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"It takes two to tango": the relational domain in a cohort of subjects with erectile dysfunction (ED).

Introduction: The relational domain of erectile dysfunction (ED) is difficult to investigate in a clinical setting. We developed and validated SIEDY, a 13-item structured interview, that evaluates, besides the organic (Scale 1) and intra-psychic (Scale 3) domains, also the relational one (Scale 2). We previously established a pathological threshold for SIEDY Scale 1 and 3. Aim: The aim of this study is to identify a pathological threshold of SIEDY Scale 2. Method: A nonselected, consecutive series of 2,992 subjects with ED was retrospectively evaluated. In a first consecutive series of 844 patients (Sample A, studied without systematically applying a psychometric test: Middlesex Hospital Questionnaire), a pathological threshold of SIEDY Scale 2 score was identified through receiver operating characteristic, using, as surrogate marker of impaired couple relationship, at least a positive answer to two standard questions on conflict within the couple and on the presence of extramarital affairs. Main outcome measure: Sensitivity and specificity, along with possible associations with biological and psychological correlates were verified in a further sample of 2,148 patients (Sample B). Results: In Sample A, a threshold of Scale 2 score ≥2 predicts couple impairment with a sensitivity of 53% and specificity of 66% and an overall accuracy of 62.0 ± 2.2% (P < 0.0001). When this threshold was verified in sample B, Scale 2 score ≥2 was associated with a higher risk of anxiety and depressive symptoms, higher prevalence of psychopathology, and higher Scale 3 scoring, even after adjusting for confounders. In the same sample, a Scale 2 score ≥2 was associated with a reduced intimacy during sexual intercourse and overall worse sexual functioning. Conclusions: Until now, no instrument is available to quantify the marital domain of ED. The validation of a threshold of SIEDY Scale 2 score (≥2) represents an easy tool for the identification of ED patients with a relevant marital impairment.

The journal of sexual medicine · cohort or longitudinal · 39 citationsread the source →

Cost-effectiveness of early intervention in first-episode psychosis: economic evaluation of a randomised controlled trial (the OPUS study).

Background: Information about the cost-effectiveness of early intervention programmes for first-episode psychosis is limited. Aims: To evaluate the cost-effectiveness of an intensive early-intervention programme (called OPUS) (trial registration NCT00157313) consisting of enriched assertive community treatment, psychoeducational family treatment and social skills training for individuals with first-episode psychosis compared with standard treatment. Method: An incremental cost-effectiveness analysis of a randomised controlled trial, adopting a public sector perspective was undertaken. Results: The mean total costs of OPUS over 5 years (€123,683, s.e. = 8970) were not significantly different from that of standard treatment (€148,751, s.e. = 13073). At 2-year follow-up the mean Global Assessment of Functioning (GAF) score in the OPUS group (55.16, s.d. = 15.15) was significantly higher than in standard treatment group (51.13, s.d. = 15.92). However, the mean GAF did not differ significantly between the groups at 5-year follow-up (55.35 (s.d. = 18.28) and 54.16 (s.d. = 18.41), respectively). Cost-effectiveness planes based on non-parametric bootstrapping showed that OPUS was less costly and more effective in 70% of the replications. For a willingness-to-pay up to €50,000 the probability that OPUS was cost-effective was more than 80%. Conclusions: The incremental cost-effectiveness analysis showed that there was a high probability of OPUS being cost-effective compared with standard treatment.

The British journal of psychiatry : the journal of mental science · randomised controlled trial · 87 citationsread the source →

Childhood maltreatment and unfavourable clinical outcomes in bipolar disorder: a systematic review and meta-analysis.

Background: Bipolar disorder affects up to one in 25 individuals and identification of early risk indicators of negative outcomes could facilitate early detection of patients with greatest clinical needs and risk. We aimed to investigate the association between childhood maltreatment and key negative outcomes in patients with bipolar disorder. Methods: For this systematic review and meta-analysis we searched MEDLINE, PsycINFO, and Embase to identify articles published before Jan 1, 2015, examining the association of maltreatment (physical, sexual, or emotional abuse, neglect, or family conflict) before age 18 years with clinical features and course of illness in bipolar disorder. Data were extracted from published reports and any missing information was requested from investigators. We did 12 independent random-effects meta-analyses to quantify the associations between childhood maltreatment and course of illness or clinical features. Findings: We initially identified 527 records and after unsuitable studies were removed, our search yielded 148 publications of which 30 were used in the meta-analysis. Patients with bipolar disorder and history of childhood maltreatment had greater mania severity (six studies, 780 participants; odds ratio [OR] 2·02, 95% CI 1·21-3·39, p=0·008), greater depression severity (eight studies, 1007 participants; 1·57, 1·25-1·99, p=0·0001), greater psychosis severity (seven studies, 1494 participants; 1·49, 1·10-2·04, p=0·011), higher risk of comorbidity with post-traumatic stress disorder (eight studies, 2494 participants; 3·60, 2·45-5·30, p<0·0001), anxiety disorders (seven studies, 5091 participants; 1·90, 1·39-2·61, p<0·0001), substance misuse disorders (11 studies, 5469 participants; 1·84, 1·41-2·39, p<0·0001), alcohol misuse disorder (eight studies, 5040 participants; 1·44, 1·13-1·83, p=0·003), earlier age of bipolar disorder onset (14 studies, 5733 participants; 1·85, 1·43-2·40, p<0·0001), higher risk of rapid cycling (eight studies, 3010 participants; 1·89, 1·45-2·48, p<0·0001), greater number of manic episodes (seven studies, 3909 participants; 1·26, 1·09-1·47, p=0·003), greater number of depressive episodes (eight studies, 4025 participants; 1·38, 1·07-1·79, p=0·013), and higher risk of suicide attempt (13 studies, 3422 participants; 2·25, 1·88-2·70, p<0·0001) compared with those with bipolar disorder without childhood maltreatment. Overall, these associations were not explained by publication bias, undue effects of individual studies, or variation in study quality. Interpretation: Childhood maltreatment predicts unfavourable clinical features and course of illness in patients with bipolar disorder. Funding: None.

The lancet. Psychiatry · meta-analysis · 278 citationsread the source →

Reducing the psychological distress of family caregivers of home based palliative care patients: longer term effects from a randomised controlled trial.

Background: Palliative care incorporates comprehensive support of family caregivers because many of them experience burden and distress. However, evidence-based support initiatives are few. Purpose: We evaluated a one-to-one psychoeducational intervention aimed at mitigating the distress of caregivers of patients with advanced cancer receiving home-based palliative care. We hypothesised that caregivers would report decreased distress as assessed by the General Health Questionnaire (GHQ). Method: A randomised controlled trial comparing two versions of the delivery of the intervention (one face-to-face home visit plus telephone calls versus two visits) plus standard care to a control group (standard care only) across four sites in Australia. Results: Recruitment to the one visit condition was 57, the two visit condition 93, and the control 148. We previously reported non-significant changes in distress between times 1 (baseline) and 2 (1-week post-intervention) but significant gains in competence and preparedness. We report here changes in distress between times 1 and 3 (8-week post-death). There was significantly less worsening in distress between times 1 and 3 in the one visit intervention group than in the control group; however, no significant difference was found between the two visit intervention and the control group. Conclusions: These results are consistent with the aim of the intervention, and they support existing evidence demonstrating that relatively short psychoeducational interventions can help family caregivers who are supporting a dying relative. The sustained benefit during the bereavement period may also have positive resource implications, which should be the subject of future inquiry.

Psycho-oncology · randomised controlled trial · 66 citationsread the source →

Effectiveness of the Extension for Community Health Outcomes Model as Applied to Primary Care for Autism: A Partial Stepped-Wedge Randomized Clinical Trial.

Importance: The Extension for Community Health Outcomes (ECHO) model is a widely adopted technology-based model for training primary care physicians and practitioners (PCPs) to care for patients with complex conditions. Despite its popularity, to our knowledge, direct effects of ECHO on clinical practice have not been tested in a large-scale study. Objective: To test the effectiveness of the ECHO model as applied to primary care for autism and whether it resulted in improved clinical practice, knowledge, and self-efficacy regarding autism screening and comorbidity management. Design, setting, and participants: Primary care physicians and practitioners were recruited to participate in a 6-month ECHO Autism program delivered by 1 of 10 academic medical center sites. A sequential, staggered rollout of ECHO Autism was delivered to 5 cohorts of participants (15 per site; 2 sites per cohort). Sites were randomized after recruitment to cohort/start time. Cohorts launched every 3 months. The ECHO Autism program used videoconferencing technology to connect community-based PCPs with interdisciplinary expert teams at academic medical centers. There were 148 participants (PCPs [family practice physicians, pediatricians, nurse practitioners, and physician assistants] providing outpatient services to underserved children) studied between December 2016 and November 2018. Interventions: The 6-month ECHO Autism program included twelve 2-hour sessions connecting PCP participants with an interdisciplinary expert team. Sessions included didactics, case-based learning, guided practice, and discussion. Main outcomes and measures: Coprimary outcomes were autism screening practices and comorbidity management (assessed by medical record review). Secondary outcomes were knowledge (assessed by direct testing) and self-efficacy (assessed by self-report survey). Assessments were conducted at baseline, mid-ECHO, post-ECHO, and follow-up (3 months after ECHO). Results: Ten sites were randomized to 1 of 5 cohorts. Participants were 82% female (n = 108), 76% white (n = 100), and 6% Hispanic or Latino (n = 8); the median age was 46 years (interquartile range, 37-55 years). Significant changes in autism screening and treatment of comorbidities in children with autism were not observed. Participants demonstrated significant improvements in knowledge (9%; 95% CI, 4-13; P < .001) and self-efficacy (29%; 95% CI, 25-32; P < .001). Conclusions and relevance: The ECHO model was developed to increase access to high-quality health care for underserved patients with complex conditions. Study results provide support for the model in improving clinician knowledge and confidence but little support for achieving practice change. Trial registration: ClinicalTrials.gov Identifier: NCT03677089.

JAMA pediatrics · randomised controlled trial · 63 citationsread the source →

A randomized controlled trial of the effectiveness of virtually delivered Body Project (vBP) groups to prevent eating disorders.

Objectives: To investigate the effectiveness of Body Project groups delivered virtually (vBP) by peer educators for prevention of eating disorders. Method: In a randomized controlled trial vBP groups (N = 149) were compared with a placebo (expressive writing, EW: N = 148) over 24-month follow-up and to a waitlist control condition (N = 146) over 6-month follow-up among females (15-20 years old) with body image concerns. The primary outcome was incidence of eating disorder onset over 2-year follow-up measured by blinded diagnostic interviews. Waitlist participants were offered the vBP after 6 months. Results: The incidence of eating disorders onset over 24 months follow up were 3 in vBP (2.0%) and 13 in EW (8.8%), a significant difference; Hazard Ratio (Experiment B) = 0.26, 95% confidence interval (CI) [0.075, 0.92], p = .037. Incidence of eating disorder onset in vBP participants was 77% less than in EW participants. The vBP participants generally showed significantly greater reduction in eating disorder symptoms, clinical impairment, body dissatisfaction, and internalization of thin ideal compared with the waitlist participants at postintervention and 6-month follow-up, and in eating disorder symptoms, restraint, body dissatisfaction, and internalization of thin ideal compared with the EW participants at postintervention, and 6-, 12-, 18-, or 24-months follow-up. EW participants reported significantly greater reduction in clinical impairment and body dissatisfaction at postintervention compared with the waitlist participants. Conclusions: The present reduction in the incidence of eating disorders is notable given that the intervention was implemented virtually, rather than in-person. The vBP might be a viable option for future evaluation of scalable prevention of eating disorders. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Journal of consulting and clinical psychology · randomised controlled trial · 46 citationsread the source →

The effects of maintenance schedules following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomised controlled trial.

Objectives: Pulmonary rehabilitation (PR) provides benefit for patients with chronic obstructive pulmonary disease (COPD) in terms of quality of life (QoL) and exercise capacity; however, the effects diminish over time. Our aim was to evaluate a maintenance programme for patients who had completed PR. Setting: Primary and secondary care PR programmes in Norfolk. Participants: 148 patients with COPD who had completed at least 60% of a standard PR programme were randomised and data are available for 110 patients. Patients had greater than 20 pack year smoking history and less than 80% predicted forced expiratory volume in 1 s but no other significant disease or recent respiratory tract infection. Interventions: Patients were randomised to receive a maintenance programme or standard care. The maintenance programme consisted of 2 h (1 h individually tailored exercise training and 1 h education programme) every 3 months for 1 year. Primary and secondary outcome measures: The Chronic Respiratory Questionnaire (CRQ) (primary outcome), endurance shuttle walk test (ESWT), EuroQol (EQ5D), hospital anxiety and depression score (HADS), body mass index (BMI), body fat, activity levels (overall score and activity diary) and exacerbations were assessed before and after 12 months. Results: There was no statistically significant difference between the groups for the change in CRQ dyspnoea score (primary end point) at 12 months which amounted to 0.19 (-0.26 to 0.64) units or other domains of the CRQ. There was no difference in the ESWT duration (-10.06 (-191.16 to 171.03) seconds), BMI, body fat, EQ5D, MET-minutes, activity rating, HADS, exacerbations or admissions. Conclusions: A maintenance programme of three monthly 2 h sessions does not improve outcomes in patients with COPD after 12 months. We do not recommend that our maintenance programme is adopted. Other methods of sustaining the benefits of PR are required. Trial registration number: NCT00925171.

BMJ open · randomised controlled trial · 36 citationsread the source →

Meta-analysis: ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury.

Background: Trials have provided conflicting results regarding the effect of different ventilatory strategies on the outcomes of patients with the acute respiratory distress syndrome (ARDS) and acute lung injury. Purpose: To determine whether ventilation with low tidal volume (Vt) and limited airway pressure or higher positive end-expiratory pressure (PEEP) improves outcomes for patients with ARDS or acute lung injury. Data sources: Multiple computerized databases (through March 2009), reference lists of identified articles, and queries of principal investigators. No language restrictions were applied. Study selection: Randomized, controlled trials (RCTs) reporting mortality and comparing lower versus higher Vt ventilation, lower versus higher PEEP, or a combination of both in adults with ARDS or acute lung injury. Data extraction: Using a standard protocol, 2 reviewer teams assessed trial eligibility and abstracted data on quality of study design and conduct, population characteristics, intervention, co-interventions, and confounding variables. Data synthesis: 4 RCTs tested lower versus higher Vt ventilation at similar PEEP in 1149 patients, 3 RCTs compared lower versus higher PEEP at low Vt ventilation in 2299 patients, and 2 RCTs compared a combination of higher Vt and lower PEEP ventilation versus lower Vt and higher PEEP ventilation in 148 patients. Lower Vt ventilation reduced hospital mortality (odds ratio, 0.75 [95% CI, 0.58 to 0.96]; P = 0.02) compared with higher Vt ventilation at similar PEEP. Higher PEEP did not reduce hospital mortality (odds ratio, 0.86 [CI, 0.72 to 1.02]; P = 0.08) compared with lower PEEP using low Vt ventilation. Higher PEEP reduced the need for rescue therapy to prevent life-threatening hypoxemia (odds ratio, 0.51 [CI, 0.36 to 0.71]; P < 0.001) and death (odds ratio, 0.51 [CI, 0.36 to 0.71]; P < 0.001) in patients receiving rescue therapies. Limitations: Pooling according to similar ventilatory strategies resulted in few RCTs analyzed in each group. The benefit of low Vt is derived from only 1 study. Conclusion: Available evidence from a limited number of RCTs shows better outcomes with routine use of low Vt but not high PEEP ventilation in unselected patients with ARDS or acute lung injury. High PEEP may help to prevent life-threatening hypoxemia in selected patients.

Annals of internal medicine · meta-analysis · 245 citationsread the source →

The impact of a bodyweight and physical activity intervention (BeWEL) initiated through a national colorectal cancer screening programme: randomised controlled trial.

Objective: To evaluate the impact of a diet and physical activity intervention (BeWEL) on weight change in people with a body mass index >25 weight (kg)/height (m)(2) at increased risk of colorectal cancer and other obesity related comorbidities. Design: Multicentre, parallel group, randomised controlled trial. Setting: Four Scottish National Health Service health boards. Participants: 329 overweight or obese adults (aged 50 to 74 years) who had undergone colonoscopy after a positive faecal occult blood test result, as part of the national bowel screening programme, and had a diagnosis of adenoma confirmed by histopathology. 163 were randomised to intervention and 166 to control. Intervention: Participants were randomised to a control group (weight loss booklet only) or 12 month intervention group (three face to face visits with a lifestyle counsellor plus monthly 15 minute telephone calls). A goal of 7% reduction in body weight was set and participants received a personalised energy prescription (2508 kJ (600 kcal) below that required for weight maintenance) and bodyweight scales. Motivational interviewing techniques explored self assessed confidence, ambivalence, and personal values concerning weight. Behavioural strategies included goal setting, identifying intentions of implementation, self monitoring of body weight, and counsellor feedback about reported diet, physical activity, and weight change. Main outcome measures: The primary outcome was weight change over 12 months. Secondary outcomes included changes in waist circumference, blood pressure, fasting cardiovascular biomarkers, and glucose metabolism variables, physical activity, diet, and alcohol consumption. Results: At 12 months, data on the primary outcome were available for 148 (91%) participants in the intervention group and 157 (95%) in the control group. Mean weight loss was 3.50 kg (SD 4.91) (95% confidence interval 2.70 to 4.30) in the intervention group compared with 0.78 kg (SD 3.77) (0.19 to 1.38) in the control group. The group difference was 2.69 kg (95% confidence interval 1.70 to 3.67). Differences between groups were significant for waist circumference, body mass index, blood pressure, blood glucose level, diet, and physical activity. No reported adverse events were considered to be related to trial participation. Conclusions: Significant weight loss can be achieved by a diet and physical activity intervention initiated within a national colorectal cancer screening programme, offering considerable potential for risk reduction of disease in older adults. Trial registration: Current Controlled Trials ISRCTN53033856.

BMJ (Clinical research ed.) · randomised controlled trial · 89 citationsread the source →

African American grandparents raising grandchildren: a national study using the Census 2000 American Community Survey.

Objective: The objective of this work was to determine the prevalence, sociodemographic characteristics, and service utilization patterns of African American grandparents raising grandchildren compared with noncaregiving peers. Methods: Data were obtained from the Census 2000 Supplementary Survey/American Community Survey, a nationally representative survey of 890,000 households. Analysis was based upon comparison of 2,362 African American grandparent caregivers aged 45+ with 40,148 noncaregiving peers. Gender-specific analyses also were conducted. Result: Over 500,000 African Americans aged 45+ were estimated to be raising grandchildren in 2000. They were disproportionately female, younger, and less educated than noncaregivers and more likely to be living in poverty and receiving public assistance. Grandmother caregivers had significantly higher rates of functional limitations and poverty than either grandfather caregivers or other African American women aged 45+. Discussion: African American grandparent caregivers, particularly grandmothers, represent a highly vulnerable population economically. The finding that four-fifths of African American grandmother caregivers below the poverty line were not receiving public assistance underscores the need for improving program outreach and substance to better serve this population. The use of theories of intersectionality and multiracial feminism in future studies of grandparent caregiving should enhance our understanding of how the impact of race on gender varies by social class.

The journals of gerontology. Series B, Psychological sciences and social sciences · 66 citationsread the source →

The pleasure of art as a matter of fact

You have accessMoreSectionsView PDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InRedditEmail Cite this article Nadal Marcos and Skov Martin 2018The pleasure of art as a matter of factProc. R. Soc. B.2852017225220172252http://doi.org/10.1098/rspb.2017.2252SectionYou have accessCommentThe pleasure of art as a matter of fact Marcos Nadal Marcos Nadal http://orcid.org/0000-0002-9341-4688 Department of Psychology, University of the Balearic Islands, Palma de Mallorca 07122, Spain [email protected] Google Scholar Find this author on PubMed Search for more papers by this author and Martin Skov Martin Skov Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Copenhagen 2650, Denmark Center for Decision Neuroscience, Copenhagen Business School, Copenhagen 2000, Denmark Google Scholar Find this author on PubMed Search for more papers by this author Marcos Nadal Marcos Nadal http://orcid.org/0000-0002-9341-4688 Department of Psychology, University of the Balearic Islands, Palma de Mallorca 07122, Spain [email protected] Google Scholar Find this author on PubMed and Martin Skov Martin Skov Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Copenhagen 2650, Denmark Center for Decision Neuroscience, Copenhagen Business School, Copenhagen 2000, Denmark Google Scholar Find this author on PubMed Published:21 March 2018https://doi.org/10.1098/rspb.2017.2252All other forms of perception divide a man, because they are exclusively based either on the sensuous or on the intellectual part of his being; only the perception of the Beautiful makes something whole of him, because both his natures must accord with it.— Schiller, 1793–1795, Letters on the Aesthetic Education of Man, p. 138, Letter 27Can art make us better people? Better members of society? In her recent article, 'Pleasure junkies all around! Why it matters and why "the arts" might be the answer: a biopsychological perspective', Christensen [1] claims that engaging with art can promote healthy choices, choices that balance short-term pleasure goals with long-term general well-being. She suggests that many modern life conveniences, such as social media, computer games or online shopping, have the potential to turn us into 'pleasure junkies' because they maximize short-term pleasures. But art, Christensen argues, is a safe choice and a means to remedy this unhealthy addiction to pleasure. Christensen's argument is grounded on three claims about the sort of pleasure we get from art. First, in contrast to low-level pleasure, which Christensen conceives as 'a mere perceptual stimulation leading to a rewarding sensation (food, sex, etc.)' ([1], p. 2), pleasure from art is presented as a kind of higher-order pleasure that engages 'broader neural networks implied in the attribution of meaning' (p. 2), presumably leading to 'long-term maintenance of healthy bodily function' (p. 2). Second, 'the arts do not induce states of craving without fulfilment—as do activities with reinforcement schedules which are prone to create habits and addictions such as intermittent variable ratio or interval reinforcement schedules (e.g. social media, gambling, football, extreme sports, drugs' (p. 4). Third, 'the arts do not search for a perceptual "Bliss point" […]. They do not just repeat over and over again a sensory stimulus that excites the senses and induces craving for more of a "pleasurable itch" (e.g. sugar, sexualized body displays, certain musical lyrics, tones; i.e. a perceptual "bliss point")' (p. 4).The claim, in a nutshell, is that the pleasure induced by art is different to the pleasure induced by food, sex, sports or drugs, because it is related to the balanced activation of brain systems related to short-term pleasure and long-term wellbeing goals, because it does not induce craving, and because it is not aimed at a perceptual 'bliss point'. This distinct sort of pleasure, according to Christensen, makes it possible for the arts to thwart the pernicious effects that the unhealthy urges and cravings licensed by 'today's mainstream acceptance of pleasure-seeking behaviour' (p. 5) have on individuals' lives and on societies. Such sweeping statements about art, food, sex, sports and society as a whole merit close examination. Christensen's primary claim that the pleasure induced by art is of a special kind, different to the pleasure induced by other activities is not supported by current understanding of what pleasure is. It is, moreover, contradicted by abundant empirical evidence. This evidence shows that pleasures, whatever their source, owe to activity in the same mesocorticolimbic circuit [2] and are encoded as a common neural currency [3]. As Kent Berridge and Morten Kringelbach put it: 'the brain mechanisms involved in fundamental pleasures (food and sexual pleasures) overlap with those for higher-order pleasures (e.g. monetary, artistic, musical, altruistic and transcendent pleasures) […] From sensory pleasures and drugs of abuse […] to monetary, aesthetic and musical delights, all pleasures seem to involve the same hedonic brain systems' ([4], p. 481). Thus, there is no evidence for specific brain regions or neural circuits related to the pleasure from art. Rather, the appreciation of art relies on brain mechanisms that evolved to appraise the value of biologically relevant objects in relation to internal homeostatic states [5]: 'Emotional reactions to music, further, activate the same cortical, subcortical and autonomic circuits, which are considered as the essential survival circuits of biological organisms in general' ([6], p. 6). In sum, the evidence shows that pleasure elicited by music and other art forms is no different in genesis and function to the pleasure induced by food, drugs and sex [7,8]. This is a matter of fact, not opinion. What supports Christensen's argument if not empirical evidence? In our view, her argument for the distinctness of art-induced pleasure seems based upon an oversimplified and devaluing conception of the pleasures of sex, food and sports, and a very narrow notion of art and its function. Christensen presents food, sex and sports as meaningless low-level sources of pleasure, and the arts as privileged vehicles for meaningful experiences. It is the personal and meaningful engagement with art—Christensen suggests—that fosters a balanced activation of brain systems related to short-term pleasure and long-term well-being goals. However, rarely—if ever—are food, sex and sports meaningless rewarding sensations. Contrary to Christensen's definition on page 2 of her article, pleasure—even sensory pleasure—is not simply reward, and never simply a sensation [4]. Indulging in food, sex or sports are meaningful and personally significant experiences that are not a matter of mere physical sensation. The experience of pleasure from food and sex is shaped by context, knowledge, expectations, anticipations, attitudes and beliefs that bring meaning to them [9–11]. Sex can be meaningful because it signifies physical connection with one's loved one, because it is cheating on someone, or deemed a sin. Likewise, eating is not about obtaining low-level pleasure. What we eat, the way we eat, what we believe about what we eat, where and whom we eat with, imbue eating with individual and social meaning, and shape the actual pleasure of eating [12]. On the other hand, encounters with art are not necessarily meaningful [13,14]. Actually, there is nothing intrinsically meaningful about engaging with art. Many laypeople lack the knowledge schemata required to engage meaningfully with abstract, cubist or contemporary art [15,16]. There are plenty of artworks people do not find meaningful or pleasant. Meaning making is not a special feature of art; it is a general feature of our species's cognition [17,18]. We can endow virtually any aspect of reality with meaning: sex, food, sports, a urinal, the shape of a cloud, an averted glance, someone's absence. Christensen's argument also rests on a historically and culturally narrow conception of art and its function. Art is presented as a circumscribed category of activities that elicit a unique sort of pleasant experiences: — The arts are set of activities of a special kind that share certain defining features distinguishing them from other activities: 'the arts push boundaries, surprise, reveal and excite both artist and spectator' ([1], p. 4).— Art encounters are positive, leading to 'pleasurable chills' and pleasurable experiences of understanding: 'The moment of meaning-assignation, also called "mastering" or "understanding" an artwork, is therefore a pleasurable experience' ([1], p. 4).— The pleasure elicited by art is special, because it does not involve craving for intense peaks: 'The arts do not search for a perceptual "bliss point" […] They do not just repeat over and over a sensory stimulus that excites the senses and induces craving for more of a "pleasurable itch"' ([1], p. 4).This characterization of the arts substantially overlaps with the notion of 'fine arts'. The core features of this characterization were instituted in the eighteenth century, after European intellectuals grouped certain activities into a distinct and autonomous collection, labelled 'fine arts'. To make sense of and promote this grouping, it became imperative to identify a common essence setting art apart from other activities [19,20,21]. One of the most popular proposals was that only art could produce a special sort of pleasure, sophisticated and polite [19,21]—a conception stemming not from any understanding of physiology, but from mere speculation. This limited historical and cultural scope renders this conception of the arts unfit for behavioural or neuroscientific research [19]. The category 'the arts' should not be mistaken for a natural kind. It is a historical convention, and has no direct biological correspondence. Moreover, this conception of art that Christensen espouses does not apply to art as practised in non-Western societies [19,22]. It does not even apply to Western art before the eighteenth century or after the nineteenth century [19,20,21]. First, art does not necessarily evoke pleasurable experiences. There are abundant artworks intended to arouse negative emotions [19,23], and to portray physical and moral ugliness [24]. Understanding art is not necessarily a pleasant experience: it can be an angering, disgusting or upsetting one [25]. Second, many artworks actually exploit repetition, bliss points and craving [26]. Repetition is a fundamental design feature of music and other performance arts [27]: In Relation in Space (1976) Marina Abramovic and Ulay ran into each other repeatedly for an hour; Ravel's Bolero is a 17 min-long instance of melodic and rhythmic repetitiveness. Anticipation and craving for bliss points are also essential to music [28]. In fact, the enjoyment of music is linked to intense feelings of anticipation and expectation caused by dopamine activity in the caudate nucleus (also involved in the rewarding aspect of food) [29,30], and peak pleasure states (bliss points) [31], caused by the release of dopamine and opioids in the brain's reward system (also involved in cocaine induced euphoria) [29,30]. Given the available evidence, therefore, there is no reason to believe that the pleasure from art is special or unique [32].In sum, Christensen's claim for the distinctiveness of pleasure from art is contradicted by empirical evidence, and her argument for the beneficial effects of art rests upon disputed foundations. Art's capacity to promote healthier choices and make us better people that can contribute to a better society remains as unconfirmed today as it was when Schiller speculated on art's power to harmonize human's conflicting sensuous and formal impulses. Christensen's argument is problematic even if intended to highlight hypothetical possibilities. Arguments about hypothetical possibilities should still rely on valid premises, and scientific hypotheses should be grounded on evidence, or at least in line with it. Otherwise, they are merely unfounded speculations. Scientific aesthetics is only just finding its footing and its place within cognitive neuroscience [33,34]. If evidence is ignored or rejected because it does not fit preconceived notions about art and its function, scientific aesthetics will become only an arena to promote and legitimize personally appealing notions of art by applying a scientific gloss over them. A proper scientific study of art needs to be grounded on empirical evidence and strong arguments that follow from solid premises [35,36]. Only then can scientific aesthetics provide reliable explanations for artistic and aesthetic behaviour, and thus make a significant contribution to the understanding of our human nature. Data accessibilityThis article has no additional data. Authors' contributionsBoth authors have contributed to conceiving, developing and writing the research presented in this paper, and approved it for publication. Competing interestsWe declare we have no competing interests. FundingThis research was supported by grant PSI2016-77327-P (MINECO/AEI/ERDF, EU).Footnotes© 2018 The Author(s)Published by the Royal Society. All rights reserved. References1Christensen JF. 2017Pleasure junkies all around! Why it matters and why 'the arts' might be the answer: a biopsychological perspective. Proc. R. Soc. B 284, 20162837. (doi:10.1098/rspb.2016.2837) Link, ISI, Google Scholar2Berridge CW, Kringelbach ML. 2013Neuroscience of affect: brain mechanisms of pleasure and displeasure. Curr. Opin. 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(doi:10.1016/j.plrev.2017.06.013) PubMed, ISI, Google Scholar Previous ArticleNext Article VIEW FULL TEXT DOWNLOAD PDF FiguresRelatedReferencesDetailsCited by Clemente A, Pearce M, Skov M and Nadal M (2021) Evaluative judgment across domains: Liking balance, contour, symmetry and complexity in melodies and visual designs, Brain and Cognition, 10.1016/j.bandc.2021.105729, 151, (105729), Online publication date: 1-Jul-2021. Chuan-Peng H, Huang Y, Eickhoff S, Peng K and Sui J (2020) Seeking the "Beauty Center" in the Brain: A Meta-Analysis of fMRI Studies of Beautiful Human Faces and Visual Art, Cognitive, Affective, & Behavioral Neuroscience, 10.3758/s13415-020-00827-z, 20:6, (1200-1215), Online publication date: 1-Dec-2020. Skov M and Nadal M (2020) A Farewell to Art: Aesthetics as a Topic in Psychology and Neuroscience, Perspectives on Psychological Science, 10.1177/1745691619897963, 15:3, (630-642), Online publication date: 1-May-2020. Kalpokas I (2019) Making the Theory Political A Political Theory of Post-Truth, 10.1007/978-3-319-97713-3_4, (87-121), . Kalpokas I (2019) Affective Encounters of the Algorithmic Kind: Post-Truth and Posthuman Pleasure, Social Media + Society, 10.1177/2056305119845678, 5:2, (205630511984567), Online publication date: 1-Apr-2019. Skov M (2019) Aesthetic Appreciation: The View From Neuroimaging, Empirical Studies of the Arts, 10.1177/0276237419839257, 37:2, Online publication date: H, I and (2020) A for We Aesthetic in Human Neuroscience, A and in A New for Arts, This March Article in 2018 The Author(s)Published by the Royal Society. All rights Citations and are available with

Proceedings of the Royal Society B Biological Sciences · editorial or comment · 24 citationsread the source →

Modifiable early-life risk factors for childhood adiposity and overweight: an analysis of their combined impact and potential for prevention.

Background: Early life may be a "critical period" when appetite and regulation of energy balance are programmed, with lifelong consequences for obesity risk. Insight into the potential impact of modifying early-life risk factors on later obesity can be gained by evaluating their combined effects. Objective: The objective was to examine the relation between the number of early-life risk factors and obesity outcomes among children in a prospective birth cohort (Southampton Women's Survey). Design: Five risk factors were defined: maternal obesity [prepregnant body mass index (BMI; in kg/m(2)) >30], excess gestational weight gain (Institute of Medicine, 2009), smoking during pregnancy, low maternal vitamin D status (<64 nmol/L), and short duration of breastfeeding (none or <1 mo). Obesity outcomes examined when the children were aged 4 and 6 y were BMI, dual-energy X-ray absorptiometry-assessed fat mass, overweight, or obesity (International Obesity Task Force). Data were available for 991 mother-child pairs, with children born between 1998 and 2003. Results: Of the children, 148 (15%) had no early-life risk factors, 330 (33%) had 1, 296 (30%) had 2, 160 (16%) had 3, and 57 (6%) had 4 or 5. At both 4 and 6 y, there were positive graded associations between number of early-life risk factors and each obesity outcome (all P < 0.001). After taking account of confounders, the relative risk of being overweight or obese for children who had 4 or 5 risk factors was 3.99 (95% CI: 1.83, 8.67) at 4 y and 4.65 (95% CI: 2.29, 9.43) at 6 y compared with children who had none (both P < 0.001). Conclusions: Having a greater number of early-life risk factors was associated with large differences in adiposity and risk of overweight and obesity in later childhood. These findings suggest that early intervention to change these modifiable risk factors could make a significant contribution to the prevention of childhood obesity.

The American journal of clinical nutrition · 85 citationsread the source →

Precision medicine for suicidality: from universality to subtypes and personalization.

Suicide remains a clear, present and increasing public health problem, despite being a potentially preventable tragedy. Its incidence is particularly high in people with overt or un(der)diagnosed psychiatric disorders. Objective and precise identification of individuals at risk, ways of monitoring response to treatments and novel preventive therapeutics need to be discovered, employed and widely deployed. We sought to investigate whether blood gene expression biomarkers for suicide (that is, a 'liquid biopsy' approach) can be identified that are more universal in nature, working across psychiatric diagnoses and genders, using larger cohorts than in previous studies. Such markers may reflect and/or be a proxy for the core biology of suicide. We were successful in this endeavor, using a comprehensive stepwise approach, leading to a wealth of findings. Steps 1, 2 and 3 were discovery, prioritization and validation for tracking suicidality, resulting in a Top Dozen list of candidate biomarkers comprising the top biomarkers from each step, as well as a larger list of 148 candidate biomarkers that survived Bonferroni correction in the validation step. Step 4 was testing the Top Dozen list and Bonferroni biomarker list for predictive ability for suicidal ideation (SI) and for future hospitalizations for suicidality in independent cohorts, leading to the identification of completely novel predictive biomarkers (such as CLN5 and AK2), as well as reinforcement of ours and others previous findings in the field (such as SLC4A4 and SKA2). Additionally, we examined whether subtypes of suicidality can be identified based on mental state at the time of high SI and identified four potential subtypes: high anxiety, low mood, combined and non-affective (psychotic). Such subtypes may delineate groups of individuals that are more homogenous in terms of suicidality biology and behavior. We also studied a more personalized approach, by psychiatric diagnosis and gender, with a focus on bipolar males, the highest risk group. Such a personalized approach may be more sensitive to gender differences and to the impact of psychiatric co-morbidities and medications. We compared testing the universal biomarkers in everybody versus testing by subtypes versus personalized by gender and diagnosis, and show that the subtype and personalized approaches permit enhanced precision of predictions for different universal biomarkers. In particular, LHFP appears to be a strong predictor for suicidality in males with depression. We also directly examined whether biomarkers discovered using male bipolars only are better predictors in a male bipolar independent cohort than universal biomarkers and show evidence for a possible advantage of personalization. We identified completely novel biomarkers (such as SPTBN1 and C7orf73), and reinforced previously known biomarkers (such as PTEN and SAT1). For diagnostic ability testing purposes, we also examined as predictors phenotypic measures as apps (for suicide risk (CFI-S, Convergent Functional Information for Suicidality) and for anxiety and mood (SASS, Simplified Affective State Scale)) by themselves, as well as in combination with the top biomarkers (the combination being our a priori primary endpoint), to provide context and enhance precision of predictions. We obtained area under the curves of 90% for SI and 77% for future hospitalizations in independent cohorts. Step 5 was to look for mechanistic understanding, starting with examining evidence for the Top Dozen and Bonferroni biomarkers for involvement in other psychiatric and non-psychiatric disorders, as a mechanism for biological predisposition and vulnerability. The biomarkers we identified also provide a window towards understanding the biology of suicide, implicating biological pathways related to neurogenesis, programmed cell death and insulin signaling from the universal biomarkers, as well as mTOR signaling from the male bipolar biomarkers. In particular, HTR2A increase coupled with ARRB1 and GSK3B decreases in expression in suicidality may provide a synergistic mechanistical corrective target, as do SLC4A4 increase coupled with AHCYL1 and AHCYL2 decrease. Step 6 was to move beyond diagnostics and mechanistical risk assessment, towards providing a foundation for personalized therapeutics. Items scored positive in the CFI-S and subtypes identified by SASS in different individuals provide targets for personalized (psycho)therapy. Some individual biomarkers are targets of existing drugs used to treat mood disorders and suicidality (lithium, clozapine and omega-3 fatty acids), providing a means toward pharmacogenomics stratification of patients and monitoring of response to treatment. Such biomarkers merit evaluation in clinical trials. Bioinformatics drug repurposing analyses with the gene expression biosignatures of the Top Dozen and Bonferroni-validated universal biomarkers identified novel potential therapeutics for suicidality, such as ebselen (a lithium mimetic), piracetam (a nootropic), chlorogenic acid (a polyphenol) and metformin (an antidiabetic and possible longevity promoting drug). Finally, based on the totality of our data and of the evidence in the field to date, a convergent functional evidence score prioritizing biomarkers that have all around evidence (track suicidality, predict it, are reflective of biological predisposition and are potential drug targets) brought to the fore APOE and IL6 from among the universal biomarkers, suggesting an inflammatory/accelerated aging component that may be a targetable common denominator.

Molecular psychiatry · 75 citationsread the source →

The impact of ART on union dissolution: a register-based study in Denmark 1994-2010.

Study question: Are couples initiating ART treatment at higher risk for future union dissolution compared to other couples? Summary answer: There is no effect of ART treatments in future marital dissolution over a period of 16 years when adjusting for all confounders. What is known already: Findings regarding marital stability and infertility treatments have been sparse and controversial. While there is data showing higher divorce rates among women who go through infertility treatments, there is also some evidence of this experience bringing couples closer by forcing them to communicate more and to deal with the surrounding stigma. Using a population-based study and couple-level data, we investigated the extent to which ART treatment increases the risk for divorce/marital dissolution during up to 16 years of follow-up. Study design size, duration: Register-based national cohort study including all women registered with ART treatment in Denmark between 1 January 1994 and 30 September 2009 (n = 42 845). Marital/cohabiting status was confirmed by matching these women to partners who they were married to or shared an address with. To account for having a significant relationship at baseline (2 years), marital/cohabiting status was confirmed by accessing this variable before the establishment of the cohort back to 1 January 1992. Participants/materials, setting, methods: A comparison group from the background population including five controls per case and matched to female age at baseline was prospectively sampled. Participants could change status during follow-up if they entered ART. The final sample had 148 972 couples, followed until marital dissolution, death of self/spouse, migration or until 31 December 2010. We used Cox regression models adjusting for female and male age, education, marriage, common child at baseline and live-born child during follow-up. Main results and the role of chance: At baseline, the majority of couples were married (69%). More non-ART couples opted for marriage (70% versus 64%; P < 0.0001) and already had common children at study entry (43% versus 9%; P < 0.0001). During the 16 years of follow-up the majority of couples had children with their baseline partners (56% non-ART versus 65% ART), and 22% ended up separated or divorced (20% ART versus 22% non-ART). Findings revealed a lower risk of break-up among ART couples (crude HR 0.84, 95% CI 0.82-0.86), even after adjusting for both partners' age, education, partnership status and having a common child at baseline (adj HR 0.83, 95% CI 0.80-0.86). However, when subsequent common children (time-dependent) was added to the model, no difference in the risk of dissolution was found (adj HR 1.00, 95% CI 0.99-1.01). A significant interaction between ART status and common children showed that the risk of break-up was attributed to childlessness regardless of having gone through ART treatment. Limitations reason for caution: This study did not control for involuntary childlessness, non-ART fertility care (ovulation induction, IUI) and biological parenthood. Additionally, there are important predictors of divorce that were not considered. We were unable to adjust for religion, existence of previous marital relationships, income, employment, health status of parents and child(ren), and quality of relationship. Wider implication of findings: The finding that going through ART does not increase the risk of break up per se is reassuring for couples who underwent ART and have children or are contemplating to start ART. Study funding/competing interest(s): This work was supported by FCT (Portuguese Foundation for Science and Technology), grant ref. SFRH/BPD/85789/2012. The authors have no conflicts of interest. Trial registration number: N/A.

Human reproduction (Oxford, England) · 11 citationsread the source →

Broadening Humor: Comic Styles Differentially Tap into Temperament, Character, and Ability.

The present study introduces eight comic styles (i.e., fun, humor, nonsense, wit, irony, satire, sarcasm, and cynicism) and examines the validity of a set of 48 marker items for their assessment, the Comic Style Markers (CSM). These styles were originally developed to describe literary work and are used here to describe individual differences. Study 1 examines whether the eight styles can be distinguished empirically, in self- and other-reports, and in two languages. In different samples of altogether more than 1500 adult participants, the CSM was developed and evaluated with respect to internal consistency, homogeneity, test-retest reliability, factorial validity, and construct and criterion validity. Internal consistency was sufficiently high, and the median test-retest reliability over a period of 1-2 weeks was 0.86 (N = 148). Exploratory and confirmatory factor analyses showed that the eight styles could be distinguished in both English- (N = 303) and German-speaking samples (N = 1018 and 368). Comparing self- and other-reports (N = 210) supported both convergent and discriminant validity. The intercorrelations among the eight scales ranged from close to zero (between humor and sarcasm/cynicism) to large and positive (between sarcasm and cynicism). Consequently, second-order factor analyses revealed either two bipolar factors (based on ipsative data) or three unipolar factors (based on normative data). Study 2 related the CSM to instruments measuring personality (N = 999), intelligence (N = 214), and character strengths (N = 252), showing that (a) wit was the only style correlated with (verbal) intelligence, (b) fun was related to indicators of vitality and extraversion, (c) humor was related to character strengths of the heart, and (d) comic styles related to mock/ridicule (i.e., sarcasm, cynicism, but also irony) correlated negatively with character strengths of the virtues temperance, transcendence, and humanity. By contrast, satire had a moral goodness that was lacking in sarcasm and cynicism. Most importantly, the two studies revealed that humor might be related to a variety of character strengths depending on the comic style utilized, and that more styles may be distinguished than has been done in the past. The CSM is recommended for future explorations and refinements of comic styles.

Frontiers in psychology · 41 citationsread the source →

Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome: The International Tourette Syndrome Deep Brain Stimulation Public Database and Registry.

Importance: Collective evidence has strongly suggested that deep brain stimulation (DBS) is a promising therapy for Tourette syndrome. Objective: To assess the efficacy and safety of DBS in a multinational cohort of patients with Tourette syndrome. Design, setting, and participants: The prospective International Deep Brain Stimulation Database and Registry included 185 patients with medically refractory Tourette syndrome who underwent DBS implantation from January 1, 2012, to December 31, 2016, at 31 institutions in 10 countries worldwide. Exposures: Patients with medically refractory symptoms received DBS implantation in the centromedian thalamic region (93 of 163 [57.1%]), the anterior globus pallidus internus (41 of 163 [25.2%]), the posterior globus pallidus internus (25 of 163 [15.3%]), and the anterior limb of the internal capsule (4 of 163 [2.5%]). Main outcomes and measures: Scores on the Yale Global Tic Severity Scale and adverse events. Results: The International Deep Brain Stimulation Database and Registry enrolled 185 patients (of 171 with available data, 37 females and 134 males; mean [SD] age at surgery, 29.1 [10.8] years [range, 13-58 years]). Symptoms of obsessive-compulsive disorder were present in 97 of 151 patients (64.2%) and 32 of 148 (21.6%) had a history of self-injurious behavior. The mean (SD) total Yale Global Tic Severity Scale score improved from 75.01 (18.36) at baseline to 41.19 (20.00) at 1 year after DBS implantation (P < .001). The mean (SD) motor tic subscore improved from 21.00 (3.72) at baseline to 12.91 (5.78) after 1 year (P < .001), and the mean (SD) phonic tic subscore improved from 16.82 (6.56) at baseline to 9.63 (6.99) at 1 year (P < .001). The overall adverse event rate was 35.4% (56 of 158 patients), with intracranial hemorrhage occurring in 2 patients (1.3%), infection in 4 patients with 5 events (3.2%), and lead explantation in 1 patient (0.6%). The most common stimulation-induced adverse effects were dysarthria (10 [6.3%]) and paresthesia (13 [8.2%]). Conclusions and relevance: Deep brain stimulation was associated with symptomatic improvement in patients with Tourette syndrome but also with important adverse events. A publicly available website on outcomes of DBS in patients with Tourette syndrome has been provided.

JAMA neurology · 173 citationsread the source →

Very preterm birth influences parental mental health and family outcomes seven years after birth.

Objective: To evaluate the long-term influence of very preterm birth on parental mental health, family functioning, and parenting stress at age 2 and 7 years. Study design: Participants were 183 children born very preterm (<30 weeks gestation; n = 148 families) and 69 term-born children (n = 66 families). When children were age 7 years, parents were assessed based on the Hospital Anxiety and Depression Scale, the Family Assessment Device, the Parenting Stress Index, and the Social Support Questionnaire. Similar measures were evaluated at age 2 years. Results: When the children were age 7 years, parents of the very preterm-born children were more likely to report moderate to severe anxiety symptoms (P = .03), higher levels of depression symptoms (P = .03), poorer family functioning (P < .05), and higher levels of parenting stress (P < .001) compared with parents of the children born at term. Group differences in parenting stress and family functioning persisted after adjustment for social risk and child neurodevelopmental disability. There was strong evidence of a relationship between family functioning and parent-related stress at age 2 and 7 years (P < .001), but little evidence that parental mental health problems at 2 years were predictive of anxiety (P = .15) or depression (P = .28) at 7 years for parents of very preterm children. Conclusion: These findings demonstrate that very preterm birth has a negative influence on parent and family functioning at 7 years after birth, which for some families is consistent with their functioning at 2 years. These results have implications for the support required by parents of very preterm children.

The Journal of pediatrics · 143 citationsread the source →

Disclosure of HIV status between parents and children in Uganda in the context of greater access to treatment.

While disclosure of HIV sero-status is encouraged in the management of the HIV and AIDS epidemic, it remains a challenge, especially among family members. This article examines the moral dilemmas and pragmatic incentives surrounding disclosure of HIV status in contemporary Uganda. Our findings are based on 12 in-depth interviews, 2 focus-group discussions, 6 key informant interviews with AIDS activists, and open-ended responses derived from 148 HIV-positive persons in a quantitative survey. The study was conducted in 2008-2009 in Kampala, Mpigi, and Soroti districts in Uganda. We found both parents and adult children facing dilemmas in disclosure, whether it was parents revealing their own HIV status to their children or the status of their perinatally infected children, or young people infected through sexual intercourse telling their parents. For both groups, there is fear of blame, stigma, discrimination, and shame and guilt related to unsafe sex, while young people also fear loss of privileges. On the other hand, there are practical imperatives for disclosure in terms of gaining access to care, treatment, and material resources. Faced with these dilemmas, HIV-positive people and their families require professional counselling to help them work through the emotional challenges encountered and identify mechanisms of support and coping.

SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance · 29 citationsread the source →

[Development and validation of the Japanese version of the Self-Compassion Scale].

A Japanese version of the Self-Compassion Scale (SCS-J) was developed. In Survey 1, confirmatory factor analysis of data from 366 participants indicated that the SCS-J had an acceptable fit to the model, as well as good internal consistency, similar to the original. In Survey 2, a test-retest correlation of the SCS-J for 101 participants indicated good reliability for the scale. In Survey 3, 148 participants completed the SCS-J and the Narcissistic Personality Inventory, the Subjective Happiness Scale, the State-Trait Anxiety Inventory-Trait form, and the Beck Depression Inventory. The partial correlations between the SCS-J and the other scales were analyzed, using self-esteem, or self-criticism as the control variables. The results demonstrated that self-compassion was associated with self-esteem and the mental health of the Japanese participants. These results indicate that the SCS-J has good reliability and validity as a measure of self-compassion.

Shinrigaku kenkyu : The Japanese journal of psychology · 46 citationsread the source →

Negative problem orientation (Part II): construct validity and specificity to worry.

Negative problem orientation, a dysfunctional set of attitudes related to problem-solving ability, has been implicated as a process variable in several psychological disorders, notably depression and generalized anxiety disorder (GAD). The goal of the present study was two-fold: (1) to further examine the construct validity of a new measure of negative problem orientation, the negative problem orientation questionnaire (NPOQ), through its relationship to conceptually similar variables, and (2) to investigate the specificity of negative problem orientation to worry, the cardinal feature of GAD, compared to depression. The sample consisted of 148 university students who completed six questionnaires, the NPOQ and measures of worry, depression, pessimism, self-mastery, and neuroticism. Multiple hierarchical regressions revealed that when entered in the last step following demographic information and personality variables (pessimism, self-mastery, and neuroticism), the NPOQ accounted for 5.6% of the variance in worry scores compared to 1.6% of the variance in depression scores. It was concluded that the NPOQ shows evidence of construct validity, and that the process variable of negative problem orientation appears to have greater specificity to worry than depression. Implications for the understanding of worry and GAD are discussed.

Behaviour research and therapy · 29 citationsread the source →

Neighbourhood deprivation and incident mobility disability in older adults.

Objective: to assess whether incident mobility disability and neighbourhood deprivation in older people are associated independent of the effects of individual socio-economic status, health behaviours and health status. Methods: prospective cohort study with a 2-year follow-up. Setting: the English Longitudinal Study of Ageing (ELSA), a national probability sample of non-institutionalised older people. Participants: 4,148 participants aged 60 years and over. Measurements: exposure was a census-based index of neighbourhood deprivation [the Index of Multiple Deprivation (IMD)]; outcomes were measured and self-reported incident mobility difficulties. Results: neighbourhood deprivation had a statistically significant effect on physical function following adjustment for individual socio-economic factors, health behaviours and health status. Compared to those living in the least deprived 20% of neighbourhoods, those in the most deprived neighbourhoods had a risk ratio (RR) of incident self-reported mobility difficulties of 1.75 (95% CI 1.14-2.70) and RR of incident-impaired gait speed of 1.63 (95% CI 1.01-2.62). In adjusted models, 4.0 per 100 (95% CI 3.0-5.4) older adults in neighbourhoods in the least deprived 20% had incident mobility difficulties over a 2-year period, whereas 13.6 per 100 (95% CI 10.5-17.4) older adults had incident mobility difficulties in neighbourhoods in the most deprived 20%. Conclusions: older people living in deprived neighbourhoods are significantly more likely to experience incident mobility difficulties than those in less-deprived neighbourhoods. The mechanisms underlying this relationship are unclear and research to identify mechanisms and appropriate interventions is needed.

Age and ageing · 42 citationsread the source →

Costs and effectiveness of neonatal male circumcision.

Objective: To evaluate the expected change in the prevalence of male circumcision (MC)-reduced infections and resulting health care costs associated with continued decreases in MC rates. During the past 20 years, MC rates have declined from 79% to 55%, alongside reduced insurance coverage. Design: We used Markov-based Monte Carlo simulations to track men and women throughout their lifetimes as they experienced MC procedure-related events and MC-reduced infections and accumulated associated costs. One-way and probabilistic sensitivity analyses were used to evaluate the impact of uncertainty. Setting: United States. Participants: Birth cohort of men and women. Intervention: Decreased MC rates (10% reflects the MC rate in Europe, where insurance coverage is limited). Outcomes measured: Lifetime direct medical cost (2011 US$) and prevalence of MC-reduced infections. Results: Reducing the MC rate to 10% will increase lifetime health care costs by $407 per male and $43 per female. Net expenditure per annual birth cohort (including procedure and complication costs) is expected to increase by $505 million, reflecting an increase of $313 per forgone MC. Over 10 annual cohorts, net present value of additional costs would exceed $4.4 billion. Lifetime prevalence of human immunodeficiency virus infection among males is expected to increase by 12.2% (4843 cases), high- and low-risk human papillomavirus by 29.1% (57 124 cases), herpes simplex virus type 2 by 19.8% (124 767 cases), and infant urinary tract infections by 211.8% (26 876 cases). Among females, lifetime prevalence of bacterial vaginosis is expected to increase by 51.2% (538 865 cases), trichomoniasis by 51.2% (64 585 cases), high-risk human papillomavirus by 18.3% (33 148 cases), and low-risk human papillomavirus by 12.9% (25 837 cases). Increased prevalence of human immunodeficiency virus infection among males represents 78.9% of increased expenses. Conclusion: Continued decreases in MC rates are associated with increased infection prevalence, thereby increasing medical expenditures for men and women.

Archives of pediatrics & adolescent medicine · 33 citationsread the source →

Expression of metastasis-associated protein 2 (MTA2) might predict proliferation in non-small cell lung cancer.

Metastatic tumor antigen 2 (MTA2) is a member of the MTA family that is closely associated with tumor progression and metastasis. In this study, the expression profile of MTA2 in 223 cases of non-small cell lung cancer (NSCLC) tissues and two lung cancer cell lines was investigated. Interestingly, we found MTA2, which was believed to have nuclear distribution only, was distributed in both nucleus and cytoplasm in normal and cancer cells. Nuclear MTA2 expression was detected in 148 cases of NSCLC (66.4%), and was correlated with advanced TNM stages (p=0.023), tumor size (p=0.036), and lymph node metastasis (p=0.004). Besides, the Ki-67 proliferation index was significantly higher in nuclear MTA2-positive tumors than in nuclear MTA2-negative tumors (r=0.538, p=0.006). However, there was no significant difference in cytoplasmic MTA2 status by age, gender, tumor stage, histology, grade, lymph node metastasis, and Ki-67 proliferation index. Univariate analysis revealed nuclear MTA2 expression was correlated with poor overall survival (p=0.035), whereas there was a nonsignificant trend in the same direction for cytoplasmic MTA2 (p=0.134). Multivariate Cox regression analysis revealed the overexpression of nuclear and cytoplasmic MTA2 not to be independent factors predictive of poor disease outcome. Our data suggested that MTA2 might play roles in both the nucleus and cytoplasm in the progression of NSCLC.

Targeted oncology · 23 citationsread the source →

The Female Athlete Triad

SUMMARY The female athlete triad (Triad) refers to the interrelationships among energy availability, menstrual function, and bone mineral density, which may have clinical manifestations including eating disorders, functional hypothalamic amenorrhea, and osteoporosis. With proper nutrition, these same relationships promote robust health. Athletes are distributed along a spectrum between health and disease, and those at the pathological end may not exhibit all these clinical conditions simultaneously. Energy availability is defined as dietary energy intake minus exercise energy expenditure. Low energy availability appears to be the factor that impairs reproductive and skeletal health in the Triad, and it may be inadvertent, intentional, or psychopathological. Most effects appear to occur below an energy availability of 30 kcal·kg−1 of fat-free mass per day. Restrictive eating behaviors practiced by girls and women in sports or physical activities that emphasize leanness are of special concern. For prevention and early intervention, education of athletes, parents, coaches, trainers, judges, and administrators is a priority. Athletes should be assessed for the Triad at the preparticipation physical and/or annual health screening exam, and whenever an athlete presents with any of the Triad's clinical conditions. Sport administrators should also consider rule changes to discourage unhealthy weight loss practices. A multidisciplinary treatment team should include a physician or other health-care professional, a registered dietitian, and, for athletes with eating disorders, a mental health practitioner. Additional valuable team members may include a certified athletic trainer, an exercise physiologist, and the athlete's coach, parents and other family members. The first aim of treatment for any Triad component is to increase energy availability by increasing energy intake and/or reducing exercise energy expenditure. Nutrition counseling and monitoring are sufficient interventions for many athletes, but eating disorders warrant psychotherapy. Athletes with eating disorders should be required to meet established criteria to continue exercising, and their training and competition may need to be modified. No pharmacological agent adequately restores bone loss or corrects metabolic abnormalities that impair health and performance in athletes with functional hypothalamic amenorrhea. INTRODUCTION Because the benefits of exercise far outweigh the risks, the American College of Sports Medicine (ACSM) encourages all girls and women to participate in physical activities and sports. In 1992, however, an association of disordered eating, amenorrhea, and osteoporosis seen in activities that emphasize a lean physique was recognized as the female athlete triad (Triad) (148,215). This Position Stand replaces the 1997 ACSM Position Stand (155), updates our understanding, and makes new recommendations for screening, diagnosis, prevention, and treatment of the Triad. EVIDENCE CLASSIFICATION This Position Stand presents clinical recommendations for guiding primary care (Table 1). We used criteria proposed by the American Academy of Family Physicians (52) for evaluating the strength of scientific evidence supporting these clinical recommendations. These criteria categorize the strength of scientific evidence as follows: A, consistent and good-quality evidence for clinical outcomes on mortality, morbidity, symptoms, cost, and quality of life; B, inconsistent or limited quality evidence for these same clinical outcomes; and C, evidence on biochemical, histological, physiological and pathophysiological outcomes, which include hormone concentrations, bone mineral density (BMD), and asymptomatic menstrual disorders such as short luteal phase and anovulation; and evidence based on case studies, consensus, usual practice, and opinion. To avoid misunderstanding, this Position Stand differentiates between two subcategories of evidence: C-1, evidence based on biochemical, histological, physiological, and pathophysiological outcomes; and C-2, evidence based on case studies, consensus, usual practice, and opinion. This Position Stand also presents evidence statements about the current state of knowledge (Table 1). Although the clinical recommendation criteria were not developed for evaluating evidence supporting statements about the current state of knowledge (52), we used these same criteria to evaluate this evidence, as well.TABLE 1: Strength of evidence taxonomy.THREE INTERRELATED SPECTRUMS Low energy availability (with or without eating disorders), amenorrhea, and osteoporosis, alone or in combination, pose significant health risks to physically active girls and women. The potentially irreversible consequences of these clinical conditions emphasize the critical need for prevention, early diagnosis, and treatment. Each clinical condition is now understood to comprise the pathological end of a spectrum of interrelated subclinical conditions between health and disease. Figure 1 illustrates the full range of the Triad. A glossary of terms pertaining to the Triad appears in Table 2.FIGURE 1: Female athlete triad. The spectrums of energy availability, menstrual function, and bone mineral density along which female athletes are distributed (narrow arrows). An athlete's condition moves along each spectrum at a different rate, in one direction or the other, according to her diet and exercise habits. Energy availability, defined as dietary energy intake minus exercise energy expenditure, affects bone mineral density both directly via metabolic hormones and indirectly via effects on menstrual function and thereby estrogen (thick arrows).TABLE 2: Glossary of terms pertaining to the female athlete triad. The goal of ACSM is for every girl and woman's physical condition to be coincident with the upper right corner of Figure 1, which represents the healthy athlete who adjusts her dietary energy intake to compensate for exercise energy expenditure. Thick arrows in this triangle indicate that energy availability promotes bone health and development indirectly by preserving eumenorrhea (Table 2) and estrogen production that restrains bone resorption, and directly by stimulating production of hormones that promote bone formation. As a result, BMD is often above average for the athlete's age. The triangle in the lower left corner of Figure 1 represents the unhealthy condition of athletes who exercise for prolonged periods without increasing dietary energy intake, who severely restrict their diet, or who have clinical eating disorders. Thick arrows in this triangle indicate that low energy availability impairs bone health and development indirectly by inducing amenorrhea and removing estrogen's restraint on bone resorption, and directly by suppressing the hormones that promote bone formation. Bone mineral accrual has slowed or reversed for so long that BMD is below average for age, and one or more stress fractures may have occurred. The narrow arrows in Figure 1 indicate the spectrums of intermediate levels of energy availability, menstrual status, and BMD where other athletes' health status may be distributed. Moderately or recurrently reduced energy availability may induce subclinical menstrual disorders and less severely suppress estrogen and metabolic hormones, and sufficient time may not yet have passed for these athletes to fall far behind their age group in BMD. Energy availability, menstrual status, and BMD move along these spectrums in one direction or the other at different rates according to an athlete's diet and exercise habits. Energy availability can change in a day, but an effect on menstrual status may not become evident for a month or more, and an effect on BMD may not be detectable for a year. Energy Availability This Position Stand refers to a spectrum of energy availability energy availability to low energy availability with or without an eating as dietary energy intake minus exercise energy expenditure, energy availability is the of dietary energy for other exercise energy availability is physiological the of energy used for and This to energy and promote but impairs health. weight in athletes that energy can be energy availability is athletes energy availability by increasing exercise energy more energy energy intake more exercise energy expenditure. eating behaviors such as and or diet and athletes also have eating disorders, which are clinical mental disorders often by other is an eating by eating in which the as and is of weight is at below weight for age and is a for appears in and is an eating in which in the weight a of or and or other behaviors such as or exercise who not meet all criteria for or are as an eating not An may meet all criteria that has or all criteria that and less per This Position Stand refers to a spectrum of menstrual function eumenorrhea to amenorrhea 1). this is recognized by menstrual at but luteal and have Because menstrual are amenorrhea is defined as the of menstrual more is amenorrhea. amenorrhea refers to a in the age of Because is the age for primary amenorrhea was reduced to that energy and development have established that often in athletes in but such are one has to the age of to athletic training The that at a age in but at the same and weight as in Bone This Position Stand refers to a spectrum of BMD bone health to osteoporosis 1). is defined as skeletal by bone strength a to an of Bone strength and the of on the density and of bone mineral and on the quality of bone which may one fractures with the same BMD Although BMD is one of bone this Position Stand on BMD screening and of osteoporosis are based on BMD. is not by bone mineral loss in may also be by not BMD and No BMD between those who and not a osteoporosis is in terms of a BMD at which the for is The criteria for and osteoporosis in women are based on that to average BMD. These criteria BMD to fractures in BMD has a and for fractures in women The for each of one in BMD The 1997 ACSM Position Stand on the Triad the criteria for and osteoporosis in female athletes BMD to fractures in and women are is on for BMD for bone skeletal or in be for in these on the of BMD alone For the Triad, this is by the of BMD to fractures in women to the for that the criteria for and osteoporosis not be to women and the that BMD in these be as to to age and and that below be bone density below the range for in women and as bone density for in The also that the not be used and that osteoporosis be in these low BMD is with clinical that an of bone mineral loss and These include eating disorders, and The recommendations have by the American for Bone and the and the American of Athletes in sports have BMD a BMD in an athlete in the of a ACSM the as a of stress and/or other clinical for with a BMD between and To an of ACSM as clinical for with BMD An athlete's BMD her of energy availability and menstrual status as as her and to other and it is to consider both where her BMD is and it is along the BMD The of amenorrhea not osteoporosis but skeletal her BMD in that not bone but mineral to her BMD. low energy availability, with or without disordered eating, can impair health. with eating disorders include low and disorders the and The for is with a increase in rates to the In one of athletes with eating disorders Although of the of of menstrual function and eating is women are to the of and luteal however, may their are in an a of is not Athletes with luteal may also be at for to development or of of seen in athletes include which the of skeletal levels and BMD as the of menstrual and the loss of BMD may not be fractures occur more in physically active women with menstrual and/or low BMD with a for stress two to in athletes also occur in the of and low BMD to a is a for fractures impairs reproductive and skeletal health. and low BMD increase stress In athletes, the of disordered eating, menstrual disorders, low BMD and stress fractures The of low energy availability without disordered eating or eating disorders is of the of disordered eating and eating disorders in athletes have to or and in the and of the athletes two have clinical eating disorders according to the and of to and of the of eating disorders in female athletes in different of sports eating disorders in of female athletes in sports to of the The other that of female athletes in and sports clinical eating disorders to of the A of a of disordered eating behaviors as as A of weight behaviors eating a exercise for the of and or in the and the of and/or were The of amenorrhea, long to with age, training and weight has in to be as as in and in to in of the of amenorrhea to as training to their to of amenorrhea is in female less of age to women The of primary amenorrhea is less in the and more in and menstrual disorders both and luteal or was in of in at one menstrual of Low BMD has with disordered eating in athletes BMD is lower in athletes in athletes A of that for diagnosis, of between and to and of osteoporosis to in female athletes to and in a of female athletes have the of disordered eating, menstrual disorders and low BMD according to criteria one eating disorders The of the Triad in athletes sports was to but the athletes' BMD were to the the athletes and of the clinical eating disorders and BMD with but not all Triad were and a of weight loss The other two BMD to the Triad in of athletes sports The other the Triad in of athletes these defined the Triad more this Position energy availability, subclinical menstrual disorders or the of amenorrhea, or assessed changes in BMD. should include of low energy availability without disordered eating or an eating luteal and and as as low BMD based the these not yet should be eating, eating disorders and amenorrhea occur more in sports that emphasize Athletes at for low energy availability are those who restrict dietary energy intake, who exercise for prolonged who are and who the of appear to to disordered eating behaviors and clinical eating disorders is a and has on the of and low family and Additional for athletes include early of training and and a increase in training more eating in athletic leanness eating behaviors are for eating disorders that of female athletes and of with disordered eating behaviors were with clinical eating disorders of menstrual have with amenorrhea, but not hormone Most have not to be in the of reproductive function in For weight and are often low in athletes, but and athletes a range of weight and the In exercise training has effect on hormone energy intake is to compensate for exercise energy for stress include low menstrual dietary training and bone Low Energy Availability A for the of eating disorders A of and girls and to be the of clinical eating disorders who were at and levels were and more to be with clinical eating disorders and girls in the and of were and more In athletes, per may not to a clinical eating but the in which the athlete is to the and the availability of weight loss counseling is also for low energy availability is to energy intake to energy In dietary but the same energy by exercise not energy are more such as those for athletes low energy availability may occur without clinical eating disorders, disordered eating behaviors or dietary In reducing dietary intake by more has and skeletal In the Triad, menstrual disorders the not of at the has that is the energy availability of women is reduced by more to less 30 kcal·kg−1 which to the energy in in healthy the energy of is at per the energy of are less 30 kcal·kg−1 also have energy less 30 kcal·kg−1 and with subclinical menstrual disorders women may be less to low energy In the to were in energy availability an average of to 30 kcal·kg−1 are to for the of hormone the have in the for metabolic hormones and to the Low energy availability levels of metabolic hormones and and and loss may also lower or more of these is to a metabolic to but and in women have yet to be of low energy availability and it can occur without a eating on about eating risks of an eating or dietary In luteal and have in women by increasing exercise energy alone In female amenorrhea has by increasing exercise energy without reducing dietary energy intake their was by increasing energy intake without the exercise This of amenorrhea is functional hypothalamic amenorrhea. Low BMD The primary of osteoporosis in women is estrogen which bone also to disorders such as and for a of the bone in athletes with functional hypothalamic amenorrhea As is the case with estrogen in athletes with functional hypothalamic amenorrhea is often by which the of bone 1). In a clinical the of bone and the of bone energy availability was reduced below 30 kcal·kg−1 in women energy availability was to suppress and bone was at energy in relationships those of and that bone Low energy availability may also suppress bone via effects on other hormones, including and and on BMD in female athletes is clinical for the and treatment of Triad disorders are in Table for the Triad can be health consequences are not Although athletes are in sports where is to be one or more clinical consequences of the Triad can occur in in any or physical for the Triad an of the relationships among the spectrum each and rates of along each spectrum 1). screening occur at the preparticipation physical and annual health occur athletes are for such as amenorrhea, stress or or An athlete who presents with one component of the Triad should be assessed for the clinical for the and treatment of Triad eating disorders appear to be and should be to for their and treatment in primary care screening for in primary care should be to meet all criteria for or should not the health-care early and intervention, early and with can athletes eating disorders in the of a clinical eating and behaviors are of energy of these behaviors are of their effects on bone are disordered eating behaviors are also of may indicate a to and behaviors or of eating for the Triad should occur at the preparticipation or annual health screening Athletes with one component of the Triad should be assessed for the on energy intake, dietary weight eating and exercise energy should be of weight and menstrual are in athletes with disordered eating or eating disorders. Athletes with disordered eating should be to a mental health for diagnosis, and recommendations for treatment. status and and other with low such as stress should also be Athletes with disordered eating should be to a mental health for and recommendations for treatment. An athlete with a of one or more of the Triad should have a physical The health-care should be for and of an eating and should be is seen as as include and and the athlete is with an eating by a mental health an should be as the is in the of With functional hypothalamic amenorrhea, the physical is but with may be on In the athlete with disordered eating or an eating an should include a a with rate, function and for can be in severely health-care should not be by is for functional hypothalamic amenorrhea, this condition is by other of amenorrhea for amenorrhea a stimulating hormone and to rule and for the seen in a to rule a and a stimulating hormone for disease. is evidence of on physical exam, and may be to evaluate for an of the or or In to the of that can be seen in functional hypothalamic amenorrhea, indicate can be or a can be to estrogen indirectly by for In functional hypothalamic amenorrhea, are low or is and stimulating hormone are in the A athlete may not to a athletes with this as Additional may be based on and physical and for of primary amenorrhea. with a physician in female athletes or a reproductive is are not of the athlete has a To functional hypothalamic amenorrhea, other of amenorrhea be Bone A of disordered eating or eating disorders for a of or more, and/or a of stress fractures or fractures BMD by is in in those with Triad disorders. should be on the same may an to or for the effects of low energy availability on BMD. in BMD among athletes and are seen between sports and skeletal of low BMD or osteoporosis is based on the BMD of the or the or not or and both should be In less of age, and are the BMD may be in athletes with functional hypothalamic amenorrhea, BMD is often BMD should be assessed a stress or low and a of of amenorrhea, disordered eating or an eating The of bone and the of to BMD in athletes with functional hypothalamic amenorrhea our and recommendations for of the Triad. of bone with a of bone and an increase in bone can irreversible in BMD of bone by of energy availability also that of without clinical menstrual disorders may to their for BMD. and treatment of the Triad should a team including a physician or other health-care or a registered dietitian, and for athletes with disordered eating or an eating a with knowledge of disordered eating and eating disorders in sports be to the of those sports. Additional valuable team members may include a certified athletic trainer, an exercise physiologist, and the athlete's coach, parents and other family members. to the treatment of eating disorders in the should be recognized treatment for the Triad disorders should include a physician other health-care a registered dietitian, and, for athletes with disordered eating or an eating a mental health practitioner. administrators and the health-care team should aim to the Triad education should be on energy availability for prevention should also be to bone mineral accrual in and athletes and to bone health and should be on for their age, including and and on the benefits of exercise for bone health Athletes with menstrual disorders and/or low energy availability with or without disordered eating or eating disorders should be about the of bone mineral osteoporosis, and stress other ACSM that and of sports and athletic and in to potentially weight loss of female and are not may be in BMD of per have in weight in and case of athletes In in BMD of per have seen with weight in but not all the first aim of to menstrual and increase BMD is to diet and exercise to increase energy availability by increasing energy intake, reducing energy expenditure, or a according to the athlete's with recommendations. may be by increasing energy availability to more 30 kcal·kg−1 but the association between in BMD and in weight that increasing BMD may more kcal·kg−1 This to energy in healthy women Athletes eating behaviors should be that in weight may be to increase BMD. is to this is athletes should be to a for counseling and to have their energy availability diet, and weight should all be of such as and are for and may be is to of and increase BMD and fractures in female athletes with the Triad disorders. for female athletes in exercise training may also be those for the at energy availability should continue and be training and The treatment goal for athletes with disordered eating or eating disorders is to status, eating unhealthy that the and that for athletes a need for the is based on a between the athlete and the care The the the more the is In to counseling and treatment group and family An athlete in treatment for disordered eating or eating disorders should meet criteria to continue training and The athlete to with all treatment to be by health-care to on treatment training and and on her status to the and of training and competition A may be used to these of and with the health-care team are the athlete not her or her eating and weight not may need to be training and but should The first aim of treatment is to increase energy availability by increasing energy intake and/or reducing energy expenditure. Athletes without disordered eating or eating disorders should be for Athletes eating behaviors should be that in weight may be to increase BMD. for disordered eating and eating disorders counseling and psychotherapy. group and/or family may also be Athletes with disordered eating and eating disorders who not with treatment may need to be training and are often for weight and for and disorders but agent for in this has to BMD in women with functional hypothalamic amenorrhea. women with functional hypothalamic amenorrhea between two pharmacological or not menstrual was hormone and the and reduced the of menstrual No mass but all those Bone mineral density by less per in two of women with functional hypothalamic amenorrhea who were with but not in a In a of for weight effects of of the of for increasing BMD in athletes and other women with functional hypothalamic amenorrhea without eating disorders is also with clinical and and not but changes in weight were often not that the increase in BMD was by an increase in weight and that the effect of weight the effect of has BMD in any of women with be that pharmacological of menstrual with not metabolic that impair bone health and it is to the low BMD in this Bone mineral density should be in women with functional hypothalamic amenorrhea, disordered eating, and/or low BMD. BMD in an athlete of age with functional hypothalamic amenorrhea intake and may be with the of bone are established as to or to to the athlete less of age with functional hypothalamic amenorrhea to about of and of to this in this age for the treatment of osteoporosis should not be used in the athlete with functional hypothalamic amenorrhea for two The first is of their in women of age The is that the may in a woman's bone for many potentially to a a aim of is to in the athlete who to become of with such as and is the athlete should be about the risks and of a low weight an not her dietary more is to any or new of hormone is for increasing BMD in athletes with functional hypothalamic amenorrhea. In this BMD and other should be to pharmacological and is also on other of energy availability and of function are the of treatment for the Triad. In functional hypothalamic amenorrhea, in BMD are more with in weight with should be in an athlete with functional hypothalamic amenorrhea age BMD is with and Low energy availability with or without eating disorders, functional hypothalamic amenorrhea, and osteoporosis, alone or in combination, pose significant health risks to physically active girls and women. and treatment of these clinical conditions should be a of those who with female athletes to that the benefits of This was for the American College of Sports Medicine by the and by and Additional are to and for their with and this Position This Position Stand replaces the 1997 ACSM Position Female Sports

Medicine & Science in Sports & Exercise · 1515 citationsread the source →