Caring for the caregiver in dementia.

Caregiver stress is higher for dementia caregiving than other types. By focusing on the family, FPs can help to ease the burden.

Mental Health Stigma in Active Duty Service Members Receiving Mental Health Services.

INTRODUCTION: Mental health treatment is a service for military service members who have experienced psychological injury or trauma. Unfortunately, the stigma associated with treatment can prevent many service members from seeking and receiving treatment designed to help them recover. Previous studies have examined the impacts of stigma among military personnel as well as civilians; however, stigma among service members currently receiving mental health treatment is unknown. The purpose of this study is to understand the relationships between stigma, demographic variables, and mental health symptoms in a sample of active duty service members receiving mental health services in a partial hospitalization program. MATERIALS AND METHODS: This cross-sectional, correlational study collected data from participants in the Psychiatric Continuity Services clinic at Walter Reed National Military Medical Center, which offers a four-week partial hospitalization program specializing in trauma recovery for active duty service members of all branches. The data from behavioral health assessments were gathered over a 6-month timespan, including the Behavior and Symptom Identification Scale-24, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item scale, and Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Stigma was measured using the Military Stigma Scale (MSS). The demographic data collected included military rank and ethnicity. Pearson correlations, t-tests, and linear regression were used to further explore the relationships between the MSS scores, demographic covariates, and behavioral health measures. RESULTS: In unadjusted linear regression models, non-white ethnicity and higher behavioral health assessment intake measures were associated with higher MSS scores. However, after adjusting for gender, military rank, race, and all mental health questionnaires, only Post-traumatic Stress Disorder Checklist for DSM-5 intake scores remained associated with MSS scores. No relationship between gender or military rank and average stigma score was observed in either the unadjusted or adjusted regression models. One-way analysis of variance detected a statistically significant difference between the white/Caucasian group and Asian/Pacific Islander group and a near significant difference between white/Caucasian group and black/African American group. The rates of stigma were higher in non-whites than whites. CONCLUSIONS: In this active duty military cohort, greater mental health stigma was associated with greater severity of mental health symptoms, especially post-traumatic stress symptoms. Some evidence found that ethnicity may also play a role in stigma score differences, particularly in the Asian/Pacific Islander group. Service providers could consider assessing mental health stigma to meet the clinical needs of their patients within the context of their willingness to obtain and adhere to treatment. Anti-stigma efforts to reduce stigma and its impacts on mental health are discussed. Additional research investigating the effect stigma has on treatment outcomes would help guide the relative importance of assessing stigma, in addition to other behavioral health realms.

Multidimensional Evaluation of Screening Brief Intervention and Referral to Treatment Training for Medical Students.

OBJECTIVE: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach to identifying and addressing alcohol use in non-specialty settings. Many medical schools teach SBIRT, but most published evaluations of these efforts exclude rigorous skill assessments and teaching methods. METHODS: During the 2017-2018 academic year, 146 third-year medical students received classroom-based learning on SBIRT and motivational interviewing (MI) and at least two SBIRT practices with feedback as part of a 4-week psychiatry clerkship. The objective of this curriculum was to improve SBIRT knowledge, attitudes, and confidence and enable learners to skillfully deliver SBIRT. Outcomes evaluated included satisfaction, knowledge, attitudes and confidence, and clinical skill in delivering SBIRT to a standardized patient (rated by the actor, as well as an expert). RESULTS: Results indicated acceptable satisfaction at post-curriculum and significant improvements in attitudes and knowledge from pre- to post-curriculum. On the clinical skills exam, all students were rated as having mastered at least 80% of SBIRT elements by standardized patients and 91.8% were rated at this level by a faculty expert. Student attitudes and knowledge were unrelated to expert ratings, and standardized patient ratings had limited associations with expert ratings. CONCLUSIONS: These results suggest curriculum objectives were achieved and provide unique contributions to the SBIRT curricular outcome research for healthcare trainees. Other findings included that trainee knowledge and confidence may not relate to skill, and standardized patient feedback provides different information on SBIRT and MI skill than expert ratings.

Disability as Diversity: Educational Opportunities for Family Medicine.

Disability is an aspect of diversity that often receives less attention in healthcare and medical education than other aspects of diversity, such as gender or race. Approximately one in four Americans has some type of disability, and individuals with disabilities have less access to healthcare, greater dissatisfaction with their healthcare, and report being in poorer health than individuals without a disability. Although many factors likely contribute to these disparities, physician perception and understanding of disability have been examined as potential pathways that influence health inequity. It is important to incorporate disability as a form of diversity in family medicine education to train physicians that provide excellent care to patients with disabilities and work toward equitable healthcare for them. In this article, we review definitions and data related to disability. We examine disparities and forms of stigmatization toward individuals with disabilities. We then present scenarios in the context of family medicine residency education that involve stigmatization of a person with a disability. Following each scenario, we identify the stigmatizing problem and its potential impact on the individual with a disability. In addition, we outline a potential intervention as an individual witnessing this scenario, and an alternative, non-stigmatizing approach to the scenario. Finally, we present proposed core competencies on disability for health care education and potential strategies to incorporate these competencies into family medicine curricula.

Neuropsychological assessment of decision making in alcohol-dependent commercial pilots.

BACKGROUND: The aim of this exploratory archival study was to discern the utility of the Iowa Gambling Task (IGT) in identifying adaptive decision-making capacities among pilots with a history of alcohol dependence both with and without Cluster B personality features. METHODS: Participants included 18 male airmen at the rank of captain with a history of receiving alcohol dependence treatment and subsequent referral for a fitness-for-duty evaluation. Data from prior comprehensive neuropsychological evaluations conducted in a private practice setting at the mandate of the FAA utilizing criteria outlined in the HIMS program was used. ANOVA was conducted to compare pilots with (N = 4) and without Cluster B personality features (N = 14) on measures of decisionmaking capacities, intelligence, and executive functioning. RESULTS: Pilots with Cluster B personality features were found to have a significantly lower Total Net T-Score on IGT (M = 35.00, SD = 9.27) than pilots without features of Cluster B (M = 56.36, SD = 9.55). Furthermore, with the exception of the first 20 cards (i.e., Net 1); the groups significantly differed in their Net scores. No statistically significant difference was found on airmen's intelligence and executive functioning. DISCUSSION: The present study found that alcohol-dependent airmen with Cluster B personality features evidenced significantly poorer decisionmaking capacities as measured by the ICT in comparison to alcohol dependent airman without Cluster B personality features. Implications and limitations of the study are discussed.

Development of a questionnaire to assess university students' intentions to use behavioral alcohol-reduction strategies.

OBJECTIVE: To evaluate the psychometric properties of a new self-report questionnaire designed to assess college students' intentions to employ 31 specific alcohol-reduction strategies. METHOD: Students attending a large public university were recruited to complete alcohol-reduction, drinking history, and personality questionnaires online. RESULTS: Based on item-total correlations and principal components analysis, the authors eliminated 3 items and calculated average intention ratings across the remaining 28 items. The resulting scale had appropriate unidimensionality and excellent internal consistency. Correlations of intention questionnaire scores with measures of drinking history, alcohol outcome expectancies, sensation seeking, and impression management provided some support for criterion and discriminant validity of the questionnaire. CONCLUSION: This questionnaire could be employed as an outcome measure to evaluate prevention programs and as a clinical tool to identify clients who have little intention to employ drinking reduction strategies in heavy drinking situations.

Stepped-care in obesity treatment: matching treatment intensity to participant performance.

This investigation examined the effectiveness of a self-help (SH), stepped-care (SC) weight loss program. Based on a failure to achieve pre-assigned weight loss goals, participants were eligible to be stepped-up from a SH program to two levels of treatment intensity (weight loss group [WLG]; individual counseling [IC]) beyond SH. The primary outcome was change in body weight. Fifty-three overweight/obese adults (BMI≥27 kg/m(2); mean BMI of 37.3, SD=6.6, 89% Caucasian, and 77% female) participated in an 18-week weight loss intervention. During several phases of the investigation, those stepped-up to more intensive treatment lost comparable weight to those who were not stepped-up. Nevertheless, by the end of treatment, individuals who remained in SH (M=8.6%) lost a significantly greater percentage of weight than individuals who received SH+IC (M=4.7%; p<.05) and individuals in SH+IC lost a significantly greater percentage of weight than individuals who received SH+WLG+IC (M=1.6%; p<.05). While some individuals benefited from being stepped-up to greater intensity treatment, other individuals experienced little benefit. The application of SC principles to the treatment of obesity needs further study.

Assessing self-efficacy to reduce one's drinking: further evaluation of the Alcohol Reduction Strategies-Current Confidence questionnaire.

AIMS: To evaluate the psychometric properties of a previously published questionnaire designed to assess young drinkers' self-efficacy to employ 31 cognitive-behavioral alcohol reduction strategies. METHODS: Undergraduates (n = 353) recruited from a large Midwestern university completed the previously published Alcohol Reduction Strategies-Current Confidence questionnaire (and other measures) for a self-selected heavy drinking setting. RESULTS: Item loadings from a principal components analysis, a high internal consistency reliability coefficient, and a moderate mean inter-item correlation suggested that all 31 items comprised a single scale. Correlations of questionnaire scores with selected aspects of drinking history and personality provided support for criterion and discriminant validity, respectively. Women reported higher current confidence to use these strategies than did men, but current confidence did not vary as a function of recent binge status. CONCLUSION: Given this further demonstration of its psychometric qualities, this questionnaire holds promise as a clinical tool to identify clients who lack confidence in their ability to employ cognitive-behavioral coping strategies to reduce their drinking.

Quantitative and qualitative assessment of university students' definitions of binge drinking.

This study was designed to assess undergraduates' (N = 424) definitions of binge drinking and to evaluate whether the number of drinks they said comprise a binge varied as a function of beverage type, respondent gender, and respondent binge drinking status. When asked to designate the specific number of drinks that comprise a binge for each of four beverage types, students reported that the number of beers constituting a binge was significantly larger than the number of glasses of wine, shots of hard liquor, and servings of any combination of alcoholic beverage types; men reported that a larger number of drinks constitute a binge than did women; and those who had engaged in 3 or more binges in the past 2 weeks reported that more drinks comprise a binge than those who had binged less often. Responses to an open-ended question asking their definition of a binge revealed that students sometimes characterize a binge in terms of motivations for and unhealthy consequences of drinking, in addition to defining a binge as comprising consumption of a large amount of alcohol in a limited (though often unspecified) time period. Furthermore, students attributed their open-ended definitions of binge drinking to informal sources of information and observation of others' drinking almost as often as they did to school-based or media-based sources. This suggests that educators might look for innovative ways to use both formal and informal social networking, and video illustrations of restrained drinking, as ways to influence young people's views of binge drinking.

The self-protective nature of implicit identity and its relationship to weight bias and short-term weight loss.

BACKGROUND/AIMS: Research suggests that making overly positive self-evaluations is the norm rather than the exception. However, unlike other stigmatized groups, overweight individuals do not exhibit a positive in-group social identity and instead exhibit significant explicit, implicit, and internalized weight bias. Therefore, it is not known whether overweight/obese individuals will evidence self-enhancement on general traits (good, attractive), or on traits inconsistent with fat stereotypes (disciplined, active, healthy eater), on an assessment of implicit attitudes. Similarly, it is not known whether these ratings will be associated with preexisting levels of weight bias, gender, or short-term weight loss. METHODS: At baseline, 53 overweight/obese adults (BMI > 27 kg/m(2), mean BMI = 37.3 kg/m(2), SD = 6.6 kg/m(2), 89% Caucasian, and 77% female) participating in a weight loss intervention completed measures of explicit and internalized weight bias as well as implicit weight bias and identity (self-other comparisons). RESULTS: Although participants evidenced significant anti-fat attitudes, they implicitly identified themselves as significantly thinner, better, more attractive, active, disciplined, and more likely to eat healthy than 'other' people. Compared to men, women were less likely to view themselves as thin and attractive relative to others. Greater implicit anti-fat bias and implicitly seeing the self as thin relative to others was associated with less short-term weight loss. CONCLUSION: Despite evidence for explicit, implicit, and internalized weight bias, participants generally evidenced a positive implicit self-identity, including areas consistent with negative fat stereotypes.

Assessing university students' self-efficacy to employ alcohol-related harm reduction strategies.

OBJECTIVE: Develop and evaluate key psychometric properties of a self-report questionnaire specifically designed to assess student drinkers' self-confidence to employ a variety of strategies intended to reduce unhealthy consequences of high-risk drinking. METHODS: Four hundred ninety-eight participants rated their confidence (from "not at all confident" to "completely confident") to employ 17 harm reduction strategies when drinking. RESULTS: Factor analysis and internal consistency reliability analyses indicated that the 17 items constitute a single scale with good test-retest reliability. Consistent with other research examining previous use of such strategies, women in our sample reported significantly higher harm reduction self-efficacy than did men. Harm reduction self-efficacy was also associated with reported number of high-risk drinking episodes in the previous 2 weeks. CONCLUSION: This brief and easily administered questionnaire holds promise as a clinical tool to identify individuals with low harm reduction self-efficacy and as an outcome measure for health promotion and educational interventions.

Measuring university students' self-efficacy to use drinking self-control strategies.

Using a Web-based, self-administered questionnaire, we assessed 498 university-student drinkers' self-efficacy to use 31 different behavioral strategies to reduce excessive drinking in each of three different locations (bar, party, own dorm/apartment). Averaging all 31 items within each drinking situation to create a single scale score revealed high internal consistency reliabilities and moderate inter-item correlations. Testing the association of self-efficacy with drinking location, sex, and frequency of recent binge drinking, we found that respondents reported higher self-efficacy to use these strategies when drinking in their own dorm/apartment than when drinking in bars and at parties; women reported higher mean self-efficacy than men; and drinkers who engaged in 3-or-more binges in the previous 2 weeks reported lower self-efficacy than those who reported either 0 or 1-or-2 binges in the same time period. This questionnaire could be used to identify self-efficacy deficits among clients with drinking problems and as an outcome measure to assess the degree to which interventions influence reported confidence to use specific drinking-reduction strategies in high-risk drinking situations.

Transforming your life: an environmental modification approach to weight loss.

This investigation compared a traditional behavioral weight loss program with a weight loss intervention emphasizing environmental modification and habit formation and disruption. Fifty-four overweight and obese adults (BMI ≥ 27 kg/m² were randomly assigned to either a 14-week LEARN or TYL intervention. Forty-two participants completed the six-month follow-up assessment. Treatment outcomes between LEARN and TYL participants were equivalent. During the six-month no-treatment follow-up period, participants evidenced a 3.3 lb (SD = 9.2) weight gain. The TYL intervention appears to represent an attractive option for individuals seeking an alternative to the traditional behavioral approach to weight loss.

Emerald dragon bites vs veggie beans: Fun food names increase children's consumption of novel healthy foods.

Caregivers often struggle with food neophobia on the part of young children. This study examined whether labeling novel healthy foods with fun names would increase children's willingness to try those foods and encourage them to eat more of those foods in a child care setting. Thirty-nine toddler and preschool age children (mean age = 3.9 years) were served each of three foods twice, once labeled with a fun name and once with a healthy name. Percentage of the food consumed by each child was recorded. Overall, children ate a greater percentage of the target foods when they were labeled with fun names. Also, a larger percentage of the children tasted the foods when they were labeled with fun names. This simple strategy could be effective for increasing consumption of healthy foods among young children.

Children's sensitivity to external food cues: how distance to serving bowl influences children's consumption.

Overweight is increasing in children, leading to negative health consequences. Children also lack appropriate levels of important vitamins and nutrients in their diets. Environmental cues, such as food proximity, have been shown to influence consumption rates in adults. The present study has tested whether proximity to either a nutrient-dense or caloric-dense food would influence children's snack consumption in a day care setting. Children (N = 46, age range 3.4-11) consumed more of both nutrient- and energy-dense foods when they are sitting closer to the food than if they are sitting farther away from the food, above and beyond the effects of age. The data indicate that it may be possible to increase the consumption of nutrient-dense foods or decrease the consumption of energy-dense foods, respectively, by modifying the proximity of such foods within a child's environment.

Successful weight loss with self-help: a stepped-care approach.

In a stepped-care approach to treatment, patients are transitioned to more intensive treatments when less intensive treatments fail to meet treatment goals. Self-help programs are recommended as an initial, low intensity treatment phase in stepped-care models. This investigation examined the effectiveness of a self-help, stepped-care weight loss program. Fifty-eight overweight/obese adults (BMI ≥27 kg/m(2)) participated in a weight loss program. Participants were predominately Caucasian (93.1%) and female (89.7%) with a mean BMI of 36.6 (SD=7.1). Of those completing the program, 57% of participants (N=21) who remained in self-help maintained an 8% weight loss at follow-up. Participants who were stepped-up self-monitored fewer days and reported higher daily caloric intake than self-help participants. Once stepped-up, weight loss outcomes were equivalent between individuals who remained in self-help compared to those who were stepped-up. Individuals who were stepped-up benefited from early intensive intervention when unsuccessful at losing weight with self-help.

Weight bias and weight loss treatment outcomes in treatment-seeking adults.

BACKGROUND: Few studies have explored the relationship between weight bias and weight loss treatment outcomes. PURPOSE: This investigation examined the relationship between implicit and explicit weight bias and (a) program attrition, (b) weight loss, (c) self-monitoring adherence, (d) daily exercise levels and overall caloric expenditure, (e) daily caloric intake, and (f) daily caloric deficit among overweight/obese treatment-seeking adults. METHODS: Forty-six overweight/obese adults (body mass index > or = 27 kg/m(2)) participating in an 18-week, stepped-care, behavioral weight loss program completed implicit and explicit measures of weight bias. Participants were instructed to self-monitor and electronically report daily energy intake, exercise, and energy expenditure. RESULTS: Greater weight bias was associated with inconsistent self-monitoring, greater caloric intake, lower energy expenditure and exercise, creation of a smaller caloric deficit, higher program attrition, as well as less weight loss during the self-help phase of the stepped-care treatment. CONCLUSIONS: Weight bias may interfere with overweight/obese treatment-seeking adults' ability to achieve optimal health.

Can following the caloric restriction recommendations from the Dietary Guidelines for Americans help individuals lose weight?

BACKGROUND: The Dietary Guidelines for Americans recommend creating an energy deficit of at least 500 kcal a day to facilitate weight loss. This investigation examined the relationship between creating a consistent, self-reported energy deficit of at least 500 kcal a day and weight loss. The relationship between self-monitoring adherence and daily energy intake and expenditure and weight loss was also examined. METHODS: Fifty-four overweight or obese adults (BMI>or=27 kg/m(2)) participating in a 14-week weight loss program were given a 5% total body weight loss goal and instructed to create an energy deficit of at least 500 kcal a day to facilitate weight loss. Participants provided daily records of total energy intake and expenditure, physical activity, and weekly and overall weight loss during treatment. RESULTS: Individuals who averaged an energy deficit in excess of 500 kcal per day lost nearly four times the weight as individuals whose average energy deficit was below 500 kcal per day (p<.01). Individuals who lost 5% of their body weight during the intervention self-monitored more than twice as many days than individuals who failed to lose 5% of their body weight (p<.01). CONCLUSION: Individuals interested in losing weight should continue to be advised to regularly self-monitor energy intake and expenditure as well as to create a consistent daily energy deficit (e.g., 500 kcal day).

Skipping meals and alcohol consumption. The regulation of energy intake and expenditure among weight loss participants.

Research suggests that specific eating patterns (e.g., eating breakfast) may be related to favorable weight status. This investigation examined the relationship between eating patterns (i.e., skipping meals; consuming alcohol) and weight loss treatment outcomes (weight loss, energy intake, energy expenditure, and duration of exercise). Fifty-four overweight or obese adults (BMI> or =27 kg/m(2)) participated in a self-help or therapist-assisted weight loss program. Daily energy intake from breakfast, lunch, dinner, and alcoholic beverages, total daily energy intake, total daily energy expenditure, physical activity, and weekly weight loss were assessed. On days that breakfast or dinner was skipped, or alcoholic beverages were not consumed, less total daily energy was consumed compared to days that breakfast, dinner, or alcoholic beverages were consumed. On days that breakfast or alcohol was consumed, daily energy expenditure (breakfast only) and duration of exercise were higher compared to days that breakfast or alcohol was not consumed. Individuals who skipped dinner or lunch more often had lower energy expenditure and exercise duration than individuals who skipped dinner or lunch less often. Individuals who consumed alcohol more often had high daily energy expenditure than individuals who consumed alcohol less often. Skipping meals or consuming alcoholic beverages was not associated with weekly weight loss. In this investigation, weight loss program participants may have compensated for excess energy intake from alcoholic beverages and meals with greater daily energy expenditure and longer exercise duration.