Psychosocial burden of autoimmune blistering diseases: A comprehensive survey study.

BACKGROUND: Autoimmune blistering diseases (AIBDs) are severe dermatologic disorders known for their debilitating physical impact. Recent research has reported that AIBDs lead to psychosocial impairment, including depression and anxiety. Missing from the extant literature is an examination of the impact of AIBDs on body image and related psychological constructs. OBJECTIVES: The current study seeks to characterize the psychological and social consequences of AIBD diagnosis, with particular attention to body image dissatisfaction. METHODS: We conducted a survey study of adults with AIBDs. The survey was open from February 2023 to March 2023. Validated self-report questionnaires assessed depressive symptomatology, body image disturbance and quality of life. Demographic information and self-reported psychiatric history before and after AIBD diagnosis were collected via self-report. Participants were 451 adults with AIBDs, recruited through the International Pemphigus and Pemphigoid Foundation newsletters, email distribution lists and social media. RESULTS: Participants reported increased incidence of psychiatric disorders following AIBD diagnosis. Participants reported high levels of depressive symptomatology and impairments to quality of life compared to other patient groups. The sample reported extremely high levels of body image disturbance, more so than other patients with disfiguring diseases or injury. Correlation analyses revealed significant relationships between body image variables and quality of life, even after controlling for depression. CONCLUSIONS: Current treatment guidelines for AIBDs focus primarily on the management of disease flares and the consequences of immunosuppression, without consideration of the psychosocial consequences of the disease. The current study underscores the need for mental health support for patients with AIBDs.

Associations between mukbang viewing and disordered eating behaviors.

OBJECTIVE: Mukbang videos are a popular cultural phenomenon that often feature a host consuming large amounts of food to entertain an audience. We aim to examine the relationship between mukbang viewing characteristics and eating disorders symptoms. METHODS: Eating disorder symptoms were evaluated using the eating disorders examination-questionnaire. Frequency of mukbang viewing, average watch time per occasion, tendency to eat while watching mukbang, and problematic mukbang viewing (using the Mukbang Addiction Scale) were assessed. We used multivariable regressions to estimate associations between mukbang viewing characteristics and eating disorder symptoms, adjusting for gender, race/ethnicity, age, education, and BMI. We used social media to recruit adults who watched mukbang at least once during the past year (n = 264). RESULTS: A total of 34% of participants reported watching mukbang daily or almost daily, with mean watch time per viewing session being 29.94 min (SD = 1.00). Eating disorder symptoms, especially binge eating and purging, were associated with greater problematic mukbang viewing and a tendency to not consume food while viewing mukbang. Participants with greater body dissatisfaction watched mukbang more frequently and were more likely to eat while watching mukbang, yet they scored lower on the Mukbang Addiction Scale and watched fewer average minutes of mukbang per viewing occasion. DISCUSSION: In a world increasingly penetrated by online media, our findings linking mukbang viewing and disordered eating may inform clinical diagnoses and treatments of eating disorders. Future studies establishing directionality of the relationship between mukbang viewing behaviors and eating disorder pathology are warranted. PUBLIC SIGNIFICANCE: Mukbang videos often feature a host consuming large amounts of food. Using a questionnaire assessing mukbang viewing behaviors and disordered eating pathology, we found associations between certain viewing habits and disordered eating symptoms. Given the health consequences of eating disorders and potentially problematic consequences of certain online media, this study can inform clinical understanding of individuals with disordered eating who engage in certain online media, like mukbang.

Preoccupation in bulimia nervosa, binge-eating disorder, anorexia nervosa, and higher weight.

OBJECTIVE: Preoccupation (excessive and constant thoughts) about shape/weight and food/eating is thought to be prominent in individuals with eating disorders but has received much less research than overt behavioral features. This study examined the significance and distinctiveness of different foci of preoccupation in individuals categorized with different forms of eating disorders and in individuals with higher weight. METHOD: Participants (N = 1,363) completed a web-based survey with established measures of eating-disorder psychopathology and depression. The current study compared preoccupation among individuals with core features of bulimia nervosa (BN; n = 144), binge-eating disorder (BED; n = 576), anorexia nervosa (AN; n = 48), and higher body weight (body mass index [BMI] ≥ 25) without eating-disorder features (higher weight [HW]; n = 595). Associations of each type of preoccupation with other eating-disorder psychopathology and depression were examined both between and within study groups. RESULTS: Preoccupation with shape/weight and with food/eating showed a graded pattern of statistically significant differences: AN and BN had higher preoccupation than BED, which was higher than HW. Within BN, BED, and AN study groups, correlation magnitudes of shape/weight and food/eating preoccupation with eating-disorder psychopathology and depression did not differ significantly. Within the HW group, shape/weight preoccupation was significantly more strongly correlated than food/eating preoccupation with overvaluation, body dissatisfaction, and depression. DISCUSSION: The preoccupation cognitive style, as well as focus, appears associated with other facets of eating-disorder psychopathology and depression. If results are confirmed among individuals with formal diagnoses, clinicians addressing maladaptive cognitions in cognitive-behavioral therapy should consider the role of preoccupation. Future research should investigate whether preoccupation predicts or moderates eating disorder treatment outcomes.

Development of a Parent-Reported Outcome Measure for Febrile Infants ≤60 Days Old.

OBJECTIVE: We aimed to develop a parent-reported outcome measure for febrile infants 60 days or younger evaluated in the emergency department. METHODS: We conducted a 3-part study: (1) individual, semistructured interviews with parents of febrile infants 60 days or younger to generate potential items for the measure; (2) expert review with pediatric emergency medicine physicians and member checking with parents, who rated each item's clarity and relevance using 4-point scales; and (3) cognitive interviews with a new sample of parents, who gave feedback and rated the measure's ease of use on a 4-point scale. The measure was iteratively revised during each part of the development process. RESULTS: In part 1, we interviewed 24 parents of 21 infants. Interviews revealed several themes: parents' experiences with medical care, communication, and decision making; parents' emotions, particularly worry, fear, and stress; the infant's outcomes valued by parents; and the impact of the infant's illness on the family. From these themes, we identified 22 potential items for inclusion in the measure. In part 2, 10 items were revised for clarity based on feedback from physicians and parents, primarily under the domains of parents' emotions and the infant's outcomes. In part 3, we further revised the measure for clarity and added an item. The final measure included 23 items and was rated as excellent in its ease of use. CONCLUSIONS: The 23-item parent-reported outcome measure includes the experiences and outcomes important to parents. Further studies are needed to evaluate the measure's psychometric properties.

The Patient Care Ownership Scale: External Validation of an Instrument that Measures Patient Care Ownership Among Internal Medicine Trainees-a Multi-Institutional Study.

BACKGROUND: Patient care ownership improves accountability, clinical skills, and quality of patient care among resident physicians, but appears to be gradually eroding. Research is limited by the lack of a reliable, objective measure of ownership. OBJECTIVE: To validate the Patient Care Ownership Scale, an instrument that measures decision ownership among internal medicine residents. DESIGN: Multi-institutional, cross-sectional study using a 66-item, online survey that queried residents on ownership's key constructs (advocacy, responsibility, accountability, follow-through, knowledge, communication, initiative, continuity of care, autonomy, self-efficacy, and perceived ownership) as well as mood and burnout. PARTICIPANTS: Internal medicine residents in five geographically diverse residency programs completing an inpatient rotation. MAIN MEASURES: We performed exploratory and confirmatory factor analysis in two randomly split groups to evaluate for subscales and inform item reduction. We conducted reliability testing with Cronbach's α. We performed bivariate analyses to examine construct validity and identify correlates of ownership. KEY RESULTS: Of the 785 eligible residents, 625 completed the survey (80% response rate); we included responses from 563 in the analysis. We identified three factors corresponding to assertiveness, conscientiousness, and confidence or perceived competence. After iterative item reduction, the 13-item ownership scale demonstrated good reliability (Cronbach's α = 0.82). Convergent validity was supported by a significant association with perceived ownership (eliminated from the final scale) (r = 0.67, p < 0.001). There was a positive association between ownership and training level (p < 0.01) and prior experience in the intensive care unit (p < 0.001). There were significant, inverse relationships between ownership and self-defined burnout (r = - 0.24, p < 0.001), depression (r = - 0.22, p < 0.001), detachment (r = - 0.26, p < 0.001), and frustration (r = - 0.15, p = 0.02), and significant positive associations between ownership and feeling energetic (r = 0.29, p < 0.001), happy (r = 0.33, p < 0.001), and fulfilled (r = 0.34, p < 0.001). CONCLUSIONS: The Patient Care Ownership Scale is valid in diverse residency program settings. Medical educators and investigators can use our scale to assess interventions aimed at fostering ownership.

Examining sex as a predictor and moderator of treatment outcomes for binge-eating disorder: Analysis of aggregated randomized controlled trials.

OBJECTIVE: This study examined whether sex predicted and/or moderated treatment outcomes among men and women who participated in binge-eating disorder (BED) randomized controlled trials (RCTs). METHOD: Data were aggregated from RCTs performed at one medical center. RCTs tested cognitive-behavioral therapy, behavioral weight loss, multimodal treatment, and/or control conditions. Participants were 660 adults, both men (n = 170) and women (n = 490), with Diagnostic and Statistical Manual-fourth edition (DSM-IV)-defined BED. Doctoral-level research-clinicians assessed participants using structured interviews and established self-report measures of eating-disorder psychopathology and depression, and measured height and weight. Assessments occurred at baseline, throughout treatment, and at post-treatment. RESULTS: Sex was not a significant moderator of any treatment outcomes. Mixed models revealed sex had a main effect: men had lower eating-disorder psychopathology and lost more weight than women over the course of treatment. DISCUSSION: Both epidemiological and RCT studies report disparities in treatment-seeking between men and women with BED. Despite this, men have comparable or better treatment outcomes compared with women, including significantly greater weight loss. Thus, disseminating evidence-based BED treatments is promising for both men and women. Additional research is necessary, however, to understand treatment effects-including other predictors and moderators of outcomes-across diverse providers, treatment settings, and patient groups.

Why Travel for Complex Cancer Surgery? Americans React to 'Brand-Sharing' Between Specialty Cancer Hospitals and Their Affiliates.

INTRODUCTION: Leading cancer hospitals have increasingly shared their 'brand' with smaller hospitals through affiliations. Because each brand evokes a distinct reputation for the care provided, 'brand-sharing' has the potential to impact the public's ability to differentiate the safety and quality within hospital networks. The general public was surveyed to determine the perceived similarities and differences in the safety and quality of complex cancer surgery performed at top cancer hospitals and their smaller affiliate hospitals. METHODS: A national, web-based KnowledgePanel (GfK) survey of American adults was conducted. Respondents were asked about their beliefs regarding the quality and safety of complex cancer surgery at a large, top-ranked cancer hospital and a smaller, local hospital, both in the presence and absence of an affiliation between the hospitals. RESULTS: A total of 1010 surveys were completed (58.1% response rate). Overall, 85% of respondents felt 'motivated' to travel an hour for complex surgery at a larger hospital specializing in cancer, over a smaller local hospital. However, if the smaller hospital was affiliated with a top-ranked cancer hospital, 31% of the motivated respondents changed their preference to the smaller hospital. When asked to compare leading cancer hospitals and their smaller affiliates, 47% of respondents felt that surgical safety, 66% felt guideline compliance, and 53% felt cure rates would be the same at both hospitals. CONCLUSIONS: Approximately half of surveyed Americans did not distinguish the quality and safety of surgical care at top-ranked cancer hospitals from their smaller affiliates, potentially decreasing their motivation to travel to top centers for complex surgical care.

Tobacco use increases risk of food insecurity: An analysis of continuous NHANES data from 1999 to 2014.

Tobacco use is a major health disparities issue in the United States; it is much more common in less-educated and lower-income groups. These groups also experience a higher prevalence of food insecurity. Previous studies analyzing the association between tobacco use and food insecurity have focused on only cigarettes. We assessed the relationship between food insecurity and use of cigarettes, alternative tobacco products (cigars, electronic cigarettes, smokeless tobacco), any tobacco product, and multiple tobacco products. Using National Health and Nutrition Examination Survey data from 1999 to 2014, we built multinomial logistic regression models predicting degree of food security (i.e., food security, low food security, very low food security) for use of different tobacco product types, any product, and multiple products. After adjustment, use of any product, relative to no use, was significantly associated with increased odds of both food insecurity outcomes: low (adjusted odds ratio (AOR) = 1.2, 95% confidence interval (CI): 1.0-1.4) and very low (AOR = 1.8, 95% CI: 1.6-2.2) food security. In a separate model, single product use, relative to no use, was significantly associated with increased odds of low (AOR = 1.5, 95% CI: 1.3-1.7) and very low (AOR = 2.2, 95% CI: 1.9-2.6) food security. For multiple product use the magnitude of association was higher for very low food security (AOR = 2.7, 95% CI: 1.8-4.0). The significant associations identified here can inform researchers and policymakers developing interventions to prevent tobacco- and food insecurity-related diseases. To be effective in reducing either health risk, interventions may need to target both tobacco use and food insecurity.

Examining physical activity and correlates in adults with healthy weight, overweight/obesity, or binge-eating disorder.

OBJECTIVE: To examine physical activity and correlates among three subgroups of adults: healthy weight without binge eating (HW), overweight/obesity without binge eating (OW/OB), and core features of binge-eating disorder (BED). METHOD: Participants (N = 2,384) completed an online survey with established measures of physical activity, eating psychopathology, and health. Most participants were White (82.6%) women (66.7%). Participants were categorized into three study groups: HW (n = 948; 39.9%), OW/OB (n = 1,308; 55.1%), and BED (n = 120; 5.1%). RESULTS: The BED group had the highest proportion of self-reported insufficiently active individuals (63.8%), followed by OW/OB (41.7%), and HW (29.2%). Associations between self-reported physical activity, eating pathology, and health were generally small in HW and OW/OB groups, whereas associations were moderate in the BED group. Self-reported weekly bouts of physical activity were more strongly, positively related to self-reported physical health for OW/OB than HW, and this effect was even more pronounced for BED compared with HW or OW/OB. DISCUSSION: This is the first study, to our knowledge, to demonstrate a stronger association between self-reported physical activity and physical health for individuals with BED compared with OW/OB alone. The high rate of physical inactivity and the strong association between physical activity and health among participants with BED suggest physical activity as an important treatment target for individuals with BED.

Weighty decisions: How symptom severity and weight impact perceptions of bulimia nervosa.

OBJECTIVE: The current study examined whether variations in patient weight and eating-disorder behavior frequency influenced the recognition of bulimia nervosa (BN) and the perception that it is a serious mental health concern. METHOD: Participants (N = 320) were randomly assigned to one of six conditions in which they read a vignette describing a young woman with BN. Each vignette was identical except for the variables of interest: weight status (underweight, healthy-weight, and overweight), and symptom frequency (daily or weekly binge-eating episodes and purging). RESULTS: Participants were more likely to have negative attitudes toward and blame the patient with overweight. Participants were less likely to believe that the patient with overweight was experiencing mental illness and that her problems were too serious to handle on her own. There were no significant differences by symptom frequency. DISCUSSION: Findings suggest the presence of weight stigma and that overweight might impede the recognition of eating disorders.

Ingredient bundles and recipe tastings in food pantries: a pilot study to increase the selection of healthy foods.

OBJECTIVE: The present study examined the effect of ingredient bundles (i.e. measured ingredients with recipes) and recipe tastings as a strategy to increase the selection of healthy, target foods (kale, brown rice and whole-wheat pasta). DESIGN: Each of the three conditions was tested once per week for three weeks. The conditions were: Treatment 1 (T1), recipe tastings only; Treatment 2 (T2), ingredient bundle plus recipe tastings; and Control, no intervention. SETTING: A food pantry in Bridgeport, CT, USA.ParticipantsFood pantry clients. RESULTS: Controlling for family size and intervention week, the likelihood of clients in T2 (n 160) selecting at least one target item compared with the Control group (n 160) was 3·20 times higher for kale, 4·76 times higher for brown rice and 7·25 times higher for whole-wheat pasta. Compared with T1 (n 128), T2 clients were 2·67 times more likely to select kale, 7·67 times more likely to select brown rice and 11·43 times more likely to select whole-wheat pasta. No differences between T1 and the Control group were found. CONCLUSIONS: Findings suggest that innovative, nudging strategies such as ingredient bundles may increase appeal of foods and encourage pantry clients to select healthier options.

An exploratory study on the intergenerational transmission of obesity and dieting proneness.

PURPOSE: There is a paucity of research exploring individuals' memories of parental dieting behavior, engagement in "fat talk", or criticism of weight or eating behavior in childhood. This exploratory study utilized a community sample to further characterize the retrospective report of parenting dieting behavior. METHODS: A total of 507 participants (78.1% females; 20.7% males; and 1.2% transgender) were recruited to participate in an online, self-administered survey. RESULTS: Forty percent (216) of participants reported maternal dieting in their family of origin and 34% (182) reported maternal fat talk, 24% (120) reported paternal dieting, and 11% recalled paternal 'fat talk' (58). Subgroup analyses suggest that both male and female participants had greater odds of remembering maternal rather than paternal weight or shape criticism and encouragement to diet (OR = 58.1; and OR = 3.12; p < 0.0001 for male and female participants, respectively). Retrospective report of indirect parental behaviors (e.g. parental dieting) also appears to be associated with direct parental behaviors (e.g. encouraging children to diet). Additionally, participants who recalled maternal encouragement to diet reported a significantly higher adult BMI (ß = 1.31, SE = 0.32, p < 0.0001). CONCLUSION: Results provide preliminary evidence that a sizeable percentage of both adult male and female participants recalled that their parents engaged in fat talk and dieting. In addition, participants recalled parental criticism of their own weight or eating behaviors, which was associated with recall of parental dieting and fat talk. LEVEL OF EVIDENCE: Level V, Descriptive Study.

Household food insecurity is associated with binge-eating disorder and obesity.

BACKGROUND: Food insecurity stems from limited financial resources. Yet, paradoxically, food insecurity is associated with overeating and excess weight. One subcategory of overeating is binge eating, which includes eating an unusually large amount of food while feeling a concurrent sense of loss of control. Associations between binge-eating disorder and food insecurity are not known, yet this is important to examine because binge eating is associated with more severe mental and physical health problems than overeating or obesity alone. METHOD: Survey respondents (N = 1,250) were recruited online. Participants were categorized into study groups: healthy weight (HW), binge-eating disorder (BED), and obesity (OB). Using HW as a reference group, hierarchical logistic regressions evaluated the extent to which low and very low food security were associated with BED and OB. RESULTS: Low food security and very low food security were both associated with increased likelihood of BED and OB group membership. CONCLUSIONS: Results highlight the need to devote resources towards policy revisions, preventative interventions, and psychiatric treatments aimed at decreasing the overall association of food insecurity with BED and obesity among low-income Americans.

Sex Differences and Correlates of Pain in Patients with Comorbid Obesity and Binge Eating Disorder.

Sex differences and correlates of pain were examined in a sample of patients with comorbid binge eating disorder (BED) and obesity. One hundred fifty-two treatment-seeking patients with BED completed the Brief Pain Inventory. Analysis of covariance was utilized to compare women and men on pain, and correlational analysis, overall and by sex, was performed to examine relationships among pain, eating behaviour and metabolic risk factors. Women reported significantly greater pain severity and pain interference than men. Among women, eating behaviour and metabolic markers were not associated with pain. Among men, however, binge frequency was significantly associated with pain, as was high-density lipoprotein cholesterol and fasting glucose. In sum, while women in this sample had more pain than men, the presence of pain in men was associated with increased behavioural and metabolic risk factors. Findings have clinical implications for the assessment of comorbid pain and obesity-related health risks among individuals with BED.

Biopsychosocial Correlates of Binge Eating Disorder in Caucasian and African American Women with Obesity in Primary Care Settings.

This study examined racial differences in eating-disorder psychopathology, eating/weight-related histories, and biopsychosocial correlates in women (n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating-disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients.

Development and Psychometric Evaluation of a Self-Administered Questionnaire to Assess Parental Attitudes Toward Firearms and Related Parenting Decisions.

The study sought to develop and evaluate the psychometric properties of the Parental Attitudes Toward Firearms Survey (PATFS), a self-report measure of parental attitudes about firearms and parenting behavior. The initial item pool was generated based on a literature review and discussion with experts in violence reduction, psychometrics, and public health. Data were collected online from 362 volunteers and subjected to exploratory factor analysis which revealed a 13-item, 3-factor solution accounting for 59.7% of the variance. The 3 conceptual factors (subscales) were interpreted as Firearms Exposure, Parental Control, and Violent Play. The PATFS demonstrated good internal consistency and content and construct validity. The PATFS can be used to investigate parenting attitudes and behaviors specific to firearms and violent play.

A pilot study linking reduced fronto-Striatal recruitment during reward processing to persistent bingeing following treatment for binge-eating disorder.

OBJECTIVE: The primary purpose of this study was to examine neurobiological underpinnings of reward processing that may relate to treatment outcome for binge-eating disorder (BED). METHOD: Prior to starting treatment, 19 obese persons seeking treatment for BED performed a monetary incentive delay task during functional magnetic resonance imaging (fMRI). Analyses examined how the neural correlates of reward processing related to binge-eating status after 4-months of treatment. RESULTS: Ten individuals continued to report binge-eating (BEpost-tx ) following treatment and 9 individuals did not (NBEpost-tx ). The groups did not differ in body mass index. The BEpost-tx group relative to the NBEpost-tx group showed diminished recruitment of the ventral striatum and the inferior frontal gyrus during the anticipatory phase of reward processing and reduced activity in the medial prefrontal cortex during the outcome phase of reward processing. DISCUSSION: These results link brain reward circuitry to treatment outcome in BED and suggest that specific brain regions underlying reward processing may represent important therapeutic targets in BED.