Ebola: Route of Transmission, Life Cycle and Treatment It is hypothesized that Ebola outbreaks are zoonotic in origin, however the true reservoir in unsubstantiated.8 The conceding belief is that fruit bats are the reservoir for the Ebolavirus, but due to their migration patterns and apparent lack of disease it has been challenging to study this effectively to yield a substantiated conclusion.28 It is further theorized that transmission to humans comes from preparation and consumption of infected bushmeat or the handling of infected animals.8 Some scientists believe that non-human primates contract Ebola from eating fruit soiled with body fluids from infected fruit bats, however there may also be direct animal to animal transmission.8 There is also evidence that domesticated animals such as pigs and dogs contract the virus.29 Once a human is infected from a zoonotic source it is then transmitted from person to person via direct contact with blood, secretions, organs and other bodily fluids of infected people. Ebolavirus is also transmitted during burial ceremonies where individuals come into direct contact with an infected deceased person.30 Healthcare workers taking care of those infected have frequently been infected themselves, due to improper infection control procedures.30 Recent evidence has shown a sexual transmission from Ebola, as semen can test positive for Ebola months after the disease has subsided.30 The WHO and CDC both report that Ebolavirus can not be transmitted through aerosols. However, there are a few studies and evidence to support that it is a possible mode of transmission. It is believed that there was animal to animal as well as animal to human transmission of the Reston virus from cynomolgus macaques in a US quarantine facility.31 The outbreak demonstrated intercage infection and in some cases with distance between the cages. In a study, rhesus macaques were infected through aerosols of the Zaire virus, with a median mass diameter ranging from 0.8 and 1.2m.32 Evidence of the respiratory tract being the primary site of infection, can be inferred from the viral concentration being the greatest in the lungs.8 Pathogenesis The incubation period for Ebolavirus ranges from 2 to 21 days and humans are non-infectious until symptoms appear.30 Ebolavirus presents with a sudden onset of fever, fatigue, muscle pain, headache and sore throat. As the disease progresses vomiting, diarrhea and a rash present. During the latent stages of the disease, patients develop impaired kidney and liver function, and in some cases, both internal and external bleeding.30 Patients will present with labs with low white blood count (WBC), low platelets, elevated liver enzymes (AST and ALT).30 The mortality rate varies among the different subtypes of Ebolavirus. The Zaire virus has an average of 77% mortality rate, Sudan virus 49.8%, Bundibugyo 30.55% and Reston virus and Tai Forest virus both have a 0% mortality rate.5 The range in mortality rates across all subgroups go from 100% to 0%. However, when looking specifically at the Zaire virus the range is 47% to 100%.5 Diagnosis, Treatment, and Prevention EBOV is difficult to distinguish early on from other infectious diseases in the area like malaria, typhoid fever and meningitis.30 In order to confirm initial symptoms are caused by EBOV healthcare workers should perform ELISA, antigen-capture detection tests, serum neutralization test, RT-PCR, electron microscopy, or virus isolation by cell culture.30 All samples are an extreme biohazard risk and can only be done under biosafety level (BSL) 4. There are currently only 10 BSL 4 labs in the US and 47 worldwide33, leading to an insufficient resource for testing and research. Current treatment for EBOV is supportive care through re-hydration as well as treatment for specific symptoms. There are currently no vaccines or approved treatment for EBOV, however there are many in development. During a recent outbreak, a US physician was treated with an experimental drug (ZMapp). He eventually went on to give a blood transfusion to another patient with EBOV in hopes of treatment; both recovered well. Evidence suggest that antibody support along with platelets and fluids could provide a key in future treatments. Currently, higher level medical facilities pose better outcomes due to their ability to assist with organ deterioration while the patient is trying to survive the viral infection. Prevention and Control is best achieved through case management, surveillance, contact tracing, good laboratory services, safe burials, and social mobilization.30 By limiting the interaction with wildlife, which are known to be reservoirs of the disease, we can limit the transmission into human hosts. If an individual becomes infected proper quarantine procedures should be put in place to ensure the disease does not spread. Proper quarantine measures include isolating infected patients in medical facilities with only essential personal entering and leaving the patients room. All essential medical personnel should don personal protective equipment (PPE) at all time, which includes a single use gown, respirator with full face shield, 2 pairs of gloves, single use boot covers, and single use apron.34 Educating the population in these endemic areas as to these quarantine procedures, not touching infected animals, and proper burial techniques can vastly improve outcomes during outbreaks.30 Weight and Discrimination: Legal Issues Weight and Discrimination: Legal Issues Ther L. Richardson Abstract Discrimination against overweight and obese people has existed for millennia but it is just in recent decades that discrimination against the overweight has been seen as a crime and research has begun in this field. Despite some research going back as far as the 1940â€™s the majority of research did not start until almost the 1970â€™s. With the pace that American law is driven there has not been considerable progress made to this point. Current research is being conducted to stem both the lack of progress and make inroads of societal progress. Current understanding and legislation may empower an entire class of world citizens, and change perception of weight discrimination and obesity while leveling the employment and earnings playing field. Weight and Discrimination: Legal Issues in Weight Discrimination According to the Centers for Disease Control (CDC) between 2009 and 2010 more than 35 percent of adults across the U.S. and Canada were considered obese, (McGuire, 2011, pp. 368-369) based on the BMI. The Body Mass Index or BMI is a scale that assigns a number value that is calculated from a persons weight and height. BMI is used to provide an indicator of body fat ratio or level and is used by the healthcare industry to screen people for weight categories. While the rates of obesity in adults has been slowing over the past decade or so, the world population has become more media centric and the idea of the ideal body type has certainly been affected by the mass media and the influence of Hollywood movies, sports and television. This change in the perception of the ideal body image has almost certainly affected the rates and types of discrimination as well. In the workplace, obese workers are considered lazy, incompetent, and lacking self-control. While womenâ€™s wages are lower on average then menâ€™s, obese womenâ€™s wages are even more out of proportion. It has also been shown that many human resource representatives do not even know it is illegal to not interview, or decline to hire someone based on their weight. As ideal body image changes to leaner more fit athletic and â€œunderwear modelâ€ looking individuals the more overweight and obese individuals pale in comparison. The contrast effect then sets up and impossible scenario where the obese worker or applicant can never meet the mindâ€™s eye image of the ideal employee. Perception of weight discrimination and obesity Sutin and Terracciano (2013) conducted research on perceived weight discrimination and obesity. They examined whether weight discrimination is associated with risk of becoming obese by follow-up survey among those not obese at baseline, and to test whether weight discrimination is associated with risk of remaining obese at follow-up among those already obese at baseline (Sutin Terracciano, 2013). This research was conducted through both face to face interviews and a survey returned by mail to the Health and Retirement Study, which is a nationally representative longitudinal survey conducted by the University of Michigan. They found that weight discrimination was reported by those that became obese during the time between the baseline and follow-up interviews, for the most part among participants who werenâ€™t obese at the time of the baseline measurements. Those subjects who reported that they experienced discrimination based on their weight were over three times more likely to remain obese at follow-up instead of dropping below the obesity threshold on the Body Mass Index (BMI) than those who did not experience such discrimination. Of the sample that was normal weight at baseline, there was not enough data for the analysis, but of the 14 participants in the normal weight category who reported weight discrimination in their follow-up, none became obese as described by the BMI (Sutin Terracciano, 2013). Sutin and Terracciano (2013) remark that â€œbody weight is a highly visible, personal characteristic that can evoke strong stereotypes and strong reactions from others,â€ and easily contribute to stereotyping and discrimination as well. Weight discrimination and harassment are also thought to be associated with behaviors which increase the risk of weight gain, these behaviors include excessive food intake (binge eating) and decreased physical inactivity (Friedman Puhl, 2012, p. 2, 3). Obese persons who feel discriminated against may tend to avoid situations where there weight would make them stand out, for instance going out dancing, and thus gaining the benefit of the exercise that might be gained by that activity. People that feel stigmatized tend to feel less confident and able to engage in physical activity and thus avoid not only exercise, but also social activity that could lead to physical activity and exercise such as line dancing or other forms of social activities like sports, and games. Weight bias can have a significant impact on social, economic, psychological and physical health. Social and economic consequences include social rejection, poor quality of relationships (Friedman Puhl, 2012, p. 2, 3). Current legal protections in the united states and results of litigation Katz and Lavan (2008) conducted research on limited legal protections of obese employees as a class, and lawsuits against employers who took adverse employment actions based on obesity against obese employees and former employees who have begun to prevail in lawsuits against those employers. They analyzed of a random sample of 80 cases to attempt to identify factors that increase an obese plaintiffs likelihood of success and found that an employee in the private sector, particularly a non-professional employee, has a significantly greater likelihood of winning than do others. Additionally, they found that an unemployed individual or an individual filing suit under legislation other than state discrimination laws or the Americans with Disabilities Act (ADA) has a statistically greater chance of prevailing as well. According to Katz and Lavan (2008), because obesity is often considered a problem wherein the obese individuals are blamed for their own weight, people see obesity as an issue of personal responsibility versus a chronic condition and this may well may have a different impact on public opinions and support for anti-discrimination laws and lawsuits. There are many facets to the discrimination towards obesity that may not even be perceived by those that are being discriminated against. For example, applicants for employment may be judged on their appearance, not just on their qualifications. Rejected candidates may not be aware of weight-related factors (Katz Lavan, 2008). One surprising result that was mentioned was that the discrimination against obesity is contagious. In one study cited by Katz and Lavan, in two experiments, average-weight male job applicants were rated more negatively when seen with an overweight compared to a normal weight female. This shows that the stigmatization and discrimination can spread simply due to association. The overweight and more specifically the morbidly obese are often given the blame for their own condition. Another impression that people hold is that of obese people being less tidy or having poor personal hygiene, this often has a lot to do with appearance. Supervisors or management may even react differently to overweight individuals, causing them to treat overweight employees differently on the job than more attractive employees (Katz Lavan, 2008). In addition, the discrimination against obese persons is not limited to the workplace by any means, obese persons are reminded, or are made to feel in everyday encounters with family members, peers, health care providers, and strangers that they deviate from social norms and are inferior to those who are not obese (Katz Lavan, 2008 pg. 3). When it comes to the current legal state, more and more it appears that Title VII (the Age Discrimination in Employment Act, 1964) and the Americans with Disabilities Act, 1990 have not been very useful to litigants either, except in cases where the litigant that is claiming discrimination was morbidly obese. If an individual claimed that they were discriminated against but not because of an actual disability but instead because of their employerâ€™s perception that they had a disability from being overweight when in fact they could perform the jobs assigned without impediment, then that litigant was in fact more likely to win (Katz Lavan, 2008 pg. 3). In addition much discussion on their part about recent litigation and the ADA, Katz and Lavan (2008) stated that courts have generally viewed obesity as a voluntary condition and therefore disqualified it as a disability under ADA. They cite few cases that have held that obesity on its own constitutes a disability (Katz Lavan, 2008 pg. 4). Obesity and obtaining work and fair wages Pagan DÃ¡vila (1997) conducted a study to explore the relationship between obesity, occupational attainment, and earnings using data from the National Longitudinal Survey of Youth to investigate the occupational selection of obese individuals. They then estimated the earnings functions that accounted for the occupational attainment of the overweight. Much the same as many other researchers they found that women seemed to pay a steeper penalty than men did as men tended to migrate into employment where their weight did not play as big of a role (Pagan DÃ¡vila, 1997). The authors did not elaborate on these types of employment other than to say service based, although the authors did at one point elude to truck drivers and movers. In all, the reported findings they said did tend to complement the existing body of work. Their research did not seem to bring much new to the table other than the fact that they had some theories on crowding, but it did support previous theory and work mentioned. Because there is very little research so far to review each new item add to the totality of the available data. In addition, they were the only authors that eluded to the use of migration into employment where their weight did not play as big of a role in their earning potential. Research into the efforts to pass new laws Puhl, Heuer Sarda (2010) conducted research assess the public support for potential legislation to prohibit weight-based discrimination against obese individuals in the United States, and to examine whether certain message frames about weight discrimination influence public support. Their participants were randomly assigned to read one of the four paragraphs that framed the topic of weight discrimination in a distinct way (or a control condition with no paragraph). Participants were then asked to indicate their level of support for six anti-discrimination laws. Participants were a national sample of 1114 participants (48% women, 52% men), with a mean age of 44.78 years (Puhl et al., 2011). The results of their study showed that there was some support for laws that would prohibit weight-based discrimination. Gender differences were observed across experimental conditions thus indicating that â€œsome message frames may increase support for certain laws among women, but not men. Message frames however, had no effect on support for laws with specific provisions to prohibit weight discrimination in the workplaceâ€ (Puhl et al., 2011). This suggested that the public held support for those particular legal measures was both consistent and high at approximately 65% of men and 81% of women, regardless of how the issue of weight discrimination was framed to the public (Puhl et al., 2011). Just as most of the articles do, the authors of this article point out that weight discrimination stems from pervasive societal stigma and stereotypes that obese persons are lazy, lacking in self-discipline and are personally at fault for their inability to lose weight, and that unfortunately, weight bias takes a significant toll on emotional and physical health for those who are affected, increasing vulnerability to depression, low self-esteem, poor body image, suicidal behaviors, unhealthy eating patterns, eating disorders and avoidance of physical activity and social exclusion. One interesting comment of note is their mention that recent estimates suggest that the prevalence of weight discrimination in the United States has increased by 66% over the past decade, and is now comparable with prevalence rates of racial discrimination in America (Puhl et al., 2011). Their results have led them to conclude that women express a stronger degree of agreement than men do with idea that there should be new laws about weight discrimination and that the government should take a more active and aggressive role to protect overweight people from size/weight discrimination. Discussion Currently, in the United States there are little or no legal protections to prohibit discrimination against an individual based solely on body shape, size, or weight, and employers basically have the right to hire anyone they want without regard to preference to thinner and more attractive applicants. Some employers have even been found to penalize heavy employees in unfair ways. Weight-based discrimination is pervasive around the world and it is damaging and worsens health disparities for obese people, in essence creating a self-fulfilling prophecy (Puhl et al., 2011). There was considerable agreement within the literature, with many studies concluding that weigh based discrimination does exist, it is pervasive, and it is experienced more by women than men (Puhl et al., 2011), (Pagan DÃ¡vila, 1997), and (Katz Lavan, 2008) for example. Many practitioners in the psychological and sociological communitiesâ€™ believe that it is critical for the public health community to recognize that this type of institutionalized bias is, in fact, both a social injustice, and a public health issue. In addition many of those individuals also feel that it is past due to look long and hard legislatively, at equal protections and definitions of obesity as a syndrome. History has demonstrated that legislation has the power to reduce institutionalized bias against stigmatized groups, thus researchers, advocacy groups and the public health community can help promote protective legislation for overweight and obese persons (Puhl et al., 2011). Public support is going to be key in enacting any weight bias legislation, and the research findings provide a springboard to explore public attitudes toward laws that prohibit discrimination based on weight. Because of womenâ€™s potentially increased vulnerability to weight stigmatization as compared to men in nearly all of these studies, over time they are more likely experience unfair treatment because of their weight, and are therefore they are far more supportive of legislation to combat Obesity discrimination. Some researchers such as Puhl et al., 2011, Pagan DÃ¡vila, 1997, and Katz and Lavan, 2008have suggested that women are more vulnerable to weight discrimination than men and may experience weight discrimination at lower levels of body weight than men do. Additionally there are roles and jobs that are typically filled by men that tend to favor some amount of over-weightiness such as movers being able to handle large or bulky items. Conclusion In order to make inroads against this type of discrimination is education of the population, overt intolerance of the discrimination, strong advocacy in support of litigation and legislation, and a public awareness campaign, and some strong rulings to create precedence. Of course almost universally as always, more research is needed. While it is generally accepted that there is weight based discrimination, it is important that there be a solid body of work to bring it to light, and in conjunction with medical research into the causes of obesity it may be possible to determine what the leading factors in obesity, continued obesity, and combating obesity are. In addition research needs to be done into the effects of socialization on obesity. One of the experienced side effects of obesity being anti-social behavior one cannot help but to wonder what if anything would be the overall effect of purposely involving the morbidly obese in social activity that bolstered self-confidence without judgment, possibly without even focusing on weight. References Friedman, R., Puhl, R. (2012). Weight Bias A Social Justice Issue A Policy Brief. 2012 Rudd Report, 2012 Rudd Report (2012), 2, 3. Katz, M., Lavan, H. (2008). Legality of Employer Control of Obesity. Journal of Workplace Rights, 13(1), 59-71. doi:10.2190/WR.13.1.e McGuire, S., Shields M., Carroll M.D., Ogden C.L., (2011). Adult Obesity Prevalence in Canada and the United States. NCHS Data Brief no. 56, Hyattsville, MD: National Center for Health Statistics, 2011. Advances in Nutrition: An International Review Journal, 2(4), 368-369. PagÃ¡n, J., DÃ¡vila, A. (1997). Obesity, Occupational Attainment, and Earnings. Social Science Quarterly, 78(3), 756 770. Puhl, R., Heuer, C., Sarda, V. (2010). Framing Messages About Weight Discrimination: Impact On Public Support For Legislation. International Journal of Obesity, 35(10), 863 872. Sutin, A. R., Terracciano, A., Newton, R. L. (2013). Perceived Weight Discrimination and Obesity. PLoS ONE, 8(7), e70048.
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