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Kaufman EJ, Tan C. White as milk: Biocentric bias in the framing of lactose intolerance and lactase persistence. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:1533-1550. [PMID: 36018892 DOI: 10.1111/1467-9566.13528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
The majority of the world population is lactose intolerant, as 65%-70% of people lose the enzymes to digest lactose after infancy. Yet, in the United States, where lactose intolerance is predicted to affect only 36% of people, this phenomenon is often framed as a deficiency as opposed to the norm. This is because the United States has a higher prevalence of people who are lactase persistent. Lactase persistence is a genetic trait most common among Europeans and some African, Middle Eastern and southern Asian groups with a history of animal domestication and milk consumption. In this study, we take the case of lactose intolerance to examine how popular media maintains biocentric biases. Analysing relevant articles published in The New York Times and Scientific American between 1971 and 2020, we document how ideas about milk, health and race evolve over time. Over this fifty-year period, writers shifted from framing lactose intolerance as racial difference to lactase persistence as evolutionary genetics. Yet, articles on the osteoporosis 'epidemic' and vitamin D deficiency worked to perpetuate lactose intolerance as a health concern and standardise the dairy-heavy American diet. Studying media portrayals of lactose intolerance and lactase persistence, we argue that popular discourses normalise biocentric biases through messages about eating behaviours and health.
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Affiliation(s)
- Eli J Kaufman
- Department of Sociology, Vassar College, Poughkeepsie, New York, USA
| | - Catherine Tan
- Department of Sociology, Vassar College, Poughkeepsie, New York, USA
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Thompson-Lastad A. Group Medical Visits as Participatory Care in Community Health Centers. QUALITATIVE HEALTH RESEARCH 2018; 28:1065-1076. [PMID: 29781398 PMCID: PMC6500445 DOI: 10.1177/1049732318759528] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
In this article, I examine group medical visits, a clinic-based intervention that aims to improve patient health by combining clinical care, health education and peer support. Research shows that health care inequalities are reproduced through the interplay of interpersonal, institutional, and structural factors. I examine changing social relations made possible by group visits, including peer support and an expanded role for patient knowledge. The qualitative data presented here are part of a mixed-methods study of how group medical visits and integrative medicine are combined and implemented for low-income people with chronic conditions. I find that patients take active roles in each other's care, supporting, challenging, and advocating in ways that shift patient-provider relationships. Such shifts demand reflection about what kinds of knowledge matter for health. Health care encounters can reproduce inequality for marginalized patients; this study suggests group visits can restructure patient-provider encounters to interrupt healthcare inequalities.
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Paterson BL, Butt G, McGuinness L, Moffat B. The Construction of Hepatitis C as a Chronic Illness. Clin Nurs Res 2016; 15:209-24. [PMID: 16801360 DOI: 10.1177/1054773806288569] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of the article is to present one aspect of the findings of a descriptive, exploratory investigation of the self-care decision making of 33 adults diagnosed with chronic hepatitis C (Hep C), specifically how they experienced living with this disease as a chronic illness. The findings were interpreted from a social constructivist perspective in which Hep C was viewed as both a biomedical entity and a social construction. The authors will suggest that although Hep C is constructed by people with the disease as a chronic illness, the care of this disease is often based on an acute model that acknowledges its chronicity only in terms of the persistence of the virus. The article points to the need for a model of Hep C care that incorporates the dimensions of the chronic illness experience.
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Anderson L, Mah C, Sellen D. Eating well with Canada's food guide? Authoritative knowledge about food and health among newcomer mothers. Appetite 2015; 91:357-65. [DOI: 10.1016/j.appet.2015.04.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 11/26/2022]
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Aronowitz R, Deener A, Keene D, Schnittker J, Tach L. Cultural reflexivity in health research and practice. Am J Public Health 2015; 105 Suppl 3:S403-8. [PMID: 25905833 DOI: 10.2105/ajph.2015.302551] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Recent public health movements have invoked cultural change to improve health and reduce health disparities. We argue that these cultural discourses have sometimes justified and maintained health inequalities when those with power and authority designated their own social practices as legitimate and healthy while labeling the practices of marginalized groups as illegitimate or unhealthy. This "misrecognition," which creates seemingly objective knowledge without understanding historical and social conditions, sustains unequal power dynamics and obscures the fact that what is deemed legitimate and healthy can be temporally, geographically, and socially relative. We use examples from research across multiple disciplines to illustrate the potential consequences of cultural misrecognition, highlight instances in which culture was invoked in ways that overcame misrecognition, and discuss how cultural reflexivity can be used to improve health research and practice.
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Affiliation(s)
- Robert Aronowitz
- Robert Aronowitz is with the Department of History and Sociology of Science, University of Pennsylvania, Philadelphia. Andrew Deener is with the Department of Sociology, University of Connecticut, Hartford. Danya Keene is with the Division of Social and Behavioral Sciences, Yale School of Public Health, Yale University, Hartford. Jason Schnittker is with the Department of Sociology, University of Pennsylvania. Laura Tach is with the Department of Policy Analysis and Management, Cornell University, Ithaca, NY
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Kazmer MM, Lustria MLA, Cortese J, Burnett G, Kim JH, Ma J, Frost J. Distributed knowledge in an online patient support community: Authority and discovery. J Assoc Inf Sci Technol 2014. [DOI: 10.1002/asi.23064] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Michelle M. Kazmer
- School of Library and Information Studies; Florida State University; 142 Collegiate Loop Tallahassee FL 32306-2100
| | - Mia Liza A. Lustria
- School of Library and Information Studies; Florida State University; 142 Collegiate Loop Tallahassee FL 32306-2100
| | - Juliann Cortese
- School of Communication; Florida State University; 296 Champions Way Tallahassee FL 32306-2664
| | - Gary Burnett
- School of Library and Information Studies; Florida State University; 142 Collegiate Loop Tallahassee FL 32306-2100
| | - Ji-Hyun Kim
- School of Library and Information Studies; Florida State University; 142 Collegiate Loop Tallahassee FL 32306-2100
| | - Jinxuan Ma
- School of Library and Information Studies; Florida State University; 142 Collegiate Loop Tallahassee FL 32306-2100
| | - Jeana Frost
- VU Amsterdam; De Boelelaan 1081 1081 HV Amsterdam
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Lee H, Fitzpatrick JJ, Baik SY. Why isn't evidence based practice improving health care for minorities in the United States? Appl Nurs Res 2013; 26:263-8. [PMID: 23928122 DOI: 10.1016/j.apnr.2013.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 04/24/2013] [Accepted: 05/23/2013] [Indexed: 11/26/2022]
Abstract
Achieving health equity by improving the health care of all racial/ethnic groups is one of the key goals of Healthy People 2020. The implementation of evidence based practice (EBP) has been a major recommendation to achieve health equity in hopes of eliminating the subjectivity of clinical decision making. However, health disparities among racial/ethnic minorities are persistent in spite of the adoption of standardized care based on evidence. The EBP with racial and ethnic minorities is often seen as a possible cause of health and health care disparities. Three potential issues of using EBP to reduce health disparities have been identified: (1) a lack of data for EBP with ethnic/racial minority populations; (2) limited research on the generalizability of the evidence based on a European-American middle-class; and (3) sociocultural considerations in the context of EBP. Using EBP to reduce disparities in health care and health outcomes requires that nurse professionals should know how to use relevant evidence in a particular situation as well as to generate knowledge and theory which is relevant to racial/ethnic minorities. In addition, EBP implementation should be contextualized within the sociocultural environments in which patients are treated rather than solely focusing on the health problems.
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Affiliation(s)
- Haeok Lee
- Department of Nursing, University of Massachusetts Boston, Boston, MA, USA.
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Sargent C, Larchanché S. Transnational Migration and Global Health: The Production and Management of Risk, Illness, and Access to Care. ANNUAL REVIEW OF ANTHROPOLOGY 2011. [DOI: 10.1146/annurev-anthro-081309-145811] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Globalization, including the global flows of people, is clearly linked to disease transmission and vulnerability to health risks among immigrant populations. Anthropological research on transnational migration and health documents the implications of population movements for health and well-being. Studies of immigrant health reveal the importance of the social, political, and economic production of distress and disease as well as the structures and dynamics that produce particular patterns of access to health services. This review points to underlying political, economic, and social structures that produce particular patterns of health and disease among transnational migrants. Both critical and phenomenological analyses explore ideas of alterity and community, which underlie the production and management of immigrant health. Research on immigrant health underscores the importance of further attention to policies of entitlement and exclusion, which ultimately determine health vulnerabilities and accessibility of health care.
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Affiliation(s)
- Carolyn Sargent
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri 63130
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Doshani A, Pitchforth E, Mayne C, Tincello DG. The value of qualitative research in urogynaecology. BJOG 2008; 116:3-6. [PMID: 19016687 DOI: 10.1111/j.1471-0528.2008.01924.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Doshani
- Urogynaecology Department, Women's, Perinatal and Sexual Health Directorate, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
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Paige DM, Witter FR, Bronner YL, Kessler LA, Perman JA, Paige TR. Lactose digestion in pregnant African-Americans. Public Health Nutr 2004; 6:801-7. [PMID: 14641951 DOI: 10.1079/phn2003489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This paper reports on the status of lactose digestion during early and late pregnancy and at 8 weeks postpartum in an African-American population. The hypothesis is that lactose digestion and milk tolerance do not change throughout pregnancy and do not differ from those of non-pregnant African-American women. DESIGN AND SUBJECTS This longitudinal study determined lactose digestion after ingesting 240 ml of 1% fat milk containing 12 g of lactose at: (1) early pregnancy, prior to 16 weeks (n=148); (2) late pregnancy, 30-35 weeks (n=77); and (3) 8 weeks postpartum (n=93). One hundred and one comparably matched non-pregnant African-American women served as controls. RESULTS Prevalence of lactose digestion, as measured by breath hydrogen, was 80.2% in the control women, 66.2% in early pregnancy, 68.8% in late pregnancy and 75.3% postpartum. The prevalence of women reporting symptoms was approximately 20% regardless of lactose absorption status. However, the control women reported significantly more symptoms than did the pregnant women. CONCLUSIONS This study indicates that there is no significant change in lactose digestion during pregnancy. The prevalence of lactose intolerance for the pregnant African-American women studied is similar to that for non-pregnant African-American women and similar to previous prevalence reports in adult African-Americans. There was no change in the tolerance of lactose noted during pregnancy in these women. There were, however, fewer symptoms reported by the lactose-maldigesting pregnant women.
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Affiliation(s)
- David M Paige
- Department of Population and Family Health Sciences, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 280, Baltimore, MD 21205, USA.
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Obermayer-Pietsch BM, Bonelli CM, Walter DE, Kuhn RJ, Fahrleitner-Pammer A, Berghold A, Goessler W, Stepan V, Dobnig H, Leb G, Renner W. Genetic predisposition for adult lactose intolerance and relation to diet, bone density, and bone fractures. J Bone Miner Res 2004; 19:42-7. [PMID: 14753735 DOI: 10.1359/jbmr.0301207] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Evidence that genetic disposition for adult lactose intolerance significantly affects calcium intake, bone density, and fractures in postmenopausal women is presented. PCR-based genotyping of lactase gene polymorphisms may complement diagnostic procedures to identify persons at risk for both lactose malabsorption and osteoporosis. INTRODUCTION Lactase deficiency is a common autosomal recessive condition resulting in decreased intestinal lactose degradation. A -13910 T/C dimorphism (LCT) near the lactase phlorizin hydrolase gene, reported to be strongly associated with adult lactase nonpersistence, may have an impact on calcium supply, bone density, and osteoporotic fractures in the elderly. MATERIALS AND METHODS We determined LCT genotypes TT, TC, and CC in 258 postmenopausal women using a polymerase chain reaction-based assay. Genotypes were related to milk intolerance, nutritional calcium intake, intestinal calcium absorption, bone mineral density (BMD), and nonvertebral fractures. RESULTS Twenty-four percent of all women were found to have CC genotypes and genetic lactase deficiency. Age-adjusted BMD at the hip in CC genotypes and at the spine in CC and TC genotypes was reduced by -7% to -11% depending on the site measured (p = 0.04). LCT(T/C-13910) polymorphisms alone accounted for 2-4% of BMD in a multiple regression model. Bone fracture incidence was significantly associated with CC genotypes (p = 0.001). Milk calcium intake was significantly lower (-55%, p = 0.004) and aversion to milk consumption was significantly higher (+166%, p = 0.01) in women with the CC genotype, but there were no differences in overall dietary calcium intake or in intestinal calcium absorption test values. CONCLUSION The LCT(T/C-13910) polymorphism is associated with subjective milk intolerance, reduced milk calcium intake, and reduced BMD at the hip and the lumbar spine and may predispose to bone fractures. Genetic testing for lactase deficiency may complement indirect methods in the detection of individuals at risk for both lactose malabsorption and osteoporosis.
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Affiliation(s)
- Barbara M Obermayer-Pietsch
- Division of Endocrinology and Nuclear Medicine, Department of Internal Medicine, Karl-Franzens University Hospital, Graz, Austria.
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Abstract
In rural Costa Rica, lay people conceptualize iron deficiency anemia differently from health care providers, and these differences impede public health initiatives. This research is based on 70 ethnographic interviews with mothers of young children 24-48 months of age and interviews with health care personnel in eight rural neighborhoods. Lay explanations of anemia draw on biomedical concepts, such as the amount of iron in the blood or in food, but one common explanation is elaborated to involve a biomedical life-threatening disease, leukemia, in cases where the anemia is not treated. Furthermore, mothers often view the liquid iron given free at the clinic as treatment for anemia as too strong, causing negative dental effects; many refuse to administer the iron drops to their children and give other treatments. Formal public health measures result in effects local people consider unacceptable and not congruent with being a good parent; with few exceptions, the medical community dismisses those preoccupations as inappropriate signs of ignorance on the part of caretakers. The existence of several systems of healing allows for parental rejection of public health measures and easy access to alternative remedies.
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Abstract
AIMS This article presents several findings of a study, conducted between 1996 and 1998, to investigate self-care decision making in diabetes. RATIONALE The underlying assumption of many practitioners is that an invitation to people with chronic illness to participate as equal partners is sufficient to guarantee their empowerment. DESIGN Using grounded theory, the research examined self-care decision making using a convenience sample of 22 Canadian adults with longstanding type 1 diabetes nominated as expert self-care managers. Participants audiotaped their decision making as it occurred for 3 weeks over the course of one calendar year. These audio-recordings were followed by an interview to clarify participants' decision making and factors that affected their decisions. FINDINGS Participants identified several covert and subtle ways that practitioners contradict their stated goal of empowerment in their interactions with diabetics. Participants revealed that despite their intention to foster participatory decision making, practitioners frequently discount the experiential knowledge of diabetes over time and do not provide the resources necessary to make informed decisions. CONCLUSION The article concludes with a discussion of the implications of the findings for practice.
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Affiliation(s)
- B Paterson
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Affiliation(s)
- J Savage
- Royal College of Nursing, London W1M OAB.
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