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Increases in food portion sizes have been identified as a possible contributor to the increased prevalence of obesity in humans. However, little is known about the origin of behavioural tendencies to overeat from larger portion sizes or whether other non-human animals are affected by meal portion size. In the present experimental study, we examined the effect that larger portion sizes have on meal consumption among domesticated dogs (N = 32). Dogs were fed three meals that varied in size on different occasions (150%, 200% and 300% of usual portion size). A repeated measures design was used and food consumption was measured for each meal. Portion size positively affected food consumption, with dogs eating significantly more food as the portion size of meal increased. The effect of portion size on food consumption was also observed when the dogs that finished all available food were excluded from analyses, however not among dogs who did not finish any of the meals. We conclude that the influence larger portions have on food consumption observed in humans is also observed in domesticated dogs. However, it is unclear whether portion size directly biases the amount of food dogs choose to consume, as has been suggested in humans. Further research is now warranted to examine commonalities between human and non-human animal eating behaviour to understand shared behavioural tendencies and their origins.

Obesity is associated with a significant disease burden, but whether recognising as opposed to failing to recognise personal overweight is beneficial or detrimental to mental health is unclear. Here we examine the associations between perceived overweight and depressive symptoms and suicidality. A systematic search of three electronic databases yielded 10,398 unique records, from which 32 studies (110 observations) were eligible for inclusion. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated for each outcome using random effects meta-analyses and potential publication bias was examined. Perceived overweight was associated with an increased risk of depressive symptoms (OR: 1.42, CI: 1.31, 1.54 p < .0001, N > 128,585) and suicidality (OR: 1.41, CI: 1.28, 1.56, p < .0001, N = 133,576) in both cross-sectional and longitudinal studies. The association between perceived overweight and poorer mental health was observed irrespective of study origin, participant age (children vs. adults), gender, and whether or not a person was objectively overweight. The pooled statistical relationship between objective weight status and poorer mental health was attenuated to non-significance when perceived overweight was accounted for, suggesting that the detrimental effect of overweight on mental health is largely dependent on whether or not a person identifies as overweight.

CONTEXT: African Americans with chronic kidney disease (CKD) are more likely to progress to end-stage renal disease (ESRD). However, African Americans are less likely to receive care to delay progression of their CKD and to prepare for ESRD treatment. OBJECTIVE: The objectives of the study are to understand knowledge among urban, African-American patients diagnosed with CKD and to discover ways they managed their illness and prepared for kidney disease progression. DESIGN: A qualitative study was conducted using structured interviews. Thematic analysis was used for data interpretation. All 23 participants identified as African American and had CKD but had not yet reached ESRD requiring renal replacement therapy (RRT). Over half of the participants were women (57%), and the mean age was 53 years old. RESULTS: Three themes emerged from the data. African Americans often did not know the severity of their CKD. They struggled to complete all of the diet, exercise and medication tasks recommended to manage their health conditions, including CKD. Finally, participants, even those with Stage 5 CKD, viewed progression to RRT in the next 12 months as unlikely. CONCLUSION: African Americans face many barriers to CKD self-care and preparation for ESRD. Improving outcomes requires clinicians to help patients understand the severity of their CKD, to make informed choices about their care, all the while motivating patients to take actions to prevent CKD progression.

Body mass index (BMI) and obesity have a complex relation with risk of dementia that evolves over the lifespan. Research in other domains indicates that the social experience of body weight, not just BMI, is associated with worse health outcomes. The present research uses data from the Health and Retirement Study (N = 12,053) to test whether weight discrimination is associated with increased risk of dementia over an up to 10-year follow-up independent of BMI and other relevant clinical and behavioral risk factors. Participants who reported weight discrimination had a 40% increased risk of incident dementia (Hazard Ratio = 1.40; 95% Confidence Interval = 1.12–1.74), controlling for age, sex, race, ethnicity, and education. The association between weight discrimination and incident dementia held controlling for BMI, diabetes, hypertension, depressive symptoms, smoking, physical activity, and genetic risk status. The present research indicates that the stigma associated with weight is associated with dementia risk independent from obesity. This research highlights that the detrimental effect of obesity on cognitive health in older adulthood may occur through the adverse social experience of body weight in addition to the biological consequences of excess weight.

Focusing attention on food during a meal has been shown to reduce later snack consumption. We report the results of two studies that aimed to replicate this effect and to elucidate the underlying mechanisms. We hypothesised that focused attention during a lunchtime meal would improve visual memory and/or memory for the satiating effects of the meal, and that this would reduce later food intake. In Study 1, participants (N = 108, 52.8% female, BMI M = 25.75 kg/m2) were randomly allocated to eat a fixed lunchtime meal while listening to instructions that encouraged them to pay attention to the sensory properties of the meal (focused attention condition), or to one of two control conditions. To determine whether the effect of focused attention on later food intake is influenced by meal satisfaction, in a second study, participants (N = 147, 100% female, BMI M = 25.15 kg/m2) were given either a satisfying or dissatisfying lunch. In both studies, after 3 h participants ate snack food ad libitum and completed assessments of their memory for the recent lunch. In both studies there was no effect of focused attention on later food intake. In Study 2, the effect of focused attention on later food intake was not moderated by meal satisfaction. In both studies focused attention did not improve memory for the lunch meal. The present studies failed to replicate the effect of focused attention on later food intake and this may be because focused attention did not improve memory for the lunchtime meal. Further research should examine the conditions under which attention during eating influences memory encoding and food intake.

BACKGROUND When administered as a continuous infusion, ketamine is known to be a potent analgesic and general anaesthetic. Recent studies suggest that a single low-dose administration of ketamine can provide a long-lasting effect on mood, but its effects when given in the postoperative period have not been studied. OBJECTIVE We hypothesised that a single low-dose administration of ketamine after bariatric surgery can improve pain and mood scores in the immediate postoperative period. DESIGN We performed a randomised, double-blind, placebo-controlled study to compare a single subanaesthetic dose of ketamine (0.4 mg kg) with a normal saline placebo in the postanaesthesia care unit after laparoscopic gastric bypass and gastrectomy. SETTING Single-centre, tertiary care hospital, October 2014 to January 2018. PATIENTS A total of 100 patients were randomised into the ketamine and saline groups. INTERVENTION Patients in the ketamine group received a single dose of ketamine infusion (0.4 mg kg) in the postanaesthesia care unit. Patients in the placebo groups received 0.9% saline. OUTCOME MEASURES The primary outcome was the visual analogue pain score. A secondary outcome was performance on the short-form McGill's Pain Questionnaire (SF-MPQ). RESULTS There were no significant differences in visual analogue pain scores between groups (group-by-time interaction P = 0.966; marginal group effect P = 0.137). However, scores on the affective scale of SF-MPQ (secondary outcome) significantly decreased in the ketamine group as early as postoperative day (POD) 2 [mean difference = -2.2 (95% bootstrap CI -2.9 to 1.6), Bonferroni adjusted P

BACKGROUND: Young adult heavy drinking is an important public health concern. Current interventions have efficacy but with only modest effects, thus novel interventions are needed. In prior studies, heavy drinkers, including young adults, have demonstrated stronger automatically triggered approach tendencies to alcohol-related stimuli than lighter drinkers. Automatic action tendency retraining has been developed to correct this tendency and consequently reduce alcohol consumption. The current study is the first to test multiple iterations of automatic action tendency retraining, followed by laboratory alcohol self-administration. METHODS: A total of 72 non-treatment-seeking, heavy drinking young adults ages 21–25 were randomized to automatic action tendency retraining or a control condition (i.e., “sham training”). Of these, 69 (54% male) completed 4 iterations of retraining or the control condition over 5 days with an alcohol drinking session on Day 5. Self-administration was conducted according to a human laboratory paradigm designed to model individual differences in impaired control (i.e., difficulty adhering to limits on alcohol consumption). RESULTS: Automatic action tendency retraining was not associated with greater reduction in alcohol approach tendency or less alcohol self-administration than the control condition. The laboratory paradigm was probably sufficiently sensitive to detect an effect of an experimental manipulation given the range of self-administration behavior observed, both in terms of number of alcoholic and non-alcoholic drinks and measures of drinking topography. CONCLUSIONS: Automatic action tendency retraining was ineffective among heavy drinking young adults without motivation to change their drinking. Details of the retraining procedure may have contributed to the lack of a significant effect. Despite null primary findings, the impaired control laboratory paradigm is a valid laboratory-based measure of young adult alcohol consumption that provides the opportunity to observe drinking topography and self-administration of non-alcoholic beverages (i.e., protective behavioral strategies directly related to alcohol use).

Background Larger portion sizes of food promote increased food intake, although the mechanisms explaining the portion size effect are unclear. In the present study we examined whether the tendency to clear one's plate when eating is associated with greater food intake in response to larger portion size. Method We recruited female participants who were either self-reported habitual plate clearers (N = 48) or non-plate clearers (N = 41) into a laboratory study. In a between-subjects design, participants were served either a ‘normal’ (500 g) or ‘large’ (1000 g) portion of pasta for lunch and ate as much as they desired. Results There was no significant interaction found between portion size and plate-clearing tendencies; portion size had a similar sized effect on food intake in both plate clearers and non-plate clearers. A significant main effect of portion size was found, whereby participants consumed significantly more when served the large versus the normal portion (100.55 g difference, p η p 2 = 0.16). There was also a significant main effect of plate clearing; participants with a tendency to clear their plate when eating consumed significantly more than non-plate clearers (68.21 g difference, p = .006, η p 2 = 0.08). Conclusions The tendency to clear one's plate when eating was associated with increased food intake during a lunchtime meal. Increasing the portion size of the lunchtime meal increased food intake, although the tendency for a larger portion size to increase food intake was observed irrespective of participant plate-clearing tendencies.

Contains fulltext : 191329.pdf (Publisher’s version ) (Open Access) The methodological quality and reporting practices of laboratory studies of human eating behavior determine the validity and replicability of nutrition science. The aim of this research was to examine basic methodology and reporting practices in recent representative laboratory studies of human eating behavior. We examined laboratory studies of human eating behavior (N = 140 studies) published during 2016. Basic methodology (e.g., sample size, use of participant blinding) and reporting practices (e.g., information on participant characteristics) were assessed for each study. Some information relating to participant characteristics (e.g., age, gender) and study methodology (e.g., length of washout periods in within-subjects studies) were reported in the majority of studies. However, other aspects of study reporting, including participant eligibility criteria and how sample size was determined were frequently not reported. Studies often did not appear to standardize pre-test meal appetite or attempt to blind participants to study aims. The average sample size of studies was small (between-subjects design studies in particular) and the primary statistical analyses in a number of studies (24%) were reliant on very small sample sizes that would be likely to produce unreliable results. There are basic methodology and reporting practices in the laboratory study of human eating behavior that are sub-optimal and this is likely to be affecting the validity and replicability of research. Recommendations to address these issues are discussed. 6 p.

Acute alcohol administration can lead to a loss of control over drinking. Several models argue that this 'alcohol priming effect' is mediated by the effect of alcohol on inhibitory control. Alternatively, beliefs about how alcohol affects behavioural regulation may also underlie alcohol priming and alcohol-induced inhibitory impairments. Here two studies examine the extent to which the alcohol priming effect and inhibitory impairments are moderated by beliefs regarding the effects of alcohol on the ability to control behaviour. In study 1, following a priming drink (placebo or .5g/kg of alcohol), participants were provided with bogus feedback regarding their performance on a measure of inhibitory control (stop-signal task; SST) suggesting that they had high or average self-control. However, the bogus feedback manipulation was not successful. In study 2, before a SST, participants were exposed to a neutral or experimental message suggesting acute doses of alcohol reduce the urge to drink and consumed a priming drink and this manipulation was successful. In both studies craving was assessed throughout and a bogus taste test which measured ad libitum drinking was completed. Results suggest no effect of beliefs on craving or ad lib consumption within either study. However, within study 2, participants exposed to the experimental message displayed evidence of alcohol-induced impairments of inhibitory control, while those exposed to the neutral message did not. These findings do not suggest beliefs about the effects of alcohol moderate the alcohol priming effect but do suggest beliefs may, in part, underlie the effect of alcohol on inhibitory control.

Melanoma lacks a clinically useful blood-based biomarker of disease activity to help guide patient management. To determine whether measurements of circulating, cell-free, tumor-associated BRAF(mutant) and NRAS(mutant) DNA (ctDNA) have a higher sensitivity than LDH to detect metastatic disease prior to treatment initiation and upon disease progression we studied patients with unresectable stage IIIC/IV metastatic melanoma receiving treatment with BRAF inhibitor therapy or immune checkpoint blockade and at least 3 plasma samples obtained during their treatment course. Levels of BRAF(mutant) and NRAS(mutant) ctDNA were determined using droplet digital PCR (ddPCR) assays. Among patients with samples available prior to treatment initiation ctDNA and LDH levels were elevated in 12/15 (80%) and 6/20 (30%) (p = 0.006) patients respectively. In patients with RECIST scores

Larger portions increase energy intake (the 'portion size effect'); however, the mechanisms behind this effect are unclear. Although pre-meal intentions are thought to be an important determinant of energy intake, little research has examined how much of a meal individuals intend to eat when served standard versus larger portion sizes. Three studies examined the effect of manipulating portion size on intended food consumption. In Studies 1 (spaghetti bolognese) and 2 (curry and rice) male participants were shown an image of either a standard or a larger meal and indicated how much of the meal they intended to consume. In Study 3 male and female participants were served either a standard or a larger portion of ice cream for dessert, they indicated how much they intended to consume and then ate as much of the ice cream as they desired. Regardless of being shown standard or large portion sizes, in Studies 1 and 2 participants reported that they intended to eat the majority of the meal, equating to a large difference in intended energy consumption between portion size conditions (a 'pre-consumption portion size effect'). This finding was replicated in male participants in Study 3, although females intended to eat a smaller proportion of the larger portion of ice cream, compared to the standard portion. Both male and female participants tended to eat in accordance with their pre-meal intentions and a portion size effect on actual consumption was subsequently observed in males, but not in females. The portion size effect may be observed when measuring pre-meal intended consumption in males.

BACKGROUND Laboratory paradigms are commonly used to study human energy intake. However, the extent to which participants believe their eating behavior is being measured may affect energy intake and is a methodologic factor that has received little consideration. OBJECTIVE Our main objective was to examine available evidence for the effect that heightened awareness of observation has on energy intake in a laboratory setting. DESIGN We systematically reviewed laboratory studies that allowed for experimental examination of the effect that heightened awareness of observation has on energy intake. From these experimental studies we combined effect estimates using inverse variance meta-analysis, calculating the standardized mean difference (SMD) in energy intake between heightened-awareness and control conditions and qualitatively synthesized potential moderators of this effect. RESULTS Nine studies, providing 22 comparisons, were eligible for inclusion. These studies largely sampled young women and examined the energy intake of energy-dense snack foods. Evidence indicated that heightened awareness of observation was associated with reduced energy intake when compared with the control condition (random-effects SMD: 0.45; 95% CI: 0.25, 0.66; P < 0.0001). We found little evidence that the type of experimental manipulation used to heighten awareness moderated the overall effect. CONCLUSIONS The available evidence to date suggests that heightened awareness of observation reduces energy intake in a laboratory setting. These findings suggest that laboratory studies should attempt to minimize the degree to which participants are aware that their eating behavior is being measured.

Cultural differences in ideal body weight are well established, but less research has examined attraction toward potential mates of heavier body weights. We examined whether exposure to obesity increases physical attraction toward overweight men. In Studies 1 and 2, we examined the effect that exposure to obese vs healthy weight men had on female attraction toward an overweight man. Study 3 examined whether females who are regularly exposed to males of heavier body weights reported a greater attraction toward overweight men. Study 4 tested whether females in an online dating study were more likely to choose to date an overweight man, after having been exposed to obesity. Exposure to obesity altered visual perceptions of what normal and therefore healthy body weights were and this resulted in greater attraction toward an overweight man (Studies 1 and 2). Females regularly exposed to men of heavier body weight reported a greater attraction toward overweight men (Study 3). After exposure to obesity, females in an online dating study were more likely to choose to date an overweight man ahead of a healthy weight man (Study 4). Exposure to male obesity increases female attraction toward overweight men and may affect mate choice.

BACKGROUND: Portion size is an important component of dietary advice for weight control, but little is known about what portion sizes people consider 'normal'. This study determined the effect of body mass index (BMI), gender, dietary restraint and liking of the food on personal and social portion size norms for a range of foods and the degree of certainty over the norms. METHODS: Thirty lean (BMI 20-25 kg m(-)(2)) and 30 obese (BMI 30-35 kg m(-)(2)) men and women (aged 18-60 years) viewed 17 different portion sizes of 12 foods on a computer screen on two occasions a week apart. Participants responded 'more' or 'less' to each photograph reflecting personal portion size preference or perceived portion sizes of others. Personal and social norms for portion sizes of each food were determined using the method of constant stimuli giving a sigmoidal curve of the probability of answering 'less' over a range of portion sizes. The slope of the sigmoid at the norm gave a measure of certainty about the norm. Regression models were used to examine the effect of BMI, gender, dietary restraint and liking of the food on personal norms, social norms, the relationship between norms, and the slopes. RESULTS: Personal norms were significantly larger in the obese (P=0.026), men (P

Resistance to RAF- and MEK-targeted therapy is a major clinical challenge1–4. RAF and MEK inhibitors are initially but only transiently effective in some but not all patients with BRAF gene mutation and are largely ineffective in those with RAS gene mutation because of resistance5–14. Through a genetic screen in BRAF-mutant tumor cells, we show that the Hippo pathway effector YAP (encoded by YAP1) acts as a parallel survival input to promote resistance to RAF and MEK inhibitor therapy. Combined YAP and RAF or MEK inhibition was synthetically lethal not only in several BRAF-mutant tumor types but also in RAS-mutant tumors. Increased YAP in tumors harboring BRAF V600E was a biomarker of worse initial response to RAF and MEK inhibition in patients, establishing the clinical relevance of our findings. Our data identify YAP as a new mechanism of resistance to RAF- and MEK-targeted therapy. The findings unveil the synthetic lethality of combined suppression of YAP and RAF or MEK as a promising strategy to enhance treatment response and patient survival.

There is consistent evidence that the amount of food we consume can be influenced by the eating behaviour of other people. Some previous experimental studies reported that consumers are unaware of this influence on their behaviour. The present research tested whether people may be more aware of social influence on their eating than previously assumed. In two studies, participants (total n = 160) were exposed to information about the amount of snack food other people had been eating shortly before being served the same snack food and eating as much as they liked. After this, participants responded to questions regarding whether they thought their food intake had been socially influenced, and reported the reasons why they believed they had or had not been influenced. Of the 160 participants, 34% reported that they had been influenced, 10% were unsure and 56% reported they had not been influenced. Crucially, participants' reports of social influence appeared to be accurate; the food intake of participants reporting social influence was significantly affected by the amount of food other people had been eating, whereas the food intake of participants denying social influence was unaffected. Individuals may be more aware of the effect that social influence has on their eating behaviour than previously assumed. Further work is needed to identify the factors which determine whether people are susceptible to social influence on eating behaviour.

© 2014 The Obesity Society. Objectives Identifying eating behaviors which contribute to excess weight gain will inform obesity prevention strategies. A tendency to clear one's plate when eating may be a risk factor for obesity in an environment where food is plentiful. Whether plate clearing is associated with increased body weight in a cohort of US participants was examined. Methods Nine hundred and ninety-three US adults (60% male, 80% American European, mean age = 31 years) completed self-report measures of habitual plate clearing together with behavioral and demographic characteristics known to be associated with obesity. Results Plate clearing tendencies were positively associated with BMI and remained so after accounting for a large number of other demographic and behavioral predictors of BMI in analyses (β = 0.18, 95% CIs = 0.07, 0.29, P

Overweight is associated with a range of negative health consequences, such as type 2 diabetes, cardiovascular disease, gastrointestinal disorders, and premature mortality.1 One means to combat overweight is through encouraging people to eat more slowly.2 People who eat quickly tend to consume more3, 4 and 5 and have a higher body mass index,6, 7, 8 and 9 whereas people who eat more slowly feel sated earlier and eat less.10, 11, 12 and 13. Unfortunately, eating rate is difficult to modify, because of its highly automatic nature.14 In clinical settings, researchers have had some success changing behavior by using devices that deliver feedback in real time.15, 16 and 17 However, existing technologies are either too cumbersome18 or not engaging enough19 for use in daily life contexts. Training people to eat more slowly in everyday eating contexts, therefore, requires creative and engaging solutions. This article presents a qualitative evaluation of the feasibility of a smart fork to decelerate eating rate in daily life contexts. Furthermore, we outline the planned research to test the efficacy of this device in both laboratory and community settings

Self-identification of being overweight has been associated with overeating and weight gain in observational studies, irrespective of whether the individual in question is objectively overweight. The aims of the present studies were to examine whether experimentally manipulating the psychosocial experience of feeling overweight impacted on snack food consumption and to identify mechanisms explaining this effect. In Study 1, to manipulate the psychosocial experience of feeling overweight, 120 women wore an obese body suit or control clothing in public or private settings, before consuming snack foods. Wearing the obese body suit resulted in an increase in snack food consumption and this effect was not moderated by whether participants wore the obese body suit in public or in private. In Study 2, we aimed to replicate the effect of the obese body suit on snack food consumption and also examined whether the effect of the body suit on eating behaviour was moderated by participant sex (n = 150; 80 women). Women who wore the obese body suit ate significantly more than women who wore the control clothing, but this effect was not observed in men. Across both studies we examined a number of potential mechanisms that could explain the effect that wearing the obese body suit had on snack food consumption, but did not find supporting evidence. The psychosocial experience of feeling overweight may lead to increased snack food consumption in women, but the psychological mechanism explaining this effect is unclear.

The Smarter Lunchrooms intervention approach aims to tackle childhood obesity by promoting healthier nutrition through the use of choice architecture or ‘nudge’ tactics in school lunchrooms. I reviewed research papers that were described by Cornell University as forming the evidence base for the Smarter Lunchrooms approach. Here I discuss concerns about the way that research informing the Smarter Lunchrooms approach has been conducted and disseminated. The widespread implementation of the Smarter Lunchrooms approach is discussed and the likely efficacy of this public health intervention is also considered.

Background\ud \ud Historical increases in the size of commercially available food products have been linked to the emergence of a worldwide obesity crisis. Although the acute effect that portion size has on food intake is well established, the effect that exposure to smaller portion sizes has on future portion size selection has not been examined.\ud \ud Objective\ud \ud We tested whether reducing a food portion size “renormalizes” perceptions of what constitutes a normal amount of that food to eat and results in people selecting and consuming smaller portions of that food in the future.\ud \ud Design\ud \ud Across 3 experiments, participants were served a larger or smaller portion of food. In experiments 1 and 2, participants selected and consumed a portion of that food 24 h later. In experiment 3, participants reported on their preferred ideal portion size of that food after 1 wk.\ud \ud Results\ud \ud The consumption of a smaller, as opposed to a larger, portion size of a food resulted in participants believing a “normal”-sized portion was smaller (experiments 1–3, P ≤ 0.001), consuming less of that food 1 d later (experiments 1–2, P ≤ 0.003), and displaying a tendency toward choosing a smaller ideal portion of that food 1 wk later (experiment 3, P = 0.07), although the latter finding was not significant.\ud \ud Conclusion\ud \ud Because consumer preferences appear to be driven by environmental influences, reducing food portion sizes may recalibrate perceptions of what constitutes a “normal” amount of food to eat and, in doing so, decrease how much consumers choose to eat. This trial was registered at www.clinicaltrials.gov as NCT03241576.

Depression is common among people living with HIV, and it is associated with impaired work functioning. However, little research has examined whether depression alleviation improves work-related outcomes in this population, which is the focus of this analysis.A sample of 1028 depressed HIV clients in Uganda enrolled in a comparative trial of depression care models and were surveyed over 12 months. Serial regression analyses examined whether depression alleviation (measured by the nine-item Patient Health Questionnaire) was associated with change in self-reported weekly amount of hours worked and income earned, and whether these relationships were mediated by change in work-related self-efficacy.Among those with major depression, depression alleviation was associated with nearly a doubling of weekly hours worked in bivariate analysis. The relationship between depression alleviation and hours worked was partially mediated by change in work self-efficacy among those with major depression, as well as those with minor depression, in multivariate regression analysis that controlled for demographic and health covariates. Depression alleviation was not significantly associated with change in weekly income.These findings suggest that depression alleviation benefits work functioning at least in part through improved confidence to engage in work-related activities. Integration of depression care services into HIV care may be important for improving the economic well-being of people living with HIV.

With depression known to impede HIV care adherence and retention, we examined whether depression alleviation improves these disease management behaviors. A sample of 1028 depressed HIV clients in Uganda enrolled in a cluster randomized controlled trial of two depression care models, and were surveyed over 12 months. Serial regression analyses examined whether depression alleviation was associated with self-reported antiretroviral therapy (ART) adherence and clinic attendance at month 12, and whether these relationships were mediated by self-efficacy and motivation. Among those with major depression, depression alleviation was associated with better ART adherence and clinic attendance at month 12; these relationships were fully mediated by self-efficacy at month 12, while adherence motivation partially mediated the relationship between depression alleviation and ART adherence. When both mediators were entered simultaneously, only self-efficacy was a significant predictor and still fully mediated the relationship between depression alleviation and adherence. These findings suggest that depression alleviation benefits both ART adherence and clinic attendance, in large part through improved confidence and motivation to engage in these disease management behaviors.

Identifying oneself as being overweight may be associated with adverse health outcomes, yet prospective tests of this possibility are lacking. Over 7 years, we examined associations between perceptions of being overweight and subsequent health in a sample of 3,582 U.S. adults. Perceiving oneself as being overweight predicted longitudinal declines in subjective health ( d = −0.22, p < .001), increases in depressive symptoms ( d = 0.09, p < .05), and raised levels of physiological dysregulation ( d = 0.24, p < .001), as gauged by clinical indicators of cardiovascular, inflammatory, and metabolic functioning. These associations remained after controlling for a range of potential confounders and were observed irrespective of whether perceptions of being overweight were accurate or inaccurate. This research highlights the possibility that identifying oneself as overweight may act independently of body mass index to contribute to unhealthy profiles of physiological functioning and impaired health over time. These findings underscore the importance of evaluating whether weight-feedback interventions may have unforeseen adverse consequences.

Objective The study had 2 objectives: first, to evaluate the success of autologous chondrocyte implantation (ACI) in terms of incidence of surgical re-intervention, including arthroplasty, and investigate predictors of successful treatment outcome. The second objective was to derive a tool predicting a patient’s arthroplasty risk following ACI. Design In this Level II, prognostic study, 170 ACI-treated patients (110 males [aged 36.8 ± 9.4 years]; 60 females [aged 38.1 ± 10.2 years]) completed a questionnaire about further surgery on their knee treated with ACI 10.9 ± 3.5 years previously. Factors commonly assessed preoperatively (age, gender, defect location and number, previous surgery at this site, and the preoperative Lysholm score) were used as independent factors in regression analyses. Results At final follow-up (maximum of 19 years post-ACI), 40 patients (23.5%) had undergone surgical re-intervention following ACI. Twenty-six patients (15.3%) underwent arthroplasty, more commonly females (25%) than males (10%; P = 0.001). Cox regression analyses identified 4 factors associated with re-intervention: age at ACI, multiple operations before ACI, patellar defects, and lower pretreatment Lysholm scores (Nagelkerke’s R2 = 0.20). Six predictive items associated with risk of arthroplasty following ACI (Nagelkerke’s R2 = 0.34) were used to develop the Oswestry Risk of Knee Arthroplasty index with internal cross-validation. Conclusion In a single-center study, we have identified 6 factors (age, gender, location and number of defects, number of previous operations, and Lysholm score before ACI) that appear to influence the likelihood of ACI patients progressing to arthroplasty. We have used this information to propose a formula or “tool” that could aid treatment decisions and improve patient selection for ACI.

Thucydides repeatedly explains that the Peloponnesian War arose not simply from the specific grievances of this or that state but from a longer process of growing Athenian power that inspired fear among the Spartans, making the war inevitable. Thucydides’ balanced and richly detailed account has not convinced everyone, however. Many scholars investigating the war’s causes have disagreed with Thucydides’ thesis, typically using the historian’s own narrative to fix primary blame for the war on the Athenians or the Spartans, or more rarely casting the war’s outbreak in broader terms, with varying degrees of success. This chapter validates Thucydides’ explanation and shows that alternative modern explanations are unsatisfactory.

Because overconsumption of food contributes to ill health, understanding what affects how much people eat is of importance. The ‘bogus’ taste test is a measure widely used in eating behaviour research to identify factors that may have a causal effect on food intake. However, there has been no examination of the validity of the bogus taste test as a measure of food intake. We conducted a participant level analysis of 31 published laboratory studies that used the taste test to measure food intake. We assessed whether the taste test was sensitive to experimental manipulations hypothesized to increase or decrease food intake. We examined construct validity by testing whether participant sex, hunger and liking of taste test food were associated with the amount of food consumed in the taste test. In addition, we also examined whether BMI (body mass index), trait measures of dietary restraint and over-eating in response to palatable food cues were associated with food consumption. Results indicated that the taste test was sensitive to experimental manipulations hypothesized to increase or decrease food intake. Factors that were reliably associated with increased consumption during the taste test were being male, have a higher baseline hunger, liking of the taste test food and a greater tendency to overeat in response to palatable food cues, whereas trait dietary restraint and BMI were not. These results indicate that the bogus taste test is likely to be a valid measure of food intake and can be used to identify factors that have a causal effect on food intake.

We examined the prevalence and correlates of safer conception methods (SCM) use in HIV-affected couples with fertility intentions. A prospective cohort of 400 HIV clients in Uganda who had fertility intentions with their partner was surveyed every 6 months for 24 months. Logistic regression analysis was used to determine individual, relationship and provider level predictors of SCM use. Over one-third (35%) reported any use of timed unprotected intercourse (TUI) during the study; use of other SCM was rare. Baseline predictors of any TUI use included lower social support, greater perceived provider stigma of childbearing, greater SCM awareness, greater control over sexual decision making in the relationship, inconsistent condom use, and the belief that a desire for childbearing impedes condom use. These findings highlight the need for policy and provider training regarding integration of safer conception counselling into family planning and reproductive health services for people living with HIV.

While much has been written about the role of caregiving for the elderly and chronically ill and for children with special needs, little is known about "military caregivers"-the population of those who care for wounded, ill, and injured military personnel and veterans. These caregivers play an essential role in caring for injured or wounded service members and veterans. This enables those for whom they are caring to live better quality lives, and can result in faster and improved rehabilitation and recovery. Yet playing this role can impose a substantial physical, emotional, and financial toll on caregivers. This article distills a longer report

Item does not contain fulltext Eating rate is a basic determinant of appetite regulation, as people who eat more slowly feel sated earlier and eat less. Without assistance, eating rate is difficult to modify due to its automatic nature. In the current study, participants used an augmented fork that aimed to decelerate their rate of eating. A total of 114 participants were randomly assigned to the Feedback Condition (FC), in which they received vibrotactile feedback from their fork when eating too fast (i.e., taking more than one bite per 10 s), or a Non-Feedback Condition (NFC). Participants in the FC took fewer bites per minute than did those in the NFC. Participants in the FC also had a higher success ratio, indicating that they had significantly more bites outside the designated time interval of 10 s than did participants in the NFC. A slower eating rate, however, did not lead to a significant reduction in the amount of food consumed or level of satiation. These findings indicate that real-time vibrotactile feedback delivered through an augmented fork is capable of reducing eating rate, but there is no evidence from this study that this reduction in eating rate is translated into an increase in satiation or reduction in food consumption. Overall, this study shows that real-time vibrotactile feedback may be a viable tool in interventions that aim to reduce eating rate. The long-term effectiveness of this form of feedback on satiation and food consumption, however, awaits further investigation. 7 p.

A previous study showed that wearing an obese body suit results in increased snack food consumption. The aim of this study was to explore mechanisms that may explain the effect that wearing an obese body suit has on snack food consumption. We examined two potential explanations; that the psychosocial experience of being overweight resulted in stereotype consistent behaviour (overeating) or in impairments to self-control. Ninety-four women participated in a laboratory study in which they were asked to wear an obese body suit or control clothing in a public setting, before being given access to snack food and alcohol. Clothing condition had no effect on snack food or alcohol consumption. It is possible that the presence of alcohol in the taste test removed the previously observed effect of the obese body suit on snack food consumption.

This report describes the likely evolution of Islamic State of Iraq and the Levant (ISIL) finances under three specific scenarios: a continuation of the current campaign, a negotiated settlement in Syria and political accommodation in Iraq, and military victory without negotiated settlement or political accommodation. Discussion of these scenarios offered ways to counter fundraising in ISIL territory and use financial information to damage ISIL.

BACKGROUND: Guidelines suggest that GPs should intervene on patients' weight, but to do so GPs must first recognise that a patient may have a weight problem and weigh them. AIM: To examine whether GPs and trainee GPs can identify overweight and obese body weights by sight, and if this influences whether they would discuss weight with a potential patient. DESIGN AND SETTING: Study of GPs and trainee GPs on the lists of the UK NHS Workforce West Midlands Deanery and NHS Sandwell and West Birmingham Clinical Commissioning Group. METHOD: Participants viewed 15 standardised photographs of healthy-weight, overweight, and obese young males, and estimated their BMI, classified their weight status, and reported whether they would be likely to make a brief intervention for weight loss with that person. RESULTS: The sample of GPs and trainee GPs correctly classified a mean of 4.0/5.0 of the healthy weight males, a mean of 2.4/5.0 of the overweight, and a mean of 1.7/5.0 of the obese males. For each 1 kg/m(2) increase in actual BMI, participants underestimated BMI by -0.21 (95% CI = -0.22 to -0.18), meaning that participants would underestimate the BMI of a man of 30 kg/m(2) by approximately 2.5 kg/m(2), but were more accurate for lower body weights. Participants were more likely to intervene with those with a higher estimated BMI (OR 1.53, 95% CI = 1.49 to 1.58). CONCLUSION: This sample of predominantly trainee GPs perceived overweight and obese weights as being of lower BMI and weight status than they actually are, and this was associated with a lower intention of discussing weight management with a potential patient. This was found to be true for trainee and fully qualified GPs who participated in the study. Healthcare professionals should not rely on visual judgements when identifying patients who may benefit from weight management treatment.

It has been suggested that providing consumers with smaller dishware may prove an effective way of helping people eat less and preventing weight gain, but experimental evidence supporting this has been mixed. The objective of the present work was to examine the current evidence base for whether experimentally manipulated differences in dishware size influence food consumption. We systematically reviewed studies that experimentally manipulated the dishware size participants served themselves at a meal with and measured subsequent food intake. We used inverse variance meta-analysis, calculating the standardized mean difference (SMD) in food intake between smaller and larger dishware size conditions. Nine experiments from eight publications were eligible for inclusion. The majority of experiments found no significance difference in food intake when participants ate from smaller vs. larger dishware. With all available data included, analysis indicated a marginal effect of dishware size on food intake, with larger dishware size associated with greater intake. However, this effect was small and there was a large amount of heterogeneity across studies (SMD: -0.18, 95% confidence interval: -0.35, 0.00, I(2) = 77%). Evidence to date does not show that dishware size has a consistent effect on food intake, so recommendations surrounding the use of smaller plates/dishware to improve public health may be premature.

Drinking partners may be influenced by each other's alcohol consumption. However, these effects have only been shown in artificially created social pairings and typically among same-sex young adults. Here, we test whether similarly strong influence effects occur among "real" pairs of social acquaintances (friends and partners) and whether people are aware of this influence on their alcohol consumption.Forty-six pairs of social acquaintances aged between 19 and 60 years old participated in a between-subjects experiment, in a semi-naturalistic bar laboratory setting. One member of each pair (the confederate) was randomly selected and asked to consume only alcoholic (alcohol condition) or soft drinks (nonalcohol condition), while the pair completed a game together in a bar setting. The other participant (naïve) was unaware of these drinking instructions. Postconsumption, we measured the extent to which naïve participants believed that their partner had influenced their own drinking behavior.A large effect of condition on alcohol consumption was observed, χ² (2) = 15.8, p0.001, Cramer's V = 0.59, whereby the number of alcoholic drinks selected by naïve participants in the alcohol confederate condition was significantly greater than in the nonalcohol confederate condition. The majority of naïve participants (81%) also tended to be unaware that their partner had influenced their alcohol consumption.Social acquaintances are influenced by each other's alcohol consumption and may not be aware of this influence on their behavior.

There is interest in the hypothesis that social norms are a determinant of healthy and unhealthy dietary practices. The objective of our work was to assess the weight of evidence that experimentally manipulated information about eating norms influences food intake and choice. This systematic review of experimental studies examined whether providing information about other peoples' eating habits influences food intake or choices. To inform the review, three electronic databases (PsycINFO, MEDLINE, and the Social Sciences Citation Index) were searched during July 2012. A narrative approach was used to synthesize studies that examined the influence of norms on food choice and meta-analyses were used to synthesize the effect that informational eating norms have on quantity of food consumed. Fifteen experimental studies were reviewed. There was evidence that both high intake norms (Z=3.84; P=0.0001; standardized mean difference 0.41, 95% confidence interval 0.20 to 0.63) and low intake norms (Z=2.78; P=0.005; standard mean difference -0.35, 95% confidence interval -0.59 to -0.10) exerted moderate influence on amounts of food eaten. There was consistent evidence that norms influenced food choices; norm information indicating that others make low-energy or high-energy food choices significantly increased the likelihood that participants made similar choices. Information about eating norms influences choice and quantity of food eaten, which could be used to promote healthy changes to dietary behavior.

Background: Reductions in eating rate are recommended to prevent and treat obesity; yet, the relation between eating rate and energy intake has not been systematically reviewed, with studies producing mixed results. Objective: Our main objective was to examine how experimentally manipulated differences in eating rate influence concurrent energy intake and subjective hunger ratings. Design: We systematically reviewed studies that experimentally manipulated eating rate and measured concurrent food intake, self-reported hunger, or both. We combined effect estimates from studies by using inverse variance meta-analysis, calculating the standardized mean difference (SMD) in food intake between fast and slow eating rate conditions. Results: Twenty-two studies were eligible for inclusion. Evidence indicated that a slower eating rate was associated with lower energy intake in comparison to a faster eating rate (random-effects SMD: 0.45; 95% CI: 0.25, 0.65; P < 0.0001). Subgroup analysis indicated that the effect was consistent regardless of the type of manipulation used to alter eating rate, although there was a large amount of heterogeneity between studies. There was no significant relation between eating rate and hunger at the end of the meal or up to 3.5 h later. Conclusions: Evidence to date supports the notion that eating rate affects energy intake. Research is needed to identify effective interventions to reduce eating rate that can be adopted in everyday life to help limit excess consumption. © 2014 American Society for Nutrition.