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1.
Plast Reconstr Surg Glob Open ; 12(6): e5893, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38855136

RESUMO

Frontosphenoidal craniosynostosis (FSC) is a rare premature fusion of the frontosphenoidal suture that results in anterior plagiocephaly. When associated with severe cranial deformity, surgical treatment is beneficial. All previously reported cases of FSC correction have utilized fronto-orbital remodeling and advancement to achieve improved anatomy and increased intracranial volume. For patients with isolated synostosis deformities, we believe that distraction osteogenesis can be a viable option, with the additional benefit of quicker operating time, shorter hospital stays, and less irregularity in final head contour. This case illustrates the feasibility of using distraction osteogenesis in the management of FSC.

2.
Plast Reconstr Surg Glob Open ; 12(6): e5883, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38855133

RESUMO

Management of mandibular fractures often involves the use of maxillomandibular fixation (MMF) to attain immobility of the fractured segments. This can be used as a primary treatment modality or as an adjunct in fracture management. This technique, however, has its drawbacks due to the great burden of care imposed on patients. In the following case, fixation of a pediatric open mandibular body fracture was attained without the use of MMF, and bone union was achieved. Due to age, safety concerns, long-distance travel, and parent's preference, the routine management of this type of fracture with MMF using piriform aperture drop wires and circummandibular wires was not done. Instead, the fracture was reduced, and an intraoral mandibular impression was taken in the operating room, which was used to create a stone model. A 2-mm acrylic splint was designed and fabricated from the stone model, and two circummandibular wires were placed. The wires were tightened over the acrylic splint to achieve stabilization of the mandibular reduction. At 4 weeks postoperatively, the splint was removed, and the patient was maintained on a soft diet. At 6 weeks, bone union was appreciated clinically by immobility of the mandibular segments, and the patient was advanced to a regular diet. Occlusion was corrected to premorbid state by clinical findings and 6 months postoperative imaging. This technique represents an effective approach in managing pediatric mandibular fractures when MMF cannot be used.

3.
Plast Reconstr Surg Glob Open ; 12(5): e5848, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38808144

RESUMO

Background: The whistle deformity, a deficiency of tissue in the central upper lip, is a consequential outcome of primary cleft lip repair. Among multiple described reconstructive options, the wide-hinged island swing transposition labial enhancement (WHISTLE) flap procedure by Grewal et al has been shown to be a reliable technique that restores the continuity of the orbicularis oris muscle and creates a more natural appearing tubercle and central lip element. This article aims to refine the WHISTLE flap procedure with the addition of tailored mucomuscular flaps and an upper lip-lengthening mucosal Z-plasty. Methods: A total of 11 patients with a whistle deformity were examined. All underwent the WHISTLE flap procedure with tailored mucomuscular flaps and a mucosal Z-plasty. The patients were followed for a period of from 6 to 51.5 months. Pre- and postoperative photographs were used for objective outcome comparison. Results: From 2018 to 2023, a total of 11 patients with a whistle deformity were included in the final cohort, comprised four bilateral and seven unilateral cleft lips. Ten cases (90.1%) resulted in satisfactory postoperative cosmetic appearance and did not require further interventions. A single patient with a significant preoperative discrepancy between the upper and lower lip volumes had a postoperative residual deformity. None of the patients demonstrated any functional deficits associated with the procedure. Conclusions: The WHISTLE flap procedure with the proposed individual tailoring of the mucomuscular flap and Z-plasty for mucosal scar lengthening has excellent cosmetic outcomes and can be considered as the primary treatment modality in most patients with a whistle deformity.

4.
Org Lett ; 26(9): 1947-1951, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38386927

RESUMO

Described herein is our effort toward achieving the decarboxylative functionalization of 2,2-difluorobicyclo[1.1.1]pentane (BCP-F2) building blocks. When compared with the nonfluorinated bicyclo[1.1.1]pentane (BCP) analogues, we discovered divergent reactivities. This is the first successful decarboxylative coupling of BCP-F2 building blocks reported via the photoredox mechanism.

5.
Med Educ Online ; 29(1): 2299534, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38159282

RESUMO

PURPOSE: This mixed-methods study quantified and characterized incidents of microaggressions experienced by Asian American medical students. The authors report on their impact and suggest improvements to create a more equitable and supportive learning environment. METHOD: Quantitative and qualitative data were collected from 305 participants who self-identified as Asian American or Pacific Islander. An online, anonymous survey was sent to US medical students through the Asian Pacific American Medical Student Association (APAMSA). Questions explored incidence, characteristics of, and response to microaggressions. We conducted four focus groups to further characterize students' experiences. Data were organized and coded, and thematic analysis was used to identify core themes. RESULTS: Racial microaggressions were prevalent among Asian American medical students. Nearly 70% (n = 213) of survey respondents reported experiencing at least one incident during their medical training to date. The most common perpetrators were patients (n = 151, 70.9%) and fellow medical students (n = 126, 59.2%), followed by professors (n = 90, 42.3%). The most prevalent themes included being perceived as a perpetual foreigner, the assumption of timidness, and ascription of the model minority myth. Students rarely reported the incident and usually did not respond immediately due to fear of retaliation, uncertainties about the experience or how to respond appropriately, and perception that they would bear the burden of advocacy alone. Experiences with microaggressions led to feelings of frustration and burnout and had a negative impact on mental health. Recommendations were made to improve the anonymous reporting systems in medical schools, and to increase diversity and inclusion in medical education and leadership. CONCLUSIONS: Asian American medical students face high exposure to racial microaggressions during their medical education that adversely impact their mental health. Changes are needed in medical training to create a more equitable and inclusive learning environment.


Assuntos
Asiático , Microagressão , Bem-Estar Psicológico , Estudantes de Medicina , Humanos , Asiático/psicologia , Grupos Minoritários , Estudantes de Medicina/psicologia , Racismo
6.
Appetite ; 191: 107090, 2023 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-37871365

RESUMO

Loss-of-control (LOC) eating involves a subjective feeling that one cannot stop eating or control one's eating. Individuals with LOC eating may exhibit strong appetitive drives and weak inhibitory control, and these two opposing motivations have been related to EEG measurements of frontal asymmetry or lateralized frontal activation. The present study investigated whether frontal asymmetry is related to hedonic hunger, LOC eating severity and frequency, and eating in the absence of hunger (EAH) in the laboratory. Fifty-nine individuals participated in an ostensible taste study after resting-state electroencephalogram (EEG) recordings. After the EEGs, they were provided a meal to eat until fullness, followed by an array of snacks and instructions to eat as much as they would like. The results indicated that several measures of right-frontal asymmetry were related to greater EAH and greater self-reported LOC eating severity. Although right-frontal asymmetry has been theorized to reflect avoidance motivation, recent evidence suggests it may indicate effortful control during approach-avoidance conflicts. Because individuals with LOC eating presumably experience heightened conflict between drives to eat beyond energy needs and to minimize such eating, those experiencing greater LOC may exert greater effort to manage these conflicting motivations. An integration of these neurobiological correlates of LOC eating may help provide a more comprehensive understanding of LOC eating and inform treatments.

7.
J Wound Care ; 32(Sup9): S22-S36, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-37682800

RESUMO

Constant, unrelieved pressure of local tissue, particularly over bony prominences, may provoke damage that progresses to necrosis and pressure injury (PI). Differentiating PIs from conditions of similar appearance is imperative to minimising complications and implementing prompt treatment. This case series describes several conditions that may be mistaken for a PI. Outlined are the key differences in patient history, presentation and clinical cues that assist in correctly identifying the true pathology behind these conditions. Conditions reviewed included: pyoderma gangrenosum; necrotising fasciitis; genital herpes; Marjolin ulcer, Rosai-Dorfman disease; vascular disease; coagulopathies; calciphylaxis; trauma and surgical wounds; pilonidal cysts; graft-versus-host disease; hidradenitis suppurativa; Stevens-Johnson syndrome; epidermolysis bullosa; radiation wounds; spider bites; and end-of-life skin failure pressure ulcers (also known as Kennedy ulcers). Although commonly recognised and diagnosed, stage 2, 3 and 4 PIs occasionally prove to be difficult to pinpoint, with undefined characteristics and similarities in presentation to several other conditions. Therefore, it is clinically vital to be aware of their appearance, risk factors and aetiology in order to make an appropriate patient assessment and avoid misdiagnosis.


Assuntos
Úlcera por Pressão , Humanos , Diagnóstico Diferencial , Úlcera por Pressão/diagnóstico , Pesquisa , Pelve , Extremidade Inferior
8.
Transl Psychiatry ; 13(1): 2, 2023 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-36604416

RESUMO

Recent models of bulimia nervosa (BN) propose that binge-purge episodes ultimately become automatic in response to cues and insensitive to negative outcomes. Here, we examined whether women with BN show alterations in instrumental learning and devaluation sensitivity using traditional and computational modeling analyses of behavioral data. Adult women with BN (n = 30) and group-matched healthy controls (n = 31) completed a task in which they first learned stimulus-response-outcome associations. Then, participants were required to repeatedly adjust their responses in a "baseline test", when different sets of stimuli were explicitly devalued, and in a "slips-of-action test", when outcomes instead of stimuli were devalued. The BN group showed intact behavioral sensitivity to outcome devaluation during the slips-of-action test, but showed difficulty overriding previously learned stimulus-response associations on the baseline test. Results from a Bayesian learner model indicated that this impaired performance could be accounted for by a slower pace of belief updating when a new set of previously learned responses had to be inhibited (p = 0.036). Worse performance and a slower belief update in the baseline test were each associated with more frequent binge eating (p = 0.012) and purging (p = 0.002). Our findings suggest that BN diagnosis and severity are associated with deficits in flexibly updating beliefs to withhold previously learned responses to cues. Additional research is needed to determine whether this impaired ability to adjust behavior is responsible for maintaining automatic and persistent binge eating and purging in response to internal and environmental cues.


Assuntos
Transtorno da Compulsão Alimentar , Bulimia Nervosa , Bulimia , Transtornos da Alimentação e da Ingestão de Alimentos , Adulto , Feminino , Humanos , Bulimia Nervosa/diagnóstico , Teorema de Bayes , Transtorno da Compulsão Alimentar/diagnóstico
9.
J Orthop Res ; 41(8): 1767-1773, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36691875

RESUMO

Kinematics of total knee replacements (TKR) play an important role in assessing the success of a procedure and would be a valuable addition to clinical practice; however, measuring TKR kinematics is time consuming and labour intensive. Recently, an automatic single-plane fluoroscopic method utilizing machine learning has been developed to facilitate a quick and simple process for measuring TKR kinematics. This study aimed to validate the new automatic single-plane technique using biplanar radiostereometric analysis (RSA) as the gold standard. Twenty-four knees were imaged at various angles of flexion in a dedicated RSA lab and 113 image pairs were obtained. Only the lateral RSA images were used for the automatic single-plane technique to simulate single-plane fluoroscopy. Two networks helped automate the kinematics measurement process, one segmented implant components and the other generated an initial pose estimate for the optimization algorithm. Kinematics obtained via the automatic single plane and manual biplane techniques were compared using root-mean-square error and Bland-Altman plots. Two observers measured the kinematics using the automated technique and results were compared with assess reproducibility. Root-mean-square errors were 0.8 mm for anterior-posterior translation, 0.5 mm for superior-inferior translation, 2.6 mm for medial-lateral translation, 1.0° for flexion-extension, 1.2° for abduction-adduction, and 1.7° for internal-external rotation. Reproducibility, reported as root-mean-square errors between operator measurements, was submillimeter for in-plane translations and below 2° for all rotations. Clinical Significance: The advantages of the automated single plane technique should aid in the kinematic measurement process and help researchers and clinicians perform TKR kinematic analyses.


Assuntos
Artroplastia do Joelho , Articulação do Joelho , Humanos , Reprodutibilidade dos Testes , Articulação do Joelho/cirurgia , Joelho , Fenômenos Biomecânicos , Fluoroscopia/métodos , Amplitude de Movimento Articular
10.
Eat Disord ; 31(5): 415-439, 2023 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-36419352

RESUMO

Recent studies have found increasing rates of overweight and obesity in bulimia nervosa (BN). However, the relationships between body mass index (BMI) and BN symptoms and other clinically relevant constructs are unknown. Participants (N = 152 adults with BN) were assigned to three groups by BMI: group with no overweight or obesity (NOW-BN; BMI <25; N = 32), group with overweight (OW-BN; BMI ≥25 and <30; N = 66), and group with obesity (O-BN; BMI ≥30; N = 54). We compared the groups on demographics, diet and weight histories, body esteem, BN symptoms, and depression using chi square, analysis of variance, analysis of covariance, and Poisson regression models. The O-BN group was older (d = 0.57) and OW-BN and O-BN groups had greater proportions of race/ethnic minorities than NOW-BN group. The O-BN group was significantly younger at first diet (d = 0.41) and demonstrated significantly higher cognitive dietary restraint (d = 0.31). Compared to NOW-BN, O-BN participants had lower incidence of objective binge eating (incidence rate ratio [IRR] = 4.86) and driven exercise (IRR = 7.13), and greater incidence of vomiting (IRR = 9.30), laxative misuse (IRR = 4.01), and diuretic misuse (d = 2.08). O-BN participants also experienced higher shape (d = 0.41) and weight (d = 0.42) concerns than NOW-BN and OW-BN, although NOW-BN experienced higher shape (d = 0.44) and weight (d = 0.39) concerns than OW-BN. Groups did not differ on depression scores. These results were replicated when examining BMI as a continuous predictor across the full sample, with the exception of objective binge eating and driven exercise, which were not significantly associated with BMI. Individuals with BN and comorbid obesity have distinct clinical characteristics. Existing interventions may need to be adapted to meet clinical needs of these individuals.


Assuntos
Transtorno da Compulsão Alimentar , Bulimia Nervosa , Bulimia , Adulto , Humanos , Bulimia Nervosa/psicologia , Bulimia/epidemiologia , Bulimia/psicologia , Transtorno da Compulsão Alimentar/psicologia , Obesidade/psicologia , Índice de Massa Corporal
11.
Protein Sci ; 31(11): e4457, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36153664

RESUMO

Antibiotics in aquaculture prevent bacterial infection of fish, but their misuse is a public health risk and contributes to the unintentional creation of multiresistant pathogens. Regulatory agencies cannot do the rigorous, expensive testing required to keep up with the volume of seafood shipments. Current rapid test kits for these drugs enable the increase in testing needed for adequate monitoring of food supply chains, but they lack a high degree of accuracy. To combat this, we set out to discover and engineer single-domain antibodies (VHHs) that bind to small molecule antibiotics, and that can be used in rapid test kits. The small size, solubility, and stability of VHHs are useful properties that can improve the reliability and shelf-life of test kits for these adulterants. Here, we report a novel anti-chloramphenicol VHH (Chl-VHH) with a disassociation constant of 57 nM. This was achieved by immunizing a llama against a chloramphenicol-keyhole limpet hemocyanin (KLH) conjugate and screening for high affinity binders through phage display. The crystal structure of the bound-VHH to chloramphenicol was key to identifying a mutation in the binding pocket that resulted in a 16-fold improvement in binding affinity. In addition, the structure provides new insights into VHH-hapten interactions that can guide future engineering of VHHs against additional targets.


Assuntos
Camelídeos Americanos , Anticorpos de Domínio Único , Animais , Cloranfenicol , Reprodutibilidade dos Testes , Antibacterianos , Especificidade de Anticorpos
12.
Appetite ; 176: 106103, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35662619

RESUMO

Behavioral treatments for psychological disorders characterized by reward-driven maladaptive behaviors (e.g., substance use disorder, eating disorders, behavioral addictions) primarily seek to reduce hyper-reward response to disorder-specific stimuli. Suboptimal outcomes for these treatments highlight the need to also target hypo-reward response to day-to-day life activities. The present study sought to conduct an initial test of a novel behavioral treatment, Reward Re-Training (RRT) to target hyper- and hypo-reward response in individuals with binge eating. Individuals with binge eating (N = 23) were randomly assigned to either 10 weeks of outpatient, group-based RRT treatment or a waitlist control. RRT was found to be feasible and acceptable, demonstrated large impacts on both hypo- and hyper-reward response (measured by self-report (pre-to post-treatment ηp2 range 0.38-0.58) and neural activation via fMRI), and was efficacious in reducing eating disorder pathology (ηp2 range 0.40-0.64, including binge eating, ηp2 = 0.64) compared to waitlist control (ηp2 range 0.00-0.04). This pilot data provides preliminary support for the feasibility, acceptability, and effectiveness of a novel treatment targeting reward imbalance for individuals with binge eating. Future evaluations of RRT may benefit from an active treatment comparison condition and a follow-up assessment to examine persistence of positive outcomes.


Assuntos
Transtorno da Compulsão Alimentar , Transtornos da Alimentação e da Ingestão de Alimentos , Terapia Comportamental , Transtorno da Compulsão Alimentar/psicologia , Transtorno da Compulsão Alimentar/terapia , Humanos , Projetos Piloto , Recompensa , Resultado do Tratamento
13.
Rev Sci Instrum ; 93(4): 043709, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35489955

RESUMO

Electrical resistance tomography (ERT) is considered a novel sensing technique for monitoring conductivity distribution. Image reconstruction of ERT is an ill-posed inverse problem. In this paper, an improved regularization reconstruction method is presented to solve this issue. We adopted homotopic mapping to choose the regularization parameter of the iterative Tikhonov algorithm. The standard normal distribution function was used to continuously adjust the regularization parameter. Subsequently, the resultant image vector was deployed as the initial value of the iterative Tikhonov algorithm to improve the image quality. Finally, the improved method was combined with a projection algorithm based on the Krylov subspace, which was also effective in reducing the computational time. Both simulation and experimental results indicated that the new algorithm could improve the real-time performance and imaging quality.

14.
Appetite ; 174: 106017, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35367481

RESUMO

Weight suppression (WS) has been consistently related to eating pathology. The weight loss that produces weight suppression has always been assumed to be intentional, but no study has tested whether unintentional weight loss would also be associated with eating pathology. The current study examined whether the association between WS and eating pathology may be moderated by intentionality of weight loss in a community-based sample of 520 adults. Participants were categorized into low WS (<5% weight loss from highest past weight), intentional, high WS (>5% intentional weight loss), and unintentional, high WS (>5% unintentional weight loss) groups. The intentional WS group reported greater restraint than the unintentional WS and low WS groups, and the low WS group reported greater restraint and more frequent loss-of-control (LOC) eating than those with unintentional WS. Further, WS was positively related to loss-of-control eating frequency only in the intentional WS group, and negatively associated with LOC eating frequency in the low WS group. Additionally, BMI was positively associated with LOC and binge eating frequency and restraint only in the low WS group. Given the relatively high prevalence of substantial but unintended weight loss found in this study, researchers studying weight suppression should consider asking about intentionality of weight loss and analyzing their data with and without unintentional weight suppressors included in the sample.


Assuntos
Bulimia , Transtornos da Alimentação e da Ingestão de Alimentos , Adulto , Peso Corporal , Comportamento Alimentar , Humanos , Magreza , Redução de Peso
15.
Eat Weight Disord ; 27(5): 1775-1785, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35298791

RESUMO

BACKGROUND: Gold-standard psychological and pharmacological treatments for bulimic-spectrum eating disorders only result in remission for around 50% of patients; patients with affective lability and impulsivity represent a subgroup with particularly poor outcomes. Both dialectical behavior therapy (DBT), a treatment for emotion dysregulation, and lamotrigine, a mood stabilizer, have demonstrated promise for targeting affective lability and impulsivity; however, data exploring the combination of these interventions remain limited. OBJECTIVE: We followed a group of women with recurrent dysregulated eating behaviors (N = 62) throughout intensive DBT treatment and compared the symptom trajectory of those prescribed lamotrigine (n = 28) and those who were not (n = 34). METHOD: Participants completed surveys every 2 weeks throughout treatment. RESULTS: Group analyses suggested that all participants self-reported decreases in emotional reactivity, negative urgency, and symptoms of borderline personality disorder (BPD). The lamotrigine group reported greater elevations in BPD symptoms at baseline, but demonstrated steeper decreases in emotion and behavioral dysregulation than the non-matched comparison group. Within-subject analyses suggested that within the lamotrigine group, subjects reported greater decreases in symptoms following prescription of lamotrigine. CONCLUSIONS: Findings provide initial data suggesting that lamotrigine could be useful as an adjunctive treatment for patients with affective lability and impulsivity. LEVEL OF EVIDENCE: IV, time series without randomization.


Assuntos
Transtorno da Personalidade Borderline , Transtornos da Alimentação e da Ingestão de Alimentos , Adulto , Sintomas Afetivos , Transtorno da Personalidade Borderline/tratamento farmacológico , Transtorno da Personalidade Borderline/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/tratamento farmacológico , Feminino , Humanos , Comportamento Impulsivo , Lamotrigina/uso terapêutico
16.
Eat Weight Disord ; 27(5): 1919-1928, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34661882

RESUMO

PURPOSE: Adults with bulimia nervosa (BN) and co-occurring emotional dysregulation and multiple impulsive behaviors are less responsive to existing interventions. Initial data suggest that the combination of Dialectical Behavior Therapy (DBT) and a mood stabilizer, lamotrigine, significantly reduces symptoms of affective and behavioral dysregulation in these patients. Identifying candidate neurobiological mechanisms of change for this novel treatment combination may help guide future randomized controlled trials and inform new and targeted treatment development. Here, we examined neurocognitive and symptom changes in a female patient with BN and severe affective and behavioral dysregulation who received DBT and lamotrigine. METHODS: Go/no-go task performance data and resting-state functional MRI scans were acquired before the initiation of lamotrigine (after 6 weeks in an intensive DBT program), and again after reaching and maintaining a stable dose of lamotrigine. The patient completed a battery of symptom measures biweekly for 18 weeks over the course of treatment. RESULTS: After lamotrigine initiation, the patient made fewer errors on a response inhibition task and showed increased and new connectivity within frontoparietal and frontolimbic networks involved in behavioral and affective control. Accompanying this symptom improvement, the patient reported marked reductions in bulimic symptoms, behavioral dysregulation, and reactivity to negative affect, along with increases in DBT skills use. CONCLUSION: Improved response inhibition and cognitive control network connectivity should be further investigated as neurocognitive mechanisms of change with combined DBT and lamotrigine for eating disorders. Longitudinal, controlled trials integrating neuroimaging and symptom measures are needed to fully evaluate the effects of this treatment. LEVEL OF EVIDENCE: IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.


Assuntos
Bulimia Nervosa , Adulto , Controle Comportamental , Terapia Comportamental/métodos , Bulimia Nervosa/diagnóstico por imagem , Bulimia Nervosa/tratamento farmacológico , Cognição , Feminino , Humanos , Comportamento Impulsivo , Lamotrigina/uso terapêutico , Imageamento por Ressonância Magnética
17.
Physiol Behav ; 240: 113530, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34273346

RESUMO

Research regarding the definition and consequences of dieting has generated controversy for years. This controversy has spilled over into the public domain, especially as eating disorders and obesity have become more prevalent. One of the earliest and longest-lasting controversies involves the restrained eating framework, which was originally developed by Herman and Polivy and also strongly influenced the development of the cognitive-behavioral model of bulimia nervosa. An alternative framework for understanding the role of dieting in nonclinical and clinical groups, called the Three-Factor Model of Dieting, took a sharply different approach to defining, and understanding the impact of, dieting. This paper provides a brief historical review of the development of these divergent perspectives and updates the Three Factor Model's critical distinction between restraining eating to prevent over-consumption and dieting to lose weight. We suggest that three historical trends impacted the development of Restraint Theory in ways that unfairly impugned dieting for weight control: the emergence of the new eating disorders of bulimia nervosa and binge eating disorder, a population-based increase in loss of control eating and a population-based increase in obesity. This update is aimed in part at encouraging new research to reconcile ongoing, unresolved issues between Herman and Polivy's restrained eating model and the Three-Factor model of Dieting model. Such research might also contribute to the public's understanding of the pros and cons of dieting and to new approaches to treating eating disorders and obesity.


Assuntos
Transtorno da Compulsão Alimentar , Bulimia Nervosa , Bulimia , Dieta Redutora , Comportamento Alimentar , Humanos
18.
Int J Eat Disord ; 54(5): 898-902, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33709469

RESUMO

OBJECTIVE: The oscillations between binge eating, purging, and dieting in bulimia nervosa (BN) may produce substantial within-subject weight variability. Although weight variability has been predictive of eating- and weight-related variables in community samples, it has not been empirically examined in eating disorders. The current study examined cross-sectional and prospective associations between weight variability and BN pathology. METHOD: Four weights were collected over an average of 42.02 days, and weight variability was calculated as the root mean square error around each individual's weight trajectory regression line. Linear regressions were performed to examine the association between weight variability and eating disorder psychopathology, cross-sectionally at baseline and prospectively at 6-month follow-up, adjusting for baseline BMI. RESULTS: Weight variability was cross-sectionally associated with eating pathology, but these relationships became non-significant after adjusting for BMI. However, at 6-month follow-up, greater baseline weight variability predicted increases in body dissatisfaction, shape and weight concerns, and global eating pathology, even after adjusting for baseline BMI. DISCUSSION: These findings demonstrate, for the first time, that within-subject weight variability predicts greater eating disorder pathology over time in BN. The results add to evidence that weight history variables contribute to BN psychopathology above and beyond well-documented psychological dysfunction in BN.


Assuntos
Transtorno da Compulsão Alimentar , Bulimia Nervosa , Imagem Corporal , Peso Corporal , Estudos Transversais , Humanos
19.
Int J Eat Disord ; 54(4): 621-626, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33340380

RESUMO

OBJECTIVE: Binge-eating and purging behaviors commonly co-occur with overweight. However, little is known about the potential associations of elevated weight status with eating disorder severity or treatment outcomes. Thus, the present study compared binge-eating and purging patients with low, normal, and high weight statuses on eating disorder and mood symptoms at treatment admission, and tested whether weight status was associated with symptom change over treatment. METHOD: The sample included 135 adult female patients in an intensive outpatient program, who completed self-assessments at admission and discharge. MANOVAs compared the groups at treatment admission, and multilevel models examined changes over time. RESULTS: At admission, the high-weight group reported greater fasting frequency than the normal-weight group, and higher shape and weight concerns than the low-weight group. Over time, the high-weight group additionally showed higher eating disorder psychological symptom severity than the normal-weight group. The groups did not differ on mood symptoms at admission. Longitudinal results indicated that the groups showed comparable symptom improvements over treatment. DISCUSSION: These findings highlight the severity of higher-weight patients with bulimia nervosa. Additionally, although these patients may present with more severe symptoms, their response to an intensive treatment may be comparable to that of normal- or lower-weight groups.


Assuntos
Transtorno da Compulsão Alimentar , Bulimia Nervosa , Adulto , Transtorno da Compulsão Alimentar/diagnóstico , Transtorno da Compulsão Alimentar/terapia , Bulimia Nervosa/diagnóstico , Bulimia Nervosa/terapia , Feminino , Humanos , Sobrepeso , Magreza , Resultado do Tratamento
20.
Behav Ther ; 51(3): 401-412, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32402256

RESUMO

Emotion regulation deficits are associated with eating disorder (ED) symptoms, regardless of eating disorder diagnosis. Thus, recent treatment approaches for EDs, such as dialectical behavior therapy (DBT), have focused on teaching patients skills to better regulate emotions. The present study examined changes in emotion regulation among adult patients with EDs during DBT-oriented partial hospital treatment, and at follow-up (M[SD] = 309.58[144.59] days from discharge). Exploratory analyses examined associations between changes in emotion regulation and ED symptoms. Patients with anorexia nervosa, restricting (AN-R, n = 77), and binge-eating/purging subtype (AN-BP, n = 46), or bulimia nervosa (BN, n = 118) completed the Difficulties in Emotion Regulation Scale (DERS) at admission, discharge, and follow-up. Patients with BN demonstrated significant improvements across all facets of emotion dysregulation from admission to discharge and maintained improvements at follow-up. Although patients with AN-BP demonstrated statistically significant improvements on overall emotion regulation, impulsivity, and acceptance, awareness, and clarity of emotions, from admission to discharge, these improvements were not significant at follow-up. Patients with AN-R demonstrated statistically significant improvements on overall emotion dysregulation from treatment admission to discharge. Changes in emotion regulation were moderately correlated with changes in ED symptoms over time. Results support different trajectories of emotion regulation symptom change in DBT-oriented partial hospital treatment across ED diagnoses, with patients with BN demonstrating the most consistent significant improvements.


Assuntos
Regulação Emocional , Transtornos da Alimentação e da Ingestão de Alimentos , Adolescente , Adulto , Hospital Dia , Emoções , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Humanos , Masculino , Adulto Jovem
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