Physiological Stress Response to Psychosocial Stress in Eating Disorders: Experimental Results of a Cross-sectional Study in Patients with Anorexia Nervosa

As social beings, we are constantly confronted with psychosocial stressors (e.g., social evaluation, exclusion, achievement and / or performance; Dickerson & Kemeny, 2004; Kirschbaum et al., 1993; Pruessner et al., 2003), which significantly affect the neuroendocrine (HPAA) and autonomic (ANS) function (Chrousos, 2009; Foley & Kirschbaum, 2010; Mohammadi et al., 2019). In a prolonged fashion and in the lack of habituation, chronic stress leads to cortisol hypersecretion, posing a risk for the development of Hypothalamic-PituitaryAdrenal Axis (HPAA) hyporeactivity. At the same time, this represents a vulnerability for the development of somatic and psychiatric conditions (Chrousos, 2009; McEwan, 1998, 2004; Fries, et al., 2005; Heim et al., 2000; Herman et al., 2005). In this regard, response parameters of the HPAA (e.g., cortisol) and the ANS (e.g., Heart rate variability) are paramount in studying the relationship between reactivity and health/illness (Chrousos, 2009; McEwen, 1998). For example, individuals with psychiatric conditions, such as eating disorders (EDs), exhibit hyporesponsiveness of the stress networks, which is associated with dysregulated biomarkers (Het et al., 2020; Monteleone et al., 2010; 2018a, 2018b; Støving, 2019). Among EDs, Anorexia nervosa (AN) records the highest mortality rate (Arcelus et al., 2011; Erskine et al., 2016; Moskowitz & Weiselberg, 2017) and displays a range of ANS and HPAA irregularities, e.g., bradycardia, hypercortisolemia (Gibson et al., 2020; Giovinazzo et al., 2019; Katzmann, 2005; Mazurak et al., 2011; Miller et al., 2013; Sauro et al., 2008). Maintenance of underweight and fear of weight gain despite being underweight (BMI < 17.5 kg/m2) are typical characteristics (DSM-V, APA, 2013). Treatment outcomes are poor (Harbottle et al., 2008; Murray et al., 2019; Watson & Bulik, 2013) and the disease burden for patients and health care substantial (Schmidt et al., 2016). Therefore, innovative and effective treatments are urgently needed. Concerning onset and maintenance, psychosocial stress has been frequently investigated (Caglar-Nazali et al., 2014; Monteleone et al., 2011, 2018b; Wierenga et al., 2018). Patients commonly showed deficient social skills and higher negative affect accompanied by hyporesponsiveness to psychosocial stress (Het et al., 2015, 2020; Monteleone et al., 2011; 2018b; Putigiano et al., 2001; Vocks et al., 2007; Zonevylle-Bender et al., 2015). However, experimental and controlled studies on the neuroendocrine and autonomic reactivity are underrepresented and ambiguous in PAN. Accordingly, the following investigations address this research gap. Objectives and Method: In order to expand ED-specific data and foster understanding at the psychological and physiological level, the stress response to a psychosocial stressor was investigated in a sample of patients with anorexia nervosa (PAN) which was age- and gender-matched to healthy controls (HC), under highly14 standardized conditions. For this purpose, biomarkers such as salivary cortisol (Study 1), heart rate (HR) and heart rate variability (HRV; see Study 2/Table 1) were assessed in a crosssectional study design under two experimental conditions: 1) rest and 2) stress (see Figure 1/Study 1-2). In addition, psychological stress indicators (PASA, VAS, TICS) and symptoms were analyzed (e.g., SCL-K-9, BDI, EDI). Based on previous evidence, elevated cortisol levels and bradycardia at rest were expected in PAN (vs. HC). A stress hyporeactivity in the examined biomarkers was hypothesized in PAN (vs. HC). Additionally, a reduced sympathetic (SNS) and pronounced parasympathetic (PNS) activity and reactivity was assumed in PAN (vs. HC). Furthermore, a regulation of the HPAA functionality regarding total cortisol expression (AUCG) and reactivity with weight recovery in PAN was postulated. Secondarily, BMI (kg/m2) was analyzed in relation to the derived biomarkers and psychological measures of concern

Bridging the Otolaryngology Peer Review Knowledge Gap: A Call for a Residency Development Program

Current otolaryngology literature and future scientific direction rely heavily on a rigorous peer review process. Just as manuscripts warrant thoughtful review with constructive feedback to the authors, the same can be said for critiques written by novice peer reviewers. Formal scientific peer review training programs are lacking. Recognizing this knowledge gap, Otolaryngology–Head and Neck Surgery is excited to offer its new Resident Reviewer Development Program. All otolaryngology residents who are postgraduate year 2 and above and in excellent academic standing are eligible to participate in this mentored program, during which they will conduct 6 manuscript reviews under the direction of a seasoned reviewer in his or her subspecialty area of interest. By completing reviews alongside a mentor, participants gain the required skills to master the peer review process—a first step that often leads to journal editorial board and associate editor invitations

Evaluating the psychometric properties of the German adaptation of the client attachment to therapist scale

Background The present study examines the psychometric properties of the German adaptation of the Client Attachment to Therapist Scale (CATS). The validity of the scale as originally proposed has recently been brought into question, as patients were identified as “pseudosecure”. Methods We examined the measure’s factorial structure, as well as reliability and validity towards related measures using a clinical sample of N = 354 participants. Results We found the original model, consisting of 36 items to be lacking in terms of model fit and construct validity. A shortened 12-item version exhibited markedly improved model fit and reliability. Correlations to related constructs demonstrated that none of the scale’s validity was lost by shortening it. Furthermore, we showed scalar invariance across groups of age and sex. Conclusions The shortened CATS-S can be recommended for future use in clinical research in German-speaking populations as a valid, reliable, and economical alternative to the longer version

Psychometric Properties of the German Version of the Self-Regulation of Eating Behavior Questionnaire

Background: The Self-Regulation of Eating Behavior Questionnaire (SREBQ) is an economical way of assessing an individual’s self-regulatory abilities regarding eating behavior. Such scales are needed in the German population; therefore, the purpose of the present study was the translation and validation of a German version of the SREBQ. Method: First, we conducted a pilot study (Study 1; N = 371) after the translation procedure. Second, we assessed the final scale in a representative sample of the German population (Sample 2; N = 2,483) and its underlying factor structure. Further, we tested for measurement invariance and evaluated the SREBQ’s associations with related scales to explore convergent and discriminant validity. Finally, we considered differences in SREBQ based on sociodemographic variables and provided derived reference scores (norm values). Results: Factor analysis revealed deficiencies in the original model. Thus, we shortened the scale based on statistical considerations and the adapted version showed improved fit in Confirmatory Factor Analysis and reliability. We also found evidence for partial strict invariance, which means the measure is equivalent for the tested groups of age and gender. Item and scale psychometric properties of the shortened version were satisfactory. In terms of diagnostic validity, it was shown that individuals with higher body mass index (kg/m2) have worse self-regulation of eating behavior than those with lower. Conclusion: In sum, the SREBQ evidenced good validity and reliability and is suitable for application in medical, psychological, and nutritional research

A Brief Assessment of Body Image Perception: Norm Values and Factorial Structure of the Short Version of the FKB-20

The Body Image Questionnaire-20 (FKB-20) is one of the most applied self-report measures in the context of body image assessment in German-speaking regions. A version of the FKB-20 capturing an ideal concept of body image is also available. A special property of the scale is its high sensitivity for individuals suffering from anorexia nervosa. The present research provided a short version of this scale (for both variants) and examined its validity in a representative sample (N = 2,347) of the German population. We utilized factor analysis methods to identify the optimal short scale of the measure, finding excellent model fit and reliability for a two-factor model (FKB-6) for both real and ideal body image. Both versions of the FKB-6 can be considered invariant across sex and age groups. Good reliability indices were shown for both versions of the FKB-6. The reliability indices were similar to those mentioned in previous studies. Our study also revealed, that large discrepancies between the real and an ideal body image are correlated with somatic and body dysmorphic symptoms. Finally, we provided norm values for comparisons of individual scores with the general population. The FKB-6 is a valid and a reliable measure that economizes assessments by clinicians and researchers

Psychometric properties of the German version of the Self-Regulation of Eating Behavior Questionnaire

BACKGROUND: The Self-Regulation of Eating Behavior Questionnaire (SREBQ) is an economical way of assessing an individual's self-regulatory abilities regarding eating behavior. Such scales are needed in the German population; therefore, the purpose of the present study was the translation and validation of a German version of the SREBQ. METHOD: First, we conducted a pilot study (Study 1; N = 371) after the translation procedure. Second, we assessed the final scale in a representative sample of the German population (Sample 2; N = 2,483) and its underlying factor structure. Further, we tested for measurement invariance and evaluated the SREBQ's associations with related scales to explore convergent and discriminant validity. Finally, we considered differences in SREBQ based on sociodemographic variables and provided derived reference scores (norm values). RESULTS: Factor analysis revealed deficiencies in the original model. Thus, we shortened the scale based on statistical considerations and the adapted version showed improved fit in Confirmatory Factor Analysis and reliability. We also found evidence for partial strict invariance, which means the measure is equivalent for the tested groups of age and gender. Item and scale psychometric properties of the shortened version were satisfactory. In terms of diagnostic validity, it was shown that individuals with higher body mass index (kg/m2) have worse self-regulation of eating behavior than those with lower. CONCLUSION: In sum, the SREBQ evidenced good validity and reliability and is suitable for application in medical, psychological, and nutritional research

Is sentinel lymph node biopsy the standard of care for cutaneous head and neck melanoma?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110046/1/lary24807.pd

Completion lymphadenectomy for sentinel node positive cutaneous head & neck melanoma

The application and utility of melanoma sentinel lymph node biopsy (SLNB) has evolved significantly since its inception over two decades ago. The current focus has shifted from a staging modality to potentially a therapeutic intervention. Recent research to include large multi‐institutional randomized trials have attempted to answer the question: is a completion lymph node dissection (CLND) required following a positive SLNB? This review provides an evidence‐based, contemporary review of the utility of CLND for SLNB positive head and neck cutaneous melanoma patients.Level of EvidenceNAPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142560/1/lio2136.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142560/2/lio2136_am.pd

The 10 Commandments of Resuscitation

Cardiopulmonary cerebral resuscitation is a part of the theoretical and practical activities that must be mastered by health professionals who care for patients with haemodynamic compromise or cardiac arrest. Since Peter Safar, the father of western reanimatology, introduced the ABC-DEF-GHI mnemonic to help rescuers remember the steps of basic and advanced life support and postarrest management in a rapid, effective, and safe way, various mnemonic resources have been utilised to encode this knowledge in the long-term memory and help with fast retrieval. The purpose of this reflection article, based on different resuscitation workshops that have been carried out since 2000 at Colombian Society of Anaesthesiology and Resuscitation (S.C.A.R.E) and Universidad Nacional de Colombia., is to share a simple and practical set of 10 rules that must be followed in order to achieve successful resuscitation

Psychological and Socio-Economical Determinants of Health: The Case of Inner German Migration

A substantial body of research has shown worse health conditions for East- vs. West-Germany in the wake of reunification. In the present study, we investigate how these differences between the two formerly divided regions developed and what maintains them. Specifically, we consider the associations between health status, income satisfaction, and health-related locus of control. In a quasi-experimental and longitudinal study design, we are particularly interested in the differences between individuals who stayed in East-Germany and those who were born in the East but migrated to West-Germany. To this end, we examined data from seven waves of the Saxony Longitudinal Study (2003–2009). Specifically, we tested a cross-lagged panel model with random effects, which evinced very good model fit. Most parameters and processes were equivalent between individuals who stayed in East-Germany vs. moved to West-Germany. Crucially, there was the expected pattern of positive correlations between health, income, and locus of control. In addition, we found substantially lower values for all three of these variables for the individuals who stayed in East-Germany (vs. moved to West-Germany). A possible explanation is the increase in socio-economic status that the internal migrants experienced. These findings present an important contribution of research in order to foster a better understanding on the social dynamics in Germany related to internal/domesticmigrants and implications in the context of health outcomes (e.g., significantly more unemployment in East vs. West-Germany), especially since almost 20–25% of East-German citizens migrated to West-Germany. Until now, there are no similar studies to the Saxony longitudinal project, since the data collection started in 1987 and almost every year an identical panel has been surveyed; which can be particularly useful for health authorities. The study mainly focuses on social science research and deals with the phenomenon of reunification, approaching several subjects such as mental and physical health, quality of life and the evaluation of the political system. Yet even though many people have experienced such a migration process, there has been little research on the subjects we approach. With our research we deepen the understanding of the health consequences of internal migration