An Internet-based program to enhance motivation to change in females with symptoms of an eating disorder: a randomized controlled trial.

BACKGROUND: Previous research has demonstrated an association between low motivation to change and an unfavorable treatment outcome in patients with an eating disorder. Consequently, various studies have examined the effects of motivational enhancement therapy (MET) on motivation to change and treatment outcome in eating disorders. In each of these studies, MET was administered in a face-to-face setting. However, because of its anonymity and ease of access, the internet provides several advantages as the format for such an intervention. Therefore, the current study investigated the effects of an internet-based program ('ESS-KIMO') to enhance motivation to change in eating disorders. METHOD: In total, 212 females were accepted for participation and assigned randomly to the intervention condition (n = 103) or waiting-list control condition (n = 109). The intervention consisted of six online MET sessions. Before and after the intervention or waiting period respectively, participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the Stages of Change Questionnaire for Eating Disorders (SOCQ-ED), the Pros and Cons of Eating Disorders Scale (P-CED), the Self-Efficacy Scale (SES), and the Rosenberg Self-Esteem Scale (RSES). A total of 125 participants completed the assessment post-treatment. Completer analyses and intent-to-treat analyses were performed. RESULTS: Significant time × group interactions were found, indicating a stronger increase in motivational aspects and self-esteem, in addition to a stronger symptom reduction on some measures from pre- to post-treatment in the intervention group compared to the control group. CONCLUSIONS: Internet-based approaches can be considered as useful for enhancing motivation to change in eating disorders and for yielding initial symptomatic improvement.

Increased plasticity of the bodily self in eating disorders.

BACKGROUND: The rubber hand illusion (RHI) has been widely used to investigate the bodily self in healthy individuals. The aim of the present study was to extend the use of the RHI to examine the bodily self in eating disorders (EDs). METHOD: The RHI and self-report measures of ED psychopathology [the Eating Disorder Inventory - 3 (EDI-3) subscales of Drive for Thinness, Bulimia, Body Dissatisfaction, Interoceptive Deficits, and Emotional Dysregulation; the 21-item Depression, Anxiety and Stress Scale (DASS-21); and the Self-Objectification Questionnaire (SOQ)] were administered to 78 individuals with an ED and 61 healthy controls. RESULTS: Individuals with an ED experienced the RHI significantly more strongly than healthy controls on both perceptual (i.e. proprioceptive drift) and subjective (i.e. self-report questionnaire) measures. Furthermore, both the subjective experience of the RHI and associated proprioceptive biases were correlated with ED psychopathology. Approximately 23% of the variance for embodiment of the fake hand was accounted for by ED psychopathology, with interoceptive deficits and self-objectification significant predictors of embodiment. CONCLUSIONS: These results indicate that the bodily self is more plastic in people with an ED. These findings may shed light on both aetiological and maintenance factors involved in EDs, particularly visual processing of the body, interoceptive deficits, and self-objectification.

Man-made transients observed by the gamma-ray spectrometer on the solar maximum mission satellite.

Since launch in early 1980 the Gamma-Ray Spectrometer (GRS) onboard the Solar Maximum Mission (SMM) satellite has monitored the sun at gamma-ray energies. In addition to observations of solar flares, cosmic gamma-ray bursts, and precipitating radiation belt electrons, the instrument has detected a new class of high-energy transient events that cannot be attributed to any of these phenomena. The duration of these transients can range from 1 second to more than 10 minutes. The average event rate between 1980 and 1986 was about five per month. However, in February 1987 this rate increased by more than a factor of 25 and continued at this high level until June 1988. These transients can be subdivided into three classes: (i) 0.511-megaelectron volt annihilation line events, (ii) particle events, and (iii) broad-band photon continuum-like events. Evidence is presented that these transients are not of natural origin. It is found that the most likely sources of these events are reactors in earth orbiting satellites. Apart from the threat these reactors pose upon accidental reentry, the reactor-generated transients may have a deleterious effect on cosmic observations obtained with gamma-ray detectors in low earth orbit.

The use of motivational enhancement strategies for the maintenance of weight loss among obese individuals: a preliminary investigation.

AIM: To investigate the efficacy of motivational enhancement strategies integrated within a standard lifestyle modification program for the maintenance of weight loss and improved psychosocial functioning of obese adults. METHODS: Twenty-two obese adults completed 20 sessions of a motivationally informed cognitive behavioural treatment for weight loss and maintenance. Treatment outcome measures included anthropometrics, obesity-specific quality of life, impulsive eating tendencies, body dissatisfaction, mood disturbance and maladaptive cognitions. RESULTS: At post-treatment, there was a significant decrease in body weight (123.04 +/- 22.06 vs. 116.84 +/- 23.53, p < 0.001) with no significant change by the 12-month follow-up. Patients also reported significant improvements in obesity-related quality of life, impulsive eating tendencies, body dissatisfaction and maladaptive cognitions at post-treatment that were maintained at the 1-year follow-up. CONCLUSIONS: The implementation of motivational enhancement strategies within a cognitive behavioural program results in sustained weight loss that compares favourably to previous lifestyle modification programs.

Therapeutic alliance and obesity management in primary care - a cross-sectional pilot using the Working Alliance Inventory.

Therapeutic alliance is a well-recognized predictor of patient outcomes within psychological therapy. It has not been applied to obesity interventions, and Bordin's theoretical framework shows particular relevance to the management of obesity in primary health care. This cross-sectional study of a weight management programme in general practice aimed to determine if therapeutic alliance was associated with patient outcomes. The Working Alliance Inventory short revised version (WAI-SR) was administered to 23 patients and 11 general practitioners (GPs) at the end of a 6-month weight management programme. Use of the WAI-SR indicated that the strength of therapeutic alliance varied between different patient-GP relationships in this pilot intervention. A robust therapeutic alliance was strongly associated with patient engagement in the weight management programme indicated by number of appointments. It was also associated with some general health and quality of life outcomes. These are promising results that require confirmation with larger studies in primary health care. The measurement of therapeutic alliance using the WAI-SR may predict patient attendance and outcomes in obesity interventions in primary healthcare settings.

bcl-2 protein expression and correlation with the interchromosomal 14;18 translocation in cutaneous lymphomas and pseudolymphomas.

The interchromosomal 14;18 translocation occurs in approximately 70-80% of follicular lymphomas and in a lower proportion of high-grade non-Hodgkin lymphomas of the lymph nodes. This translocation results in the fusion of the bcl-2 oncogene on chromosome 18 with immunoglobulin heavy chain genes on chromosome 14, and in the expression of higher amounts of normal bcl-2 protein. We studied bcl-2 expression in biopsies of 108 patients with benign and malignant cutaneous lymphoproliferative diseases (B-cell lymphoma, primary cutaneous, 42; secondary cutaneous, 21; primary cutaneous T-cell lymphoma, 21; B-cell pseudolymphoma, 24), using a monoclonal anti-bcl-2 antibody on paraffin-embedded tissue sections, bcl-2 protein was detected immunohistochemically in 16 of 63 cases of cutaneous B-cell lymphoma, whereas cutaneous T-cell lymphomas and B-cell pseudolymphomas were negative. The proportion of bcl-2 protein expression was significantly higher in secondary (11/21) than in primary cutaneous B-cell lymphomas (5/42; chi 2 test, p < 0.001). Biopsies from 25 of these patients (B-cell lymphoma, 22; B-cell pseudolymphoma, three) were analyzed previously on the molecular level for the t(14;18), using polymerase chain reaction amplification of DNA obtained from paraffin-embedded sections. In four of 11 cases of bcl-2 protein-positive B-cell lymphoma (primary, one; secondary, three) the t(14;18) was detected by polymerase chain reaction. All other cases of B-cell lymphoma, including seven cases where bcl-2 protein was detected by immunohistology, and B-cell pseudolymphoma were negative. These results demonstrate: 1) bcl-2 protein is expressed in a small portion of cutaneous B-cell lymphomas; 2) bcl-2 protein expression is significantly more frequent in secondary than in primary cutaneous B-cell lymphoma; 3) only approximately one-third of cases expressing the bcl-2 protein are characterized also by the t(14;18). bcl-2 protein expression might indicate that the cutaneous manifestation of the lymphoma represents a secondary spread from a node-based lymphoma.

Expression of the homeobox gene HOXC4 in keratinocytes of normal skin and epithelial skin tumors is correlated with differentiation.

Homeobox (HOX) genes share a highly conserved 183-bp sequence. The encoded proteins are capable of binding to specific DNA sequences and functioning as transcription factors. HOX genes play a critical role in the temporal and spatial differentiation of cells during embryogenesis. In several adult tissues, HOX genes are expressed in a constant, tissue-specific pattern, whereas in malignant tumors of these tissues an altered expression pattern was found. We investigated the expression of HOXC4 in adult normal skin by reverse-transcription polymerase chain reaction and non-radioactive RNA in situ hybridization. Moreover, HOXC4 expression was studied in various epidermal neoplasms (solar keratosis, six specimens; Bowen's disease, four; squamous cell carcinoma, nine; basal cell carcinoma, three) by RNA in situ hybridization. HOXC4 was found to be expressed in the suprabasal layers of the epidermis in normal skin specimens and the adjacent non-lesional epidermis of all other specimens. Atypical keratinocytes of solar keratoses and Bowen's disease as well as basaloid cells of basal cell carcinomas were negative. In squamous cell carcinoma, well differentiated areas with keratinization showed HOXC4 expression, whereas poorly differentiated areas were negative. Immunostaining with an antibody against cytokeratin 10, a marker of epidermal differentiation, was performed. A good correlation between the distribution pattern of HOXC4 and cytokeratin 10 in the lesions examined was found. These results suggest that HOXC4 is expressed mainly in differentiated keratinocytes. Lack of differentiation (as in neoplastic cells) is accompanied by downregulation of HOXC4 expression.

Clinicopathologic and immunologic features associated with transformation of mycosis fungoides to large-cell lymphoma.

Mycosis fungoides (MF) can progress to a large-cell malignant lymphoma (LCL). This transformation is associated with a more aggressive biologic behavior and course. We reviewed cutaneous tumors of 36 MF patients and divided them into two groups, one showing histologic evidence of transformation into LCL, another characterized by infiltrates of small- to medium-sized cerebriform cells (nontransformed cases). Biopsies of patches or plaques from early MF stages were available from 34 patients. Twenty of the 36 cases (55.6%) showed transformation to a large-cell variant: nine tumor-stage (T) medium-sized and large-cell pleomorphic, five T immunoblastic, two T large-cell anaplastic, and four unclassified T LCL. Sixteen cases represented nontransformed tumor stage MF. In 23 cases, including both nontransformed (n = 6) and LCL (n = 17) groups, immunohistochemical investigations revealed aberrant patterns of antigen expression (partial loss of one or more T cell-associated antigens) and the presence of activation- and proliferation-associated antigens. Clusters of B-lymphocytes formed a distinctive component of the infiltrate in two nontransformed and nine LCL biopsies. Although survival rates after tumor onset did not significantly differ between the two groups (5-year survival rate 23% for nontransformed patients, 11.1% for LCL patients, p greater than 0.05), overall survival from first biopsy diagnostic of MF showed a statistically significant difference between patients with nontransformed tumor stage MF compared with LCL patients (10-year survival rate 46.6% and 11.2%, respectively, p less than 0.02). The recognition of transformation to LCL in MF should provide a better assessment of future therapeutic approaches.

Ultraviolet radiation of melanocytic nevi: a dermoscopic study.

BACKGROUND: UV radiation can lead to clinical, histological, and ultrastructural changes in melanocytic nevi. In this study, we investigated whether exposure to 2 minimal erythema doses of UV radiation induces changes in the dermoscopic image of acquired melanocytic nevi. OBSERVATIONS: Fifteen melanocytic nevi were exposed to 2 minimal erythema doses of UV radiation. Differences in dermoscopic parameters (asymmetry, border, erythema, and telangiectasias in the nevus; pigmentation; hypopigmented areas; presence, regularity, and sharpness of pigment network; and brown-black globules) in digital dermoscopic images taken before and 3, 7, 14, and 28 days after UV irradiation were scored. Three days after UV irradiation, the borders of nevi were more faded (P<.02), the nevi were darker brown (P<.02), the hypopigmented areas were smaller (P<.02), and the pigment network structures were more faded (P<.007) and less prominent (P<.02) than before UV irradiation. Seven days after UV irradiation, pigmented globules have also grown (P<.05). After 28 days, all parameters, except hypopigmented areas, were essentially the same as before UV irradiation. CONCLUSION: UV irradiation of melanocytic nevi with 2 minimal erythema doses induces transient changes in their dermoscopic appearance that are sometimes suggestive of malignant melanoma.

Proliferative activity in Spitz's naevi compared with other melanocytic skin lesions.

Proliferative activity has been shown to correlate with the degree of malignancy in various human neoplasms. Immunostaining with the monoclonal antibody PC10 binding to proliferating cell nuclear antigen (PCNA) facilitates the assessment of proliferation in routinely fixed, paraffin-embedded tissue sections. In this study we investigated the expression of PCNA in 29 Spitz's naevi in comparison with 43 primary malignant melanomas (MM), 18 cutaneous metastases of malignant melanoma (MMM) and 16 benign melanocytic naevi (BMN). After selection of the microscopic field with the highest number of PCNA-positive nuclei, the nuclear density (NDmax) of PCNA-stained nuclei in this field was assessed using interactive image analysis. The mean value of NDmax (given as 1000 nuclei/mm3 tissue) of SN was 27.9 (+/- 16.7) and differed significantly from that of MM (48.1 +/- 40.5; U-test: p < 0.05) and that of MMM (114.4 +/- 56.3; p < 0.01). Comparing NDmax of the subgroups of MM according to their maximal vertical tumour thickness with NDmax of SN we found significant differences only between SN and MM > 1.5 mm thick (n = 14; NDmax = 67.8 +/- 36.1) but not between SN and MM < or = 1.5 mm thick (n = 29; NDmax = 38.8 +/- 39.3). PCNA expression in SN did not differ from that of BMN (NDmax 23.8 +/- 28.5). Proliferative activity as assessed by measurement of PCNA expression therefore showed significant differences between BMN, SN and thin primary melanomas on one hand and thick primary melanomas and cutaneous metastases of malignant melanomas on the other hand.

The diet-heart disease hypothesis: a response to Atrens.

In a recent examination of the main tenets of the widely accepted diet-heart disease hypothesis, Atrens concluded that the evidence to date is not sufficient to support the hypothesis. Reviewing Atrens' critique highlights both strengths and limitations in his case against the role of dietary lipids and cholesterol in coronary heart disease mortality. Research on the following hypothesized relationships is discussed in light of the objections raised by Atrens: the relationships between fat intake and heart disease mortality; dietary fat and serum cholesterol; serum cholesterol and atherosclerosis; atherosclerosis and heart disease death; and serum cholesterol and heart disease death. The inconsistency of the findings suggests that definitive answers regarding the diet-heart disease hypothesis are premature and that the polarized positions of acceptance vs rejection of the hypothesis fail to account for the full range of results.

The role of the clinical psychologist in gynecological cancer.

Gynecological cancers, which account for a substantial proportion of cancer cases in women, can precipitate a wide range of psychological difficulties including affective disturbances, sexual problems, certain somatic symptoms, and family issues. The clinical psychologist has a unique contribution to make in the assessment and treatment of the psychological needs of gynecological cancer patients, while also conducting research and providing training for health professionals regarding the psychological issues associated with gynecological cancer. Although the gynecological cancer setting affords the clinical psychologist multiple personal benefits, strategies must usually be implemented to minimize any negative impact arising from working in an area of considerable psychological stress.

Satellite observation of atmospheric nuclear gamma radiation.

We present a satellite observation of the spectrum of gamma radiation from the Earth's atmosphere in the energy interval from 300 keV to 8.5 MeV. The data were accumulated by the gamma ray spectrometer on the Solar Maximum Mission over 3 1/2 years, from 1980 to 1983. The excellent statistical accuracy of the data allows 20 atmospheric line features to be identified. The features are superimposed on a continuum background which is modeled using a power law with index -1.16. Many of these features contain a blend of more than one nuclear line. All of these lines (with the exception of the 511-keV annihilation line) are Doppler broadened. Line energies and intensities are consistent with production by secondary neutrons interacting with atmospheric 14N and 16O. Although we find no evidence for other production mechanisms, we cannot rule out significant contributions from direct excitation or spallation by primary cosmic ray protons. The relative intensities of the observed line features are in fair agreement with theoretical models; however, existing models are limited by the availability of neutron cross sections, especially at high energies. The intensity and spectrum of photons at energies below the 511-keV line, in excess of a power law continuum, can be explained by Compton scattering of the annihilation line photons in traversing an average of approximately 21 g cm-2 of atmosphere.

Normative data for the personal report of confidence as a speaker.

Normative data for the Personal Report of Confidence as a Speaker (PRCS; Paul, 1966), a measure of public-speaking anxiety, were collected by administering the PRCS to 1109 college students. PRCS scores were examined in relation to gender, race, age, and grade-point average. No significant between-group differences were found. The findings indicate that levels of public-speaking anxiety are generally constant across gender, race, and age. Normative data for all scores across Caucasian and African-American subjects are presented.

[Clinical epidemiologic data of malignant melanoma based on 1,368 patients of the Graz University Dermatology Clinic (1970-1989)]. / Klinisch-epidemiologische Daten des malignen Melanoms anhand von 1368 Patienten der Grazer Universitäts-Hautklinik (1970-1989).

Epidemiological and histological data of 1368 patients with invasive malignant melanoma treated at the Department of Dermatology between 1970 and 1989 were analysed retrospectively. Frequency of melanoma increased from 103 cases between 1970 and 1974 to 593 between 1985 and 1989. The male/female ratio was 1/1.5 and did not change during the study period. Mean age of patients at the time of primary operation was 56.1 years and was approximately the same for males and females (males 55.8, females 56.3 years). The predominant site was the trunk in males (58.7 per cent) and the lower leg in females (41.6 per cent). There was a relative increase of melanomas of the back in males and the lower leg in females at the expense of melanomas of the face. The Breslow index was significantly higher in males than in females. In patients older than 69 years, the proportion of thick melanomas was above average. During the study period, the frequency of thick melanomas (greater than 1.5 mm) showed an encouraging decrease in both sexes. In 1989, 50 per cent of all melanomas were thinner than 1.01 mm. This can be interpreted as a successful outcome of efforts in preventive medicine.

Two computer programs using logit transformation for the analysis of S-shaped curves.

Two BASIC computer programs using logit transformation for the analysis of S-shaped curves are presented. The first program estimates the median effective dose (ED50) of drugs. A maximum likelihood method similar to Finney's algorithm of probit analysis is applied. The second fits S-shaped curves to empirical data which cannot be transformed easily to proportions. Logit transformation proves to be a simple and accurate alternative to probit transformation when computing memory is limited or calculation speed is critical.

[Skin symptoms in extracutaneous lymphomas, leukemias and plasmacytomas]. / Hautsymptome bei extrakutanen Lymphomen, Leukämien und Plasmozytom.

In neoplastic diseases of the haemopoietic and the lymphatic system, the skin may be infiltrated specifically by neoplastic cells or may display 'nonspecific' cutaneous reactions, frequently associated with a systemic malignancy. Acute febrile neutrophilic dermatosis associated with myeloproliferative disorders and scleromyxedema, lichen myxedematosus, diffuse plane xanthomas and necrobiotic xanthogranuloma associated with paraproteinemia may serve as examples. These conditions as well as several other, often atypical cutaneous manifestations should rise suspicion as to the potential presence of some underlying systemic neoplastic disorder.

A qualitative investigation of obese women's experiences of effective and ineffective social support for weight management.

An obese individual's social context influences the extent to which they engage in weight control behaviors. Although the available literature acknowledges the importance of social support for weight management, detailed analyses of obese individuals' experiences of social support for weight loss and/or weight loss maintenance have not been undertaken. Using a qualitative approach, this study presents 22 Australian obese women's perspectives of the availability and effectiveness of social support for weight control. Three superordinate categories, namely, ineffective support, effective support and personal barriers to accessing support, and 12 subcategories were identified. Participants reported minimal access to quality support for weight management, while also suggesting ways in which obese women themselves may hamper significant others' provision of effective support. The results support the investigation of interventions designed to enhance the skills of significant others in assisting obese individuals with weight management.

The effectiveness of including support people in a cognitive behavioural weight loss maintenance programme for obese adults: study rationale and design.

The well-documented finding that obese adults have a high likelihood of weight regain following participation in behavioural weight loss programmes highlights the importance of developing more effective approaches for weight loss maintenance. One promising approach is to improve the quality of social support for effective weight control available to an obese individual by including support people in behavioural weight loss programmes. This paper describes the rationale and design of a randomized controlled trial that evaluates the effectiveness of training support people to assist obese adults in their weight management. The study entails a two-arm randomized controlled trial in which obese participants take part in a 1-year (26-session) cognitive behaviour therapy group weight management programme, including motivational interviewing strategies (CBT-MI). In one arm, participants receive CBT-MI alone, while in the second arm (CBT-MI-SP), participants also have a support person who attends 10 group sessions designed to teach effective skills for supporting an individual in healthy weight control. More specifically, support people will be trained in skills that aim to promote self-motivation for weight management. Assessments of anthropometric, medical, behavioural, motivational, psychological and social functioning take place at pre-treatment, post-treatment and a 1-year follow-up. By helping obese participants to increase and sustain their motivation and skills for weight control both during treatment and in the crucial period after treatment cessation through the ongoing input of support people, the CBT-MI-SP approach of the current study has the potential to effectively help patients to achieve sustained weight loss while minimizing the patient's need for ongoing, intensive weight control treatment with its attendant costs.

[ORION®: a simple and effective method for systemic analysis of clinical events and precursors occurring in hospital practice]. / Méthode Orion(®) : analyse systémique simple et efficace des événements cliniques et des précurseurs survenant en pratique médicale hospitalière.

PURPOSE: Morbimortality review is now recommended by the French Health Authority (Haute Autorité de santé [HAS]) in all hospital settings. It could be completed by Comités de retour d'expérience (CREX), making systemic analysis of event precursors which may potentially result in medical damage. As commonly captured by their current practice, medical teams may not favour systemic analysis of events occurring in their setting. They require an easy-to-use method, more or less intuitive and easy-to-learn. It is the reason why ORION(®) has been set up. METHODS: ORION(®) is based on experience acquired in aeronautics which is the main precursor in risk management since aircraft crashes are considered as unacceptable even though the mortality from aircraft crashes is extremely low compared to the mortality from medical errors in hospital settings. The systemic analysis is divided in six steps: (i) collecting data, (ii) rebuilding the chronology of facts, (iii) identifying the gaps, (iv) identifying contributing and influential factors, (v) proposing actions to put in place, (vi) writing the analysis report. When identifying contributing and influential factors, four kinds of factors favouring the event are considered: technical domain, working environment, organisation and procedures, human factors. Although they are essentials, human factors are not always considered correctly. The systemic analysis is done by a pilot, chosen among people trained to use the method, querying information from all categories of people acting in the setting. RESULTS: ORION(®) is now used in more than 400 French hospital settings for systemic analysis of either morbimortality cases or event precursors. It is used, in particular, in 145 radiotherapy centres for supporting CREX. CONCLUSION: As very simple to use and quasi-intuitive, ORION(®) is an asset to reach the objectives defined by HAS: to set up effective morbi-mortality reviews (RMM) and CREX for improving the quality of care in hospital settings. By helping the efforts of medical teams, ORION(®) is an essential tool contributing to the patients' security.