The relationship between working alliance with peer mentors and eating psychopathology in a digital 6-week guided self-help intervention for anorexia nervosa

Objective: The quality of working alliance (WA) is associated with treatment outcomes across several types of psychiatric disorders and psychological interventions. This study examined the role of WA with peer mentors (people with lived experience of illness) and student mentors (graduated psychology students) in a 6-week, digital, guided self-help (GSH) intervention for anorexia nervosa. Method: Ninety-nine patients rated weekly, for 6 weeks: (a) eating psychopathology using the short version of the Eating Disorder Examination Questionnaire (EDE-QS) and (b) WA with a student mentor (n = 14) or a peer mentor (n = 10). WA was assessed by asking patients the extent to which they felt comfortable working with their mentor and the extent to which they agreed with them on the goals for support. WA with mentors and the association with eating psychopathology change were measured on a session-by-session basis. The analysis involved a random intercepts cross-lagged panel model. Results: WA with peer mentors was slightly higher than WA with students (ES = 0.3). Peer mentors' WA in the previous session was significantly associated with eating psychopathology ratings in the next session. No significant relationship was found between the previous session's EDE-QS scores and peer mentor alliance in the following session. In the student mentor group, there were no session-by-session associations between WA and eating psychopathology. However, greater WA with the student mentor across sessions was associated with less eating psychopathology. Discussion: These findings suggest that clinical outcomes are in part associated with the characteristics of the mentor delivering guidance in an online GSH for eating disorders

To Go or Not to Go: A Proof of Concept Study Testing Food-Specific Inhibition Training for Women with Eating and Weight Disorders

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.Inefficient food-specific inhibitory control is a potential mechanism that underlies binge eating in bulimia nervosa and binge eating disorder. Go/no-go training tools have been developed to increase inhibitory control over eating impulses. Using a within-subjects design, this study examined whether one session of food-specific go/no-go training, versus general inhibitory control training, modifies eating behaviour. The primary outcome measure was food consumption on a taste test following each training session. Women with bulimia nervosa and binge eating disorder had small non-significant reductions in high-calorie food consumption on the taste test following the food-specific compared with the general training. There were no effects on eating disorder symptomatic behaviour (i.e. binge eating/purging) in the 24 h post-training. The training task was found to be acceptable by the clinical groups. More research is needed with larger sample sizes to determine the effectiveness of this training approach for clinical populations.Robert Turton receives funding from the Medical Research Council (MRC) and the Psychiatry Research Trust (PRT) (Grant PCPTAAR). Dr. Bruno Palazzo Nazar has received funding from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and from the Federal University of Rio de Janeiro (UFRJ). Dr. Emilee Burgess received funding from the University of Alabama at Birmingham and Nova Scotia Health Authority. Dr. Colette Hirsch, Professor Janet Treasure OBE and Dr. Valentina Cardi, receive salary support from the National Institute for Health Research (NIHR), Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London

The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence

The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02336841

Characterising binge eating over the course of a feasibility trial among individuals with binge eating disorder and bulimia nervosa

This is the final version. Available from Elsevier via the DOI in this record.Binge eating disorder and bulimia nervosa are eating disorders that are characterized by recurrent binge eating episodes. The highly contextualized nature of binge eating makes naturalistic research a particularly suitable means of understanding the context within which binge eating occurs. The present study aimed to characterise binge eating days with regards to the frequency and probability of negative affect, food craving, meal skipping, and dietary restriction. In addition, it aimed to examine whether a combined intervention that targets the experience of ‘loss of control’ over eating can decrease these potential maintenance factors that often precede binge eating episodes. Seventy-eight participants with bulimia nervosa (N = 40) or binge eating disorder (n = 38), who were randomly allocated to a food-specific or general intervention combining inhibitory control training and implementation intentions, completed mood and food diaries over four weeks. Results suggest that negative affect and food craving were elevated on binge eating days, but that dietary restraint and meal skipping did not characterise binge eating days. Moreover, meal skipping, binge eating, restriction, and compensation decreased throughout the intervention period, while negative affect and food craving did not. This suggests that some interventions may successfully reduce binge eating frequency without necessarily decreasing negative affect or food craving, thus pointing to the different routes to targeting binge eating and providing implications for future interventions.National Institute for Health Research (NIHR)H2020 European Research Council (ERC)National Institute for Health Research (NIHR)Maudsley NHS Foundation TrustKing's College Londo

Traditional banana diversity in Oceania: an endangered heritage

This study aims to understand the genetic diversity of traditional Oceanian starchy bananas in order to propose an efficient conservation strategy for these endangered varieties. SSR and DArT molecular markers are used to characterize a large sample of Pacific accessions, from New Guinea to Tahiti and Hawaii. All Pacific starchy bananas are shown of New Guinea origin, by interspecific hybridization between Musa acuminata (AA genome), more precisely its local subspecies M. acuminata ssp. banksii, and M. balbisiana (BB genome) generating triploid AAB Pacific starchy bananas. These AAB genotypes do not form a subgroup sensu stricto and genetic markers differentiate two subgroups across the three morphotypes usually identified: Iholena versus Popoulu and Maoli. The Popoulu/Maoli accessions, even if morphologically diverse throughout the Pacific, cluster in the same genetic subgroup. However, the subgroup is not strictly monophyletic and several close, but different genotypes are linked to the dominant genotype. One of the related genotypes is specific to New Caledonia (NC), with morphotypes close to Maoli, but with some primitive characters. It is concluded that the diffusion of Pacific starchy AAB bananas results from a series of introductions of triploids originating in New Guinea area from several sexual recombination events implying different genotypes of M. acuminata ssp. banksii. This scheme of multiple waves from the New Guinea zone is consistent with the archaeological data for peopling of the Pacific. The present geographic distribution suggests that a greater diversity must have existed in the past. Its erosion finds parallels with the erosion of cultural traditions, inexorably declining in most of the Polynesian or Melanesian Islands. Symmetrically, diversity hot spots appear linked to the local persistence of traditions: Maoli in New Caledonian Kanak traditions or Iholena in a few Polynesian islands. These results will contribute to optimizing the conservation strategy for the ex-situ Pacific Banana Collection supported collectively by the Pacific countries

Targeting binge eating in bulimia nervosa and binge eating disorder using inhibitory control training and implementation intentions: A feasibility trial

This is the author accepted manuscript. The final version is available from Cambridge University Press via the DOI in this recordBackground. This trial examined the feasibility, acceptability, and effect sizes of clinical outcomes of an intervention that combines inhibitory control training (ICT) and implementation intentions (if-then planning) to target binge eating and eating disorder psychopathology. Methods. Seventy-eight adult participants with bulimia nervosa or binge eating disorder were randomly allocated to receive food-specific, or general, ICT and if-then planning for four weeks. Results. Recruitment and retention rates at four weeks (97.5% and 79.5%, respectively) met the pre-set cut-offs. The pre-set adherence to the intervention was met for the ICT sessions (84.6%), but not for if-then planning (53.4%). Binge eating frequency and eating disorder psychopathology decreased in both intervention groups at post-intervention (four weeks) and follow-up (eight weeks), with moderate to large effect sizes. There was a tendency for greater reductions in binge eating frequency and eating disorders psychopathology (i.e. larger effect sizes) in the food-specific intervention group. Across both groups, ICT and if-then planning were associated with small-to-moderate reductions in high energy-dense food valuation (post-intervention), food approach (post-intervention and follow-up), anxiety (follow-up), and depression (follow-up). Participants indicated that both interventions were acceptable. Conclusions. The study findings reveal that combined ICT and if-then planning is associated with reductions in binge eating frequency and eating disorder psychopathology, and that the feasibility of ICT is promising, while improvements to if-then planning condition may be needed.National Institute for Health Research (NIHR

Non-adherence to Mediterranean diet and synergy with lifestyle habits in the occurrence of breast cancer: a case-control study in Italy

Objective: The aim of this study was to assess the synergistic effect of non-adherence to the Mediterranean Diet (MD) and lifestyle habits on the occurrence of breast cancer (BC). Patients and methods: A case-control study was carried out from September 2018 to February 2019 at the Teaching Hospital "Umberto I" in Rome. A Food Frequency Questionnaire was used for assessing the level of adherence to MD, the IPAQ Questionnaire to measure physical activity, and AUDIT-C to estimate alcohol consumption. The possible interaction between risk factors was tested using the synergism index. Results: A total of 94 cases and 88 controls were enrolled (median age 55.8 for cases and 57.9 for controls). The MD Score over 6 was associated with low odds of having breast cancer (OR = 0.29; 95% CI: 0.12-0.69). There is a clear indication for the additivity and synergism between non-adherence to MD and many risk factors on the occurrence of BC: current smoker (S = 2.02; 95% CI 0.62-8.07), physical inactivity (S = 2.14; 95% CI 0.71 2-8.28) and alcohol consumption (S = 3.02; 95% CI 0.91-12.95). Conclusions: Primary prevention of BC can benefit from intervention targeting nutritional and lifestyle factors that act synergistically

A community-based feasibility randomized controlled study to test food-specific inhibitory control training in people with disinhibited eating during COVID-19 in Italy

This is the final version. Available on open access from Springer via the DOI in this recordData availability: Data are available on request to the corresponding author.PURPOSE: The aim of this study was to expand the evidence on the feasibility and impact of food-specific inhibitory control training in a community sample of people with disinhibited eating. METHODS: Recruitment and data collection were conducted during the COVID-19 outbreak, in Italy. Ninety-four adult individuals with disinhibited eating were randomised to one of two conditions: App-based food-specific inhibitory control training or waiting list. Participants were assessed at baseline, end of intervention (2 weeks following baseline) and follow-up (one week later). The assessment measures included questionnaires about eating behaviour and mood. RESULTS: Seventy-three percent of the sample reported a diagnosis of binge eating disorder, and 20.4% a diagnosis of bulimia nervosa. Retention rates were 77% and 86% for the food-specific inhibitory control training and the waiting list conditions, respectively. Almost half of the participants allocated to the training condition completed the "recommended" dose of training (i.e., 10 or more sessions). Those in the training condition reported lower levels of wanting for high-energy dense foods (p < 0.05), a trend for lower levels of perceived hunger (p = 0.07), and lower levels of depression (p < 0.05). Binge eating symptoms, disinhibition, wanting for high-energy dense foods, stress and anxiety were significantly lower at end of intervention, compared to baseline (p < .05). CONCLUSION: Findings corroborated the feasibility of food-specific inhibitory control training, and its impact on high-energy dense foods liking. The study expands the evidence base for food-specific inhibitory control training by highlighting its impact on perceived hunger and depression. The mechanisms underlying these effects remain to be clarified. LEVEL OF EVIDENCE: Level I, Evidence obtained from at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies.National Institute for Health Research (NIHR)University of PadovaDipartimenti di Eccellenza, Ministero dell'Istruzione (MIUR

Training Rejection Interpretation in Eating disordeRs (TRIER): Preliminary Findings of a Feasibility Study in Adolescents with Anorexia Nervosa

This study investigated expectations of social rejection in adolescents with anorexia nervosa. Female adolescents (N = 24) admitted for hospital treatment completed both a positive interpretation bias training (experimental training) and a 50% positive and 50% negative interpretation bias training (control training), in a counterbalanced order, in two different testing sessions using a within-subjects design. The primary outcome for the training was the frequency of negative interpretations produced in the sentence completion task. At baseline, participants produced more negative than benign interpretations of ambiguous social scenarios (medium/large effect size). Following experimental training, participants produced fewer negative and more benign interpretations compared to control training (medium/large effect sizes). A trend for higher levels of self-esteem following virtual ostracism was found in the experimental condition compared to the control condition (small/medium effect size). Interpretation bias modification has the potential to improve resilience to rejection in adolescents with anorexia nervosa

WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting

Background Despite the current therapeutic options for the treatment of inflammatory bowel disease, surgery is still frequently required in the emergency setting, although the number of cases performed seems to have decreased in recent years. The World Society of Emergency Surgery decided to debate in a consensus conference of experts, the main pertinent issues around the management of inflammatory bowel disease in the emergent situation, with the need to provide focused guidelines for acute care and emergency surgeons. Method A group of experienced surgeons and gastroenterologists were nominated to develop the topics assigned and answer the questions addressed by the Steering Committee of the project. Each expert followed a precise analysis and grading of the studies selected for review. Statements and recommendations were discussed and voted at the Consensus Conference of the 6th World Society of Emergency Surgery held in Nijmegen (The Netherlands) in June 2019. Conclusions Complicated inflammatory bowel disease requires a multidisciplinary approach because of the complexity of this patient group and disease spectrum in the emergency setting, with the aim of obtaining safe surgery with good functional outcomes and a decreasing stoma rate where appropriate.Peer reviewe