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1.
Eur Eat Disord Rev ; 31(2): 258-270, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36349493

RESUMO

OBJECTIVE: Improved understanding of adolescent eating disorders (EDs), including identification and refinement of treatment and recovery targets, may help improve clinical outcomes. Interpersonal function is a proposed risk and maintenance factor that may be particularly relevant given the significance of adolescence for both psychosocial development and ED onset. This study examined self-referential thinking in adolescents with EDs compared to healthy adolescents. METHOD: Twenty-nine adolescents with EDs and 31 healthy controls completed a self-report measure of interpersonal attributions as well as a verbal appraisal task that required conducting direct and indirect evaluations about oneself and direct evaluations about others. RESULTS: The ED group had a more negative self-attribution bias than the control group (p = 0.006) even when controlling for depression severity. Additionally, the ED group exhibited less positive direct self (p < 0.001), direct social (p = 0.015), and social reflected self-appraisals (p = 0.011) than the healthy cohort. After including depression as a covariate in the verbal appraisal model, the model was no longer significant, suggesting group differences related to social appraisals may be mediated by depression. CONCLUSIONS: Adolescents with EDs have more negative interpersonal beliefs than comparison adolescents. Future studies are needed to determine how the constructs identified here relate to clinical course.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Adolescente , Humanos , Autoavaliação Diagnóstica , Autorrelato , Percepção Social
2.
Matern Child Health J ; 24(Suppl 2): 163-170, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32860586

RESUMO

PURPOSE: The New Mexico Graduation Reality and Dual-role Skills (GRADS) program provides services for expectant and parenting students at high schools. The GRADS program has operated since 1989, serving more than 17,000 youth. This study summarizes the GRADS program model and program administrators' lessons learned from implementing this comprehensive, large-scale program. DESCRIPTION: The GRADS program is a multicomponent intervention that can include a classroom intervention, case management, linkages to child care and health care, and support for young fathers. The program aims to support expectant and parenting youth in finishing high school, delaying a repeat pregnancy, promoting health outcomes for their children, and preparing for college and career. This study presents program administrators' lessons learned to increase understanding of how to implement a statewide program to support expectant and parenting students. ASSESSMENT: During the 2010-2017 school years, the GRADS program operated in 26-31 sites each year, serving a total of 2691 parenting youth. Program administrators identified lessons learned from implementing the GRADS program during that period of expansion, including allowing variation across sites based on resources and needs, providing centralized implementation support, fostering buy-in from school and district leaders, and collecting consistent data to better understand participant outcomes. CONCLUSIONS: Although not based on a rigorous impact or implementation study, this article provides lessons learned from a statewide, school-based program that may be a promising way to serve a large number of expectant and parenting youth and help them overcome challenges for completing high school.


Assuntos
Cuidado do Lactente , Poder Familiar , Pais/educação , Estudantes , Adolescente , Feminino , Humanos , Recém-Nascido , New Mexico , Gravidez , Gravidez na Adolescência , Instituições Acadêmicas , Adulto Jovem
3.
J Paediatr Child Health ; 55(9): 1029-1037, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31257692

RESUMO

Prader-Willi syndrome (PWS) is a rare genetic condition with multi-system involvement. The literature was reviewed to describe neurodevelopment and the behavioural phenotype, endocrine and metabolic disorders and respiratory and sleep functioning. Implications for child and family quality of life were explored. Challenging behaviours contribute to poorer well-being and quality of life for both the child and caregiver. Recent evidence indicates healthy outcomes of weight and height can be achieved with growth hormone therapy and dietary restriction and should be the current target for all individuals with PWS. Gaps in the literature included therapies to manage challenging behaviours, as well as understanding the effects of growth hormone on respiratory and sleep function. New knowledge regarding the transition of children and families from schooling and paediatric health services to employment, accommodation and adult health services is also needed. Developing a national population-based registry could address these knowledge gaps and inform advocacy for support services that improve the well-being of individuals with PWS and their families.


Assuntos
Família/psicologia , Satisfação Pessoal , Síndrome de Prader-Willi/fisiopatologia , Qualidade de Vida , Adolescente , Criança , Pré-Escolar , Humanos , Hiperfagia
4.
Eur Eat Disord Rev ; 26(3): 265-271, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29464819

RESUMO

OBJECTIVE: To determine if an interpersonal attribution bias associated with self-perception, the externalizing bias, was related to neural activations during mentalization. METHODS: A functional magnetic resonance imaging task involving verbal appraisals measured neural activations when thinking about oneself and others in 59 adults, including healthy women as well as women with and recovered from anorexia nervosa. Whole-brain regressions correlated brain function during mentalization with the externalizing bias measured using the Internal, Personal, and Situational Attributions Questionnaire. RESULTS: Women with anorexia nervosa had a lower externalizing bias, demonstrating a tendency to self-attribute more negative than positive social interactions, unlike the other groups. The externalizing bias was correlated with activation of the left inferior frontal gyrus and posterior insula, when comparing thinking about others evaluating oneself with direct self-evaluation. DISCUSSION: Externalizing biases may provide an office-based assay reflecting neurocognitive disturbances in social self-perception that are common during anorexia nervosa.


Assuntos
Mapeamento Encefálico , Córtex Cerebral , Mentalização , Autoimagem , Percepção Social , Adulto , Anorexia Nervosa/psicologia , Encéfalo/fisiopatologia , Córtex Cerebral/fisiopatologia , Autoavaliação Diagnóstica , Humanos , Relações Interpessoais , Imageamento por Ressonância Magnética , Córtex Pré-Frontal/fisiopatologia
5.
Eur Eat Disord Rev ; 25(6): 491-500, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28799287

RESUMO

OBJECTIVE: To identify clinical or cognitive measures either predictive of illness trajectory or altered with sustained weight recovery in adult women with anorexia nervosa. METHODS: Participants were recruited from prior studies of women with anorexia nervosa (AN-C) and in weight-recovery following anorexia nervosa (AN-WR). Participants completed a neuropsychological battery at baseline and clinical assessments at both baseline and follow-up. Groups based on clinical outcome (continued eating disorder, AN-CC; newly in recovery, AN-CR; sustained weight-recovery, AN-WR) were compared by using one-way ANOVAs with Bonferroni-corrected post hoc comparisons. RESULTS: Women with continued eating disorder had poorer neuropsychological function and self-competence at baseline than AN-CR. AN-CR showed changes in depression and externalizing bias, a measure of self-related attributions. AN-WR differed from both AN-CC and AN-CR at baseline in externalizing bias, but only from AN-CC at outcome. DISCUSSION: Neuropsychological function when recently ill may be a prognostic factor, while externalizing bias may provide a clinical target for recovery. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.


Assuntos
Anorexia Nervosa/psicologia , Anorexia Nervosa/reabilitação , Cognição , Adulto , Viés , Peso Corporal , Depressão , Feminino , Humanos , Pessoa de Meia-Idade , Testes Neuropsicológicos , Autoimagem , Resultado do Tratamento , Adulto Jovem
6.
BMC Geriatr ; 16: 15, 2016 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-26767619

RESUMO

BACKGROUND: The co-administration of multiple drugs (polypharmacy) is the single most common cause of adverse drug events in the older population, and residents of long-term care facilities (LTCFs) are at particularly high risk of medication harm. 'Deprescribing'--the withdrawal of an inappropriate medication with goal of managing polypharmacy and improving outcomes--may improve the quality of life of LTCF residents. The RELEASE study sought to explore perceptions of medication use and the concept of deprescribing in LTCFs. METHODS: Focus groups and interviews were conducted with General Practitioners (GPs), pharmacists, nursing staff, residents and their relatives within three LTCFs in the Illawarra-Shoalhaven region of NSW, Australia. Audiotapes were transcribed verbatim and, using the Integrative Model of Behaviour Prediction as a framework, thematic analysis of transcripts was conducted using QSR NVivo 10. RESULTS: Participants acknowledged the burden of too many medications (time to administer, physical discomfort, cost), yet displayed passivity towards medication reduction. Residents and relatives lacked understanding of medicine indications or potential harms. Willingness to initiate and accept medication change was dependent on the GP, who emerged as a central trusted figure. GPs preferred 'the path of least resistance', signalling systems barriers (poor uniformity of LTCF medical records, limited trained LTCF personnel); time constraints (resident consultations, follow-up with specialists and family); and the organisation of care (collaborating with LTCF staff, pharmacists and prescribing specialists) as obstacles to deprescribing. CONCLUSIONS: Targeted engagement is required to raise awareness of the risks of polypharmacy in LTCFs and encourage acceptance of deprescribing amongst residents and their relatives. GPs are integral to the success of deprescribing initiatives within this sector.


Assuntos
Desprescrições , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Prescrição Inadequada , Assistência de Longa Duração , Polimedicação , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Austrália , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Feminino , Grupos Focais , Humanos , Prescrição Inadequada/efeitos adversos , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/psicologia , Assistência de Longa Duração/métodos , Assistência de Longa Duração/psicologia , Masculino , Pesquisa Qualitativa , Percepção Social
7.
Eat Weight Disord ; 19(3): 355-61, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24374724

RESUMO

PURPOSE: This study was designed to test the effects of different types of influence on the expression of stereotypes towards people who are obese. It was hypothesized that public social pressure would more significantly impact the expression of stereotypes towards obese people than other types of influence. METHODS: One-hundred fifty-eight undergraduate students were randomly assigned to one of three conditions or a control condition. Participants completed measures of stereotypes towards obese people prior to and after receiving manipulated feedback depicting purported stereotypes possessed by others (anonymously or publically) or scientific information about the base rates of these stereotypical traits in the obese population (i.e., trait prevalence). Participants also completed a measure of weight bias unrelated to the manipulated feedback. RESULTS: Explicit beliefs were influenced more when people perceived that others' views were inconsistent with their own in a public setting than an anonymous setting or when they received trait prevalence feedback. However, levels of weight bias on a separate measure were unchanged. CONCLUSION: Strong, public manipulations of social feedback have great potential to impact, at least, the short-term expression of stereotypes towards obese people.


Assuntos
Relações Interpessoais , Obesidade/psicologia , Estigma Social , Estereotipagem , Adolescente , Feminino , Humanos , Masculino , Adulto Jovem
8.
Phys Occup Ther Pediatr ; 34(3): 229-44, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24547689

RESUMO

Adolescents with mild traumatic brain injuries (MTBI) are at substantial risk for repeat injury if they return to activity too soon. Post-concussion symptoms and impaired balance are two factors that limit return to activity. Post-injury assessments that challenge activity tolerance and balance skills are needed to ensure readiness to return to activity. This cross-sectional study evaluated the Nintendo Wii as a measure of exertion (heart rate [HR], respiration rate [RR], and caloric expenditure) and balance testing for youth with MTBI in a clinical setting. Twenty-four youth with MTBI, ages 9-18, played six Wii games. The Bruininks-Oseretsky Test of Motor Proficiency 2nd edition (BOT-2) and the Community Balance and Mobility Scale (CBM) were used as balance indicators. The Wii Fit Running game demonstrated the highest caloric expenditure and HR (p = .010). Frequency counts of balance loss during Wii game play did not correlate with performance on the BOT-2 or the CBM. Type, number, and time since injury were predictive of balance performance on the CBM (p = .008). Findings provide preliminary evidence for the use of the Wii as an exertion challenge to evaluate tolerance for exercise post-concussion. Frequency count of balance loss during Wii game play, however, was not a valid measure of balance impairment post-MTBI.


Assuntos
Concussão Encefálica/fisiopatologia , Tolerância ao Exercício , Equilíbrio Postural , Recuperação de Função Fisiológica , Jogos de Vídeo , Adolescente , Criança , Estudos Transversais , Metabolismo Energético , Feminino , Frequência Cardíaca , Humanos , Masculino , Preferência do Paciente , Esforço Físico/fisiologia , Taxa Respiratória , Fatores de Tempo
9.
J Am Geriatr Soc ; 72(5): 1574-1582, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38445895

RESUMO

The National Institute on Aging (NIA), part of the National Institutes of Health (NIH), was founded in 1974 to support and conduct research on aging and the health and well-being of older adults. Fifty years ago, the concept of studying aging generated much skepticism. Early NIA-funded research findings helped establish the great value of aging research and provided the foundation for significant science advances that have improved our understanding of the aging process, diseases and conditions associated with aging, and the effects of health inequities, as well as the need to promote healthy aging lifestyles. Today, we celebrate the many important contributions to aging research made possible by NIA, as well as opportunities to continue to make meaningful progress. NIA emphasizes that the broad aging research community must continue to increase and expand our collective efforts to recruit and train a diverse next generation of aging researchers.


Assuntos
Envelhecimento , Aniversários e Eventos Especiais , Pesquisa Biomédica , National Institute on Aging (U.S.) , Humanos , Estados Unidos , Idoso , Envelhecimento/fisiologia , Pesquisa Biomédica/história , História do Século XX , História do Século XXI , Envelhecimento Saudável , Geriatria/história
10.
J Osteopath Med ; 123(3): 135-141, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36448407

RESUMO

CONTEXT: One of the two major pathways to become a physician in the United States is the Doctor of Osteopathic Medicine (DO) degree. A major distinctive feature is often perceived as the addition of manual training in osteopathic manipulative treatment (OMT) in the DO education. However, the profession also has a distinct philosophy imbedded in the curriculum of all osteopathic medical schools. Many medical schools offer professional degrees with graduates who may choose to continue their education in medicine, such as the Master of Science in Biomedical Sciences (MSBS). At our institution, there is no formal exposure to the differences between osteopathic and allopathic medicine in the MSBS curriculum, and most of this understanding is gained through out-of-classroom conversations. During the SARS-CoV-2 pandemic, virtual learning prohibited the usual gathering and discourse that occurs when students are learning on campus. OBJECTIVES: The objective of this study is to create a curriculum in the form of a seminar series to assist premedical students in making an informed choice about which profession is the best fit for their own education and to gain an appreciation for osteopathic medicine. This appreciation could also aid in the future collaboration of premedical students with osteopathic providers, recommendations to patients, and potentially their own medical care. Questionnaires were utilized to determine if our osteopathic seminar series was effective at changing the preferences and understanding of MSBS students. We also sought to determine the effectiveness of virtual vs. in-person delivery of our curriculum. METHODS: A seminar series with pre-established objectives was developed and presented to MSBS students at an osteopathic institution during the Fall of 2020 and 2021. The 2020 seminar was delivered through a virtual conference platform, and the 2021 seminar was delivered in-person. An eight question pre-and postquestionnaire was given to participants to evaluate their preferences and understanding. Internal validity and differences between delivery formats were assessed. RESULTS: Both seminar series produced equally effective, significant changes in the preferences and perceptions of osteopathic medicine in both virtual and in-person delivery formats. Differences in pre-vs. post understanding across both seminar series were not consistently significant and were smaller than those observed in preferences and perceptions. Positive changes included an increased willingness to see a DO and to recommend a loved one see a DO as their personal physician. Preference changes between the in-person vs. virtual delivery platforms did not show significant differences; however, understanding did show some inconsistent differences. CONCLUSIONS: This study demonstrates the utility of a virtual or in-person seminar to improve the preferences and perceptions of the osteopathic profession in MSBS students. The seminar series was successful in its goal of offering formal exposure to the osteopathic profession. The improved preferences and perceptions will have potential substantial benefits to the field of osteopathic medicine in the future. Further research is warranted to determine the most effective way to increase understanding of the osteopathic profession.


Assuntos
COVID-19 , Osteopatia , Medicina Osteopática , Humanos , Estados Unidos , Medicina Osteopática/educação , COVID-19/epidemiologia , SARS-CoV-2 , Currículo
11.
CMAJ Open ; 11(5): E956-E968, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37848258

RESUMO

BACKGROUND: Most children who need emergency care visit general emergency departments and urgent care centres; the weighted pediatric readiness score (WPRS) is currently used to evaluate emergency departments' readiness for pediatric patients. The aim of this study was to determine whether a higher WPRS was associated with decreased mortality and improved health care outcomes and utilization. METHODS: We conducted a systematic review of cohort and cross-sectional studies on emergency departments that care for children (age ≤ 21 yr). We searched MEDLINE (Ovid), Embase (Ovid), the Cochrane Library (Wiley), CINAHL (EBSCO), Global Health (Ovid) and Scopus from inception until July 29, 2022. Articles identified were screened for inclusion by 2 independent reviewers. The primary outcome was mortality, and the secondary outcomes were health care outcomes and utilization. We used the Newcastle-Ottawa Scale to assess for quality and bias of the included studies. The I 2 statistic was calculated to quantify study heterogeneity. RESULTS: We identified 1789 articles. Eight articles were included in the final analysis. Three studies showed an inverse association between highest WPRS quartile and pediatric mortality (pooled odds ratio [OR] 0.45, 95% confidence interval [CI] 0.26 to 0.78; I 2 = 89%, low certainty of evidence) in random-effects meta-analysis. Likewise, 1 study not included in the meta-analysis also reported an inverse association with a 1-point increase in WPRS (OR 0.93, 95% CI 0.88 to 0.98). One study reported that the highest WPRS quartile was associated with shorter length of stay in hospital (ß -0.36 days, 95% CI -0.61 to -0.10). Three studies concluded that the highest WPRS quartile was associated with fewer interfacility transfers. The certainty of evidence is low for mortality and moderate for the studied health care outcomes and utilization. INTERPRETATION: The data suggest a potential inverse association between the WPRS of emergency departments and mortality risk in children. More studies are needed to refute or confirm these findings. PROTOCOL REGISTRATION: PROSPERO-CRD42020191149.

12.
J Eat Disord ; 9(1): 127, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34649621

RESUMO

BACKGROUND: Problems in social cognition and social support contribute to eating disorders (ED). Group therapy provides an ideal format to create an experiential learning environment focused on understanding social interactions. This pilot study examined the qualitative content of the participants' experiences in the Self-Blame and Perspective-Taking Intervention (SBPI) for ED. METHODS: The SBPI was a 4-week group therapy intervention involving art therapy and psychoeducation that focused on social behaviors in ED patients. Participants received surveys immediately after the intervention and at 1 to 4 weeks after the post-intervention. Thematic analyses of qualitative feedback were performed using Braun and Clarke's thematic analysis framework. RESULTS: Inductive analyses revealed three main themes: (1) Developing self-acceptance through emotional reflection, (2) Changing expectations with neurosocial knowledge, and (3) Bonding and vulnerability in social interactions; all concepts intentionally targeted by the SBPI. Participants varied in their support of a guideline to exclude personal discussion of ED-related cognitions and behaviors in the group. CONCLUSIONS: As a whole, patients valued the combination of psychosocial education with group experientials focused on social behavior. Positive feedback from the SBPI suggests that adjunctive treatments that target mental-wellness constructs indirectly related to ED pathology may be helpful by allowing patients to see themselves as separable from the illness. Trial registration ClinicalTrials.gov, NCT0487758. Registered 7 May 2021-Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04877158 .


Adult patients with eating disorders frequently report challenges in developing and maintaining supportive social relationships. A group therapy intervention utilizing structured art tasks in conjunction with psychoeducation about interpersonal relationships was piloted in twenty-four women with eating disorders. Participants provided written feedback about their experiences in the intervention. These responses were coded by three raters to identify consistent themes related to those experiences. Participants reported benefits related to self-acceptance and emotional regulation, valued learning about their brain and behaviors, and appreciated peer interactions in this setting. In sum, this adjunctive and structured outpatient group targeting social interactions was acceptable to outpatients with eating disorders.

13.
J Behav Cogn Ther ; 31(1): 57-66, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34124699

RESUMO

Eating disorders (EDs) are characterized by altered eating behaviors and valuation of self-image, as well as difficulty establishing supportive social relationships. This pilot study evaluated feasibility, acceptability, and clinical responses to a novel and brief group-therapy intervention for EDs, the Self-Blame and Perspective-Taking Intervention (SBPI). The SBPI consisted of four sessions of experiential art therapy activities in conjunction with psychoeducation targeting interpersonal attributions and mentalization. Twenty-four outpatient, treatment-seeking women with EDs participated in the SBPI, with 87.5% completing the intervention and 94% rating their participation positively. ED symptoms, depression, anxiety, self-attribution bias, and self-esteem were assessed before (T1) and after participation (N = 20 at T2; N = 18 at T3). Separate repeated measures MANOVAs were performed to assess these clinical and self-concept variables. Relative to baseline, participants demonstrated significant improvements in two all self-concept measures: self-attribution bias, trait self-esteem and state self-esteem at T2. ED, depression, and anxiety symptoms were significantly decreased at both T2 (1-4 weeks post) and T3 (3-5 months post). The SBPI altered self-concept targets acutely and led to sustained clinical improvements. Future work is needed to evaluate how self-concept and social constructs are related to clinical symptom expression in EDs.

14.
CJEM ; 22(6): 793-801, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32513343

RESUMO

OBJECTIVES: Vomiting is common in children after minor head injury. In previous research, isolated vomiting was not a significant predictor of intracranial injury after minor head injury; however, the significance of recurrent vomiting is unclear. This study aimed to determine the value of recurrent vomiting in predicting intracranial injury after pediatric minor head injury. METHODS: This secondary analysis of the CATCH2 prospective multicenter cohort study included participants (0-16 years) who presented to a pediatric emergency department (ED) within 24 hours of a minor head injury. ED physicians completed standardized clinical assessments. Recurrent vomiting was defined as ≥ four episodes. Intracranial injury was defined as acute intracranial injury on computed tomography scan. Predictors were examined using chi-squared tests and logistic regression models. RESULTS: A total of 855 (21.1%) of the 4,054 CATCH2 participants had recurrent vomiting, 197 (4.9%) had intracranial injury, and 23 (0.6%) required neurosurgical intervention. Children with recurrent vomiting were significantly more likely to have intracranial injury (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.7-3.1), and require neurosurgical intervention (OR, 3.5; 95% CI, 1.5-7.9). Recurrent vomiting remained a significant predictor of intracranial injury (OR, 2.8; 95% CI, 1.9-3.9) when controlling for other CATCH2 criteria. The probability of intracranial injury increased with number of vomiting episodes, especially when accompanied by other high-risk factors, including signs of a skull fracture, or irritability and Glasgow Coma Scale score < 15 at 2 hours postinjury. Timing of first vomiting episode, and age were not significant predictors. CONCLUSIONS: Recurrent vomiting (≥ four episodes) was a significant risk factor for intracranial injury in children after minor head injury. The probability of intracranial injury increased with the number of vomiting episodes and if accompanied by other high-risk factors, such as signs of a skull fracture or altered level of consciousness.


Assuntos
Traumatismos Craniocerebrais , Criança , Estudos de Coortes , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/epidemiologia , Escala de Coma de Glasgow , Humanos , Estudos Prospectivos , Vômito/epidemiologia , Vômito/etiologia
15.
Ann Behav Med ; 37(3): 350-5, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19548044

RESUMO

BACKGROUND: Few studies have explored the relationship between weight bias and weight loss treatment outcomes. PURPOSE: This investigation examined the relationship between implicit and explicit weight bias and (a) program attrition, (b) weight loss, (c) self-monitoring adherence, (d) daily exercise levels and overall caloric expenditure, (e) daily caloric intake, and (f) daily caloric deficit among overweight/obese treatment-seeking adults. METHODS: Forty-six overweight/obese adults (body mass index > or = 27 kg/m(2)) participating in an 18-week, stepped-care, behavioral weight loss program completed implicit and explicit measures of weight bias. Participants were instructed to self-monitor and electronically report daily energy intake, exercise, and energy expenditure. RESULTS: Greater weight bias was associated with inconsistent self-monitoring, greater caloric intake, lower energy expenditure and exercise, creation of a smaller caloric deficit, higher program attrition, as well as less weight loss during the self-help phase of the stepped-care treatment. CONCLUSIONS: Weight bias may interfere with overweight/obese treatment-seeking adults' ability to achieve optimal health.


Assuntos
Cooperação do Paciente/psicologia , Pacientes Desistentes do Tratamento/psicologia , Preconceito , Resultado do Tratamento , Redução de Peso , Adulto , Terapia Comportamental/métodos , Ingestão de Energia , Metabolismo Energético , Exercício Físico , Feminino , Humanos , Masculino , Obesidade/psicologia , Obesidade/terapia , Sobrepeso/psicologia , Sobrepeso/terapia
16.
J Behav Med ; 32(6): 503-9, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19521759

RESUMO

In a stepped-care approach to treatment, patients are transitioned to more intensive treatments when less intensive treatments fail to meet treatment goals. Self-help programs are recommended as an initial, low intensity treatment phase in stepped-care models. This investigation examined the effectiveness of a self-help, stepped-care weight loss program. Fifty-eight overweight/obese adults (BMI ≥27 kg/m(2)) participated in a weight loss program. Participants were predominately Caucasian (93.1%) and female (89.7%) with a mean BMI of 36.6 (SD=7.1). Of those completing the program, 57% of participants (N=21) who remained in self-help maintained an 8% weight loss at follow-up. Participants who were stepped-up self-monitored fewer days and reported higher daily caloric intake than self-help participants. Once stepped-up, weight loss outcomes were equivalent between individuals who remained in self-help compared to those who were stepped-up. Individuals who were stepped-up benefited from early intensive intervention when unsuccessful at losing weight with self-help.


Assuntos
Comportamentos Relacionados com a Saúde , Obesidade/terapia , Sobrepeso/terapia , Autocuidado/métodos , Redução de Peso , Adulto , Análise de Variância , Índice de Massa Corporal , Dieta , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Resultado do Tratamento
17.
Front Psychol ; 10: 981, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31130898

RESUMO

Anorexia nervosa (AN) has a prolonged course of illness, making both defining recovery and determining optimal outpatient treatments difficult. Here, we report the types of treatments utilized in a naturalistic sample of adult women with AN in Texas. Participants were recruited from earlier studies of women with AN (n = 28) and in weight recovery following AN (n = 18). Participants provided information about both their illness and treatments during their most severe period as well as during the 2-6 years following original assessments. Based upon their baseline and follow-up clinical status participants were classified as remaining ill (AN-CC, n = 17), newly in recovery (AN-CR, n = 11), and sustained weight-recovery (AN-WR, n = 18). Utilization of health care institutions and providers were compared across groups. There were no differences in groups related to symptoms or treatments utilized during the severe-period. During the follow-up period, intensive outpatient programs were utilized significantly more by the AN-CC group than the other groups, and dietitians were seen significantly less by the AN-WR group. Medical complications related to the ED were significantly more common in the AN-CC group. All groups maintained similar levels of contact with outpatient psychiatrists, therapists, and primary care physicians. Current treatments remain ineffective for a subset of AN participants. Future prospective studies assessing medical health and comorbidities in AN may provide additional insights into disease severity and predictors of clinical outcome.

18.
Health Psychol ; 26(3): 369-74, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17500624

RESUMO

OBJECTIVE: This investigation was designed to improve behavioral weight loss program (BWLP) treatment outcomes by providing stepped care (SC) to individuals experiencing difficulties with weight loss during treatment. SC entails transition to more intensive treatments when less intensive treatments fail to meet treatment goals. In a BWLP, motivational interviewing (MI) may increase participants' motivation toward behavioral change and thus complement the acquisition of behavioral change skills. It was hypothesized that BWLP+SC (MI) participants (i.e., participants who failed to meet weight loss goals and received MI) would demonstrate superior treatment outcomes when compared with BWLP (SC matched) participants (i.e., participants who failed to meet weight loss goals but did not receive MI). DESIGN: Fifty-five obese, sedentary adults were randomly assigned to a BWLP+SC or a BWLP. MAIN OUTCOME MEASURES: Changes in weight, cardiorespiratory fitness, self-reported physical activity, and diet (i.e., calories, percentage daily intake of fat, protein, and carbohydrates) in response to treatment were assessed. RESULTS: Participants significantly decreased their weight, increased physical activity/fitness, and improved dietary intake (ps<.05). BWLP+SC (MI) participants lost more weight and engaged in greater weekly exercise than BWLP (SC matched) participants who did not receive MI (ps<.05). CONCLUSION: For individuals experiencing weight loss difficulties during a BWLP, MI may have considerable promise.


Assuntos
Entrevistas como Assunto , Motivação , Obesidade/terapia , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Meio-Oeste dos Estados Unidos
19.
Gen Hosp Psychiatry ; 48: 56-61, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28779589

RESUMO

OBJECTIVE: To determine whether depressed or anxious patients experience greater affective change than mentally healthy individuals following influenza vaccination. METHODS: Participants (n=112) completed the Positive and Negative Affect Schedule (PANAS) before influenza vaccination and 1-2days post-vaccination (M=32.3h). Pre- and post-vaccination PANAS scores were compared using two-tailed, paired-samples t-tests. Change in positive affect between participants with depression or anxiety and those without was compared using two-way ANOVA. Follow up positive affect was further examined using multiple linear regression. RESULTS: Positive affect decreased following vaccination (M=2.18, 95% CI [1.07, 3.29], t(111)=3.89, p<0.001) for all participants and was more pronounced for those with anxiety or depression (F(1, 110)=7.51, p=0.009). Similarly, predicted follow up affect score was higher for those without a mental health conditions (ß=3.67, 95% CI [1.18, 6.16], t(103)=2.92, p=0.004). CONCLUSIONS: These data suggest that influenza vaccine has a greater effect on affect in patients with depression and anxiety than in mentally healthy individuals. This effect was focused on positive affect, suggesting that influenza vaccine induced inflammation may be best suited to examine alterations in positive affect and positive valence systems.


Assuntos
Ansiedade/fisiopatologia , Depressão/fisiopatologia , Comportamento de Doença/fisiologia , Inflamação/complicações , Vacinas contra Influenza/efeitos adversos , Transtornos Mentais/fisiopatologia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Inflamação/etiologia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Adulto Jovem
20.
Soc Cogn Affect Neurosci ; 12(6): 956-964, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-28338784

RESUMO

Even in predominantly religious societies, there are substantial individual differences in religious commitment. Why is this? One possibility is that differences in social conformity (i.e. the tendency to think and behave as others do) underlie inclination towards religiosity. However, the link between religiosity and conformity has not yet been directly examined. In this study, we tested the notion that non-religious individuals show dampened social conformity, using both self-reported and neural (EEG-based ERPs) measures of sensitivity to others' influence. Non-religious vs religious undergraduate subjects completed an experimental task that assessed levels of conformity in a domain unrelated to religion (i.e. in judgments of facial attractiveness). Findings showed that, although both groups yielded to conformity pressures at the self-report level, non-religious individuals did not yield to such pressures in their neural responses. These findings highlight a novel link between religiosity and social conformity, and hold implications for prominent theories about the psychological functions of religion.


Assuntos
Religião e Psicologia , Conformidade Social , Eletroencefalografia , Potenciais Evocados , Expressão Facial , Feminino , Humanos , Individualidade , Masculino , Autorrelato , Comportamento Social , Desejabilidade Social , Confiança , Adulto Jovem
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