Abortion stigma among abortion seekers, healthcare professionals and the public in high-income countries: A mixed-methods systematic review protocol.

INTRODUCTION: Abortion is a crucial sexual and reproductive right. However, the legal situation of pregnancy termination is rather heterogeneous across countries and regions. The political climate and cultural perception may result in abortion-related stigma. This mixed-methods systematic review protocol aims to detail the proposed methods for assessing the current state of research on abortion stigma in high-income countries from an abortion seeker, healthcare provider and public perspective. METHODS AND ANALYSIS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline, we conducted a systematic literature search of peer-reviewed studies from high-income countries in relevant electronic databases: PubMed, CINHAL, PsycINFO, LIVIVO and Cochrane Library. Qualitative, quantitative and mixed-method studies that measured or examined abortion-related stigma in abortion seekers, healthcare professionals and the general public will be included. Assessment of risk of bias, data synthesis and qualitative meta-aggregation will be carried out. ETHICS AND DISSEMINATION: The results of the systematic review will be submitted to peer-reviewed journals and presented at relevant conferences.

Assessment of reporting quality of randomized controlled trials investigating the effects of inulin-type fructans supplementation on cardiovascular disease risk factors: A systematic survey.

BACKGROUND: Transparent and detailed reporting of randomized controlled trials (RCTs) is essential to judge its validity and generalizability. We assessed the reporting quality of RCTs examining the effects of inulin-type fructans supplementation on cardiovascular risk factors, before and after the publication of the Consolidated Standards of Reporting Trials (CONSORT) in 2010. METHODS: We searched MEDLINE, EMBASE, Emcare, AMED, the Cochrane Library, and CINAHL from inception to May 15, 2022, including the reference lists of selected RCTs. We screened titles and abstracts and extracted the data independently and in duplicate. We included RCTs that investigated the effects of inulin-type fructans on cardiovascular disease risk factors (e.g., low-density lipoprotein cholesterol, triglycerides, fasting blood glucose) in adults (18 years or older). The primary outcomes of this study were: the overall reporting quality of RCTs (defined as the total number of items [0 to 36] present from the CONSORT checklist) published before and after CONSORT; and the study characteristics (e.g., sample size, significance of primary outcome) predictive of the CONSORT score. The secondary outcome was the reporting of each specific item of the CONSORT checklist during pre- and post-CONSORT periods. The mean difference in the total number of reported items in studies published before and after CONSORT were compared using a t-test and Poisson regression to explore the factors associated with overall reporting quality of RCTs. We used Fisher's exact test to compare the adherence to each of the 36 items during pre- and post-CONSORT periods. RESULTS: We identified 1,767 citations from our systematic search, of which 55 were eligible. There was a significant increase in the reporting of CONSORT items (mean difference 8.5, 95% confidence interval [CI] 5.24 to 11.71) between studies published before and after publication of CONSORT. The sole variable that was predictive of better reporting quality of RCTs was whether the study was published before or after CONSORT (incidence rate ratio 1.67, 95% CI 1.40 to 2.02). Completeness of reporting of RCTs only improved in 15 out of 36 items (41.6%) after the publication of CONSORT. CONCLUSION: The completeness of reporting in RCTs investigating inulin-type fructans supplementation on cardiovascular disease risk factors remains inadequate after the publication of CONSORT. Greater adherence to CONSORT by authors and enforcement of CONSORT by journals may improve the quality of reporting among RCTs.

Strategies of adults for dealing with feelings of guilt - findings from a large web-based survey.

BACKGROUND: Feelings of guilt are common in adulthood. Depending on the situation, individuals need different strategies for dealing with these usually unpleasant experiences. The aim of this study was to provide comprehensive empirical information about such different guilt-related strategies used in adulthood. PARTICIPANTS AND PROCEDURE: A cross-sectional web-based survey was conducted (05/2019-04/2020) collecting autobiographical information on guilt experiences. Stated strategies for dealing with feelings of guilt were classified into inductively defined categories, and the frequency of the categorized strategies was calculated (total, gender-, age-specific). Associations between applied strategies and gender and age were analyzed using Cramér's φ and V as appropriate. RESULTS: Analyzing statements of 579 participants (18-84 years), we differentiated 34 different categories of guilt-related strategies. The most frequently used strategies were "Self-reflection; contemplation; analyzing/reviewing things one feels guilty about" and "Repressing/ignoring/(actively) forgetting/not thinking about/bottling up the feelings of guilt". Female and male participants showed a significantly different use only in the strategy of utilizing "Professional support/therapy/counseling" (10.57% vs. 3.67%; Cramér's φ = .13, p = .001). Additionally, only a few differences were found with regard to age. CONCLUSIONS: Adults use a broad variety of different strategies for dealing with feelings of guilt. Strategies regulating emotional responses to the problem causing feelings of guilt seem to be at least as important as strategies targeting the problem itself. Many strategies do not serve pro-social functions. Feelings of guilt are an issue relevant for mental health care since several of the adults with feelings of guilt utilize professional help, and an even higher number may need such help.

Adverse Childhood Experiences and Primary Headache Disorders: A Systematic Review, Meta-analysis, and Application of a Biological Theory.

BACKGROUND AND OBJECTIVES: Headache disorders are among the leading causes of disability worldwide. While an association between adverse childhood experiences and primary headaches has been reported, the pooled magnitude across studies and pathways of the association are unknown. Our objectives were (1) to estimate the pooled effect of ≥1 adverse childhood experience (ACE) on primary headache disorders in adulthood and (2) to test the hypothesis that ACEs categorized as "threat" traumas or "deprivation" traumas have distinct effects on primary headaches based on a selected theory from our narrative review of how ACEs affect human development along the life course. METHODS: PubMed, EMBASE, MEDLINE, Web of Science, Google Scholar, Biological Psychiatry, and gray literature were searched up to March 16, 2023 (PROSPERO, CRD42020223403). Selected articles included (1) observational studies with a comparator group, (2) ACEs that occurred before 18 years of age, and (3) primary headaches occurring at or after 21 years of age. Pooled odds ratios (ORs) were calculated using multilevel linear random-effects modeling. The narrative review included theories that describe how ACEs affect human development and disease across the life course. We selected a theory from our narrative review and tested ACEs categorized according to this theory for any modification of point estimates. RESULTS: Our search identified 32 studies, of which 28 were eligible for meta-analysis (n = 154,739 participants, 19 countries). The occurrence of ≥1 adverse childhood experience(s) was associated with primary headaches (pooled OR = 1.48 [95% CI 1.36-1.61]; high-quality evidence, 134,696 participants). As the number of ACEs increased, the odds of primary headaches increased (range: 1 ACE OR = 1.24 [95% CI 1.14-1.35] to ≥4 ACEs OR = 2.09 [95% CI 1.83-2.38], p for trend <0.0001). From the narrative review, a neurodevelopmental theory that categorizes ACEs into threat or deprivation was tested, and both were independently associated with primary headaches (threat OR = 1.46 [95% CI 1.32-1.60] and deprivation OR = 1.35 [95% CI 1.23-1.49], respectively), accounting for heterogeneity (p = 0.021). DISCUSSION: This systematic review and meta-analysis confirm that ACEs are important risk factors of primary headache disorders in adulthood. Our findings provide epidemiologic support that ACEs categorized as threat and deprivation may manifest as distinct pathways of early adversity.

Individual- and supply-level macronutrient intakes are well correlated over a 50-year period (1961-2011) in 18 countries in Asia, North America, and Europe.

Reliable information on dietary trends is essential. We compared individual-level dietary estimates for total energy, carbohydrate, fat, and protein intake over time with national supply data from the Global Expanded Nutrient Supply Model (186 paired estimates from 1961 to 2011, 18 countries). We hypothesized that supply data would overestimate individual measures and that the two measures would be weakly correlated. Individual- and supply-level estimates were compared using Spearman correlation coefficients and linear mixed-effect models were used to estimate the differences between measures. Overall, the correlations between individual- and supply-level measures were moderate for energy (rs = 0.34) and carbohydrate (rs = 0.39), strong for fat (rs = 0.85), and protein (rs = 0.69). Trends in total energy measured by individual-level surveys and total energy supply were positively correlated in 38.9% of countries, whereas trends in macronutrients aligned between estimates in most countries. Supply-level dietary data overestimated individual-level intakes, especially in higher income countries in Europe and in the United States. In the United States, supply-level data exceeded individual-level estimates by 26.3% to 29.9% for energy, carbohydrate, and fat, whereas protein estimates were similar between measures. In Europe, supply-level estimates overestimated individual-level intake by 19.9% for energy, 17.0% for carbohydrate, 13.7% for fat, and 7.7% for protein, whereas estimates for energy and macronutrients were similar in Asia. In Asia and lower income countries, our findings generally support the use of supply-level data in the absence of individual-level data, though this finding may be related to smaller sample size and differences in underlying national statistics that inform supply data.

[Development of a self-report questionnaire for the measurement of stigmatizing attitudes of the psychiatric staff towards patients with borderline personality disorder]. / Entwicklung eines Selbstauskunftsfragebogens zur Erfassung stigmatisierender Einstellungen des psychiatrischen Personals gegenüber Patienten mit Borderline-Persönlichkeitsstörung.

OBJECTIVE: The development of a self-report questionnaire for quantitative measurement of stigmatizing attitudes of the psychiatric staff towards patients with borderline personality disorder. METHOD: Online survey with psychiatrists, psychologists and nursing staff (n=94) in the (semi-)stationary psychiatric sector with translated items of an attitude questionnaire, followed by a principal component analysis and correlations between principal components and social distance. RESULTS: Analyses revealed a 4-principal component structure (BPD-treatment difficulties, BPD-assessment of suicide risk, BPD-assumption of manipulative tendencies, BPD-negative emotions) with 63,60% explained variance and small to large correlations between principal components and social distance. CONCLUSION: Results initially indicate possible validity and reliability of the developed questionnaire. Further analyses with larger sample size and confirmatory factor analysis for continued development are advised.

Digital communication and virtual reality for extending the behavioural treatment of obesity - the patients' perspective: results of an online survey in Germany.

BACKGROUND: CBT has been found effective for the treatment of EDs and obesity. However not all patients achieve clinically significant weight loss and weight regain is common. In this context, technology-based interventions can be used to enhance traditional CBT but are not yet widespread. This survey therefore explores the status quo of pathways of communication between patients and therapists, the use of digital applications for therapy as well as attitudes towards VR from the perspective of patients with obesity in Germany. METHODS: This cross-sectional online survey was conducted in October 2020. Participants were recruited digitally through social media, obesity associations and self-help groups. The standardized questionnaire included items concerning current treatment, paths of communication with their therapists, and attitudes toward VR. The descriptive analyses were performed with Stata. RESULTS: The 152 participants were mostly female (90%), had a mean age of 46.5 years (SD = 9.2) and an average BMI of 43.0 kg/m² (SD = 8.4). Face-to-face communication with their therapist was considered of high importance in current treatment (M = 4.30; SD = 0.86) and messenger apps were the most frequently used digital application for communication. Participants were mostly neutral regarding the inclusion of VR methods in obesity treatment (M = 3.27; SD = 1.19). Only one participant had already used VR glasses as part of treatment. Participants considered VR suitable for exercises promoting body image change (M = 3.40; SD = 1.02). DISCUSSION: Technological approaches in obesity therapy are not widespread. Face-to-face communication remains the most important setting for treatment. Participants had low familiarity with VR but a neutral to positive attitude toward the technology. Further studies are needed to provide a clearer picture of potential treatment barriers or educational needs and to facilitate the transfer of developed VR systems into clinical practice.

CBT is the treatment of choice for a variety of psychological disorders, among them eating disorders and obesity. However not all patients benefit equally and weight-regain is frequent. Technology-based approaches like virtual reality can enhance traditional CBT, but they are not yet used very often in clinical practice. This study asked patients with obesity which digital methods of communication and treatment were part of their obesity therapy and whether they would welcome VR approaches in their therapy. 152 patients participated and reported a face-to-face communication with their therapist to be of high importance. Messenger apps (e.g. WhatsApp) were the most commonly used digital methods of communication. VR applications or wearables do not play a role in the respondents' therapy. Participants were mostly neutral toward VR technology but expressed positive expectations toward VR as part of body image therapy.

The relationship between weight history and psychological health-Differences related to gender and weight loss patterns.

BACKGROUND: The prevalence and burden of obesity continues to grow worldwide. Psychological comorbidities may not only influence quality of life, but may also hinder successful weight loss. The causality between excess weight and mental health issues is still not fully understood. The aim of the study was to investigate whetherweight history parameters, (ie.age of onset) are related to psychological comorbidities. METHOD: The data were derived from a representative telephone survey in Germany, collecting information on weight loss patterns and mental health outcomes among individuals with BMI>30kg/m2. Overall, 787 participants were examined in terms of depressive symptoms (Patient Health Questionnaire, PHQ-9) and anxiety (Generalized Anxiety Disorder Questionnaire, GAD7). In addition, participants were asked about different aspects of their weight history (ie. weight loss patterns and trajectories) over the lifespan. The relationship between weight history and mental health was analyzed using multivariate statistics. RESULTS: According to regression analyses, having had more weight loss attempts, a greater weight loss being desired and being a "weight maintainer" was associated with more symptoms of depression (p < 0.001), whereas a greater desired weight loss and being categorized as a "weight maintainer" was associated with more anxiety (p < 0.001). Moroever, the prevalence of depressive symptoms was significantly higher in male individuals who desire to lose more weight or had more weight loss attempts in the past. CONCLUSION: Gender-specific differences were observed in terms of weight history parameters, as well as mental health outcomes. Especially for men, weight loss patterns seem to be related to depressive symptoms. Concerning the overall results, it becomes clear that screening for weight history at the beginning of a multidisciplinary weight loss program in the context of gender-specific psychological comorbidities is important. The question remains why some aspects of weight history seem to be more important than others.

Changes in energy, macronutrient, and food consumption in 47 countries over the last 70 years (1950-2019): a systematic review and meta-analysis.

OBJECTIVES: We aimed to systematically examine trends in dietary energy, macronutrient, and food consumption in different geographic regions. METHODS: We searched Medline, Embase, CINAHL, and organizations for studies and reports using individual-level dietary assessments from 1950 to 2019 (PROSPERO CRD42022302843) and quantified changes using multivariable linear mixed-effects models. RESULTS: We identified 109 articles and reports from 47 countries, including Europe and Australasia (47% of studies), Asia (30%), Latin America (13%), the Middle East (6%), and North America (4%). In Southeast and East Asia, carbohydrate intake decreased, whereas fat consumption increased; the opposite pattern occurred in North America; and fat decreased while carbohydrate intake remained stable in Europe and Australasia. Consumption of carbohydrate and fat were stable in South Asia, Latin America, and the Middle East, but data were limited in these regions. A greater increase in national gross domestic product over time was associated with decreased carbohydrate and increased fat and protein intake. Dietary saturated fatty acid intake decreased in Northern and Eastern Europe and was stable in other regions. Changes in food varied by region; East and Southeast Asia increased meat, fish, dairy, egg, fruit, and vegetable consumption and decreased intake of grains, roots and tubers, legumes, whereas North America decreased dairy and red meat but increased eggs, nuts, poultry, and vegetable oil intake. Intakes of fruits, nuts, legumes, and roots and tubers were below recommendations in most regions. CONCLUSIONS: Our findings indicate regional variations in dietary trends and identify countries that would benefit from nutritional policies aimed at decreasing lower-quality carbohydrate foods and increasing consumption of fruits, vegetables, nuts, legumes, and dairy.

Cancer prevention in females with and without obesity: Does perceived and internalised weight bias determine cancer prevention behaviour?

BACKGROUND: Women with obesity are not only at higher risk of developing cancer such as gynaecological malignancies but are also less likely to attend cancer prevention screenings (CPS). In this study, we aimed to obtain a better database for Germany and to investigate whether women with obesity are less likely to undergo CPS compared to women without obesity. Moreover, we aimed to identify factors that determine CPS behaviour. METHODS: A quantitative cross-sectional telephone survey was conducted that assessed data of 1003 females in the general public with obesity (BMI ≥ 30 kg/m2; n = 500) and without obesity (BMI < 30 kg/m2; n = 503). We assessed participants' utilisation of cervical, breast, and colorectal CPS. Group differences were investigated by using Chi-Square tests, whereas influencing factors that might determine CPS behaviour were examined by multivariate logistic regression analyses. Therefore, logistic regression models for (a) the full sample and (b) the obese sample were conducted. Explanatory factors (i.e., cancer awareness, the internalisation of weight bias (WBIS) and perceived weight-based discrimination) were included. Confounding factors such as sociodemographic variables were included in the multivariate analysis. RESULTS: Women with obesity were less likely to undergo Pap smear (χ2(1) = 13.90, p < 0.001) and clinical breast examination (χ2(4) = 14.41, p < 0.01) compared to women without obesity. In contrast, the utilisation of all other CPS methods did not differ between women with and without obesity. Logistic regression analyses revealed neither an association between CPS behaviour and WBI nor perceived weight bias. Instead, previous cancer diagnoses and knowledge about CPS forms were found to reinforce CPS behaviour. CONCLUSION: Although data did not suggest that internalised or perceived weight bias deter women with obesity from undergoing CPS, the role of weight bias has not yet been conclusively clarified. Future studies should address potential methodological limitations and evaluate the effectiveness of most recently established cancer prevention programs and in particular how they affect CPS behaviour in women with obesity.

The wide variety of reasons for feeling guilty in adults: findings from a large cross-sectional web-based survey.

BACKGROUND: Experiencing some sort of guilt is a common phenomenon in adulthood. As feeling guilty is usually unpleasant and may even lead to further negative psychological consequences like depression, the aim of this study was to provide comprehensive information on the reasons for such feelings in adults. METHODS: A cross-sectional web-based survey was conducted between May 2019 and April 2020, collecting qualitative information on reasons for feeling guilty in n = 604 adults (mean/SD age = 45.3/16.4 years; n = 346/57.3% women, n = 255/42.2% men and n = 3/0.5% adults without identification with a particular gender). Stated reasons were inductively classified into (super-)/categories, and information on frequency and percentage (total, gender- and age-specific) for each of these (super-)/categories was provided. RESULTS: Participants altogether stated 1515 reasons for feeling guilty that were classified into 12 supercategories and 49 categories. "Telling lies/withholding truth/information" followed by "Not spending (enough) time with family (members)/Not taking (enough) care of family (members)/not being there for family (members)" were the most frequent categories of reasons for feeling guilty in the sample. Guilt feelings explicitly referring to "religious beliefs" or a "subjectively perceived more general responsibility'" (e.g., for society, humankind, problems of the world), by contrast, were of minor importance. Male and female participants as well as participants of different ages showed similarities but also several differences in stated reasons for feeling guilty. Female participants, for example, more often experienced feelings of guilt related to family members, children and to some kind of general responsibility for the wellbeing of others, whereas male participants felt guilty more often because of some kind of misconduct/mistakes being made or because of difficulties in marriage/relationship. CONCLUSIONS: Adults can feel guilty for a wide variety of different reasons. Most reasons seem to be rather concrete (e.g., related to concrete negative self-attributions/flaws or to concrete social situations with concrete individuals). There also seem to be some age- and gender-related differences in reasons for feeling guilty.

Attitude of Nutrition Experts Toward Psychotherapy and Virtual Reality as Part of Obesity Treatment-An Online Survey.

Background: The management of obesity requires lifestyle-based interventions covering nutrition, physical activity, and behavior. As part of cognitive behavioral therapy (CBT), body image therapy approaches can be used not only by psychotherapists. One tool to conduct behavioral therapy is virtual reality (VR). It is unknown, whether nutrition experts conduct behavioral therapy, and whether they would like to use VR technology as a tool to conduct body image therapy as part of obesity management. Objective: This survey aimed to collect data from nutrition experts treating people with obesity about the status quo regarding behavioral and body image therapy as part of obesity management, and regarding their attitude toward VR in obesity therapy. Methods: The survey was conducted online in autumn 2020. Participants were recruited digitally through expert and professional associations. The standardized questionnaire included items concerning sociodemographic, professional status, behavioral therapy, body image, and VR. The descriptive analysis was performed with Excel, the subgroup analyses with R. Results: Data from 158 nutrition experts was analyzed. Participants were mostly female (98/102, 96.1%) and had a mean age of 45.6 ± 11.3 years (n = 101). Most of the survey participants (93/124, 75.0%) stated to use behavioral treatment methods in case of weight reduction as the primary target. More than half of the participants stated to address body image (99/150, 66.0%). Almost all (111/112, 99.1%) nutrition experts have never used VR-glasses. The suitability and importance of VR technology as part of obesity therapy was estimated as neutral by around 50%. Overall, no statistically significant difference could be shown between age groups regarding attitudes toward VR in obesity treatment. Conclusion: The results of this non-representative survey indicate that nutrition experts do not use VR technology in nutrition counseling sessions to treat obesity. In addition, survey participants have a positive attitude to VR technology, whereas they are not familiar with this technology. In future, VR technology might support nutrition experts of every age using elements of body image therapy. Survey Registration: The German Register of Clinical Studies (Registration Number: DRKS00022853).

Serum metabolomic signatures of gestational diabetes in South Asian and white European women.

INTRODUCTION: This study aimed to identify serum metabolomic signatures associated with gestational diabetes mellitus (GDM), and to examine if ethnic-specific differences exist between South Asian and white European women. RESEARCH DESIGN AND METHODS: Prospective cohort study with a nested case-control analysis of 600 pregnant women from two Canadian birth cohorts; using an untargeted approach, 63 fasting serum metabolites were measured and analyzed using multisegment injection-capillary electrophoresis-mass spectrometry. Multivariate logistic regression modeling was conducted overall and by cohort. RESULTS: The proportion of women with GDM was higher in South Asians (27.1%) compared with white Europeans (17.9%). Several amino acid, carbohydrate, and lipid pathways related to GDM were common to South Asian and white European women. Elevated circulating concentrations of glutamic acid, propionylcarnitine, tryptophan, arginine, 2-hydroxybutyric acid, 3-hydroxybutyric acid, and 3-methyl-2-oxovaleric acid were associated with higher odds of GDM, while higher glutamine, ornithine, oxoproline, cystine, glycine with lower odds of GDM. Per SD increase in glucose concentration, the odds of GDM increased (OR=2.07, 95% CI 1.58 to 2.71), similarly for metabolite ratios: glucose to glutamine (OR=2.15, 95% CI 1.65 to 2.80), glucose to creatinine (OR=1.79, 95% CI 1.39 to 2.32), and glutamic acid to glutamine (OR=1.46, 95% CI 1.16 to 1.83). South Asians had higher circulating ratios of glucose to glutamine, glucose to creatinine, arginine to ornithine, and citrulline to ornithine, compared with white Europeans. CONCLUSIONS: We identified a panel of serum metabolites implicated in GDM pathophysiology, consistent in South Asian and white European women. The metabolic alterations leading to larger ratios of glucose to glutamine, glucose to creatinine, arginine to ornithine, and citrulline to ornithine in South Asians likely reflect the greater burden of GDM among South Asians compared with white Europeans.

A Structured Intervention for Medical Students Significantly Improves Awareness of Stigmatisation in Visible Chronic Skin Diseases: A Randomised Controlled Trial.

People with visible skin diseases often experience stigmatisation. The aim of this study was to develop and evaluate a new intervention for medical students to counter the stigmatisation of people with skin diseases. The intervention was evaluated using a randomised controlled design. Effectiveness was assessed at 3 time points. Data from 127 participants were analysed. Regarding the outcome "social distance", a significant difference between the measurement points was observed for the intervention group (χ2(2) = 54.32, p < 0.001), which also showed a significant effect on agreement with negative stereotypes (F(1.67, 118.67) = 23.83, p < 0.001, partial η2 = 0.25). Regarding the outcome "agreement with disease-related misconceptions", a significant difference between the measurement time points was observed for the intervention group (χ2(2) = 46.33, p < 0.001); similar results were found for the outcome "stigmatising behaviour" (F(1.86, 131.89) = 6.16, p = 0.003, partial η2 = 0.08). The results should encourage medical faculties to invest in such courses in order to prevent stigmatisation of people with skin diseases.

Efficacy of DiaLife, an Education Program for Relatives of Adults with Diabetes - A Cluster Randomized Controlled Trial.

OBJECTIVE: Diabetes affects the lives of patients and their close relatives. Considering the proven benefit of patient education programs, DiaLife was elaborated as the first German education program addressing the needs of relatives. The objective of this study was to investigate its efficacy. METHODS: The evaluation was implemented in the form of a cRCT with longitudinal design and waiting list condition.In total, 179 relatives were recruited. Participants' diabetes-related knowledge was defined as the primary outcome. Diabetes-related strains, family interaction and other psychosocial factors were determined as secondary outcomes. RESULTS: A generalized estimating equation model showed a persistent increase of diabetes-related knowledge in the intervention group compared to the control group regardless of the type of diabetes. Concerning secondary outcomes, mixed linear models showed an improvement for relatives of people with type 2 diabetes who participated in the DiaLife program. CONCLUSION: This study provides evidence of DiaLife's efficacy regarding a persistent increase of diabetes-related knowledge and a positive effect on psychosocial outcomes in relatives of people with type 2 but not in type 1 diabetes. Adding (an)other psychosocial module(s) might improve their well-being and psychosocial outcomes. PRACTICE IMPLICATIONS: Diabetes centers should consider implementing an education program for relatives, such as DiaLife, in their curriculum. TRIAL REGISTRATION: The study was registered at the German Clinical Trials Register (DRKS00015157; date of registration: 24.08.2018).

Weight Stigma and Disease and Disability Concepts of Obesity: A Survey of the German Population.

INTRODUCTION: Recent years have witnessed a medicalization of obesity, promoting a classification as a disease or disability in order to reduce or protect against weight stigma and discrimination. This study sought to investigate the public understanding of the disability and disease concepts in obesity, their acceptance, and association with weight stigma. METHODS: In a representative German population sample (n = 2,524), public views of obesity as a disease or disability were assessed via a self-report questionnaire. For the assessment of weight stigma, the Weight Control/Blame subscale from the Antifat Attitudes Test was used. RESULTS: A significantly greater acceptance of the disease than the disability concept was found (37.1 vs. 15.4%). Both disease and disability were mainly viewed as physical conditions, although one-third also viewed obesity as a mental disease. While agreement with the disease concept - especially of physical and genetic disease - significantly predicted lower weight stigma; agreement with the disability concept - especially of mental or intellectual disability - predicted higher weight stigma. CONCLUSIONS: These results suggest a careful use of the disease and disability terms and precise definitions. The disability concept in particular carries notions that are publicly devalued.

Effectiveness of a structured short intervention against stigmatisation in chronic visible skin diseases: Results of a controlled trial in future educators.

BACKGROUND: Chronic visible skin diseases are highly prevalent, and patients affected frequently report feeling stigmatised. Interventions to reduce stigmatisation are rare. OBJECTIVES: This study aimed to evaluate the effectiveness of a structured short intervention in reducing stigmatising attitudes towards psoriasis in future educators. METHODS: The intervention consisted of four components: (1) self-reflection, (2) education on skin diseases, (3) contact between participants and a person with psoriasis and (4) practising of knowledge via case studies. A quasi-experimental, pre-post study design was chosen with a nonrandomized contemporaneous control group that attended regular lessons. The main outcomes were participants' desire for social distance, stereotype endorsement, illness-related misconceptions and intended behaviour. Intervention effects were analysed using mixed repeated-measures analysis of variance, with Bonferroni post-hoc tests for pairwise comparisons. RESULTS: The sample consisted of 221 students attending vocational training as educators (n = 118 intervention group, n = 103 control group). While no effect of the intervention was found in social distance, small to large effect sizes were observed for intended behaviour (r = .14), illness-related misconceptions (r = .28) and stereotype endorsement (r = .42). The intervention group reported significantly higher satisfaction with the seminar compared to the control group. CONCLUSIONS: Overall, the short intervention was effective at reducing stigmatising attitudes in future educators. In perspective, revised versions could help in reducing stigmatisation in various demographics and promote patient empowerment by acknowledging and including them as experts on their own behalf. PATIENT OR PUBLIC CONTRIBUTION: Patient advocate groups were consulted and involved in the superordinate destigmatization research programme and intervention.

Using a brief web-based 5A intervention to improve weight management in primary care: results of a cluster-randomized controlled trial.

BACKGROUND: The primary health care setting is considered a major starting point in successful obesity management. However, research indicates insufficient quality of weight counseling in primary care. Aim of the present study was to implement and evaluate a 5A online tutorial aimed at improving weight management and provider-patient-interaction in primary health care. The online tutorial is a stand-alone low-threshold minimal e-health intervention for general practitioners based on the 5As guidance for obesity management by the Canadian Obesity Network. METHODS: In a cluster-randomized controlled trial, 50 primary care practices included 160 patients aged 18 to 60 years with obesity (BMI ≥ 30). The intervention practices had continuous access to the 5A online tutorial for the general practitioner. Patients of control practices were treated as usual. Primary outcome was the patients' perspective of the doctor-patient-interaction regarding obesity management, assessed with the Patient Assessment of Chronic Illness Care before and after (6/12 months) the training. Treatment effects over time (intention-to-treat) were evaluated using mixed-effects linear regression models. RESULTS: More than half of the physicians (57%) wished for more training offers on obesity counseling. The 5A online tutorial was completed by 76% of the physicians in the intervention practices. Results of the mixed-effects regression analysis showed no treatment effect at 6 months and 12 months' follow-up for the PACIC 5A sum score. Patients with obesity in the intervention group scored lower on self-stigma and readiness for weight management compared to participants in the control group at 6 months' follow-up. However, there were no significant group differences for weight, quality of life, readiness to engage in weight management, self-stigma and depression at 12 months' follow-up. CONCLUSION: To our knowledge, the present study provides the first long-term results for a 5A-based intervention in the context of the German primary care setting. The results suggest that a stand-alone low-threshold minimal e-health intervention for general practitioners does not improve weight management in the long term. To improve weight management in primary care, more comprehensive strategies are needed. However, due to recruitment difficulties the final sample was smaller than intended. This may have contributed to the null results. TRIAL REGISTRATION: The study has been registered at the German Clinical Trials Register (Identifier: DRKS00009241 , Registered 3 February 2016).

Cannabis Consumption, Purchasing and Sources among Young Canadians: The Cannabis Purchase and Consumption Tool (CPCT).

BACKGROUND: Despite its extensive use, there is a paucity of research on consumption and purchasing patterns of cannabis, especially by modes of delivery. OBJECTIVE: To assess the self-reported use and frequency of use of 12 different cannabis modes of delivery, their associated purchase sources, self-reported price, average consumption amount, and knowledge of THC and CBD levels. METHODS: The Cannabis Purchase and Consumption Tool, an online survey, sampled Canadians 16-30 years old (N = 868) in October 2017. Final sample included participants reporting use of any mode of cannabis within the past 30-days (N = 185). RESULTS: The most common modes of delivery were dried herb that was either smoked or vaporized, and cannabis edibles. Use of hashish, hash oil and other concentrates followed, while liquids, tinctures, topical ointments, and fresh flower/leaf were used less frequently. Average dried herb consumption was 17.8 g/month, 17.4 g/month, and 9.4 g/month among licensed medical, non-licensed medical, and non-medical cannabis users, respectively. At last time of purchase, participants paid an average of $17.97/gram for dried herb. 31.5% of current users reported knowing THC and 13.2% CBD levels of their cannabis. CONCLUSIONS: Youth and young adults report a wide diversity of cannabis products and modes of administration. Traditional measures that rely primarily on frequency of use may be inadequate to assess the rapidly evolving cannabis market, particularly given policy changes, including legalization of non-medical cannabis.

[Lifetime Prevalence of Feelings of Guilt in the German Adult Population - Results of a Nation-Wide Telephone Survey]. / Die Lebenszeitprävalenz von Schuldgefühlen in der deutschen Erwachsenenbevölkerung ­ Ergebnisse einer bundesweiten telefonischen Bevölkerungsbefragung.

OBJECTIVE: To provide information on lifetime prevalence of feelings of guilt in the German adult population based on data from a nation-wide telephone survey (n = 1.003; 18+ years; May-June 2019). METHODS: We calculated weighted lifetime prevalence rates with confidence intervals (95 %-CI) and used multivariable logistic regression analyses to evaluate the association of guilt feelings with covariates. RESULTS: We identified a weighted lifetime prevalence of experienced feelings of guilt of 68.5 % (95 %-CI = 65.6-71.3). Younger age, higher education and current depressive symptoms were associated with higher prevalence rates. No association was found with regard to gender and major depression. CONCLUSION: A substantial part of the adult population experienced some sort of guilt feelings in their lives. Further research efforts are required to answer the question whether feelings of guilt are only a criterion of depression or whether they may contribute to an increased risk of the disorder.