How visitation affects the behavior and welfare of different species of captive amazonian primates? / Como a visitação afeta o comportamento e o bem-estar de diferentes espécies de primatas cativos da Amazônia? / ¿Cómo visitas afectan el comportamiento y bienestar de diferentes especies de primates en cautiverio en Amazonia?

This study had the purpose of understanding the effects of visitation on behavioral patterns and on the well-being of primates in captivity. Five Amazonian primate species were observed using the focal animal method: Ateles chamek, Ateles belzebuth, Ateles paniscus, Lagothrix cana, and Sapajus apella. Two categories of visitor behavioral observations were adopted - active and passive. From the total number of records, the behavior of primates could be observed in 53.7% of the notes in the presence of visitors. The behavior of the visitors in front of the cages was considered passive in 91.2% of those records. The three species of Ateles reacted in different ways in the presence and absence of visitors. The type of visitor behavior had influence on the behavior of the primate (Chi-square=22.9, p<0.001). Stress indicating behaviors (CIE) represented 3.3% of the behavioral repertoire of the species (n=253 records). The primates presented a varied number of CIE, which included indexes of reduced well-being levels. A. belzebuth was ranked first as the species most affected by visitation. These results show the importance of understanding the stress effects on the behavioral pattern of captive primates in relation to visitation and other factors, leading to alternative actions for the zoo in order to improve the level of their welfare.(AU)

O entendimento dos efeitos da visitação nos padrões comportamentais e no bem-estar dos primatas em cativeiro foi o objetivo deste estudo. Por meio do método animal focal foram realizadas observações de cinco espécies de primatas amazônicos: Ateles chamek, Ateles belzebuth, Ateles paniscus, Lagothrix cana e Sapajus apella. Para observações comportamentais dos visitantes, foram adotadas duas categorias, ativo e passivo. Do total de registros, encontrou-se que os comportamentos dos primatas foram exibidos em 53,7% das anotações na presença de visitantes. O comportamento dos visitantes diante dos recintos foi em 91,2% considerado passivo. As três espécies de Ateles reagiram de formas diferentes na presença e ausência de visitantes. O tipo de comportamento dos visitantes teve influência no comportamento dos primatas (Chi-quadrado=22,9, p<0,001). Os comportamentos indicadores de estresse (CIE) representaram 3,3% do repertório comportamental das espécies (n=253 registros). Os primatas apresentaram um número variado de CIE, apresentando indicadores de reduzido grau de bem-estar. A. belzebuth esteve em primeiro lugar no ranking das espécies mais afetadas pela visitação. Estes resultados mostraram a importância de compreender os efeitos do estresse no padrão comportamental dos primatas cativos relacionados a visitação e outros fatores, levando ao zoológico alternativas que conduzam a ações para melhorar o grau de bem-estar.(AU)

Comprender los efectos de visitaciones en los estándares comportamentales y en el bienestar de los primates en cautiverio fue el objetivo de este estudio. Mediante el método de animales focales se realizaron observaciones en cinco especies de primates amazónicos: Ateles chamek, Ateles belzebuth, Ateles paniscus, Lagothrix cana y Sapajus apella. Para observaciones comportamentales de los visitantes, se adoptaron dos categorías, activa y pasiva. Del total de registros, se encontró que los comportamientos de los primates se mostraron en 53,7% de las notas en presencia de visitantes. El comportamiento de los visitantes frente a los recintos fue considerado pasivo en un 91,2%. Las tres especies de Ateles reaccionaron de manera diferente a la presencia y ausencia de visitantes. El tipo de comportamiento de los visitantes influyó en el comportamiento de los primates (Chi-cuadrado=22,9, p<0,001). Los comportamientos indicadores de estrés (CIE) representaron el 3,3% del repertorio conductual de la especie (n=253 registros). Los primates presentaron un número variado de CIE, mostrando indicadores de un reducido grado de bienestar. A. belzebuth ocupó el primer lugar en el ranking de las especies más afectadas por las visitas. Estos resultados mostraron la importancia de comprender los efectos del estrés en el estándar comportamental de los primates en cautivos relacionados con las visitas y otros factores, llevando al zoológico alternativas que conduzcan a acciones para mejorar el grado de bienestar.(AU)

Appropriate number of observations for determining hand hygiene compliance among healthcare workers.

We sought to determine the minimum number of observations needed to determine hand hygiene (HH) compliance among healthcare workers. The study was conducted at a referral hospital in South Korea. We retrospectively analyzed the result of HH monitoring from January to December 2018. HH compliance was calculated by dividing the number of observed HH actions by the total number of opportunities. Optimal HH compliance rates were calculated based on adherence to the six-step technique recommended by the World Health Organization. The minimum number of required observations (n) was calculated by the following equation using overall mean value (ρ), absolute precision (d), and confidence interval (CI) (1 - α) [the equation: [Formula: see text]]. We considered ds of 5%, 10%, 20%, and 30%, with CIs of 99%, 95%, and 90%. During the study period, 8791 HH opportunities among 1168 healthcare workers were monitored. Mean HH compliance and optimal HH compliance rates were 80.3% and 59.7%, respectively. The minimum number of observations required to determine HH compliance rates ranged from 2 ([Formula: see text]: 30%, CI: 90%) to 624 ([Formula: see text]: 5%, CI: 99%), and that for optimal HH compliance ranged from 5 ([Formula: see text]: 30%, CI: 90%) to 642 ([Formula: see text]: 5%, CI: 99%). Therefore, we found that our hospital required at least five observations to determine optimal HH compliance.

Infant's Behaviour Checklist for low birth weight infants and later neurodevelopmental outcome.

Assessment of the characteristics of spontaneous movements and behaviour in early infancy helps in estimating developmental outcomes. We introduced the Infant Behaviour Checklist (IBC) and examined the relationship between the behavioural characteristics of low-birth-weight infants and neurodevelopmental outcomes at 6 years of age. The behavioural characteristics during the neonatal (36-43 weeks, adjusted) and early infancy periods (49-60 weeks, adjusted) were assessed in very-low-birth-weight infants. The IBC includes 44 common behaviours. We assessed the appearance of individual behavioural characteristics at each period according to the neurodevelopmental outcome. Of the 143 infants assessed during the neonatal period, 89 had typical development (TD), 30 had intellectual disability (ID), and 24 had autism spectrum disorder (ASD). In 78 infants assessed during early infancy, 40, 21, and 17 had TD, ID, and ASD, respectively. The frequency of appearance of three behaviour-related items was significantly lower in the ID group than in the TD group. The frequency of appearance of three posture- and behaviour-related items was significantly lower, while that of two posture-related items was significantly higher, in the ASD group than in the TD group. Behavioural assessment using the IBC may provide promising clues when considering early intervention for low-birth-weight infants.

Healthy Eating Index-2015 Scores Among Adults Based on Observed vs Recalled Dietary Intake.

BACKGROUND: The construct and predictive validity of the Healthy Eating Index (HEI) have been demonstrated, but how error in reported dietary intake may affect scores is unclear. OBJECTIVE: These analyses examined concordance between HEI-2015 scores based on observed vs reported intake among adults. DESIGN: Data were from two feeding studies (Food and Eating Assessment STudy, or FEAST, I and II) in which true intake was observed for three meals on 1 day. The following day, participants completed an unannounced 24-hour dietary recall. PARTICIPANTS/SETTING: FEAST I (2012) included 81 men and women, aged 20 to 70 years, living in the Washington, DC, area. FEAST II (2016) included 302 women, aged 18 years or older, with low household incomes and living in the Washington, DC, area. In FEAST I, recalls were completed independently using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24-2011) or interviewer-administered using the Automated Multiple-Pass Method. In FEAST II, recalls were completed using ASA24-2016, independently or in a small group setting with assistance. MAIN OUTCOME MEASURES: HEI-2015 scores were calculated using the population ratio method. STATISTICAL ANALYSES PERFORMED: T-tests determined whether differences between scores based on observed and reported intake were different from zero. FEAST I data were stratified by sex, and in FEAST II, analyses were repeated by education and body mass index (BMI). RESULTS: Differences in total HEI-2015 scores between observed and reported intake ranged from -1.3 to 5.8 points among those completing ASA24 independently in both studies, compared with -2.5 points in the small group setting. For interviewer-administered recalls, the differences were -1.1 for men and 2.3 for women. In FEAST II, total HEI-2015 scores derived from observed intake were lower than scores derived from reported intake among those who had completed high school or less (-3.2, SE 1.1, P<0.01) and those with BMI ≥ 30 (-2.8, SE 1.1, P = 0.01). CONCLUSIONS: HEI-2015 scores based on 24-hour dietary recall data are generally well estimated.

Higher Depression of Patients with Alzheimer's Disease During than Before the Lockdown.

We assessed depression in 72 patients with Alzheimer's disease (AD) who live in retirement homes during the COVID-19-related lockdown. We invited caregivers of 72 patients with AD who live in retirement homes to rate depression in the patients both before and during the lockdown. Analysis demonstrated increased depression in the patients during the lockdown. We attribute this increased depression to the restrictive measures on activities, visits, and physical contact between patients with AD and family members during the lockdown.

Quantifying influence of human choice on the automated detection of Drosophila behavior by a supervised machine learning algorithm.

Automated quantification of behavior is increasingly prevalent in neuroscience research. Human judgments can influence machine-learning-based behavior classification at multiple steps in the process, for both supervised and unsupervised approaches. Such steps include the design of the algorithm for machine learning, the methods used for animal tracking, the choice of training images, and the benchmarking of classification outcomes. However, how these design choices contribute to the interpretation of automated behavioral classifications has not been extensively characterized. Here, we quantify the effects of experimenter choices on the outputs of automated classifiers of Drosophila social behaviors. Drosophila behaviors contain a considerable degree of variability, which was reflected in the confidence levels associated with both human and computer classifications. We found that a diversity of sex combinations and tracking features was important for robust performance of the automated classifiers. In particular, features concerning the relative position of flies contained useful information for training a machine-learning algorithm. These observations shed light on the importance of human influence on tracking algorithms, the selection of training images, and the quality of annotated sample images used to benchmark the performance of a classifier (the 'ground truth'). Evaluation of these factors is necessary for researchers to accurately interpret behavioral data quantified by a machine-learning algorithm and to further improve automated classifications.

Behavioral Observation of Infants With Life-Threatening or Life-Limiting Illness in the Neonatal Intensive Care Unit.

BACKGROUND: Infants in the neonatal intensive care unit experience aversive stimuli that cause pain and distress. Maintaining adequate relief from pain and distress is challenging because of infants' varying ages and stages of development and their nonverbal status. Thus, pain and distress must be interpreted by a healthcare provider or other proxy from their own observations or perceptions. There is no standard research or clinical measure for pain and distress in infants. OBJECTIVE: The purpose of this analysis was to evaluate the use of the COMFORT Behavior (COMFORT-B) Scale as a measure of pain and distress in infants diagnosed with life-threatening or life-limiting illnesses in the neonatal intensive care unit in comparison with the nurse-documented Neonatal Pain, Agitation and Sedation Scale; the infants' Technology Dependence Scale; and the mothers' report of total perceived symptom scores. METHODS: Infants diagnosed with life-threatening or life-limiting illnesses and hospitalized in a Level IV neonatal intensive care unit in the Midwestern United States and their parents were included. Measurement of pain and distress in infants was collected weekly from enrollment through 12 weeks or until discharge, whichever occurred first. Observations for the COMFORT-B Scale were conducted before and after standard caregiving activities. Pearson r correlations were used to compare means between pain and distress, technology dependence, and mothers' total perceived symptom scores over time. RESULTS: Data from 78 infants (46 male and 32 female infants) of ages 23-41 weeks of gestation at birth were analyzed. No correlations were found among the COMFORT-B Scale; the Neonatal Pain, Agitation and Sedation Scale; and mothers' total perceived symptom scores. Moderate correlations were found among the Technology Dependence Scale; mothers' total perceived symptom scores; and the Neonatal Pain, Agitation and Sedation Scale. DISCUSSION: Performing COMFORT-B observations can be challenging, and it is unclear whether the information obtained from the COMFORT-B Scale added to the assessment of the infant's pain and distress that is typically recorded in the health record or from parents. Further evaluation is needed to determine if it is more reliable to collect the Neonatal Pain, Agitation and Sedation Scale scores rather than conduct observations using the COMFORT-B Scale in studies of infants with life-threatening and life-limiting illnesses in the neonatal intensive care unit.

Do males bond? A study of male-male relationships in Nicobar long-tailed macaques Macaca fascicularis umbrosus.

In primates, males compete for a mate, which is a non-sharable resource. This makes the conditions less conducive for males to have stable relationships. One such special kind of relationship is a bond where the interactions are reciprocated, equitable and differentiated. Bonds in macaque societies are based on the degree of within-group contest competition for mates which is dependent on the synchronization of female fertile phase and reliability of fertility signals. Species of the Fascicularis group, including Nicobar subspecies, show intermediate reliability in the signals with mild peaks, and studies have shown reciprocity but no differentiation. We conducted a study on a group of wild Nicobar long-tailed macaques Macaca fascicularis umbrosus to understand the existing patterns of male-male relationships. We examined whether there is reciprocity in affiliation among the individuals and whether the rate of affiliation is balanced. We also measured the dominance linearity and steepness in the group to understand the monopolizability of females. We used social network analysis to understand whether the relations are differentiated based on hierarchical position and whether the high-ranking individuals are the most central individuals in the distribution of grooming in the group. We found that there is reciprocity among the males although that is not equitable. There was no rankrelated differentiation of affiliation among the males of the group. Instead, the identities of individuals influenced affiliation patterns. Our results correspond to the existent strong relationships but lack of social bond otherwise found in the Fascicularis group of macaques.

Efficacy of covert closed-circuit television monitoring of the hand hygiene compliance of health care workers caring for patients infected with multidrug-resistant organisms in an intensive care unit.

BACKGROUND: To compare covert closed-circuit television (CCTV) monitoring to standard overt observation in assessing the hand hygiene (HH) conduct of health care workers (HCWs) caring for patients infected with multidrug-resistant organisms (MDROs). This was a cross-sectional study in a general intensive care unit of a 1,000-bed university hospital. METHODS: Forty-six general intensive care unit HCWs (staff physicians, registered nurses, and auxiliary workers) caring for contact isolation MDRO-infected patients. The study incorporated the following 3 phases: phase 1, establishment of interrater reliability between 2 simultaneous observers using the overt observation method; phase 2, establishment of interrater reliability between 2 simultaneous observers using the CCTV method; and phase 3, simultaneous monitoring of HH by both methods to evaluate the suitability of CCTV as an alternative to direct observation of the HH conduct of HCWs caring for MDRO-infected patients. RESULTS: Overall, 1,104 opportunities to perform HH were documented during 49 observation sessions. The compliance rate observed by the overt method (37.3%) was significantly higher than that observed when only the covert method was used (26.5%). However, simultaneous overt-covert observations were found to have intraclass correlation coefficients of >0.85. CONCLUSIONS: Covert CCTV observation of HCW HH compliance appears to provide a truer and more realistic picture than overt observation, probably because of its ability to neutralize the Hawthorne effect of overt observation. The high intraclass correlation coefficients between covert observation and overt observation supports this conclusion.

Clinical experiences with a new system for automated hand hygiene monitoring: A prospective observational study.

BACKGROUND: Hand hygiene compliance (HHC) among health care workers remains suboptimal, and good monitoring systems are lacking. We aimed to evaluate HHC using an automated monitoring system. METHODS: A prospective, observational study was conducted at 2 Danish university hospitals employing a new monitoring system (Sani nudge). Sensors were located on alcohol-based sanitizers, health care worker name tags, and patient beds measuring hand hygiene opportunities and sanitations. RESULTS: In total, 42 nurses were included with an average HHC of 52% and 36% in hospitals A and B, respectively. HHC was lowest in patient rooms (hospital A: 45%; hospital B: 29%) and highest in staff toilets (hospital A: 72%; hospital B: 91%). Nurses sanitized after patient contact more often than before, and sanitizers located closest to room exits and in hallways were used most frequently. There was no association found between HHC level and the number of beds in patient rooms. The HHC level of each nurse was consistent over time, and showed a positive correlation between the number of sanitations and HHC levels (hospital A: r = 0.69; hospital B: r = 0.58). CONCLUSIONS: The Sani nudge system can be used to monitor HHC at individual and group levels, which increases the understanding of compliance behavior.

Use of an automated hand hygiene compliance system by emergency room nurses and technicians is associated with decreased employee absenteeism.

Few studies have examined the use of hand hygiene interventions among health care personnel and employee absenteeism. To improve the hand hygiene practices of emergency room nurses and technicians, we implemented mandatory use of an automated hand hygiene compliance system. After implementation, we found reductions in employee absenteeism and the number of overtime hours worked by substitute staff. These unanticipated results demonstrate a return on investment that benefits the health of employees.

Observed Interactions in Families of Adolescent Suicide Attempters.

Family interactions of 71 adolescents hospitalized following a suicide attempt were compared with those of 29 psychiatric controls, using observational methods and a 2-year prospective, longitudinal design. Parent-adolescent dyadic interactions were coded for emotional validation and invalidation, and problem-solving constructiveness. There were no between-group differences for parents. However, adolescents who had attempted suicide displayed more emotional invalidation than controls. Within the suicide attempt group, maternal constructive problem solving predicted greater declines in youth suicide ideation, and a similar trend was observed for fathers. Adolescents who displayed more unconstructive problem solving with fathers were more likely to reattempt suicide during the follow up.

More than just co-workers: Presence of humanoid robot co-worker influences human performance.

Does the presence of a robot co-worker influence the performance of humans around it? Studies of motor contagions during human-robot interactions have examined either how the observation of a robot affects a human's movement velocity, or how it affects the human's movement variance, but never both together. Performance however, has to be measured considering both task speed (or frequency) as well as task accuracy. Here we examine an empirical repetitive industrial task in which a human participant and a humanoid robot work near each other. We systematically varied the robot behavior, and observed whether and how the performance of a human participant is affected by the presence of the robot. To investigate the effect of physical form, we added conditions where the robot co-worker torso and head were covered, and only the moving arm was visible to the human participants. Finally, we compared these behaviors with a human co-worker, and examined how the observed behavioral affects scale with experience of robots. Our results show that human task frequency, but not task accuracy, is affected by the observation of a humanoid robot co-worker, provided the robot's head and torso are visible.

Neonatal Behavioral Assessment Scale (NBAS): Confirmatory factor analysis of the six behavioral clusters.

The Neonatal Behavioral Assessment Scale (NBAS) is a widely used in the neurobehavioral assessment of neonates in clinical practice and research. Lester's data reduction system for the NBAS items is the most often used in research, but the few factor analytic studies carried out with it leave gaps in its validation. The current study aimed to test and compare (a) the factorial structure of the Lester's data reduction system for the NBAS and (b) an alternative data reduction system, slightly modified from Lester's system. The NBAS was administered to 196 healthy Portuguese full-term infants (51% male) in the first 72 h of life (M = 43.63 h). Construct validity of the data reduction systems was tested through confirmatory factor analysis (CFA). Lester's original system was compared to three alternative models, two of which included a revision of the scoring rules for three items and the exclusion of five items. The CFA generally supported the six-factor structure. However, fit indices for Lester's original model were only fair. An alternative, revised model with a second-order factor - Self-Organizing System - demonstrated a better fit. The results provide evidence to support a modified form of Lester's six behavioral clusters as a data reduction model for the NBAS items.

Determining Anxiety in Obsessive Compulsive Disorder through Behavioural Clustering and Variations in Repetition Intensity.

BACKGROUND AND OBJECTIVES: Over the last decade, the application of computer vision techniques to the analysis of behavioural patterns has seen a considerable increase in research interest. One such interesting and recent application is the visual behavioural analysis of mental disorders. Despite the very recent surge in interest in this area, relatively little has been done thus far to assist individuals living with Obsessive Compulsive Disorder. The work proposed herein represents a proof of concept system designed to demonstrate the efficacy of such an approach, from the computational perspective. The specific focus of this work lies in demonstrating a mechanism for clustering different kinds of Obsessive Compulsive Disorder behaviours and then comparing new behaviours to existing behaviours to determine the approximate level of anxiety represented by a compulsive behaviour. METHODS: The proposed system uses Temporal Motion Heat Maps, SURF descriptors, a visual bag of words model and SVM-based classification to categorise representations of various behaviours commonly seen in OCD. Moreover, we apply a set of statistical measures to the images in a given category in order to derive an approximate anxiety level for a given compulsive behaviour. This proof of concept is an essential step in the direction of integrating computational approaches into the treatment of psychiatric conditions such as Obsessive Compulsive Disorder, for more effective recovery. RESULTS: Results gleaned from experimental simulations indicate that the proposed system is capable of correctly classifying different types of simulated Obsessive Compulsive Disorder behaviour classes 75% of the time, with the misclassifications almost exclusively occurring when two behavioural clusters appear highly similar. Based on this information the proposed system is then able to assign an approximate behavioural anxiety level to the compulsive behaviours that meets the approval of a mental health professional. CONCLUSIONS: The proposed system demonstrates a good ability to categorise various types of simulated OCD behaviour, in addition to establishing an approximate anxiety level for a given compulsive behaviour. This research demonstrates strong potential for the use of such systems in assisting mental health professionals looking to better understand their patients' condition and treatment progress across time.

Family Perspectives of Traumatically Brain-Injured Patient Pain Behaviors in the Intensive Care Unit.

Behavioral scales allow for the pain assessment of vulnerable critically ill patients who are unable to self-report. However, validity of the use of such scales is limited in traumatic brain injury patients with an altered level of consciousness as a result of the different way that these patients express pain. Family participation is considered as an important component of pain assessment for those unable to self-report, but research in this area is minimal so far. This study aimed to describe what behaviors family caregivers deemed relevant to pain for patients with a traumatic brain injury with an altered level of consciousness in the intensive care unit. Using a mixed-method descriptive design, semistructured interviews were conducted and behaviors' relevance was quantitatively rated by seven family caregivers of nonverbal patients with traumatic brain injury in the intensive care unit of a tertiary trauma center in Montreal, Canada. Family caregivers were able to provide rich descriptions of a number of behaviors they observed in their loved ones that were perceived to be relevant indicators of pain, such as muscle tension and key facial expressions and body movements. Several factors influenced how behaviors were interpreted by family, including personal medical beliefs and intimate knowledge of the patient's history. The pain behaviors determined by family caregivers can be useful in the pain assessment process of traumatic brain injury patients with an altered level of consciousness. Their input could also be helpful in further development of pain assessment tools.

Assessment Practices of Child Clinicians.

Assessment is an integral component of treatment. However, prior surveys indicate clinicians may not use standardized assessment strategies. We surveyed 1,510 clinicians and used multivariate analysis of variance to explore group differences in specific measure use. Clinicians used unstandardized measures more frequently than standardized measures, although psychologists used standardized measures more frequently than nonpsychologists. We also used latent profile analysis to classify clinicians based on their overall approach to assessment and examined associations between clinician-level variables and assessment class or profile membership. A four-profile model best fit the data. The largest profile consisted of clinicians who primarily used unstandardized assessments (76.7%), followed by broad-spectrum assessors who regularly use both standardized and unstandardized assessment (11.9%), and two smaller profiles of minimal (6.0%) and selective assessors (5.5%). Compared with broad-spectrum assessors, unstandardized and minimal assessors were less likely to report having adequate standardized measures training. Implications for clinical practice and training are discussed.

Brief Report: An Observational Measure of Empathy for Autism Spectrum: A Preliminary Study of the Development and Reliability of the Client Emotional Processing Scale.

People with autism spectrum disorder (ASD), can have difficulties in emotion processing, including recognising their own and others' emotions, leading to problems in emotion regulation and interpersonal relating. This study reports the development and piloting of the Client Emotional Processing Scale-Autism Spectrum (CEPS-AS), a new observer measure of four interrelated aspects of emotional processing: emotion recognition, self-reflection, cognitive empathy, and affective empathy. Results showed good interrater reliability (alpha: .69-.91), while inter-dimension associations were high (r = .66-.82). The measure was able to detect significant differences on the four dimensions across a short-term humanistic-experiential group therapy. The CEPS-AS shows promise as a potential addition to current self-report instruments measuring empathy or emotion processes in individuals with ASD.

Clinical Features of Japanese Males with Anorexia Nervosa.

BACKGROUND: Anorexia nervosa (AN) is a mental disease with a high mortality rate, and progresses to a serious state, even in males; however the characteristics of male AN patients, including the sex ratio in Japan and the consultation behavior, have not yet been clarified. Therefore, the objective of the present study was to investigate the clinical characteristics of Japanese male AN patients, with the aim of achieving early interventions. METHODS: A total of 2015 AN patients, 60 males and 1955 females, were extracted from 4606 eating disorder patients who consulted Osaka City University Hospital for 34.5 years. The sex ratio was examined, and clinical features, mainly those related to consultation behavior, were compared between males and females. The rate of early drop-outs from outpatient treatments was also determined in male AN patients. RESULTS: The male ration in AN patients was 3.0%, which was markedly lower than generally considered. No significant sex difference was noted in the mean age at the time of consultation or delays in treatment. The rate of weight loss from the premorbid to lowest body weight was similar between males and females. Regarding social backgrounds, the employment rate was higher in males than in females. Male AN patients were more likely to initially consult the psychiatry department. Furthermore, the rate of early drop-outs from outpatient treatments appeared to be higher among males than females. CONCLUSIONS: The male ratio in Japanese clinical AN patients was low. Consultation between may be restricted in males more than in other countries because eating disorders are considered to be female diseases. Male AN is physically severe, similar to female AN; therefore, early interventions were considered important. Educational programs for eating disorders not only in the general public, but also in school and companies may promote early interventions. Treatments that considered sex differences need to be developed in order to prevent early drop-outs.