Experiential Aspects of Participation in Employment and Mobility for Adults With Physical Disabilities: Testing Cross-Sectional Models of Contextual Influences and Well-Being Outcomes.

OBJECTIVE: To use structural equation modeling to test research- and theory-informed models of potential predictors and outcomes of subjective experiences of employment and mobility participation in a national sample of people with physical disabilities. DESIGN: Cross-sectional survey. SETTING: Canada. PARTICIPANTS: English or French-speaking adults with a physical impairment affecting mobility and restricting activities or participation, and who participated in employment (n=457) or mobility (n=711) life domains. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Participants completed standardized measures of perceived health, and employment-specific and/or mobility-specific measures of perceived abilities, social support, accessibility and policies (predictor variables); the Measure of Experiential Aspects of Participation (MeEAP) in employment and/or mobility; and standardized measures of emotional well-being, social well-being and life satisfaction (outcome variables). RESULTS: Analyses using structural equation modeling showed that in both employment and mobility domains, perceived health, abilities, social support, and accessibility were positively related to experiential aspects of participation. Participation experiences were positively related to social well-being, emotional well-being, and life satisfaction. CONCLUSIONS: Results support and extend current theorizing on participation experiences among adults with physical disabilities. Intrapersonal and environmental factors may play a role in optimizing participation experiences in employment and mobility which, in turn, may lead to better well-being and life satisfaction. These results emphasize the importance of conceptualizing participation from an experiential perspective and provide a basis for advancing theory and practice to understand and improve the participation experiences and well-being of adults living with physical disabilities.

Plasma Human Immunodeficiency Virus 1 Soluble Glycoprotein 120 Association With Correlates of Immune Dysfunction and Inflammation in Antiretroviral Therapy-Treated Individuals With Undetectable Viremia.

BACKGROUND: Chronic inflammation persists in some people living with human immunodeficiency virus (HIV) during antiretroviral therapy and is associated with premature aging. The glycoprotein 120 (gp120) subunit of HIV-1 envelope sheds and can be detected in plasma, showing immunomodulatory properties even in the absence of detectable viremia. We evaluated whether plasma soluble gp120 (sgp120) and a family of gp120-specific anti-cluster A antibodies, linked to CD4 depletion in vitro, contribute to chronic inflammation, immune dysfunction, and subclinical cardiovascular disease in participants of the Canadian HIV and Aging Cohort Study with undetectable viremia. METHODS: Cross-sectional assessment of sgp120 and anti-cluster A antibodies was performed in 386 individuals from the cohort. Their association with proinflammatory cytokines and subclinical coronary artery disease was assessed using linear regression models. RESULTS: High levels of sgp120 and anti-cluster A antibodies were inversely correlated with CD4+ T cell count and CD4/CD8 ratio. The presence of sgp120 was associated with increased levels of interleukin 6. In participants with detectable atherosclerotic plaque and detectable sgp120, anti-cluster A antibodies and their combination with sgp120 levels correlated positively with the total volume of atherosclerotic plaques. CONCLUSIONS: This study showed that sgp120 may act as a pan toxin causing immune dysfunction and sustained inflammation in a subset of people living with HIV, contributing to the development of premature comorbid conditions.

Plasmatic HIV-1 soluble gp120 is associated with immune dysfunction and inflammation in ART-treated individuals with undetectable viremia.

Background: Chronic inflammation persists in some people living with HIV (PLWH), even during antiretroviral therapy (ART) and is associated with premature aging. The gp120 subunit of the HIV-1 envelope glycoprotein can shed from viral and cellular membranes and can be detected in plasma and tissues, showing immunomodulatory properties even in the absence of detectable viremia. We evaluated whether plasmatic soluble gp120 (sgp120) and a family of gp120-specific anti-cluster A antibodies, which were previously linked to CD4 depletion in vitro , could contribute to chronic inflammation, immune dysfunction, and sub-clinical cardiovascular disease in participants of the Canadian HIV and Aging cohort (CHACS) with undetectable viremia. Methods: Cross-sectional assessment of plasmatic sgp120 and anti-cluster A antibodies was performed in 386 individuals from CHACS. Their association with pro-inflammatory cytokines, as well as subclinical coronary artery disease measured by computed tomography coronary angiography was assessed using linear regression models. Results: In individuals with high levels of sgp120, anti-cluster A antibodies inversely correlated with CD4 count (p=0.042) and CD4:CD8 ratio (p=0.004). The presence of sgp120 was associated with increased plasma levels of IL-6. In participants with detectable atherosclerotic plaque and detectable sgp120, sgp120 levels, anti-cluster A antibodies and their combination correlated positively with the total volume of atherosclerotic plaques (p=0.01, 0.018 and 0.006, respectively). Conclusion: Soluble gp120 may act as a pan toxin causing immune dysfunction and sustained inflammation in a subset of PLWH, contributing to the development of premature comorbidities. Whether drugs targeting sgp120 could mitigate HIV-associated comorbidities in PLWH with suppressed viremia warrants further studies. Key points: Soluble gp120 is detected in the plasma of people living with HIV-1 with undetectable viremia. The presence of soluble gp120 and anti-cluster A antibodies is associated with immune dysfunction, chronic inflammation, and sub-clinical cardiovascular disease.

Planning and self-monitoring the quality and quantity of eating: How different styles of self-regulation strategies relate to healthy and unhealthy eating behaviors, bulimic symptoms, and BMI.

This research examined if planning and self-monitoring could be distinguished in terms of quality and quantity, and if differences in the uses of these strategies were associated with distinct eating outcomes. In Study 1 (n = 355), the structure of a new scale designed to measure planning and self-monitoring in terms of quality (i.e., nutrient intake) and quantity (i.e., calories and portion sizes) was examined through Confirmatory Factor Analysis. Structural equation models were also tested in which the relationships between the proposed strategies, healthy and unhealthy eating behaviors and bulimic symptoms, as well as BMI, were examined. The purpose of Study 2 (n = 318) was to replicate the results found in Study 1, using a different sample. Overall, a 6-factor structure was found for the scale and results revealed that strategies related to the quality of eating were more strongly and positively associated with healthy eating and more strongly and negatively associated with unhealthy eating behaviors, whereas strategies related to the quantity of eating were more strongly and positively associated with bulimic symptoms and BMI. Results are discussed in terms of implications for health professionals who wish to improve individuals' eating behaviors and/or weight.

Examining fat talk and self-compassion as distinct motivational processes in women's eating regulation: A self-determination theory perspective.

This study examined whether pursuing intrinsic versus extrinsic goals was associated with distinct motivational processes in eating regulation and with healthy versus unhealthy eating. Path analysis demonstrated that appearance goals were associated with fat talk, whereas health goals were associated with self-compassion. Fat talk was positively associated with non-self-determined motivation and unhealthy eating, whereas self-compassion was positively associated with self-determined motivation and healthy eating, and negatively associated with unhealthy eating. Findings emphasize the negative effects of pursuing appearance goals and engaging in fat talk and the benefits of pursuing health goals and being self-compassionate.

The validation of the Healthy and Unhealthy Eating Behavior Scale (HUEBS): Examining the interplay between stages of change and motivation and their association with healthy and unhealthy eating behaviors and physical health.

The purpose of the present research was to examine how self-determined and non-self-determined motivation for eating was related to healthy and unhealthy eating behaviors at different stages of change. In Study 1 (n = 360), the structure of a new scale designed to measure healthy and unhealthy eating behaviors based on recent recommendations of the Canadian Food Guide was examined through Principal Component Analysis. Study 2 (n = 711) retested the structure of the scale and also examined whether women reported different patterns of motivation and eating behaviors depending on their stage of change for eating regulation. In Study 3 (n = 264), moderated mediation models were used to examine if eating behaviors served to mediate the relationship between motivation and waist circumference, and whether stages of change moderated the link from motivation to eating behaviors. Overall, the studies provided evidence for the 2-factor structure of the scale, where the first factor represents healthy eating and the second factor represents unhealthy eating behaviors. It was also demonstrated that as women moved along the stages of change for eating regulation, they reported higher levels of self-determined motivation and lower levels of non-self-determined motivation, as well as a higher consumption of healthy foods and a lower consumption of unhealthy foods. Finally, findings indicated that healthy eating fully mediated the relationship between self-determined motivation and waist circumference, and that the relationship between self-determined motivation and healthy eating was moderated by stages of change. Together, these studies highlight the interactive roles of motivation and stages of change in their association with healthy and unhealthy eating behaviors, as well as the importance of healthy eating for a lower waist circumference.

The pediatric inflammatory bowel disease INTERMED: A new clinical tool to assess psychosocial needs.

OBJECTIVE: The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization. METHODS: We performed a cross-sectional study of children (aged 8-17 y) with IBD (n = 148) and their parents, seen in a hospital-based clinic. Subjects completed semi-structured interviews that were scored on the 34 pIBD-INTERMED items. To assess inter-rater reliability, 40 interviews were videotaped and scored by a second assessor. Convergent and predictive validity were assessed by examining the relation of the pIBD-INTERMED to standardized measures of psychological, social, and family functioning, disease activity, and healthcare utilization. RESULTS: Correlational analyses supported the validity of all five pIBD-INTERMED domains with very good inter-rater reliability (median r = 0.87) and internal consistency (α = 0.91) for the total complexity index. Ratings of 2-3 on the pIBD-INTERMED "mental health/cognitive threat" item were associated with greater odds of behavior and social problems (CBCL-Internalizing scale OR = 7.27, 95% CI 2.17-24.36); CBCL-Externalizing scale OR = 24.79, 95% CI 5.00-122.84), depression (Children's Depression Inventory OR = 8.52, 95% CI 1.70-43.02) and anxiety (Multidimensional Anxiety for Children OR = 11.57, 95% CI 3.00-45.37). The pIBD-INTERMED complexity index added significantly to the prediction of healthcare utilization, beyond the contribution of disease severity. CONCLUSIONS: The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks and needs of children with IBD. It can be used to guide planning of individualized care and enhance interdisciplinary pediatric IBD care.

Starting Off on the Best Foot: A Review of Message Framing and Message Tailoring, and Recommendations for the Comprehensive Messaging Strategy for Sustained Behavior Change.

Health promotion programs represent a salient means through which physical activity promoters can cultivate positive health behavior change and maintenance. The messages communicated within these programs serve as an essential component as they are often used to convey valuable information, resources, or tools that facilitate health behavior initiation and sustained engagement. Identifying the most effective way to communicate health promotion information is, therefore, of considerable importance to ensuring that people not only attend to these messages, but also connect with and internalize the information conveyed within them. This paper was written to (1) summarize and evaluate the most prominent reviewed research approaches of message framing and tailoring to message design; and (2) offer a comprehensive messaging strategy to promote sustained health behavior change. A review of the literature demonstrated that a messaging strategy that has consistently led to healthy behavior change has yet to be identified. Furthermore, scholars have articulated that a multi-theoretical approach that places emphasis on facilitating motivation and healthy behavior change needs to be employed. Thus, this paper proposes and provides recommendations for employing the Comprehensive Messaging Strategy for Sustained Behavior Change (CMSSBC), which advocates tailoring messages to peoples' stage of change and framing them to focus on self-determined motives and intrinsic goals.

Why do women engage in fat talk? Examining fat talk using Self-Determination Theory as an explanatory framework.

This study used Self-Determination Theory to examine the motivational processes involved in individuals' engagement in fat talk and its association with unhealthy eating behaviors. Female undergraduate students (N=453) completed an online questionnaire, which assessed general and contextual motivation, importance placed on goals, fat talk, and unhealthy eating behaviors. Structural equation modeling revealed that being generally non-self-determined and placing more importance on extrinsic goals, such as thinness, was associated with fat talk. Fat talk was further associated with non-self-determined motivation for eating regulation, which in turn was associated with unhealthy eating. General self-determination and placing more importance on intrinsic goals, such as health, were not associated with fat talk, but instead, were associated with more adaptive forms of eating regulation and diet quality. Findings further current knowledge on the respective roles of motivation and goals on the engagement in fat talk, and its consequences on eating regulation and behavior.

Homeostasis balance, homeostasis imbalance or distinct motivational processes? Comments on Marks (2015) 'Homeostatic Theory of Obesity'.

In his article, 'Homeostatic theory of obesity', Marks suggested that imbalances in homeostatic processes could explain weight gain and obesity. He proposes that over-consumption of high-caloric, low-nutrient and low satiating foods, combined with a stressful environment, is the origin of weight gain. Once weight gain occurs, individuals may develop body dissatisfaction and negative affect, leading to continued over-consumption, which sets in motion a system of feedback loops that leads to a Circle of Discontent and further weight gain. In this article, we attempt to clarify certain problematic aspects of Marks framework and identify specific directions that researchers should pursue to address these shortcomings.

The role of motivation and the regulation of eating on the physical and psychological health of patients with cardiovascular disease.

This study tested a longitudinal motivation model for healthy eating in patients with cardiovascular disease, using self-determination and social-cognitive theories. A total of 513 patients completed measures of eating habits, global motivation, motivation for eating, self-efficacy for eating and life satisfaction, immediately after a major cardiac incident and at three times during a year (e.g. 2008-2009). Physiological indicators were measured to examine how they predicted the participants' physical health. Results found participants with self-determined motivation were more likely to develop a sense of self-efficacy towards eating and a healthy diet, which had beneficial effects on their physical health and life satisfaction.