for their pain complaints. Clinicians should be mindful of expressing pain stigma more significantly amongst patients with higher BMI.

Exploring correlation between social determinants and overweight/obesity in children and youths with epilepsy

Aim

This study aimed to explore the correlation between social determinants and overweight and obesity in children and youths with epilepsy.

Methods

The study data were derived from the National Survey of Children's Health (NSCH) 2016-2017 and 2018-2019, a cross-sectional sample of young people aged 10-17. Three groups participated by weight: 423 in body mass index (BMI) 5th-84th group (normal weight), 108 in BMI 85th-94th group (overweight), and 124 in BMI ≥ 95th group (obesity). Multivariate ordinal logistic regression analyses were conducted. The three subgroups were divided to explore the correlation between social determinants and overweight and obesity.

Results

A total of 655 children were included. After adjusting for sex, age, race, use of cigarets, cigars, or pipe tobacco inside, afterschool activity, and physical activity, children in poor physical condition reported by their parents [OR = 1.573 (95% CI, 1.164-2.125)] were associated with overweight/obesity. There were negative correlations between parents with higher education and overweight/obesity, especially in children and youths with previous or current epilepsy groups. Also, overweight/obesity was correlated with the 200%-400% family poverty level (FPL) [the adjusted odds ratio (OR) = 0.156 (95% CI, 0.028-0.876)] and above 400% FPL [the adjusted OR = 0.121 (95% CI, 0.023-0.641)] in children and youths with mild symptoms of epilepsy, and above 400% FPL [the adjusted OR = 0.103 (95% CI, 0.023-0.460)] in children with moderate to severe epilepsy.

Conclusion

Poor physical conditions were correlated with obesity in childhood epilepsy. Parents with higher education and FPLs were negatively correlated to childhood obesity. Therefore, this study was intended to advocate for a greater emphasis on BMI for children and youths with epilepsy in families with lower-educated and low-income groups.