Search

BackgroundPortion sizes of many foods have increased over time and reducing food portion sizes has been proposed as a public health strategy to reduce obesity. However, the extent to which reducing food portion sizes affects daily energy intake and body weight is unclear.ObjectiveTo systematically review and meta-analyse experimental studies that have examined the effect that serving smaller vs. larger portion sizes has on total daily energy intake.DesignWe used systematic review methodology to search identify eligible articles that used an experimental design to manipulate portion size served to human participants and measured energy intake for a minimum of one day. Multi-level meta-analysis was used to used to pool effects of portion size on daily energy intake.ResultsFourteen eligible studies were included and 85 effects were included in the primary meta-analysis. There was a moderate-to-large reduction in daily energy intake when comparing smaller vs. larger portions (SMD = -.709 [95% CI: -.956 to -.461], p < .001, I2 = 80.6%) and evidence of a dose dependent response. Larger reductions to portion size and reducing portion sizes of multiple meals per day both resulted in larger decreases in daily energy intake. There was also evidence of a curvilinear relationship between portion size and daily energy intake, whereby reductions to daily energy intake were markedly smaller when reducing portion size from very large portions. In a subset of studies that measured body weight (n=5), being served smaller portions was associated with less weight gain than larger portions (SMD = .536 ([95% CI: .268 to .803], p < .001, I2 = 47.0%).ConclusionsSmaller food portion sizes substantially decrease daily energy intake and there is evidence that over time this results in lower body weight. Reducing food portion sizes may be an effective population level strategy to reduce obesity.

Background Increases in mental health problems have been observed during the COVID-19 pandemic. The objectives were to examine the extent to which mental health symptoms changed during the pandemic in 2020, whether changes were persistent or short lived, and if changes were symptom specific. Methods Systematic review and meta-analysis of longitudinal cohort studies examining changes in mental health among the same group of participants before vs. during the pandemic in 2020. Results Sixty-five studies were included. Compared to pre-pandemic outbreak, there was an overall increase in mental health symptoms observed during March-April 2020 (SMC = .102 [95% CI: .026 to .192]) that significantly declined over time and became non-significant (May-July SMC = .067 [95% CI: -.022 to .157]. Compared to measures of anxiety (SMC = 0.13, p = 0.02) and general mental health (SMC = -.03, p = 0.65), increases in depression and mood disorder symptoms tended to be larger and remained significantly elevated in May-July [0.20, 95% CI: .099 to .302]. In primary analyses increases were most pronounced among samples with physical health conditions and there was no evidence of any change in symptoms among samples with a pre-existing mental health condition. Limitations There was a high degree of unexplained heterogeneity observed (I2s > 90%), indicating that change in mental health was highly variable across samples. Conclusions There was a small increase in mental health symptoms soon after the outbreak of the COVID-19 pandemic that decreased and was comparable to pre-pandemic levels by mid-2020 among most population sub-groups and symptom types.

Objectives: The primary objective of the study was to examine the effect of calorie labelling and physical activity equivalence labelling of alcoholic drinks on drinking intentions in participants of lower and higher socioeconomic position (SEP). Methods: Participants (N = 1,084) of higher and lower SEP were recruited into an online study and randomized into one of three drink label conditions; Control (standard alcohol labelling), kcal labelling (standard labelling plus drink kilocalorie information), or kcal + PACE labelling (standard labelling and kilocalorie information, plus information on physical activity needed to compensate for drink calories). After viewing drink labels, participants reported alcohol drinking intentions. Participants also completed measures of alcoholic drink energy content estimation, beliefs about how calorie labelling would affect health behaviour and support for calorie labelling of alcoholic drinks. Results: kcal labelling (d = 0.31) and kcal + PACE labelling (d = 0.38) conditions had significantly lower drinking intentions compared to the control condition (ps

Summary Background The COVID‐19 crisis is likely to have had wide‐ranging consequences on lifestyle behaviours and may have affected weight management. The objective of the present study was to examine perceptions of how weight‐related lifestyle changed in social lockdown among UK adults compared with before the emergence of the COVID‐19 crisis. Methods As part of an online cross‐sectional survey conducted during social lockdown in the United Kingdom, 723 UK adults reported on the extent to which their eating (healthiness of diet, frequency of bingeing on food), physical activity, sleep and alcohol consumption had changed since the emergence of the COVID‐19 crisis and completed measures of current psychological well‐being. Results Although both improvements and declines in weight gain protective behaviours were reported, 79% of participants reported a decline in one or more weight gain protective behaviours. Both participants with a diagnosis of psychiatric illness or obesity (body mass index [BMI] ≥ 30) were most likely to report declines in weight gain protective behaviours and show an overall profile of weight management behaviours worsening. Participants experiencing high levels of stress also reported reductions in more weight gain protective behaviours. Conclusions Lifestyle behaviours associated with weight gain are likely to have been affected by the COVID‐19 crisis. Reductions to the perceived frequency by which people engage in behaviours usually associated with successful weight management appear to be common, and people living with obesity and mental health problems may be at increased risk.

Summary The obesity crisis is one of the largest public health challenges of the 21st century. Population‐level adiposity has increased dramatically in recent times, and people not recognizing that they have overweight or obesity is now common. It has been widely assumed that not recognizing oneself as having overweight is detrimental to weight management and long‐term health. Here, diverse research is reviewed that converges on the counterintuitive conclusion that not recognizing oneself as having overweight is actually associated with more favourable physical and mental health outcomes than recognizing oneself as having overweight. Drawing on existing models in social psychology and weight stigma research, an explanatory model of the health effects of self‐perception of overweight is outlined. This model proposes that self‐perception of overweight triggers social rejection concerns and the internalization of weight stigma, which in turn induce psychological distress and negatively impact health‐promoting lifestyle behaviours. How self‐perception of overweight may in part explain progression from overweight to obesity, and the public health implications of self‐perception of overweight and obesity are also discussed.

Background Interoception refers to the processes by which we sense, interpret and integrate signals originating from within the body. Deficits in interoception have been linked to higher BMI and may contribute to weight gain. However, there have been conflicting findings and it is not clear how higher BMI is associated with different facets of interoception, such as interoceptive accuracy (the ability to detect internal signals) and sensibility (the tendency to attend to internal signals). Methods We conducted a systematic review and meta-analysis of studies that measured interoception and BMI. We examined relationships between interoception and BMI in children and adults separately and as a function of interoceptive facet and measure. In sensitivity analyses, we tested for evidence of publication bias and whether the results were consistent when studies with a high risk of bias were excluded. Results A total of 87 articles were eligible for inclusion. In adults (121 effects, 10,425 participants), there was cross-sectional evidence of higher BMI being associated with overall deficits in interoception (r = −0.054, 95% CI: −0.084 to −0.025) and this was consistent across sensitivity analyses. There was no statistically significant evidence of moderation by interoceptive facet or measure, although there was some variability in effect size estimates based on interoceptive facet and measures. A smaller meta-analysis limited to studies that compared participants with normal weight vs. overweight/obesity indicated poorer interoception in participants with overweight/obesity (SMD = −0.39, 95% CI −0.60 to −0.18). Conclusions In cross-sectional studies, deficits in interoception are associated with higher BMI. However, it remains unclear whether deficits in interoception contribute to or are a consequence of weight gain and obesity.

International audience; Background Snacking is associated with a higher daily energy intake and dietary guidelines recommend snacks of no more than 200 kcal for adults and 100 kcal for children. The present study examines the energy content, nutritional quality and price of single-serving snack food products sold by major supermarket and coffee shop chains in the UK. Methods Energy content, nutritional content and price of single-serving snack products were recorded in 2019 via the websites of 14 major chains (seven supermarkets; seven coffee shops). Results The mean energy content of all eligible snack products (n = 2283) was 186 kcal [95% confidence interval (CI) = 182–190]. The mean energy content of the snack products sold at coffee shops (n = 379; 282 kcal [95% CI = 269–295]) was significantly higher than the energy content of the snack products sold at supermarkets (n = 1904; 167 kcal [95% CI = 164–170]). Seventy nine % of supermarket snacks exceeded energy recommendations for children and 32% for adults. In coffee shops, 91% exceeded recommendations for children and 73% for adults. Forty one % of snacks were high in fat, 42% were high in saturated fat, 39% were high in sugar and 7% were high in salt. Cheaper snack products were more likely to be of lower nutritional quality. Conclusions The high proportion of snack products that do not meet public health recommendations for energy content may contribute to the association between snacking and increased energy intake. Public health measures to increase the availability and reduce the price of snack products that meet public health energy content recommendations may reduce population-level obesity.

BackgroundDietary energy density is thought to be a contributor to obesity, but the extent to which different magnitudes and types of reductions to food energy density decreases daily energy intake is unclear.ObjectiveTo systematically review and meta-analyse experimental studies that have examined the effect that manipulating energy density of food has on total daily energy intake.DesignA systematic review and multi-level meta-analysis of studies on human participants that used an experimental design to manipulate the energy density of foods served and measured energy intake for a minimum of one day.ResultsThirty-one eligible studies contributed 90 effects comparing the effect of higher vs. lower energy density of served food on daily energy intake to the primary meta-analysis. Lower energy density of food was associated with a large decrease in daily energy intake (SMD = -1.002 [95% CI: -0.745 to -1.266]). Findings were consistent across studies that did vs. did not manipulate macronutrient content to vary energy density. The relation between decreasing energy density and daily energy intake tended to be strong and linear, whereby compensation for decreases to energy density of foods (i.e. by eating more at other meals) was minimal. Meta-analysis of (n=5) studies indicated that serving lower energy dense food tended to be associated with greater weight loss than serving higher energy dense food, but this difference was not significant (−0.7kg, 95% CIs: -1.34, 0.04).ConclusionsDecreasing the energy density of food can substantially reduce daily energy intake and may therefore be an effective public health approach to reducing population level energy intake.

Patients with advanced stages of chronic kidney disease (CKD), especially racial minorities, often do not receive treatment or education until specific symptoms begin to manifest. The Patient Referral and Education Program prior to Renal Replacement Therapy (PREP-RRT) study is intended to capture the perspective of African Americans receiving renal care and then tailor education for hospitalized patients who may not be well linked to the medical system. In the U.S., African Americans and other minorities are less likely to be seen by a nephrologist prior to dialysis and the lack of pre-dialysis care and education is associated with lower likelihood of pre-emptive transplant. The primary outcome for the PREP-RRT study will be change in patient knowledge, attitudes and behavior about CKD treatment options which will be assessed by the previously validated Kidney Knowledge Survey (KiKS). Secondary outcomes of interest are patient satisfaction with education, time-to-event for nephrology appointment, appearance at transplant center, likelihood of fistula, self-care dialysis at dialysis initiation, or documentation of patient decision not to initiate RRT. The PREP RRT intervention will identify, educate and motivate patients to increase CKD self-care and to improve communication and shared decision-making about RRT treatments among patients, their families and their providers.

Purpose: Biomarkers for disease-specific survival (DSS) in early-stage melanoma are needed to select patients for adjuvant immunotherapy and accelerate clinical trial design. We present a pathology-based computational method using a deep neural network architecture for DSS prediction. Experimental Design: The model was trained on 108 patients from four institutions and tested on 104 patients from Yale School of Medicine (YSM, New Haven, CT). A receiver operating characteristic (ROC) curve was generated on the basis of vote aggregation of individual image sequences, an optimized cutoff was selected, and the computational model was tested on a third independent population of 51 patients from Geisinger Health Systems (GHS). Results: Area under the curve (AUC) in the YSM patients was 0.905 (P < 0.0001). AUC in the GHS patients was 0.880 (P < 0.0001). Using the cutoff selected in the YSM cohort, the computational model predicted DSS in the GHS cohort based on Kaplan–Meier (KM) analysis (P < 0.0001). Conclusions: The novel method presented is applicable to digital images, obviating the need for sample shipment and manipulation and representing a practical advance over current genetic and IHC-based methods.

BACKGROUND: Previous studies of acute hypoxia have largely examined different altitudes in isolation. Pilots, however, receive two exposures during in-flight hypoxic emergencies (IFHEs): the initial exposure at altitude, followed by a second mild exposure after descending and removing the breathing mask. Conventional wisdom holds that performance recovers with blood oxygen saturation and that exposure to mild hypoxia is safe. This study examined the possibility that the effects of moderate hypoxia may linger to overlap with the effects of mild hypoxia during sequential exposures such as those experienced by pilots during an IFHE.METHODS: Subjects performed a simulated flight task and secondary task while being exposed to normobaric hypoxia via the ROBD-2.RESULTS: Average error on the flight task during exposure to 3048 m (10,000 ft) was marginally worse when preceded by exposure to 7620 m (25,000 ft; 7.40 ± 3.32) than when experienced in isolation (6.42 ± 3.82). Performance on the secondary task was likewise worse when the mild exposure followed the moderate exposure (0.27 ± 0.30 lapses per minute) than when the mild exposure occurred by itself (0.19 ± 0.20 lapses per minute). Minimum Spo₂ showed a similar pattern of results (84.87 ± 4.37 vs. 86.61 ± 2.47).DISCUSSION: We believe our results are most likely due to a failure to recover from the original moderate exposure rather than an additive effect between the exposures. Even so, our findings suggest that pilot impairment following an IFHE may be worse than previously believed.Robinson FE, Horning D, Phillips JB. Preliminary study of the effects of sequential hypoxic exposures in a simulated flight task. Aerosp Med Hum Perform. 2018; 89(12):1050-1059.

Muscle function is dependent on innervation by the correct motor nerves. Motor nerves are composed of motor axons which extend through peripheral tissues as a compact bundle, then diverge to create terminal nerve branches to specific muscle targets. As motor nerves approach their targets, they undergo a transition where the fasciculated nerve halts further growth then after a pause, the nerve later initiates branching to muscles. This transition point is potentially an intermediate target or guidepost to present specific cellular and molecular signals for navigation. Here we describe the navigation of the oculomotor nerve and its association with developing muscles in mouse embryos. We found that the oculomotor nerve initially grew to the eye three days prior to the appearance of any extraocular muscles. The oculomotor axons spread to form a plexus within a mass of cells, which included precursors of extraocular muscles and other orbital tissues and expressed the transcription factor Pitx2. The nerve growth paused in the plexus for more than two days, persisting during primary extraocular myogenesis, with a subsequent phase in which the nerve branched out to specific muscles. To test the functional significance of the nerve contact with Pitx2+ cells in the plexus, we used two strategies to genetically ablate Pitx2+ cells or muscle precursors early in nerve development. The first strategy used Myf5-Cre-mediated expression of diphtheria toxin A to ablate muscle precursors, leading to loss of extraocular muscles. The oculomotor axons navigated to the eye to form the main nerve, but subsequently largely failed to initiate terminal branches. The second strategy studied Pitx2 homozygous mutants, which have early apoptosis of Pitx2-expressing precursor cells, including precursors for extraocular muscles and other orbital tissues. Oculomotor nerve fibers also grew to the eye, but failed to stop to form the plexus, instead grew long ectopic projections. These results show that neither Pitx2 function nor Myf5-expressing cells are required for oculomotor nerve navigation to the eye. However, Pitx2 function is required for oculomotor axons to pause growth in the plexus, while Myf5-expressing cells are required for terminal branch initiation.

BackgroundWidespread uptake of COVID-19 vaccines will be essential to extinguishing the COVID-19 pandemic. Vaccines have been developed in unprecedented time and hesitancy towards vaccination among the general population is unclear.MethodsSystematic review and meta-analysis of studies using large nationally representative samples (n≥1000) to examine the percentage of the population intending to vaccinate, unsure, or intending to refuse a COVID-19 vaccine when available. Generic inverse meta-analysis and meta-regression were used to pool estimates and examine time trends. PubMed, Scopus and pre-printer servers were searched from January-November, 2020. Registered on PROSPERO (CRD42020223132).FindingsTwenty-eight nationally representative samples (n = 58,656) from 13 countries indicate that as the pandemic has progressed, the percentage of people intending to vaccinate and refuse vaccination have been decreasing and increasing respectively. Pooled data from surveys conducted during June-October suggest that 60% (95% CI: 49% to 69%) intend to vaccinate and 20% (95% CI: 13% to 29%) intend to refuse vaccination, although intentions vary substantially between samples and countries (I2 > 90%). Being female, younger, of lower income or education level and belonging to an ethnic minority group were consistently associated with being less likely to intend to vaccinate. Findings were consistent across higher vs. lower quality studies.InterpretationIntentions to be vaccinated when a COVID-19 vaccine becomes available have been declining globally and there is an urgent need to address social inequalities in vaccine hesitancy and promote widespread uptake of vaccines as they become available.FundingN/AResearch in contextEvidence before this studyWe searched PubMed, Scopus and pre-print servers for manuscripts from January to November, 2020, reporting on studies examining intentions to be vaccinated against COVID-19 in large nationally representative samples (N≥1000). No language restrictions were applied. Search terms were [(COVID OR coronavirus OR SARS-COV-2) AND (Vaccine OR Vaccination) AND (Inten* OR willing* OR attitud* OR hypothetical)]. From 792 articles, we identified 20 eligible articles reporting on 28 nationally representative samples.Added value of this studyThis is the first systematic study and meta-analysis to estimate the proportion of the global population willing to be vaccinated against vs. intending to refuse a vaccine when COVID-19 vaccines become available and how this trend has changed over time, using large and nationally representative samples. Results indicate that COVID-19 vaccination intentions vary substantially across countries, the percentage of the population intending to be vaccinated has declined across countries as the pandemic has progressed (March-May estimate: 79%, June-October estimate: 60%) and a growing number report intending to refuse a vaccine, when available (March-May estimate: 12%, June-October estimate: 20%). There is consistent socio-demographic patterning of vaccination intentions; being female, younger, of lower income or education level and belonging to an ethnic minority group are associated with a reduced likelihood of intending to be vaccinated when a vaccine become available.Implications of all the available evidenceIntentions to vaccinate against COVID-19 among the general public when a vaccine becomes available have been declining and this will limit the effectiveness of COVID-19 vaccination programmes. Findings highlight the need to improve public acceptability, trust and concern over the safety and benefit of COVID-19 vaccines and target vaccine uptake in disadvantaged groups who have already been disproportionately affected by the pandemic.

BackgroundThe novel coronavirus (SARS-CoV-2) has produced a considerable public health burden but the impact that contracting the disease has on mental health is unclear. In this observational population-based cohort study, we examined longitudinal changes in psychological distress associated with testing positive for coronavirus disease 2019 (COVID-19).MethodsParticipants (N = 8002; observations = 139 035) were drawn from 23 waves of the Understanding America Study, a nationally representative probability-based online panel of American adults followed-up every 2 weeks from 1 April 2020 to 15 February 2021. Psychological distress was assessed using the standardized total score on the Patient Health Questionnaire-4.ResultsOver the course of the study, 576 participants reported testing positive for COVID-19. Using regression analysis including individual and time-fixed effects we found that psychological distress increased by 0.29 standard deviations (p < 0.001) during the 2-week period when participants first tested positive for COVID-19. Distress levels remained significantly elevated (d = 0.16, p < 0.01) for a further 2 weeks, before returning to baseline levels. Coronavirus symptom severity explained changes in distress attributable to COVID-19, whereby distress was more pronounced among those whose symptoms were more severe and were slower to subside.ConclusionsThis study indicates that testing positive for COVID-19 is associated with an initial increase in psychological distress that diminishes quickly as symptoms subside. Although COVID-19 may not produce lasting psychological distress among the majority of the general population it remains possible that a minority may suffer longer-term mental health consequences.

International audience

BackgroundRecent evidence suggests that willingness to vaccinate against COVID-19 has been declining throughout the pandemic and is low among ethnic minority groups.MethodsObservational study using a nationally representative longitudinal sample (N =7,840) from the Understanding America Study (UAS). Changes in the percentage of respondents willing to vaccinate, undecided, or intending to refuse a COVID-19 vaccine were examined over 20 survey waves from April 1 2020 to February 15 2021.ResultsAfter a sharp decline in willingness to vaccinate against COVID-19 between April and October 2020 (from 74.0% to 52.7%), willingness to vaccinate increased by 8.1% (p ConclusionsWillingness to vaccinate against COVID-19 increased in the US from October 2020 to February 2021.Funding statementN/A

BackgroundIncreases in mental health problems have been observed in some studies during the COVID-19 pandemic. It is unclear whether changes have been large and experienced by most population sub-groups, persisted over time or been symptom specific.MethodsWe systematically reviewed and meta-analysed longitudinal cohort studies that examined changes in mental health among the same group of participants before and during the pandemic (PROSPERO: CRD42021231256). Searches for published and unpublished studies were conducted in January 2021. Changes in mental health (standardised mean change; SMC) were examined using meta-analyses.FindingsSixty-five studies were included. There was an overall increase in mental health symptoms that was most pronounced during March-April 2020 (SMC = .102 [95% CI: .026 to .192], p = 0.03) before significantly declining over time (May-July SMC = .067 [95% CI: -.022 to .157], p = .141). Compared to measures of anxiety (SMC = 0.13, p = 0.02) and general mental health (SMC = -.03, p = 0.65), increases in depression and mood disorder symptoms tended to be larger (SMC = 0.22, p < .001) and reductions over time appeared less pronounced. Increased mental health symptoms were observed across most population subgroups examined but there was no evidence of any change in symptoms among samples with a pre-existing mental health condition.InterpretationThere was a small increase in mental health symptoms soon after the outbreak of the COVID-19 pandemic that decreased and was comparable to pre-pandemic levels by mid-2020 among most population sub-groups and symptom types.FundingN/AResearch in contextEvidence before this studyThere have been reported increases in mental health problems during the outbreak of the COVID-19 pandemic. However, it is unclear whether changes in mental health problems have been symptom specific, how changes have differed across populations and whether increased mental health problems have persisted over time. We systematically reviewed and meta-analysed longitudinal cohort studies that examined mental health among the same participants prior to and during the pandemic in 2020. This approach allowed us to quantify the mental health burden associated with the outbreak of the pandemic and how it has changed over time. We searched Pubmed, SCOPUS, Web of Science and PsychInfo from January 2020 to January 11, 2021 and identified eligible unpublished articles available on pre-print servers.Added value of this studyWe identified 65 eligible articles that reported 201 comparisons of mental health pre vs. post pandemic outbreak. Meta-analysis indicated that longitudinal cohort studies that examined mental health prior to and during the COVID-19 pandemic in 2020 showed a significant but statistically small increase in mental health symptoms. The overall increase in mental health symptoms was most pronounced during the early stages of the pandemic (March-April), before decreasing and being generally comparable to pre-pandemic levels by mid-2020.Compared to anxiety and general measures of mental health functioning, increases tended to be larger in depressive symptoms and although statistically small, remained elevated past the early stages of the pandemic. Increases in mental health symptoms were observed across most population sub-groups, but there was no evidence of a change in mental health symptoms among samples of participants with a pre-existing mental health condition.Implications of all the available evidenceFindings confirm that the initial outbreak of the pandemic was associated with a significant but statistically small increase in mental health symptoms. Given that small effects may have meaningful cumulative consequences at the population level, there is a need for continued mental health provision and monitoring particularly during periods of the pandemic when infection rates and deaths are high. Further into the pandemic, mental health problems decreased significantly, which indicated recovery and resilience in overall mental health. Contrary to predictions made early in the pandemic, there was also no evidence of a worsening of mental health symptoms among samples of participants with a pre-existing mental health condition. Overall the results of the present analyses suggest that the pandemic may not have caused an unprecedented and long lasting mental health crisis, instead there appears to have been resilience in mental health.

Background : The impact of the coronavirus disease 2019 (COVID-19) on the mental health of the US population is unclear. This study drew on two nationally representative samples to compare the prevalence rate of anxiety in the U.S. before and during the 2020 COVID-19 pandemic. Methods : The Generalized Anxiety Disorder-2 (GAD-2) screening tool was used to detect the proportion of US adults screening positive for high levels of anxiety symptoms. Anxiety symptoms was assessed in 2019 using the National Health Interview Survey (NHIS; N = 30,915) and during the pandemic using biweekly surveys collected as part of the Understanding America Study (UAS; N=8,022 Obs.=121,768) between March and December 2020. Results : The proportion of participants with high levels of anxiety symptoms increased significantly from 8.1% (95% CI[7.7, 8.5]) in 2019 to 21.4% (95% CI[19.9, 22.9]) at the beginning of April, 2020. The prevalence then declined to 11.4% (95% CI[10.3, 12.5]) in May and remained 3% above 2019 levels until December 2020. This pattern of increasing anxiety between 2019 and April 2020 followed by a rapid decrease in anxiety was identified across all demographic characteristics examined. Limitations : The NHIS and UAS samples differ in their sampling and mode of administration which may bias comparisons between samples. Conclusions : Anxiety symptoms increased markedly during the onset of the COVID-19 pandemic and reduced quickly as stay-at-home orders were lifted. These findings highlight the importance of providing mental health supports during future lockdowns and suggest that resilience in mental health may have been a key population-level response to the demands of the pandemic.

International audience; BackgroundInteroception refers to the process of identifying and listening to internal bodily signals, which may be a modifiable determinant of appetite regulation and weight gain. The objective was to examine whether the extent to which self-reported interoception is associated with higher BMI is explained by eating behavior traits.MethodsUK adults (N = 1181, 49% female, 53% with overweight/obesity) completed validated self-report measures of interoception, habitual tendencies to eat in response to satiety signals (intuitive eating), emotional over-eating and other eating traits.ResultsPoorer self-reported ability to detect interoceptive signals (deficits in interoceptive accuracy) was predictive of higher BMI (r = - 0.07 (95% CI -0.13; -0.01), p < .05). In parallel mediation analyses, participants with poorer interoceptive accuracy were significantly less likely to report considering satiety signals when eating and this explained the cross-sectional association between interoceptive accuracy and higher BMI. There was also some evidence that participants with poorer interoceptive accuracy were more likely to report emotional overeating and this also in part explained why interoceptive accuracy was predictive of higher BMI.ConclusionsDeficits in interoception may decrease the likelihood that satiety signals are integrated into eating behaviour related decision making and in doing so contribute to higher BMI.

In a large (n =10918), national, longitudinal probability-based sample of UK adults the prevalence of clinically significant psychological distress rose from prepandemic levels of 20.8% in 2019 to 29.5% in April 2020 and then declined significantly to prepandemic levels by September (20.8%). Longitudinal analyses showed that all demographic groups examined (age, sex, race/ethnicity, income) experienced increases in distress after the onset of the pandemic followed by significant decreases. By September 2020 distress levels were indistinguishable from prepandemic levels for all groups. This recovery may reflect the influence of the easing of restrictions and psychological adaptation to the demands of the pandemic.

Objective: The historical factors and contemporary mechanisms underlying geographical inequalities in obesity levels remain uncertain. In this study we examine whether modern regional variation in obesity is partly a result of the impact of large-scale industry on the personality traits of those living in regions once at the center of the Industrial Revolution. Method: Exposure to the effects of the Industrial Revolution was assessed using unique historical data from English/Welsh counties (N=111). Specifically, we examined the relationship between the regional employment share in large-scale coal-based industries in 1813-1820 and contemporary regional obesity levels (2013-2015). The Big Five personality traits and regional unemployment levels were examined as potential mediators of this association. Results: The historical regional employment share in large-scale industries positively predicted the modern-day regional prevalence of obesity. Mediation analysis showed that areas exposed to the decline of large-scale industries experienced elevated neuroticism and unemployment levels that explained almost half of the association between the historical dominance of large-scale industry and modern-day obesity levels. Conclusions: Our results provide initial evidence that raised regional neuroticism levels may play a key role in explaining why exposure to the rapid growth and subsequent decline of large-scale industries forecasts modern-day obesity levels.

There is growing concern that the COVID-19 crisis may have long-standing mental health effects across society particularly amongst those with pre-existing mental health conditions. In this observational population-based study, we examined how psychological distress changed following the emergence of the COVID-19 crisis in the United States and tested whether certain population subgroups were vulnerable to persistent distress during the crisis. We analyzed longitudinal nationally representative data from eight waves of the Understanding America Study (UAS) collected between March 10th and July 20th, 2020 (N = 7319 Observations = 46,145). Differences in distress trends were examined by age, sex, race/ethnicity, and household income and by the presence of a pre-existing mental health diagnosis. Psychological distress was assessed using the standardized total score on the Patient Health Questionnaire-4 (PHQ-4). On average psychological distress increased significantly by 0.27 standard deviations (95% CI [0.23,0.31], p, Highlights • The global spread of COVID-19 may have had an enduring impact on mental health. • Longitudinal nationally representative studies addressing this topic are scarce. • This study examines mental health beyond the initial stage of the COVID-19 crisis. • Identifies a substantial rise in distress in the U.S. from March to April 2020. • Psychological distress levels returned to baseline by June 2020.

IntroductionVaccines against COVID-19 have been developed in unprecedented time. However, the effectiveness of any vaccine is dictated by the proportion of the population willing to be vaccinated. This observational population-based study examines intentions to be vaccinated against COVID-19 throughout the pandemic.MethodsIn November 2020, longitudinal data from a nationally representative sample of 7,547 U.S. adults enrolled in the Understanding America Study were analyzed using multinomial logistic regression. Participants reported being willing, undecided, and unwilling to get vaccinated against COVID-19 across 13 assessments conducted from April to October 2020. Public attitudes to vaccination against COVID-19 were also assessed on a 4-point Likert-type scale.ResultsWillingness to vaccinate declined from 71% in April to 53.6% in October. This was explained by an increase in the percentage of participants undecided about vaccinating (from 10.5% to 14.4%) and the proportion of the sample unwilling to vaccinate (from 18.5% to 32%). The population subgroups most likely to be undecided/unwilling to vaccinate were those without a degree (undecided: RR=2.47, 95% CI=2.04, 3.00; unwilling: RR=1.92, 95% CI=1.67, 2.20), Black participants (undecided: RR=2.18, 95% CI=1.73, 2.74; unwilling: RR=1.98, 95% CI=1.63, 2.42), and female participants (undecided: RR=1.41, 95% CI=1.20, 1.65; unwilling: RR=1.29, 95% CI=1.14, 1.46). Participants who were older or were on higher incomes were least likely to be undecided or unwilling to vaccinate. Concerns about potential side effects of a vaccine were common.ConclusionsIntentions to be vaccinated against COVID-19 have declined rapidly during the pandemic, and close to half of Americans are undecided or unwilling to be vaccinated.

Highlights • COVID-19 has had negative social and economic effects that may contribute to mental health problems. • There is a lack of nationally representative data examining depression before and during the pandemic. • Findings indicate that there is likely to have been a rise in depression since during the COVID-19 pandemic. • Depression levels increased among all population sub-groups except those aged 65+ and Black participants. • A particularly large increase in depression among young adults is a cause for concern. • Findings highlight the importance of mental health service provision and treatment during the COVID-19 crisis., Background Coronavirus disease 2019 (COVID-19) and the associated social distancing and lockdown restrictions are expected to have substantial and enduring mental health effects. In this study, we aimed to assess depression levels before and during the COVID-19 pandemic in the United States. Methods We used the Patient Health Questionnaire-2 (PHQ-2) brief screening instrument to detect probable depression in two nationally representative surveys of US adults. Pre-pandemic levels of depression were assessed in a sample of 5,075 adults from the 2017–2018 National Health and Nutrition Examination Survey (NHANES). Depression was assessed in March (N = 6,819) and April 2020 (N = 5,428) in the Understanding America Study, a representative sample of the US population. Results The percentage of US adults with depression increased significantly from 8.7% (95% CI[7.6%–9.8%]) in 2017–2018 to 10.6% (95% CI[9.6%–11.6%) in March 2020 and 14.4% (95% CI[13.1%–15.7%]) in April 2020. Statistically significant increases in depression levels were observed for all population subgroups examined with the exception of those aged 65+ years and Black participants. Young adults (aged 18–34) experienced a marked increase in depression of 13.4 percentage points (95% CI [9.5%–17.2%]) that was larger than any other age group. Additional analyses of depression trends in NHANES from 2007/2008–2017/2018 showed that the substantial increase in depression in April 2020 was unlikely to be due to typical year-to-year variation. Conclusions Our findings suggest that depression levels have risen substantially during the COVID-19 pandemic and reinforce recent findings indicating that young adults may be particularly vulnerable to the mental health effects of the pandemic.

Background There are a range of interventions designed to promote healthier food choices in full-service restaurants. However, it is unclear how these interventions affect dietary choices in people of lower and higher socioeconomic position (SEP). Methods A total of 2091 US participants recruited online completed Study 1 (n = 1001) and Study 2 (n = 1090). Recruitment was stratified by participant highest education level, resulting in higher SEP and lower SEP groups. In a between-subjects design, participants made hypothetical food choices (main dish, plus optional sides and desserts) from six restaurants menus in the absence vs. presence of menu energy labelling and from menus with baseline (10%) vs. increased availability (50%) of lower energy main dishes. Data were collected and analysed in 2019. Two studies were conducted in order to examine replicability and generalisability of findings across different restaurant menu types. Results Across both studies, increasing the availability of lower energy main menu options decreased the average energy content of the ordered main dish (− 129 kcal, 95% CI [− 139; − 119]) and total energy ordered (− 117 kcal, 95% CI [− 138; − 95]) in both higher and lower SEP participants. Energy labelling significantly reduced the energy content of ordered main dishes in higher SEP participants (− 41 kcal, 95% CI [− 54; − 29]), but not lower SEP participants (− 5 kcal, 95% CI [− 22; 11]). However, energy labelling reduced total energy ordered (− 83 kcal, 95% CI [− 105; − 60]) irrespective of SEP. Conclusions In two virtual experiments, increasing the availability of lower energy restaurant main menu options impacted on main menu dish choice and decreased total energy ordered irrespective of SEP. Energy labelling had a less pronounced effect on total energy ordered and had a larger impact on the energy content of main menu dish choice in higher as opposed to lower SEP participants. Trial registration Clinicaltrials.gov NCT04336540 retrospectively registered (7 April, 2020).

International audience; Eating, physical activity and other weight-related lifestyle behaviors may have been impacted by the COVID-19 crisis and people with obesity may be disproportionately affected. We examined weight-related behaviors and weight management barriers among UK adults during the COVID-19 social lockdown. During April-May of the 2020 COVID-19 social lockdown, UK adults (N = 2002) completed an online survey including measures relating to physical activity, diet quality, overeating and how mental/physical health had been affected by lockdown. Participants also reported on perceived changes in weight-related behaviors and whether they had experienced barriers to weight management, compared to before the lockdown. A large number of participants reported negative changes in eating and physical activity behavior (e.g. 56% reported snacking more frequently) and experiencing barriers to weight management (e.g. problems with motivation and control around food) compared to before lockdown. These trends were particularly pronounced among participants with higher BMI. During lockdown, higher BMI was associated with lower levels of physical activity and diet quality, and a greater reported frequency of overeating. Reporting a decline in mental health because of the COVID-19 crisis was not associated with higher BMI, but was predictive of greater overeating and lower physical activity in lockdown. The COVID-19 crisis may have had a disproportionately large and negative influence on weight-related behaviors among adults with higher BMI.

Mandatory energy (calorie) labeling of alcoholic drinks is a public health measure that could be used to address both alcohol consumption and obesity. We systematically reviewed studies examining consumer knowledge of the energy content of alcoholic drinks, public support for energy labeling, and the effect of energy labeling of alcoholic drinks on consumption behavior. Eighteen studies were included. Among studies examining consumer knowledge of the energy content of alcoholic drinks (N = 8) and support for energy labeling (N = 9), there was moderate evidence that people are unaware of the energy content of alcoholic drinks (pooled estimate: 74% [95% CI: 64%-82%] of participants inaccurate) and support energy labeling (pooled estimate: 64% [95% CI: 53%-73%] of participants support policy). Six studies examined the effect of energy labeling on consumption behavior. In these studies, there was no evidence of a beneficial effect of labeling on alcohol drinking-related outcome measures. However, the majority of studies were of low methodological quality and used proxy outcome measures, and none of the studies were conducted in real-world settings, resulting in a very low level of evidence and high degree of uncertainty. Further research is required to determine whether energy labeling of alcoholic drinks is likely to be an effective public health policy.

Reducing the energy density (ED) of product selections made during online supermarket food shopping has potential to decrease energy intake. Yet it is unclear which types of intervention are likely to be most effective and equitable. We recruited 899 UK adults of lower and higher socioeconomic position (SEP) who completed a shopping task in an online experimental supermarket. Participants were randomised in a 2 &times, 2 between-subjects design to test the effects of two interventions on the ED of shopping basket selections: labelling lower-ED products as healthier choices and increasing the relative availability of lower-ED products within a range (referred to as proportion). Labelling of lower-ED products resulted in a small but significant decrease (&minus, 4.2 kcal/100 g, 95% CIs &minus, 7.8 to &minus, 0.6) in the ED of the shopping basket. Increasing the proportion of lower-ED products significantly decreased the ED of the shopping basket (&minus, 17 kcal/100 g, 95% CIs &minus, 21 to &minus, 14). There was no evidence that the effect of either intervention was moderated by SEP. Thus, both types of intervention decreased the ED of foods selected in an online experimental supermarket. There was no evidence that the effectiveness of either intervention differed in people of lower vs. higher SEP.

IntroductionVaccines against COVID-19 have been developed in unprecedented time. However, the effectiveness of any vaccine is dictated by the proportion of the population willing to be vaccinated. In this observational population-based study we examined intentions to be vaccinated against COVID-19 over the course of the pandemic.MethodsWe analyzed longitudinal data from a nationally representative sample of 7,547 US adults enrolled in the Understanding America Study (UAS). Participants reporting being willing, undecided and unwilling to get vaccinated against coronavirus across 13 assessments conducted from April-October, 2020. Public attitudes to vaccination against the coronavirus were also assessed.ResultsWillingness to vaccinate declined from 71% in April to 53.6% in October. This was explained by an increase in the percentage of participants undecided about vaccinating (from 10.5% to 14.4%) and the portion of the sample unwilling to vaccinate (from 18.5% to 32%). The population subgroups most likely to be undecided/unwilling to vaccinate were those without a degree (undecided: RRR=2.47, 95% CI: 2.04-3.00; unwilling: RRR=1.92, 95% CI: 1.67-2.20), Black participants (undecided: RRR=2.18, 95% CI: 1.73-2.74; unwilling: RRR=1.98, 95% CI: 1.63-2.42), and females (undecided: RRR=1.41, 95% CI: 1.20-1.65; unwilling: RRR=1.29, 95% CI: 1.14-1.46). Those aged 65+, those on high incomes, and other race/ethnicity participants were least likely to be undecided or unwilling to vaccinate. Concerns about potential side effects of a vaccine were common.ConclusionsIntentions to be vaccinated against coronavirus have declined rapidly during the pandemic and close to half of Americans are undecided or unwilling to be vaccinated.

Background Short-term laboratory studies suggest that eating attentively can reduce food intake. However, in a recent randomized controlled trial we found no evidence that using an attentive eating smartphone app outside of the laboratory had an effect on energy intake or weight loss over 8 weeks. Objective This research examined trial participants’ experiences of using an attentive eating smartphone app and whether app usage was associated with energy intake and weight loss outcomes over 8 weeks. Methods We conducted thematic analysis of semistructured interviews (N=38) among participants in the attentive eating smartphone app group of the trial who completed the 8-week assessment. Linear regression models examined the associations between energy intake and weight loss outcomes at 8 weeks and app usage. Results Participants reported several barriers and facilitators to using the smartphone app, including repetition of app content, social setting, motivation, and habitual use of the app. Participants believed that using the app had some beneficial effects on their eating behavior and diet. Exploratory analyses indicated that more frequent recording of eating episodes in the app was associated with lower body weight (B=–0.02, P=.004) and greater self-reported energy intake (B=5.98, P=.01) at 8 weeks, but not body fat percentage or taste-test energy intake. Total audio clip plays, gallery views, and percentage of food entries recorded using an image were not significantly associated with energy intake or weight. Conclusions Frequent recording of eating episodes in a smartphone app was associated with greater weight loss. There are barriers and facilitators to frequent use of an attentive eating smartphone app that may be useful to address when designing dietary behavior change smartphone apps. Trial Registration ClinicalTrials.gov NCT03602001; https://clinicaltrials.gov/ct2/show/NCT03602001; Open Science Framework DOI 10.17605/osf.io/btzhw; https://osf.io/btzhw/

ObjectiveThis study aimed to examine whether BMI and weight discrimination are associated with psychological, behavioral, and interpersonal responses to the coronavirus pandemic.MethodsUsing a prospective design, participants (N = 2,094) were first assessed in early February 2020 before the coronavirus crisis in the United States and again in mid-March 2020 during the President's "15 Days to Slow the Spread" guidelines. Weight, height, and weight discrimination were assessed in the February survey. Psychological, behavioral, and interpersonal responses to the coronavirus were assessed in the March survey.ResultsPrepandemic experiences with weight discrimination were associated with greater concerns about the virus, engaging in more preventive behaviors, less trust in people and institutions to manage the outbreak, and greater perceived declines in connection to one's community. BMI tended to be unrelated to these responses.ConclusionsDespite the risks of complications of coronavirus disease associated with obesity, individuals with higher BMI were neither more concerned about the virus nor taking more behavioral precautions than individuals in other weight categories. Weight discrimination, in contrast, may heighten vigilance to threat, which may have contributed to both positive (greater concern, more precautionary behavior) and negative (less trust, declines community connection) responses to the pandemic.

Background: Public health policies attempt to increase parental identification of child overweight and obesity. The objective of the present research was to determine the cross-sectional, prospective and longitudinal associations between parental identification of child overweight and child mental health problems. Methods: We made use of two cohort studies of Australian (Longitudinal Study of Australian Children, LSAC) and Irish children (Growing up in Ireland Study, GUI) that measured parental identification of child overweight and child mental health problems. Participant included 6502 (LSAC) and 7503 (GUI) children (49% female) and their parents. Child mental health problems were measured using child, parent and teacher-reported Strengths and Difficulties Questionnaires (SDQ) at ages 9/10 years old to 12/13 years old. In all analyses we controlled for child Z-BMI. Results: In LSAC children whose parents identified them as being overweight at age 10 experienced worse mental health at age 10 ([beta] = 0.21, SE = 0.04) and age 12 ([beta] = 0.13, SE = 0.04) than children whose parents failed to identify them as overweight. In GUI children whose parents identified them as being overweight at age 9 experienced worse mental health at age 9 ([beta] = 0.20, SE = 0.04) and age 13 ([beta] = 0.22, SE = 0.04). In LSAC parental identification of child overweight at age 10 did not significantly predict changes in mental health problems from age 10 to 12 ([beta] = -0.02, SE = 0.03). In GUI parental identification of child overweight was predictive of increases in mental health problems from age 9 to 13 ([beta] = 0.08, SE = 0.03). Conclusions: Parental identification of child overweight and obesity is associated with worse child mental health, independent of child body weight. Parents should be aware of the potential stigma and mental health difficulties associated with labelling a child as overweight.

Mandatory energy (calorie) labelling of alcoholic drinks is a public health measure that could be used to address both alcohol consumption and obesity. We used systematic review methodology to assess evidence from studies examining 1) consumer knowledge of the energy content of alcoholic drinks, 2) public support for energy labelling and 3) experiments examining the effect of energy labelling of alcoholic drinks on consumption behaviour. Levels of evidence level were evaluated using the GRADE approach. Eighteen eligible studies (from 16 sources) were included. Among studies examining consumer knowledge of the energy content of alcoholic drinks (N=8) and support for energy labelling (N=9), there was consistent evidence that people tend to be unaware of the energy content of alcoholic drinks, and were more likely to support than oppose energy labelling of alcoholic drinks. The level of evidence supporting these conclusions was rated as moderate due to the majority of studies being of low methodological quality. Six studies examined the effect of energy labelling on outcome measures related to alcohol drinking. Overall, findings were indicative of no likely effect of energy labelling on outcome measures. However, the majority of studies were of low methodological quality, used proxy outcome measures of alcohol drinking and none of the studies were conducted in real-world settings, so the level of evidence supporting this conclusion was classed as very low. Further research is required to determine whether energy labelling of alcoholic drinks affects consumer behaviour and is likely to be an effective public health policy.

Psychological factors may explain why some people develop obesity and others remain a normal weight during their life course. We use an umbrella review approach to build an evidence-based map of the psychological correlates of heavier body weight. Synthesising findings from 42 meta-analyses that have examined associations between psychological factors and heavier body weight, we assessed level of evidence for a range of cognitive, psychosocial and mental health individual difference factors. There is convincing evidence that impaired mental health is associated with heavier body weight and highly suggestive evidence that numerous cognitive factors are associated with heavier body weight. However, the relatively low methodological quality of meta-analyses resulted in lower evidential certainty for most psychosocial factors. Psychological correlates of heavier body weight tended to be small in statistical size and on average, people with obesity were likely to be more psychologically similar than different to people with normal weight. We consider implications for understanding the development of heavier body weight and identifying effective public health interventions to reduce obesity.

Introduction Emerging evidence suggests that the COVID-19 pandemic and associated lockdown restrictions may have influenced alcohol consumption. This study examines changes in high-risk alcohol consumption from before to during the COVID-19 crisis in an established cohort of middle-aged British adults. Methods Participants consisted of 3,358 middle-aged adults from the 1970 British Cohort Study who completed the Alcohol Use Disorders Identification Test for detecting hazardous drinkers in primary care settings in 2016–2018 (when aged 46–48 years) and May 2020 (aged 50 years). Multivariable logistic regression analysis was used to examine changes in high-risk drinking (scores of ≥5), and multinomial regression was used to compare responses with individual test items in 2016–2018 and May 2020. Results Among middle-aged British adults, high-risk drinking increased by 5.2 percentage points from 19.4% to 24.6% (p

BackgroundThe impact of the COVID-19 crisis on potentially harmful alcohol consumption is unclear.AimsTo test whether the prevalence of problem drinking has changed from before to during the COVID-19 crisis in the US and UK.Design/SettingWe examined nationally representative longitudinal data on how problem drinking has changed from pre-pandemic levels among adults in the US (N=7,327; Understanding America Study) and UK (N=12,594; UK Household Longitudinal Study).MethodsIn the US, we examined rates of consuming alcohol ≥ 4 times in the past week at baseline (March, 2020) and across four waves of follow-up (April-May, 2020). In the UK we assessed the prevalence of consuming alcohol ≥ 4 times per week and weekly heavy episodic drinking using the AUDIT-C at baseline (2017-2019) and during the COVID-19 lockdown (April, 2020). We also tested whether there were specific groups at greater risk of increased problem drinking during the pandemic.ResultsAmong US adults, there was a statistically significant increase in the percentage of participants reporting drinking alcohol ≥ 4 times a week which rose significantly from 11.7% to 17.9% (53% increase, p < .001) as the COVID-19 crisis developed in the US. Among UK adults, the percentage of participants reporting drinking ≥ 4 times a week increased significantly from 14.2% to 23% (62% increase, p < .001) and heavy episodic drinking at least weekly increased significantly from 9.7% to 16.6% (71% increase, p < .001) when compared to pre-COVID-19 lockdown levels. Trends were similar across population demographics, although those aged under 50 years and higher income groups displayed the largest increases.ConclusionsThe COVID-19 crisis has been associated with substantial increases in problematic drinking in both US and UK adults.

BACKGROUND: The use of sex to cope with negative affective states during the coronavirus disease 2019 (COVID-19) pandemic may be influenced by various sociodemographic and psychological characteristics. AIM: We aimed to examine the effects of social distancing, loneliness, difficulties in emotion regulation, and self-regulation on participants self-reported coping using sex during lockdown in the United Kingdom. METHODS: Participants had to be residents of the United Kingdom, aged between 18-60 years, fluent in English, and had to have an Internet connection. They were instructed not to participate if they had consumed alcohol in the previous 24 hours. A total of 789 participants aged 18-59 years completed an online survey. Participants provided self-report measures of social distancing, loneliness, and difficulties in emotion regulation. A Go/No-Go task was used to assess self-regulation. OUTCOMES: Participants self-reported their use of sex to cope over a 14-day period during lockdown, as well as retrospectively for a 14-day period immediately preceding lockdown. Coping using sex items included consensual and non-consensual themes. RESULTS: Overall, there was no increase in coping using sex during lockdown compared with before lockdown. Findings showed that 30% of participants reported increased coping using sex during lockdown compared with before, 29% reported decreased coping using sex, and 41% reported no change. All regression models included age, gender, ethnicity, diagnosis of psychiatric condition, level of education, being at high-risk for difficulties relating to COVID-19, living alone, and diagnosed or suspected COVID-19 as covariates. Being younger, being male, and greater emotion dysregulation were associated with higher coping using sex total and consent subscale scores during lockdown. Being younger, being male, not living alone, and less adherence to social distancing advice were associated with coping using sex with a theme of rape/violence during lockdown. CLINICAL TRANSLATION: A proportion of participants used sex to cope more often during lockdown compared with before. Less adherence to social distancing advice and emotion dysregulation were associated with using sex to cope during lockdown. STRENGTHS & LIMITATIONS: Strengths of this study were the large sample size and inclusion of key sociodemographic characteristics as covariates. The main limitations were the cross-sectional design and a sample that was mostly white, educated, and female. CONCLUSION: Participants who had difficulty regulating emotions were more likely to use sex to cope. It is important that support is available for people who have problems regulating their emotions during the pandemic and that they have access to appropriate help and advice. Gillespie SM, Jones A, Uzieblo K, et al. Coping Using Sex During the Coronavirus Disease 2019 (COVID-19) Outbreak in the United Kingdom. J Sex Med 2021;18:50-62.

Background Renal replacement therapies (RRT) other than in-centre haemodialyses are underutilised by African Americans with end-stage renal disease (ESRD) even though they are associated with reduced costs, morbidity and mortality as well as improved quality of life for patients. Objectives To understand African American patients' knowledge of RRT options and how patient, provider and system-factors contribute to knowledge and preferences. Participants' interviews were conducted at the University of Chicago Medical Center with African American patients with chronic kidney disease (CKD). The final analysis included 28 interviews; 22 patients had CKD not yet on dialysis or having received a transplant, while 6 had reached ESRD and were receiving treatment for kidney failure. Approach Transcripts were uploaded into NVivo8 for coding. Thematic analysis was used for data interpretation. Results Four themes were identified: (1) limited knowledge of home modalities and deceased donor options, (2) CKD patients gave little thought to choosing RRT options, (3) CKD patients relied on doctors for treatment decisions, and (4) while patients reported knowledge of living kidney donation transplants (LKDT), it did not translate to receiving an LKDT. Conclusion African Americans face significant knowledge and access barriers when deciding on their RRT treatment. Even patients with advanced CKD were still in the early stages of RRT selection. Understanding the knowledge gaps and barriers patients face will inform our subsequent intervention to educate and motivate patients to increase CKD self-care and improve communication between patients, their families and their providers about different RRT treatments.

Identifying oneself as overweight is a risk factor for poor mental health and suicidality independent from objective weight status. The stigma associated with heavier body weight has risen in recent decades and this may have exacerbated the detrimental mental health effects of perceived overweight. In this study, we examined the association between perceived overweight and suicidality in a nationally representative sample (N = 115,180) of US adolescents assessed from 1999 to 2017. We drew on data from the Youth Risk Behavior survey, a biennial population-based survey of students in grades 9–12. Suicidality was gauged by participant reports of past-year suicidal ideation, suicide plans, or suicide attempts. Across all waves, perceived overweight (vs. perceived “normal” weight) predicted a 7.7 percentage point (p

Background.To date, there have been no published investigations on the cause of acetabular debonding, a rare failure phenomenon in metal-on-metal hip resurfacing where the acetabular porous coating delaminates from the implant while remaining well fixed to the pelvic bone.Purposes.This study aims to summarize the current understanding of acetabular debonding and to investigate the discrepancy in rate of debonding between two implant systems.Patients and Methods.To elucidate potential causes of debonding, we retrospectively analyzed a single-surgeon cohort of 839 hip resurfacing cases. Specifically, we compared rate of debonding and manufacturing processes between two implant systems.Results.Group 1 experienced significantly more cases of debonding than Group 2 cases (4.0% versus 0.0%, p valueConclusions.We identified implant system, postoperative time, and acetabular component placement as variables contributing to rate of debonding. We recommend minimizing acetabular inclination angle according to RAIL guidelines. Further, we evaluated manufacturing differences between the two implant systems but did not have access to proprietary data to identify the cause of debonding. Both implants met ASTM standards, yet only the Group 1 implant debonded. This suggests the second implant had greater fatigue shear strength. Because the Group 2 implant achieved a more durable interface that did not debond, we suggest the ASTM F1160 standard for fatigue shear strength be increased to that achieved by its manufacturer.Level of Evidence II. A retrospective evaluation of prospectively collected data.

Previous research indicates that attachment anxiety (fear of abandonment) is predictive of overeating and higher body mass index (BMI). The current study explored the nature of the mechanisms underpinning this relationship. Study 1 assessed the relative contribution of ‘emotional eating’, 'susceptibility to hunger’ and ‘uncontrolled eating’. Study 2 assessed whether misperception of emotion and poor emotion management would mediate the relationship between attachment anxiety and stress-induced eating (and then BMI). Two cross-sectional online questionnaire studies were conducted (Study 1 N = 665, & Study 2 N = 548), in UK and US-based samples, which assessed attachment orientation and BMI alongside the potential mediators. The relative contribution of emotional eating, susceptibility to hunger and uncontrolled eating (Study 1) and difficulties in emotion regulation and stress-induced eating (Study 2) as mediators of this relationship were examined. In Study 1, parallel multiple mediation analysis (PROCESS) showed that emotional eating and susceptibility to hunger (but not uncontrolled eating) were significant mediators of the relationship between attachment anxiety and BMI. In Study 2, serial mediation analysis showed that difficulties in ‘engaging with goal directed behaviours when upset’ and stress-induced eating operated in series to significantly mediate the relationship between attachment anxiety and BMI. These findings suggest that attachment anxious individuals feel less capable in disengaging from negative emotions and go on to try to soothe themselves through eating which has a negative impact on their BMI. There was less support for an explanation of the relationship between attachment anxiety and BMI based around the misperception of emotion. Taken together, the findings highlight attachment anxiety and emotion regulation strategies as key targets for interventions that aim to reduce overeating and excess body weight.

Long-term retention of trauma procedural core-competency skills and need for re-training after a 1-day cadaver-based course remains unknown. We measured and compared technical skills for trauma core competencies at mean 14 months (38 residents), 30 months (35 practicing surgeons), and 46 months (10 experts) after training to determine if skill degradation occurs with time. Technical performance during extremity vascular exposures and lower-extremity fasciotomy in fresh cadavers measured by validated individual procedure score (IPS) was the primary outcome.We performed a prospective study between May 2013 and September 2016.Practicing surgeons had lower IPS and IPS component scores (p = 0.02 to 0.001) than residents (p 0.05) and experts (p0.002) for vascular procedures. Frequencies of errors were no different among residents and experts. Practicing surgeons made more critical errors (p0.05) than experts or residents. Experts had shortest time to proximal vascular control. Fasciotomy procedural errors occurred in all participants. Cluster analysis of anatomy vs procedural steps identified tertiles of performance and wide variance (32.5% practicing surgeons, 26.5% residents vs 13% experts) for vascular procedures. Vascular control duration20 minutes (n = 21) and failure to decompress fasciotomy compartments were correlated with incorrect landmarks and skin incisions. Modeling found interval trauma skills experience, not time since training, was associated with lower IPS.Practicing surgeons with low trauma skills experience since training had lower IPS and component scores (p = 0.02 to 0.001) and more errors compared with experts and residents (p0.05). Surgeons, including experts with low interval experience performing trauma procedures, may benefit from refreshing of correct landmarks and skin incision placement identification.