ED pills for male sexual dysfunction

The Ohio Supreme Court on Wednesday ruled that a clinic operated by Planned ParenthoodSouthwest Ohio Region does not have to release 10 years of child abuse reports and medical records of minors who received abortions, the AP/Middletown Journal reports. The lawsuit was filed by parents of a 14yearold girl who allegedly had an abortion at the clinic in 2004 after being impregnated by a 21yearold man (Cornwell, AP/Middletown Journal, 7/1). The clinic provided the girls medical records in the case but refused the parents request to release records on other patients, citing physicianpatient privilege. Ohio law at the time required parental notification for minors, and the girl provided the phone number of the man, who pretended to be her father. The state now requires parental consent.

The court, in a split decision, ruled that the need to protect confidentiality of medical records “trumps” the parents claims that Planned Parenthood “systematically ignored claims of sexual abuse by its patients,” according to the Columbus Dispatch (Nash, Columbus Dispatch, 7/2). The decision upholds a 2007 state appeals court ruling that said other patients records are not necessary for the parents lawsuit. The Supreme Court said that the parents may still sue for damages over their allegations related to whether the abortion was unlawful, whether the girls consent to the procedure was proper and whether the clinic had a duty to report suspected abuse.

Becki Brenner, CEO of PPSOR, said the courts decision reaffirms the importance of maintaining the confidentiality of medical records. She said, “Our perspective is that thirdparty records of people who are not involved in the lawsuit should not be shared with the plaintiff and their attorney.” Brian Hurley, a lawyer for the parents, said that the courts decision not to turn over the medical records “has significantly weakened the protection Ohio has provided to sexually abused children and undermined parents rights to protect their minor children” (AP/Middletown Journal, 7/1).

Court Rules In Favor of State Restrictions on Mifepristone

The state Supreme Court also ruled on Wednesday that Ohio can restrict the use of mifepristone, which is used in medication abortion, the Dispatch reports. A 2004 Ohio law required providers to comply with FDA guidelines regarding the drugs use, which allow use of the drug up to the seventh week of pregnancy. However, doctors sometimes prescribe the drug up to nine weeks gestation. The Ohio law has not been enforced pending a lawsuit by Planned Parenthood. The state Supreme Court in its decision interpreted the 2004 law as barring physicians from prescribing the drug beyond seven weeks gestation and limiting its dosage. The case can be appealed to the Sixth U.S. Circuit Court of Appeals to determine if the law is constitutional (Columbus Dispatch, 7/2).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

A new neuropsychological memory test is helping to uncover how Parkinsons disease can alter peoples ability to learn about the consequences of the choices they make. The test was developed by Dr. Mark Gluck, professor of neuroscience at the Center for Molecular and Behavioral Neuroscience at Rutgers University, Newark, working with coresearchers at Rutgers, New York University, and in Hungary.

As reported in a forthcoming article in the journal Brain (advanced access published May 4, 2009 doi10.1093/brain/awp094), Gluck and coresearchers Nikoletta Bodi and Szabolcs Keri of Semmelweis University, Hungary, found that nonmedicated patients in the early stages of Parkinsons were selectively impaired at learning from reward.

Patients in Hungary were tested using a novel feedbacklearning task developed by Gluck and his colleagues Catherine E. Myers, research professor, Rutgers University, Newark; and Nathaniel Daw, assistant professor, New York University. The research was supported by a Dekker Foundation Award from the BachmanStrauss Dystonia and Parkinson Foundation.

“What we are seeing in recently diagnosed patients is that prior to being put on any medications, they exhibit a selective impairment in their ability to learn from positive (rewarding) outcomes while their sensitivity to learning from negative (or punishing) outcomes is normal,” says Gluck, director of Rutgers Center for Collaborative Research on Cognition and Parkinsons Disease.

This selective deficit in learning from reward is not surprising, says Gluck, because scientists have long known that dopamine is used to carry reward information throughout the brain. Parkinsons patients, however, have lost most of their dopamineproducing cells by the time they are first diagnosed with the disease. This decrease in their ability to process rewarding outcomes could be one reason why many Parkinsons patients experience depression, says Gluck. “Its not just that they have an awful disease, but they have lost the ability to process the rewarding aspects of life.”

Gluck and colleagues found that this rewardlearning deficit in unmedicated Parkinsons patients is in direct contrast to what is seen in patients once they begin treatment with dopamine agonists, a standard therapy for treating the diseases motor symptoms. On dopamine agonists, a patients ability to learn from positive rewarding outcomes improved to normal levels. But there was a catch their ability to learn from negative (or punishing) outcomes, which had previously been normal, was now impaired.

Gluck explains that an increased sensitivity to learning from events that results in positive outcomes, coupled with a decrease in the ability to learn from negative outcomes, could explain why some Parkinson patients treated with dopamine agonists develop impulsecontrol disorders, including pathological gambling, hypersexuality, alcoholism, and compulsive eating and shopping. All of these behaviors can be understood as rewardseeking behaviors in the absence of appropriate sensitivity to their negative consequences.

“For example,” notes Gluck, “if your ability to learn from negative outcomes is reduced and you play the slot machines and win $10 for a few rounds but lose many more times in between, what you may recall best is the thrill of winning. As such, you will be hampered in your ability to learn that gambling can also have negative consequences.”

The ability to test the effects on feedback learning in early onset Parkinsons disease could provide additional insight into the impact of dopamine loss on cognition and behavior. It also could pave the way for identifying which Parkinsons patients are most likely to experience agonistrelated feedback problems so they can be treated with alternate medications.

Other ongoing research by Gluck and his clinical collaborators in New Jersey, New York, Europe and the Middle East aims to further understand how and why learning and decision making is impaired by Parkinsons disease and how the medications used to treat motor symptoms can impair or remediate these essential cognitive abilities.

Feedback Learning, Dementia, Depression and Drug Addiction

In addition to providing new insight into the effects of Parkinsons disease and dopamine agonists on learning and personality, the new feedbacklearning tasks developed at Rutgers University are being used to study learning and decisionmaking deficits in people suffering from frontotemporal dementia (FTD), a degenerative condition involving the front part of the brains cortex. FTD is associated with dramatic changes in personality, behavior and thought processes, which can include inhibition, social withdrawal and compulsive behaviors.

With coinvestigator Murray Grossman of the University of Pennsylvania, Gluck is studying changes in positive and negative feedback learning in those diagnosed with FTD. That research, funded with a grant from the Association for Frontotemporal Dementia, has the potential to help in identifying methods to aid in correcting behavior for FTD patients.

“If, for example, FTD patients learn better from reward then punishment, this would mean caregivers might be advised to avoid reacting negatively to inappropriate behaviors and to focus instead on rewarding patients for not engaging in inappropriate behaviors,” says Gluck.

In related research, Gluck is working with Palestinian and Israel doctors, as part of a joint Rutgerssponsored IsraeliPalestinian brain research project, to study cognitive deficits in Israeli and Palestinian patients suffering from Parkinsons disease and depression.

Source
Helen Paxton

A new study of obese adolescents has shown that laparoscopic gastric banding surgery the “LapBand” procedure not only helps them achieve significant weight loss but can also improve and even reverse metabolic syndrome, reducing their risk for cardiovascular disease and diabetes.

Metabolic syndrome is defined as a cluster of risk factors high blood pressure; low levels of HDL or “good” cholesterol; excessive abdominal fat; and elevated levels of blood sugar, Creactive protein and triglycerides that increase a persons chances of developing cardiovascular disease or diabetes later in life. The single biggest risk factor is obesity, and metabolic syndrome usually improves when a person loses weight.

The study was led by Drs. Ilene Fennoy, Jeffrey Zitsman and colleagues at NewYorkPresbyterian Morgan Stanley Childrens Hospital and Columbia University Medical Center and presented at the annual Endocrine Society meeting in Washington, D.C.

“An estimated 17 percent of all American adolescents are obese, and increasing numbers of them also have metabolic syndrome,” says Dr. Fennoy, a pediatric endocrinologist at NewYorkPresbyterian Morgan Stanley Childrens Hospital, clinical professor of pediatrics at the Columbia University College of Physicians and Surgeons and coauthor of the study. “Until recently, there have been few treatments capable of helping these young patients lose weight, much less improving their lifelong health prospects. The LapBand may well be a useful intervention for tackling teen obesity which is why it is so important to investigate the procedures safety and efficacy in this growing population.”

In the new study, Dr. Fennoy and her colleagues followed 24 morbidly obese adolescents between the ages of 14 and 17 who underwent the LapBand procedure. The study participants either had a BMI of greater than 40 or greater than 35 if already suffering from diabetes or obesityrelated illnesses.

Six months after surgery, they noted a significant drop in participants BMI, waist circumference, and blood levels of Creactive protein. These indicators continued to improve among the 12 patients being followed up at the oneyear point.

Other measures of metabolic syndrome such as blood lipid and sugar levels, the authors reported, came down quickly in the first six months, with “less dramatic” changes seen one year after surgery.

“Of all the bariatric procedures,” she says, “the LapBand is the most benign, with complication rates of less than 1 percent.” The device, inserted via minimally invasive laparoscopic surgery, consists of a simple band to make the stomach smaller and a balloon that can be decompressed when necessary, she explains.

Although it is technically reversible, the procedure should be considered a longterm solution for extreme and intractable obesity.

The LapBand is the favored bariatric procedure in Europe, while in the U.S., gastric bypass has been the preferred approach. At present, NewYorkPresbyterian Morgan Stanley Childrens Hospital/Columbia University Medical Center is one of a few medical centers offering the LapBand option in this country.

The LapBand procedure, an approved treatment for adults with extreme obesity, has not yet been thoroughly studied in adolescents. Larger, multicenter studies with longer followup periods will be needed, Dr. Fennoy says, to validate the findings of the current study.

NewYorkPresbyterian Morgan Stanley Childrens Hospital

NewYorkPresbyterian Morgan Stanley Childrens Hospital, located in New York City, offers the best available care in every area of pediatrics including the most complex neonatal and critical care, and all areas of pediatric subspecialties in a familyfriendly and technologically advanced setting. Building a reputation for more than a century as one of the nations premier childrens hospitals, NewYorkPresbyterian Morgan Stanley Childrens Hospital is affiliated with Columbia University College of Physicians and Surgeons, and is Manhattans only hospital dedicated solely to the care of children and one of the largest providers of childrens health services in the tristate area with a longstanding commitment to its community. It is also a major international referral center, meeting the special needs of children from infancy through adolescence worldwide. NewYorkPresbyterian Hospital also comprises NewYorkPresbyterian Hospital/Columbia University Medical Center, NewYorkPresbyterian Hospital/Weill Cornell Medical Center, NewYorkPresbyterian Hospital/Westchester Division and NewYorkPresbyterian Hospital/The Allen Pavilion. NewYorkPresbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report.

Columbia University Medical Center

Columbia University Medical Center provides international leadership in basic, preclinical and clinical research, in medical and health sciences education, and in patient care. The Medical Center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians & Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbias College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the largest medical research enterprise in New York City and state and one of the largest in the United States.

The UKs leading dementia charities united with eminent scientists to urge the government to commit to a national dementia research strategy and triple annual investment to £96 million in five years.

The Alzheimers Research Trust and Alzheimers Society revealed that the UK government lags behind France, Germany and the US in dementia research funding and has no plans for the future. They called on the government to exploit the UKs huge scientific talent and lead the world in the race for a cure.

In a joint statement launched ahead of the governments forthcoming Dementia Research Summit due to take place this summer, the charities set out priorities and opportunities for dementia research. Significant opportunities in dementia research include improving diagnosis, genetic research, improving care, and utilising the NHS in clinical trials.

Neil Hunt, Chief Executive of Alzheimers Society, says,

Dementia is the health challenge of our generation, it is absolutely vital that dementia research funding is tripled. One million people will develop dementia in the next ten years, yet the government invests just 2% of its medical research budget on dementia.

The Dementia Research Summit must be more than just a talking shop. It is a crucial opportunity for the government, charities and stakeholders to commit to a shared vision for dementia research. We need an ambitious plan that drives change and defeats this devastating condition.

Rebecca Wood, Chief Executive of the Alzheimers Research Trust, says,

700,000 people in the UK live with dementia, costing our economy £17 billion annually. Given the stakes, the government cannot afford to get its dementia research policy wrong.

Spending £96 million per year would put the UK proportionately on a par with other worldleaders like the United States, and bring funding per person with dementia up to a similar level to government investment in cancer research.

Notes

The Alzheimers Research Trust and Alzheimers Societys joint statement calls for

A comprehensive plan that addresses cause, cure, care and public health research.
Joint engagement by the government, the research community, charities, people with dementia, carers and pharmaceutical companies to make this happen.
Actions to make NHS patients routinely aware that they may participate in research studies.
Steps to support and grow the dementia research community to meet the growing research demands over the next five years.

About the Alzheimers Research Trust

The Alzheimers Research Trust is the UKs leading dementia research charity and provides free information on Alzheimers disease and related dementias phone 01223 843899 or visit alzheimersresearch.org.uk. The charity relies solely on public donations to fund its research.

Source

Patients who have regained weight after gastric bypass surgery now have access to an incisionless procedure that appears highly effective at reversing weight gain, according to data presented at the annual meeting of the American Society of Metabolic and Bariatric Surgeons. Santiago Horgan, MD, professor of surgery and director of the Center for the Treatment of Obesity at UC San Diego, presented sixmonth outcomes from a national registry of 116 patients who underwent the procedure, known as ROSE (Restorative Obesity Surgery, Endolumenal).

“We believe this registry represents the largest collection of data showing the effectiveness, safety and durability of the ROSE procedure,” said Horgan. “There are not many options to repair a failing gastric bypass. Invasive procedures to restore the anatomy are complicated and risky for most patients. In comparison, there were no significant complications associated with ROSE and most of the patients lost clinically relevant amounts of weight.”

To perform ROSE, a small, flexible endoscope and tools are inserted through the mouth, down the esophagus, and into the stomach pouch during an outpatient procedure. The tools, developed by USGI Medical Inc., are used to grasp, fold and stitch tissue to reduce both the diameter of the stomach opening and the volume of the stomach pouch. No cuts are made into the patients skin.

The registry data showed that 88 percent of the patients stopped regaining weight after ROSE. Overall, these 96 patients lost an average 18 percent of their excess weight six months after the procedure. For the purposes of the registry, excess body weight is defined as anything over a body mass index rating of 55.

One patient in the study lost 66 pounds or 84 percent of her excess weight during that sixmonth time period. Patients who were most successful losing weight after their original gastric bypass had the best results following the ROSE procedure. This subset of patients dropped 29 percent of their excess weight during the six months after ROSE.

Up to 50 percent of patients who undergo gastric bypass surgery begin to regain weight after two years. This often occurs because the stomach pouch and stoma, the opening to the small intestine, slowly stretch out, allowing the patient to eat more without feeling full.

When a patient is diagnosed with metastatic disease the primary site of the cancer is usually, but not always, evident. When the origin of the cancer is not identified it is described as a Cancer of Unknown Primary site, or CUP.

Each year in the UK over 10,000 people are diagnosed with CUP. This is a higher incidence than known cancers such as pancreatic, ovarian, uterine, kidney, brain, cervical or blood (leukaemia) cancers.

This October, the first international conference devoted to CUP will be held in London. It aims to bring together people of different disciplines and experiences to share knowledge and understanding and to look for ways forward. There will be a number of short presentations, expert panel discussions and the chance to interact and network with colleagues in the field.

The conference, titled Overcoming the unknown New approaches to the diagnosis and treatment of carcinomas of unknown primary, will be held on October 15th at the Royal College of Obstetricians and Gynaecologists, in Regents Park, London.

The conference is for oncologists, radiologists, pathologists, palliative care physicians, surgeons, nurses, researchers and all medical practitioners with an interest in CUP. There will also be representation from cancer charities and those whose lives are, or have been, touched by CUP.

The registration fee is £98 inclusive of lunch, refreshments, conference materials, VAT. There is a discount of £30 for anyone registering on or before 30 June.To register, please see the website cupfoundjo.org/conference/index.and download a registration form.

Bursaries

The widely used antidepressant and pain medication amitriptylinebut not other closely related drugs can impersonate the brains own growth factors, researchers at Emory University School of Medicine have shown.

The results are published online and will appear in the June 26 issue of the journal Chemistry & Biology.

Amitriptyline, a tricyclic antidepressant first introduced in the 1960s, and other tricyclics are thought to exert their effects by increasing the levels of the messenger chemicals serotonin and norepinephrine in the brain.

But the delay required for antidepressants to work has led scientists to the idea that a secondary effect, pushing neurons to survive and grow, must occur indirectly.

The finding that amitriptyline can directly stimulate molecules that help neurons grow and resist toxins suggests a separate mechanism by which some antidepressant and pain relief compounds may function.

Keqiang Ye, PhD, associate professor of pathology and laboratory medicine at Emory University School of Medicine, and his colleagues were looking for chemicals that could imitate a protein in the brain known as NGF (nerve growth factor).

NGF has been used experimentally to treat Alzheimers disease and the degeneration of nerves in the extremities caused by diabetes. However, NGF cannot cross the bloodbrain barrier and has puzzled investigators with its side effects, such as increased sensitivity to pain.

Working in Yes laboratory, postdoctoral fellow SungWuk Jang sorted through a library of chemicals to find those that could stimulate one of NGFs “receiver dish” molecules on nerve cells, called TrkA. The way NGF works is to pull together two TrkA molecules on the cell surface.

“We were surprised to find that amitriptyline has these same properties,” Ye says. “This is an antidepressant that has been used for decades.”

Doctors also prescribe amitriptyline for chronic pain such as migraine headaches or the nerve damage caused by diabetes, he notes.

In laboratory tests, amitriptyline could protect neurons from oxygen and glucose deprivation or the toxin kainic acid. Only amitriptyline, and not other antidepressants, could duplicate NGFs ability to stimulate neurons to send out “neurites,” small projections thought to be the beginnings of connections to other neurons.

Amitriptyline directly binds TrkA and a related molecule called TrkB, the authors found. Amitriptyline could also bring together a mismatched pair of TrkA and TrkB a phenomenon not seen before, Ye says.

Also surprising was the finding that other tricyclic antidepressants, even those with a similar molecular structure such as imipramine, could not match amitriptylines ability to stimulate cells through TrkA.

In a model of antidepressant function called a “forced swim test,” amitriptylines effects do not depend on TrkA, because it still works on mice with modified TrkA genes, the authors found.

Recent studies have indicated that the presence of TrkB is necessary for antidepressants to function in mouse models. The relationship between amitriptylines ability to directly stimulate TrkA and TrkB and its antidepressant and painrelief properties needs to be explored further, Ye says.

The research was supported by the National Institutes of Health.

Reference SW Jang, X. Liu, CB Chan, D. Weinshenker, R.A. Hall, G. Xiao and K. Ye.Amitriptyline is a TrkA and TrkB receptor agonist that promotes TrkA/TrkB heterdodimerization and has potent neurotrophic activity.
Chemistry and Biology, 16, xy (2009).

Source
Holly Korschun

At the opening of a threeday U.N. financial summit on Wednesday, developing countries joined U.N. officials in “calling for more money and a greater role in regulating the world economy in the wake of the worst global financial crisis since the Great Depression, which has taken a disproportionate toll on poor nations,” AP/Google.com reports (Astor, AP/Google.com, 6/25).

“Developing countries, which make up the vast majority of the 192member assembly, argue that they are paying the price for a crisis that was created by the developed world,” according to AFP/Google.com (Aziaku, AFP/Google.com, 6/24).

U.N. General Assembly President Miguel DEscoto Brockmann, the events organizer, said the goal of the conference is to identify emergency and longterm responses to ease the impact of the financial crisis, especially on vulnerable populations. “Brockmann also said the conference aims to start a dialogue on the transformation of the international financial architecture, taking into account the needs and concerns of all member states,” Deutsche Welle reports (Deutsche Welle, 6/24).

U.S. Ambassador to the U.N. Susan Rice told the summit that the U.S. believes “we should use every instrument at our disposal to tackle different dimensions of the crisis.” According to AP/Google.com, “Rice also said the U.S. was committed to substantially increasing our own official development assistance despite the challenging times.”

An agreement among developing and developed countries prior to the conference “calls for the International Monetary Fund, the World Bank and other lending institutions to be flexible in imposing conditions on developing countries so they can take action to deal with the economic crisis, including adopting stimulus packages. The draft also calls for measures to avoid a new debt crisis and new approaches to restructuring debt,” AP/Google.com writes.

World Bank Managing Director Ngozi OkonjoIweala said an additional 200,000 infants could die from malnutrition and other diseases each year between now and 2015, if the crisis continues (AP/Google.com, 6/25).

In an address to the conference, Chinese Foreign Minister Yang Jiechi said the international community should look at the development issue from a broader perspective and seek to resolve the development issue as a key part of the effort to tackle the financial crisis. “To this end, we should deepen global development partnership, strengthen development institutions, increase input in development and ensure unimpeded progress towards the attainment of the Millennium Development Goals,” he said (Xinhua, 6/26).

There is minimal data evaluating the prevalence of GERD complications in any United States general population, other than nonHispanic whites. Presently, it is thought that such complications occur less frequently in AfricanAmericans than in nonHispanic whites. A research group in Jacksonville, FL investigated the prevalence of reflux esophagitis between nonHispanic whites and AfricanAmericans. The distribution of esophagitis severity and its complications were equivalent between groups, except for Barretts esophagus.

A research article published on June 21, 2009 in the World Journal of Gastroenterology addresses this question. The research team, lead by Dr. Vega at the University of Florida Health Science Center/Jacksonville, performed a retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from 1 January to 31 March 2001. The database search identified 259 patients with reflux esophagitis or its complications. One hundred seventy one were nonHispanic whites and 88 were African Americans. Mean ages and male/female ratios were similar in the two groups. RE grade, esophageal ulcer, stricture, and hiatal hernia frequency were likewise similar in the groups. Endoscopic and histological Barretts esophagus was present more often in nonHispanic whites than in African Americans. Heartburn was a more frequent indication for endoscopy in nonHispanic whites with erosive esophagitis than in African Americans.

This is the first study to report that reflux esophagitis and its complications, other than Barretts esophagus, occur at a similar frequency in nHw and AA. In addition, indication for the index endoscopy appears to be different in the above ethnic groups. By understanding GERD and its complications among ethnic groups in the United States, this study might indicate future avenues for investigation to prevent the development of Barretts esophagus and esophageal adenocarcinoma.

Notes

Reference Vega KJ, Chisholm S, Jamal MM. Comparison of reflux esophagitis and its complications between African Americans and nonHispanic whites. World J Gastroenterol 2009; 15(23) 28782881wjgnet.com/10079327/15/2878.asp

Correspondence to Kenneth J Vega, MD, Associate Professor, Divisions of Gastroenterology and General Internal Medicine, University of Florida Health Sciences Center, Jacksonville, Florida 32207, United States.

Source
Lin Tian

Dr. Janet D. Latner, an Associate Professor of Psychology at the University of Hawaii at Manoa, has coauthored an article in the July 2009 edition of the Journal of Sex & Marital Therapy on “Weight Stigma in Existing Relationships.”

The research conducted jointly by Professor Latner and New Zealand clinical psychologist Dr. Alice D. Boyes addresses body image, weight, romantic relationships, and differences between men and women.

Associations between body mass index (BMI) and relationship quality and other partner/relationship perceptions were investigated in 57 couples in New Zealand. Heavier women had lower quality relationships, which they predicted were more likely to end. They partnered with less desirable men and thought their partners would rate them as less warm/trustworthy.

The male partners of heavier women judged the womens bodies less positively and men rated heavier women as poorer matches to their ideal partners for attractiveness/vitality. In contrast, mens BMIs were generally not associated with relationship functioning. These findings point to the potential mechanisms that may contribute to heavier womens relationship difficulties.

“Prejudice and discrimination are commonly directed at overweight individuals. However, few previous studies have examined whether weight stigma occurs within established romantic relationships. Our results suggest it does,” said Dr. Latner.

Source
Janet D. Latner