Recommendations for assessing appearance concerns related to plexiform and cutaneous neurofibromas in neurofibromatosis 1 clinical trials.

BACKGROUND/AIMS: Individuals with neurofibromatosis 1 may experience changes in their appearance due to physical manifestations of the disorders and/or treatment sequelae. Appearance concerns related to these physical changes can lead to psychological distress and poorer quality of life. While many neurofibromatosis 1 clinical trials focus on assessing changes in tumor volume, evaluating patients' perspectives on corresponding changes in symptoms such as physical appearance can be key secondary outcomes. We aimed to determine whether any existing patient-reported outcome measures are appropriate for evaluating changes in appearance concerns within neurofibromatosis 1 clinical trials. METHODS: After updating our previously published systematic review process, we used it to identify and rate existing patient-reported outcome measures related to disfigurement and appearance. Using a systematic literature search and initial triage process, we focused on identifying patient-reported outcome measures that could be used to evaluate changes in appearance concerns in plexiform or cutaneous neurofibroma clinical trials in neurofibromatosis 1. Our revised Patient-Reported Outcome Rating and Acceptance Tool for Endpoints then was used to evaluate each published patient-reported outcome measures in five domains, including (1) respondent characteristics, (2) content validity, (3) scoring format and interpretability, (4) psychometric data, and (5) feasibility. The highest-rated patient-reported outcome measures were then re-reviewed in a side-by-side comparison to generate a final consensus recommendation. RESULTS: Eleven measures assessing appearance concerns were reviewed and rated; no measures were explicitly designed to assess appearance concerns related to neurofibromatosis 1. The FACE-Q Craniofacial Module-Appearance Distress scale was the top-rated measure for potential use in neurofibromatosis 1 clinical trials. Strengths of the measure included that it was rigorously developed, included individuals with neurofibromatosis 1 in the validation sample, was applicable to children and adults, covered item topics deemed important by neurofibromatosis 1 patient representatives, exhibited good psychometric properties, and was feasible for use in neurofibromatosis 1 trials. Limitations included a lack of validation in older adults, no published information regarding sensitivity to change in clinical trials, and limited availability in languages other than English. CONCLUSION: The Response Evaluation in Neurofibromatosis and Schwannomatosis patient-reported outcome working group currently recommends the FACE-Q Craniofacial Module Appearance Distress scale to evaluate patient-reported changes in appearance concerns in clinical trials for neurofibromatosis 1-related plexiform or cutaneous neurofibromas. Additional research is needed to validate this measure in people with neurofibromatosis 1, including older adults and those with tumors in various body locations, and explore the effects of nontumor manifestations on appearance concerns in people with neurofibromatosis 1 and schwannomatosis.

Are Patients With Adult Traumatic Brachial Plexus Injuries Satisfied With Their Appearance?

PURPOSE: Adult traumatic brachial plexus injuries (tBPI) are devastating physically and emotionally. In addition to the physical loss of function and pervasive neuropathic pain, patients describe difficulty with negative self-image and social relationships. Our goal was to gain an initial understanding of body image and satisfaction with appearance among tBPI patients. METHODS: Among 126 patients in a prospective cohort study, 60 completed a brachial plexus injury-specific modification of the Satisfaction with Appearance survey. The survey encompasses three major domains: social discomfort because of the affected limb, interference with relationships because of the affected limb, and appearance of the affected limb. We performed a cross-sectional descriptive analysis to provide an initial understanding of these domains among brachial plexus injury patients. RESULTS: Among all 60 patients, nearly half (27/60, 45%) reported they are satisfied with their overall appearance. The appearance of their affected hand(s) was the body part with which patients expressed the most concern. Patients also reported feeling increasingly uncomfortable among those less familiar to them: 11/60 (18%) were uncomfortable around family, 18/60 (30%) were uncomfortable around friends, and 19/60 (32%) were uncomfortable around strangers. One-quarter (15/60, 25%) of brachial plexus injury patients agreed that their injury interfered with relationships and that their tBPI was unattractive (16/60, 27%) to others. CONCLUSIONS: Almost half of patients who have experienced tBPI endorse dissatisfaction with their appearance, which can subsequently interfere with their personal relationships. Further, tBPI may influence patients' comfort levels in unfamiliar social surroundings and may influence how patients feel they are perceived by others. CLINICAL RELEVANCE: The patient's perception of their affected limb and its influence on their daily social interactions should be recognized by their tBPI care team, noting opportunities for improved counseling.

Scientific Exercise Approach to Scoliosis in Adolescents With Mild Idiopathic Scoliosis: A Controlled Clinical Trial.

OBJECTIVE: This study aimed to investigate the effectiveness of Scientific Exercise Approach to Scoliosis (SEAS) protocol for patients with mild adolescent idiopathic scoliosis (AIS). METHOD: (A controlled clinical trial) This preliminary study included 32 patients with AIS, aged 10 to 16 years, with Cobb angles ranging from 12° to 25°. The participants were divided into 2 groups: the SEAS group (n = 21) and standard care (n = 11). We assessed Cobb angles via radiographs, axial trunk rotation using the Adams test, spinal deformity from various perspectives with the Spinal Appearance Questionnaire (SAQ), and health-related quality of life with the Scoliosis Research Society-22 (SRS-22) questionnaire, both before and after 1 year of treatment. RESULTS: Repeated measure-ANOVA revealed significant group x time interactions for various parameters: Cobb angle (F1,30 = 35.757; P < .001), axial trunk rotation (F1,30 = 39.595; P < .001), SAQ appearance domain for the physiotherapist (F1,30 = 53.943; P < .001), SAQ appearance (F1,30 = 14.054; P = .001), expectations (F1,30 = 9.103; P = .005) domains, the total score (F1,30 = 23.574; P < .001) for the child, and the SAQ appearance domain for the parent (F1,29 = 5.412; P = .027). There were no significant differences in SRS-22 scores between the 2 groups. The success rates for the SEAS group and the standard care group were 100% and 72.7%, respectively. CONCLUSION: After 1 year, the group of patients with mild AIS who received the SEAS method showed greater improvements in the Cobb angle, axial trunk rotation, and spinal appearance than those who received standard care. This preliminary study suggests that larger trials should be completed.

The effect of social appearance anxiety and body perception on the quality of life in burn patients.

This study was conducted with a descriptive and cross-sectional design to demonstrate the effect of social appearance anxiety and body perception on quality of life in burn patients. The study was conducted in the intensive care units and burn clinic of Elazig Firat University Hospital between 17 February 2022 and 30 April 2022. Data were collected from 94 burn patients using the Personal Information Form, Social Appearance Anxiety Scale, Body-Cathexis Scale and Quality of Life Scale-Short Form. Most participants were 30 years old and under, male, married, had no children and had an education level of high school or below. Most had social security and an income equal to their expenses. They were not uncomfortable with coming to the hospital, and 1-3 months had passed since the burn incident. They did not spend time outside, and most had no part of their bodies that they did not like, while 26.1% did not like their feet. A negative relationship was detected between the Social Appearance Anxiety Scale and Body-Cathexis Scale, and a positive relationship between the total and sub-dimensions of the Quality of Life Scale (p > 0.05). There was a negative relationship between the Body-Cathexis Scale and the Quality of Life Scale total and sub-dimensions (p < 0.05), and a positive relationship between the total and sub-dimensions of the Quality of Life Scale (p < 0.05).

Exploring the utility of eye tracking for sociological research on race.

One part of the social construction of race is the symbolic association of given physical features with different races. This research note explores the utility of eye tracking for sociological research on racial perception, that is, for determining what race someone 'looks like.' Results reveal that participants gave greatest attention to targets' hair. This was especially so when targets of all races had straight hair or when a target identified as Black/White mixed-race. The mixed-race results in particular provide physiological evidence of the theory of multiracial dissection. We conclude by suggesting that eye tracking can be useful to sociologists by revealing subconscious tendencies and biases which, once identified, can be consciously addressed in service to reducing social disparities.

The relationship between problematic Instagram use and eating disorders psychopathology: an explanatory structural equation model.

An emerging body of research has evidenced the negative influence of using and being exposed to social networking sites (SNSs) on body image. Furthermore, it has been postulated that SNS use might be related with onset and persistence of eating disorders (EDs) psychopathology. The aim of the present study is to evaluate the complex interplay between problematic Instagram use (PIU) (conceptualized as a potential behavioral addiction comprising withdrawal, conflict, tolerance, salience, mood modification and relapse) and ED psychopathology, by means of an explanatory structural equation model. We hypothesized that PIU would be associated with ED symptoms through the mediating role of appearance comparison, individual psychological investment in physical appearance, and body uneasiness. A sample of 386 young female participants (Mage = 26.04 ± 6.73) was recruited, of which 152 had received a diagnosis of ED. ED patients used Instagram more than the control group and showed higher levels of PIU. Results from structural equation modeling (fit indices: χ2 = 44.54, df = 19, p < 0.001; RMSEA = 0.059; CFI = 0.98; SRMR = 0.02) showed that PIU predicted appearance comparison and psychological investment in physical appearance, which in turn predicted body uneasiness. In turn, body uneasiness predicted ED psychopathology and interpersonal difficulties. Our model provides a useful account of how eating disorder symptoms could be triggered and maintained by an addictive use of Instagram.

Measurement properties of the Spinal Appearance Questionnaire in adolescents with idiopathic scoliosis: a systematic review.

BACKGROUND: Scoliosis is defined as a three-dimensional deformity of the spine characterized by lateral tilt and axial rotation of the vertebrae. Its magnitude in the frontal plane is identified by a Cobb angle greater than 10o. The aim of the study was to systematically examine the clinimetric properties of the Spinal Appearance Questionnaire (SAQ) in its cross-cultural adaptations in different languages. METHODS: Medline (PubMed), CINAHL, EMBASE, Science Direct, PsycINFO and WorldWideScience.org databases were used for screening studies until July 16, 2022. In this study, records on the development, evaluation and translation of the SAQ instrument in adolescents with idiopathic scoliosis were included. In addition, two independent reviewers defined whether the studies were eligible and analyzed their psychometric properties of internal consistency, reliability, content validity, cross-cultural validity, construct validity and structural validity, according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The modified GRADE was applied for evidence synthesis. RESULTS: A total of 95 articles were selected by title and abstract. After removing duplicates and reading and searching the references, a total of 13 studies were included in this review. The original version of the SAQ was described in English, and the instrument was translated into Polish, Canadian French, Simplified Chinese, Spanish (Europe), Danish, Traditional Chinese, Portuguese (Brazil), Korean, German, Turkish and Persian. The evidence was moderate for construct validity, low for internal consistency, and very low for reliability and cross-cultural validity; the content and structural validity properties did not present minimum data for classification. CONCLUSION: The quality of the evidence regarding the clinimetric properties of the SAQ instrument in adolescents with idiopathic scoliosis was low due to the absence of clinimetric properties or dubious methodological quality. However, for clinical practice and research, we recommend the use of the instrument to assess the self-perception of the spine in adolescents. For future translations and adaptations, we recommend the use of the COSMIN guidelines.

Correlation between individual physical characteristics and spinal cerebrospinal fluid volume.

Spinal cerebrospinal fluid (CSF) volume is the primary determinant for the spread of spinal anesthesia. However, it cannot generally be obtained during spinal anesthesia, and patient physical characteristics are always adopted to obtain a suitable spinal spread. In this study, we sought to explore the relationship between individual physical characteristics and thoracosacral CSF volume to provide a theoretical basis for more accurate spinal anesthesia. In total 35 healthy volunteers were enrolled in this study. Three-dimensional magnetic resonance imaging was used to reconstruct and measure the spinal CSF volume. Physical characteristics and spinal CSF volume were recorded. Bivariate and multiple linear regression analyses were used to analyze the correlation between the individual physical characteristics and thoracosacral CSF volume. Total of 31 participants were included in the final analysis. Bivariate linear correlation analysis showed that the volume of thoracosacral CSF was correlated with both individual dorso-sacral distance and height (both p < 0.01), but not with abdominal girth (p > 0.05). Multiple linear regression analyses revealed that the adjusted R2 values were 0.404 for the regression equation between thoracosacral CSF volume, dorso-sacral distance, and abdominal girth. Our study showed that dorso-sacral distance and abdominal girth were essential factors contributing to thoracosacral CSF volume. A longer dorso-sacral distance and smaller abdominal girth mean larger spinal CSF volume.

Selfie behavior and cosmetic surgery consideration in adolescents: the mediating roles of physical appearance comparisons and facial appearance concern.

Selfie activity may contribute to the acceptance of cosmetic surgery in adolescents, although few empirical studies exist. Based on social comparison theory, this study examined the association between selfie behavior and cosmetic surgery consideration among Chinese adolescents and further tested the possible mediating roles of social comparison and facial appearance concern in this relationship. A sample of 537 adolescents (339 girls and 198 boys) were recruited voluntarily to complete questionnaires on selfie behavior, upward physical appearance comparison, facial appearance concern and cosmetic surgery consideration. Linear regression and mediation analyses were conducted. The results showed that selfie behavior predicted higher level of adolescents' cosmetic surgery consideration. Moreover, this relationship was sequentially mediated through upward physical appearance comparison and facial appearance concern. These findings expand the existent literature by suggesting that selfie behavior may trigger upward social comparison in adolescents, which in turn increase their acceptance of cosmetic surgery.

[Social networks use and risk factors for the development of eating disorders: A systematic review]. / Uso de redes sociales y factores de riesgo para el desarrollo de trastornos relacionados con la alimentación en España: una revisión sistemática.

OBJECTIVE: Review the available scientific literature on the relationship between the use of social networks and risk factors for the development of eating disorders, such as low self-esteem, body dissatisfaction and/or idealization of thinness, in the Spanish population. DESIGN: A systematic review of scientific literature published between 2010 and 2022 was carried out. DATA SOURCES: PubMed, Scopus and Web of Science. SELECTION OF STUDIES: Only original articles were included, published in Spanish or English, that measured at least one variable of use of social networks and at least one risk factor for eating disorders in the Spanish population. DATA EXTRACTION: The PRISMA 2009 statement was used as a guide. The quality of selected articles was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS: Twelve cross-sectional studies that met the inclusion criteria were identified. Evidence suggests that the use and frequency of use of social networks is significantly associated with body dissatisfaction (p≤0,01), drive for thinness (p≤0,001), and low self-esteem (p≤0,05) in adolescents and young adults in the Spanish population. CONCLUSIONS: Users of social networks, mainly those based on images, are exposed to factors that could increase their risk of developing an eating disorder.

Zoom dysmorphia in e-teaching: shifting the value from attributes to appearance.

The current study is motivated by Tory Higgins's self-discrepancy theory and the objectification theory. It aimed to investigate university staff members' perspectives towards zoom dysmorphia while involved in e-teaching during the Covid-19 Pandemic in terms of its popularity, causes, and instructors' experiences with the healing or eliminating mechanisms. Put simply, the researchers meant to identify the impact of the pandemic on body image and the long-term repercussions of e-teaching on instructors' quality. A descriptive online questionnaire was compiled to explore the way (630) university staff members having academic and academic/administrative positions evaluate, perceive, and handle zoom dysmorphia while teaching online. The study results showed several associations between the variables studied. Gender was significant because females proved to have more features of dysmorphia; faculty members who serve in scientific faculties also proved to expect more features of dysmorphia as they tended not to turn on their cameras. The study results also showed that sufferers of zoom dysmorphia warranted that their appearances occasionally made them feel insecure and occupationally unstable. Therefore, they tried different healing mechanisms to eliminate or, at least, reduce its traits. The study concluded that the prevalence of zoom dysmorphia may result in shifting the value from good, effective attributes (e.g., professionalism, adaptability, collaboration, empathy, and patience) of instructors to merely outside physical appearances. The researchers recommend that educators should elicit the presence of zoom dysmorphia at an early stage. They should prepare courses to improve instructors' self-confidence, and provide them with proper technical experience.

Body satisfaction of lesbian and bisexual Brazilian women: Indicators of self-esteem, physical appearance perfectionism, and identity processes.

This article examined the association between body satisfaction and sexual identification among lesbian and bisexual women, since these factors help to understand the cultural background of the objectification of female bodies in Latin cultures. Women who identify as lesbian (N = 239) and bisexual (N = 60) completed demographic data and measures of self-esteem, physical appearance perfectionism, lesbian and bisexual identity difficulties, and body satisfaction. We performed a three-stage hierarchical multiple regression to explore how variables relate to body satisfaction. The results suggest that self-esteem plays a key role, explaining 20.4% of the variance in body satisfaction. We discussed the psychosocial and cultural aspects involved in the relationship between the variables, and social and aesthetic pressures on women's bodies. This study contributes to discussions on psychosocial aspects associated with body satisfaction among Brazilian lesbian and bisexual women.

The Developmental Significance of Looks from Middle Childhood to Early Adolescence.

Physical appearance during the transition into adolescence matters for youths' socioemotional development. This study explored these implications by adding visual data to the NICHD Study of Early Child Care and Youth Development (n = 1,049) to test how others' ratings of youths' looks (1 = very unattractive to 5 = very attractive) at the beginning (grade 3) and end (grade 9) of this transition shaped their emotional well-being, popularity/likability, and dating/sexual behavior. Results revealed recency effects of grade 9 looks on popularity/likability and dating/sexual behaviors and a lingering amplification effect of grade 3 looks on popularity/likability at the start of high school. Few associations were evident for emotional well-being. Thus, physical appearance offers an important lens for studying adolescent development.

Satisfaction with dental appearance in two cohorts of 75-year-olds examined in 2007 and 2017: A repeated cross-sectional study.

BACKGROUND: Satisfaction with dental appearance plays an important role in the self-esteem and psychological well-being of the elderly, the significance of which the attending dentist may not always be fully cognisant of. OBJECTIVES: To assess the level of satisfaction with dental appearance, its associated factors and temporal changes in two cohorts of 75-year-old Swedes born 10 years apart. METHODS: In 2007, a questionnaire was mailed to all those living in Örebro and Östergötland counties, Sweden, who were born in 1932 (n = 5195), and in 2017 to all born in 1942 (n = 7204). The evaluation was carried out with a global question 'Are you satisfied with the appearance of your teeth?', and four attitude-related statements about dental appearance. RESULTS: About 80% in both cohorts were 'very satisfied' or 'to large extent satisfied' with their dental appearance. The 1932 cohort was significantly more concerned about their dental appearance than the 1942 cohort, and women were generally also significantly more concerned than men. In the regression analysis, 'very satisfied' with dental appearance was predicted by good chewing efficiency, having complete dentures, no impact from Oral Impacts on Daily Performance, disagreement that 'minor esthetic imperfections of the teeth have no importance, only they should function well', better perceived general health than same-aged peers and belonging to the 1932 cohort. CONCLUSION: Satisfaction with dental appearance among 75-year-olds was generally high, with attitudes varying by gender and temporally. Women and the earlier-born generation (1932) were more concerned about dental appearance than men and the later-born generation (1942), respectively.

Effects of fitspiration content on body image: a systematic review.

PURPOSE: Fitspiration (also known as "fitspo") aims to inspire individuals to exercise and have healthy habits, but emerging research indicates that exposure to it can have a negative impact on body image. This study aims to analyze the relationship between individuals' exposure to fitspiration content and body image measures or associated variables (e.g., appearance comparison). MATERIALS AND METHODS: A comprehensive search of peer-reviewed papers published in English between 2000 and August 2022 was conducted in PubMed, PsycINFO and Google Scholar, based on the PICOS model. To be included, studies had to analyze the relationship between exposure to fitspiration content (I) and body image or associated variables (O) in adolescents and adults (P). Study methodological quality was assessed using an adaptation of the EPHPP Quality Assessment Tool for Quantitative Studies. Outcome data were synthesized narratively and by vote counting. RESULTS: Twenty articles met the eligibility criteria and were included. Nineteen studies analyzed the relationship between fitspiration and body image, twelve analyzed the association between exposure to fitspiration and physical appearance comparison tendencies, and nine analyzed the association between fitspiration content and mood. One study analyzed the association between frequency of viewing fitspiration content and motives for exercise. Results showed that exposure to "fitspiration" increased individuals' body dissatisfaction, physical appearance comparisons, and negative mood, especially in younger populations. CONCLUSIONS: Fitspiration has been seen as a new and prolific digital trend, considered beneficial for health. However, our results showed that fitspo is associated with negative body image, especially in younger populations that are more exposed to this content. Most of the studies were conducted in females and young age participants, which limits the extrapolation of results by gender and age. Future studies are needed to confirm and extend these findings. LEVEL OF EVIDENCE: Level 1, Systematic Review.

Clinical relevance of a Body Image Scale cut point of 10 as an indicator of psychological distress in cancer patients: results from a psychiatric oncology clinic.

PURPOSE: Adequate adjustment to bodily changes during various phases of cancer treatment is important to patients' emotional well-being. The Body Image Scale (BIS) is a widely used tool for assessment of body image concerns in different cancer types. However, a cut point score indicative of clinically relevant body image concerns has not been established. The purpose of our study was to evaluate whether the previously suggested, but not validated, BIS cut point score of ≥ 10 is an adequate indicator of psychological distress. METHODS: In a prospective cross-sectional study, 590 adult patients were recruited from a psychiatric oncology clinic (November 2017-March 2018). Patient-reported body image concerns, depression, anxiety, and emotional distress were assessed with the BIS, Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, and National Comprehensive Cancer Network Distress Thermometer, respectively. RESULTS: Almost half of the patients had a BIS score ≥ 10; these were more likely to be younger, female, Hispanic, and to have breast cancer than patients with a score < 10. BIS scores were positively associated with depression, anxiety, and distress scores. A BIS score ≥ 10 was a significant predictor of moderate depression and anxiety (odds ratios = 3.555 [95% CI 2.478-5.102] and 3.655 [2.493-5.358]; p < 0.001 for both). CONCLUSION: To our knowledge, this is the first study to have assessed the validity of the previously suggested clinically relevant BIS cut point score of ≥ 10 as an indicator of psychological distress. Our results suggest that a BIS score of ≥ 10 or higher should lead to follow-up on body image concerns and/or appropriate referral.

The impact of oro-facial appearance on oral health-related quality of life: A systematic review.

Esthetics in the oro-facial region are important for perceived oral health and a common reason for treatment of discoloured, missing or crowded teeth. As one of the fundamental bricks of a patient's oral health, changes in the domain of oro-facial esthetics resides within the oral health-related quality of life (OHRQoL) of an individual. Four main dimensions, oral function, oro-facial pain, oro-facial appearance and psychosocial impact, are suggested to cover the concept of OHRQoL. The aim of this systematic review was to map the impact from oral conditions with principal impact on the oro-facial appearance dimension of OHRQoL (PROSPERO: CRD42017064033). Publications were included if they reported Oral Health Impact Profile (OHIP) mean or median domain scores for patients with esthetic treatment need relating to tooth wear, orthodontics, orthognathic surgery, frontal tooth loss or tooth whitening. A search in PubMed (Medline), EMBASE, Cochrane, CINAHL and PsycINFO 8 June 2017 and updated 14 January 2019, identified 2,104 abstracts. After screening of abstracts, 1607 articles were reviewed in full text and 33 articles included. These 33 articles reported OHIP-data for 9409 patients grouped in 63 patient populations. Median oro-facial appearance impact scores on a standardised 0-8 scale, for populations with treatment need relating to tooth wear, orthodontics, orthognathic surgery, frontal tooth loss and tooth whitening, ranged from 0.13 for tooth wear to 3.04 for tooth whitening populations. In conclusion, a moderate impact for the oro-facial appearance dimension of OHRQoL was found in patients with different conditions with esthetically related treatment need.

Perceptions and experiences of female burn survivors with facial disfigurement.

PURPOSE: This study aimed at exploring the perceptions and experiences of female burn survivors with facial disfigurement in Pakistan. METHODS: Two different quantitative and qualitative studies were conducted, of which the data were collected from 100 burn patients. A pilot interview protocol was developed. An indepth interview of five female burn survivors with facial disfigurement was taken in Lahore, Pakistan. The transcripts were analyzed using thematic analysis and four major themes were identified, respectively physical appearance, posttraumatic growth, relationships and coping strategies. RESULTS: Thematic analysis reflected differences in attributional style, perceptions and individual experiences of female burn survivors with facial disfigurement. The study showed the importance of physical appearance for different burn survivors and how their life had changed after suffering from a burn injury. CONCLUSION: It could be easy to have a positive outlook towards life and accept visible differences post injury for the burn survivors, who are grateful for life, get a strong family support and have available resources. On the contrary, with low self-esteem, lack of a family support and available resources, patients would be dissatisfied with their life.

Do Alzheimer's Disease Patients Appear Younger than Their Real Age?

INTRODUCTION: The most prominent risk factor of Alzheimer's disease (AD) is aging. Aging also influences the physical appearance. Our clinical experience suggests that patients with AD may appear younger than their actual age. Based on this empirical observation, we set forth to test the hypothesis with human and computer-based estimation systems. METHOD: We compared 50 early-stage AD patients with 50 age and sex-matched controls. Facial images of all subjects were recorded using a video camera with high resolution, frontal view, and clear lighting. Subjects were recorded during natural conversations while performing Mini-Mental State Examination, including spontaneous smiles in addition to static images. The images were used for age estimation by 2 methods: (1) computer-based age estimation; (2) human-based age estimation. Computer-based system used a state-of-the-art deep convolutional neural network classifier to process the facial images contained in a single-video session and performed frame-based age estimation. Individuals who estimated the age by visual inspection of video sequences were chosen following a pilot selection phase. The mean error (ME) of estimations was the main end point of this study. RESULTS: There was no statistically significant difference between the ME scores for AD patients and healthy controls (p = 0.33); however, the difference was in favor of younger estimation of the AD group. The average ME score for AD patients was lower than that for healthy controls in computer-based estimation system, indicating that AD patients were on average estimated to be younger than their actual age as compared to controls. This difference was statistically significant (p = 0.007). CONCLUSION: There was a tendency for humans to estimate AD patients younger, and computer-based estimations showed that AD patients were estimated to be younger than their real age as compared to controls. The underlying mechanisms for this observation are unclear.

Body Weight of Cartoon Characters in Children Series Is Associated to Food Consumption, Attractiveness, and Physical Activity Engagement.

BACKGROUND: Research is lacking regarding the eating habits of cartoon characters in relation to their body weight. The present study explored the context of food consumption and the cartoon characters' traits, according to body weight. Studies show that slim cartoon characters are usually considered as attractive; however, little is known regarding the type of messages projected about their physical appearance. METHOD: One hundred episodes of ten series with high TV audience rates were reviewed. Characters' body weight status was classified into underweight, normal weight, and overweight, and food consumed as processed and less processed. Characters' traits such as physical activity and attractiveness were classified as positive, negative, or neutral. Comments made by the characters themselves regarding their proper physical appearance or the appearance of partner characters were recorded and classified as positive or negative. RESULTS: Results show that characters' body weight was related to both type and quantity of foods consumed, as 58% of the non-core and 48% of all foods were actually eaten by oversized characters. Positive characters' traits, as defined by attractiveness and physical activity engagement, referred consistently to slim characters, with nine out of ten shown as good-looking and physically active. In addition, the majority (51 out of 58) of the positive comments on physical appearance were recorded for slim and attractive characters, either expressed by fellow actors or the characters themselves. CONCLUSION: Body weight of cartoon characters seems to follow stereotypic perceptions which value slimness and relate unhealthy food consumption with overweight.