Low Magnesium Concentration Enforces Bone Calcium Deposition Irrespective of 1,25-Dihydroxyvitamin D3 Concentration.

Efficient coordination between Mg2+ and vitamin D maintains adequate Ca2+ levels during lactation. This study explored the possible interaction between Mg2+ (0.3, 0.8, and 3 mM) and 1,25-dihydroxyvitamin D3 (1,25D; 0.05 and 5 nM) during osteogenesis using bovine mesenchymal stem cells. After 21 days, differentiated osteocytes were subjected to OsteoImage analysis, alkaline phosphatase (ALP) activity measurements, and immunocytochemistry of NT5E, ENG (endoglin), SP7 (osterix), SPP1 (osteopontin), and the BGLAP gene product osteocalcin. The mRNA expression of NT5E, THY1, ENG, SP7, BGLAP, CYP24A1, VDR, SLC41A1, SLC41A2, SLC41A3, TRPM6, TRPM7, and NIPA1 was also assessed. Reducing the Mg2+ concentration in the medium increased the accumulation of mineral hydroxyapatite and ALP activity. There was no change in the immunocytochemical localization of stem cell markers. Expression of CYP24A1 was higher in all groups receiving 5 nM 1,25D. There were tendencies for higher mRNA abundance of THY1, BGLAP, and NIPA1 in cells receiving 0.3 mM Mg2+ and 5 nM 1,25D. In conclusion, low levels of Mg2+ greatly enhanced the deposition of bone hydroxyapatite matrix. The effect of Mg2+ was not modulated by 1,25D, although the expression of certain genes (including BGLAP) tended to be increased by the combination of low Mg2+ and high 1,25D concentrations.

Nanoscale metal-organic frameworks for the delivery of nucleic acids to cancer cells.

Therapeutic nucleic acids (TNAs) are gaining increasing interest in the treatment of severe diseases including viral infections, inherited disorders, and cancers. However, the efficacy of intracellularly functioning TNAs is also reliant upon their delivery into the cellular environment, as unmodified nucleic acids are unable to cross the cell membrane mainly due to charge repulsion. Here we show that TNAs can be effectively delivered into the cellular environment using engineered nanoscale metal-organic frameworks (nanoMOFs), with the additional ability to tailor which cells receive the therapeutic cargo determined by the functional moieties grafted onto the nanoMOF's surface. This study paves the way to integrate the highly ordered programmable nucleic acids into larger-scale functionalized nanoassemblies.

Driver-initiated take-overs during critical braking maneuvers in automated driving - The role of time headway, traction usage, and trust in automation.

Transitions of vehicle control between automated vehicle and driver remain a necessity in the near future. Most research focuses on system-initiated transitions of control. However, drivers may also actively decide to take over without being prompted by the automation. The present study aims to uncover predictors of such driver-initiated take-overs in automated driving and to examine their impact on traffic safety. We conducted two driving simulator studies with a total of 100 participants examining whether trust in automation and the criticality of the driving situation predict driver-initiated take-overs during highly dynamic braking maneuvers. Trust was varied via automation reliability in a prior induction phase, while criticality was manipulated via different levels of time headway (THW) and traction usage (TU). Potential limitations of study 1 concerning trust induction and predictor operationalization were addressed and eliminated in study 2. Results of both studies show that drivers' trust in automation and THW affected the probability of driver-initiated take-overs. TU affected take-over probability only in interaction with THW and trust. Moreover, TU was associated with rear-end collisions. Our experiments demonstrate that driver-initiated take-overs in automated driving do occur and that drivers' subsequent behavior may impair traffic safety. A better understanding of driver-initiated take-overs helps to increase the safety potential of automated vehicles, e.g., by designing assistance systems which will support drivers who initiate a take-over under critical, highly dynamic conditions.

Religiosity and mental health as aspects of comprehensiveness in care / Religiosidad y salud mental como aspectos de la atención integral / Religiosidade e saúde mental como aspecto da integralidade no cuidado

ABSTRACT Objective: to understand how religiosity can influence the health of individuals diagnosed with mental disorders, based on comprehensive care. Methods: this is an integrative literature review, with the inclusion of articles in Portuguese, English and Spanish, between 2010 and 2018. Results: the critical analysis and qualitative synthesis of the 24 selected studies were categorized into two subtopics: The influence of religiosity in promoting comprehensive mental health care; Mental health versus religiosity: influencing conditions for effective access to comprehensive care. Final considerations: a positive influence of religiosity was identified in the lives of individuals diagnosed with mental disorders; however, evidence shows that health teams do not feel comfortable and prepared to work with religiosity as an expression of spirituality. This being one of the dimensional aspects of health, it can be inferred, on the results, the existence of this gap in the comprehensive care approach.

RESUMEN Objetivo: comprender cómo la religiosidad puede influir en la salud de las personas diagnosticadas con trastornos mentales, a partir de una atención integral. Métodos: se trata de una revisión bibliográfica integradora, que incluye artículos en portugués, inglés y español, entre 2010 y 2018. Resultados: el análisis crítico y la síntesis cualitativa de los 24 estudios seleccionados se categorizaron en dos subtemas: La influencia de la religiosidad en la promoción de la atención integral de la salud mental; Salud mental versus religiosidad: influyendo en las condiciones para el acceso efectivo a la atención integral. Consideraciones finales: se identificó una influencia positiva de la religiosidad en la vida de las personas diagnosticadas con trastornos mentales, sin embargo la evidencia muestra que los equipos de salud no se sienten cómodos y preparados para trabajar con la religiosidad como expresión de la espiritualidad. Siendo este uno de los aspectos dimensionales de la salud, es posible inferir de los resultados la existencia de esta brecha en el enfoque de atención integral.

RESUMO Objetivo: compreender como a religiosidade pode influenciar a saúde dos indivíduos diagnosticados com transtornos mentais, com base no cuidado integral. Métodos: trata-se de uma revisão integrativa de literatura, com inclusão de artigos em português, inglês e espanhol, no período entre 2010 e 2018. Resultados: a análise crítica e síntese qualitativa dos 24 estudos selecionados foram categorizados em dois subtópicos: A influência da religiosidade na promoção do cuidado integral em saúde mental; Saúde mental versus religiosidade: condicionantes influenciadores para efetivação do acesso ao cuidado integral. Considerações finais: identificou-se uma influência positiva da religiosidade na vida dos indivíduos diagnosticados com transtornos mentais, no entanto as evidências demonstram que as equipes de saúde não se sentem confortáveis e preparados para trabalhar a religiosidade como expressão da espiritualidade. Sendo este um dos aspectos dimensionais de saúde, pode-se inferir, sobre os resultados, a existência desta lacuna na abordagem integral do cuidado.

Characterization and differentiation potential of mesenchymal stem cells isolated from multiple canine adipose tissue sources.

BACKGROUND: Mesenchymal stem cells (MSCs) are undifferentiated cells that can give rise to a mesoderm lineage. Adipose-derived MSCs are an easy and accessible source for MSCs isolation, although each source of MSC has its own advantages and disadvantages. Our study identifies a promising source for the isolation and differentiation of canines MSCs. For this purpose, adipose tissue from inguinal subcutaneous (SC), perirenal (PR), omental (OM), and infrapatellar fat pad (IPFP) was isolated and processed for MSCs isolation. In the third passage, MSCs proliferation/metabolism, surface markers expression, in vitro differentiation potential and quantitative reverse transcription PCR (CD73, CD90, CD105, PPARγ, FabP4, FAS, SP7, Osteopontin, and Osteocalcin) were evaluated. RESULTS: Our results showed that MSCs derived from IPFP have a higher proliferation rate, while OM-derived MSCs have higher cell metabolism. In addition, MSCs from all adipose tissue sources showed positive expression of CD73 (NT5E), CD90 (THY1), CD105 (ENDOGLIN), and very low expression of CD45. The isolated canine MSCs were successfully differentiated into adipogenic and osteogenic lineages. The oil-red-O quantification and adipogenic gene expression (FAS, FabP4, and PPARγ) were higher in OM-derived cells, followed by IPFP-MSCs. Similarly, in osteogenic differentiation, alkaline phosphatase activity and osteogenic gene (SP7 and Osteocalcin) expression were higher in OM-derived MSCs, while osteopontin expression was higher in PR-derived MSCs. CONCLUSION: In summary, among all four adipose tissue sources, OM-derived MSCs have better differentiation potential toward adipo- and osteogenic lineages, followed by IPFP-MSCs. Interestingly, among all adipose tissue sources, MSCs derived from IPFP have the maximum proliferation potential. The characterization and differentiation potential of canine MSCs isolated from four different adipose tissue sources are useful to assess their potential for application in regenerative medicine.

Religiosity and mental health as aspects of comprehensiveness in care.

OBJECTIVE: to understand how religiosity can influence the health of individuals diagnosed with mental disorders, based on comprehensive care. METHODS: this is an integrative literature review, with the inclusion of articles in Portuguese, English and Spanish, between 2010 and 2018. RESULTS: the critical analysis and qualitative synthesis of the 24 selected studies were categorized into two subtopics: The influence of religiosity in promoting comprehensive mental health care; Mental health versus religiosity: influencing conditions for effective access to comprehensive care. FINAL CONSIDERATIONS: a positive influence of religiosity was identified in the lives of individuals diagnosed with mental disorders; however, evidence shows that health teams do not feel comfortable and prepared to work with religiosity as an expression of spirituality. This being one of the dimensional aspects of health, it can be inferred, on the results, the existence of this gap in the comprehensive care approach.

The Combined Influence of Magnesium and Insulin on Central Metabolic Functions and Expression of Genes Involved in Magnesium Homeostasis of Cultured Bovine Adipocytes.

At the onset of lactation, dairy cows suffer from insulin resistance, insulin deficiency or both, similar to human diabetes, resulting in lipolysis, ketosis and fatty liver. This work explored the combined effects of different levels of magnesium (0.1, 0.3, 1 and 3 mM) and insulin (25, 250 and 25,000 pM) on metabolic pathways and the expression of magnesium-responsive genes in a bovine adipocyte model. Magnesium starvation (0.1 mM) and low insulin (25 pM) independently decreased or tended to decrease the accumulation of non-polar lipids and uptake of the glucose analog 6-(N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino)-6-deoxyglucose (6-NBDG). Activity of glycerol 3-phosphate dehydrogenase (GPDH) was highest at 25 pM insulin and 3 mM magnesium. Expression of SLC41A1 and SLC41A3 was reduced at 0.1 mM magnesium either across insulin concentrations (SLC41A1) or at 250 pM insulin (SLC41A3). MAGT1 expression was reduced at 3 mM magnesium. NIPA1 expression was reduced at 3 mM and 0.1 mM magnesium at 25 and 250 pM insulin, respectively. Expression of SLC41A2, CNNM2, TRPM6 and TRPM7 was not affected. We conclude that magnesium promotes lipogenesis in adipocytes and inversely regulates the transcription of genes that increase vs. decrease cytosolic magnesium concentration. The induction of GAPDH activity by surplus magnesium at low insulin concentration can counteract excessive lipomobilization.

Motivation-Enhancing Psychotherapy for Inpatients With Anorexia Nervosa (MANNA): A Randomized Controlled Pilot Study.

Patients with anorexia nervosa (AN) are frequently characterized by an unstable readiness to change and high ambivalence toward treatment. Enhancing readiness to behavioral change therefore plays an essential role for adherence to treatment especially for severely ill patients treated in inpatient settings. Therefore, a novel 10 week program for the individual psychotherapy sessions was designed using elements from motivational interviewing to be applied within the multidisciplinary inpatient treatment for patients with AN. In a randomized controlled pilot trial, N = 22 patients with AN received either the new intervention or treatment as usual in one of two recruiting university hospitals. Readiness to change, eating disorder pathology, therapeutic alliance as well as acceptance and feasibility of the new intervention were measured from patients and therapists in week 1, 5, and 10 of inpatient treatment. Results confirm acceptance and feasibility of the MANNA intervention as evaluated by patients as well as therapists. Patients receiving the new intervention completed their inpatient treatment significantly more often on regular terms than patients receiving treatment as usual. No differences between the groups could be found concerning therapeutic alliance during and at the end of treatment and readiness to change. Absolute numbers of BMI increase indicate a larger increase in the intervention group albeit not significant in this pilot study sample. Limitations of the study such as the small sample size as well as possible adaptions and advancements of the intervention that need to be examined in a larger clinical trial of efficacy are discussed. This phase II study is registered with the German Clinical Trials Register (DRKS) under the trial number DRKS00015639.

[Are Facebook Ratings Associated with Hospital Quality and Patient Satisfaction? A Cross-Sectional Analysis of Obstetrics Care in German Hospitals]. / Spiegeln Facebook-Bewertungen die Versorgungsqualität und Patientenzufriedenheit von Krankenhäusern wider? Eine Querschnittstudie am Beispiel der Geburtshilfe in Deutschland.

OBJECTIVE: Social media websites, such as Facebook, have been gaining popularity. Little is known about the usefulness of such online ratings when searching for a hospital. We therefore assessed the association between online Facebook ratings and clinical quality of care measures as well as patient satisfaction for German hospitals in obstetrics care. METHODS: (1) We identified all German hospitals providing services in obstetrics care based on the German external quality assurance system (2015) and gathered relevant data. (2) Based on a structured dialogue, we determined quality of care results for all hospitals and (3) assigned them to 3 different performance groups. (4) We collected Facebook online ratings as well as (5) patient satisfaction (Patients' Experience Questionnaire, PEQ) results for all included hospitals. (6) We applied the Spearman rank coefficient of correlation. RESULTS: We could find a Facebook page for almost all of the included hospitals (728/752; 96.8%). Facebook hospital ratings in general were mostly positive, especially in obstetrics care. There was no association between Facebook hospital ratings (ρ=0.007; p=0.860) or those for obstetrics care (ρ=0.008; p=0.856) and clinical quality of care measures. In contrast, we could detect an association between Facebook ratings and patient satisfaction scores. The association was stronger for overall hospital ratings (ρ=0.383-0.543; p<0.001) than those for obstetrics care (ρ=0.111-0.250; p<0.05) in particular. CONCLUSION: So far, Facebook online ratings are of limited usefulness in guiding patients towards high-performing hospitals from a clinical point of view. However, our findings suggest that Facebook ratings may serve as an indicator of patient satisfaction when searching for hospitals.

Perceived Stress Mediates the Relationship of Body Image and Depressive Symptoms in Individuals With Obesity.

Obesity is a world-wide increasing condition classified by a BMI ≥ 30 kg/m2 that is frequently accompanied by various somatic comorbidities as well as an increased risk for mental comorbidities. Studies show associations of obesity with symptoms of depression, lower quality of life, and higher (perceived) stress compared to the general population. Body image has also been shown to play an important role in eating and weight disorders. The present study therefore aims to contribute to the understanding of the relationship of body image, perceived stress, and symptoms of depression in a morbidly obese population. N = 579 individuals with obesity were included upon presentation at a university clinic. The hypothesized mediating role of perceived stress in the relationship of body image dimensions and symptoms of depression could be confirmed. The results underline the importance of identifying promising stress management techniques and addressing perceived stress e.g. through mindfulness based approaches in the (lifestyle and/or weight) interventions for obesity taking into account the specific stressors of obesity affected individuals such as body image.

IMPULS: Impulsivity-Focused Group Intervention to Reduce Binge Eating Episodes in Patients with Binge Eating Disorder - A Randomised Controlled Trial.

BACKGROUND: Impulsivity is a risk factor for binge eating disorder, and binge eating (BE) equates to impulsive eating behaviour. Hence, we developed IMPULS, a cognitive behavioural group intervention focusing on impulsive eating. METHODS: We randomised 41 patients to the IMPULS group and 39 to the control group. The IMPULS group participated in the IMPULS treatment, while both groups completed weekly self-observations. We compared both groups concerning BE episodes in the past 4 weeks at the end of treatment (primary outcome). As secondary outcomes, we investigated eating pathology, depression, general impulsivity and body mass index (BMI) at the end of treatment and in a 3-month follow-up. RESULTS: The primary outcome failed, because BE episodes in the past 4 weeks were reduced in both groups at the end of treatment. At follow-up, the IMPULS group showed further improvement, contrary to the control group. The BE days/episodes in the 2 months before were overall reduced in both groups. Eating pathology was reduced in the IMPULS group at the end of treatment and partly in both groups at the follow-up. Depression was only reduced in the IMPULS group. General impulsivity and BMI did not change. CONCLUSIONS: The IMPULS study has a negative primary outcome. However, secondary outcomes indicate that the IMPULS treatment might be promising, as BE, eating pathology and depression were reduced in the IMPULS group. The initially reduced BE in the control group might represent a short-term effect from the self-observations. General impulsivity and BMI might need a longer time or more intensive treatment to change.

Stress experience and performance during an oral exam: the role of self-efficacy, threat appraisals, anxiety, and cortisol.

BACKGROUND AND OBJECTIVES: High self-efficacy may reduce emotional and physiological stress responses in the context of an examination. The present study investigated how these stress responses develop on an exam day, and sequential indirect effects between self-efficacy, threat appraisals, stress responses and performance. DESIGN AND METHODS: The sample comprised 92 students (46 women). Self-efficacy, threat appraisals and state anxiety were assessed on a control day one week before an oral exam. Additionally, anxiety was assessed three times on the exam day. Salivary cortisol samples were collected at all time points. RESULTS: Pre-exam anxiety and cortisol decreased until grades were announced. For both responses, greater levels were related to a steeper decline. However, changes in anxiety and cortisol were unrelated. Self-efficacy was negatively related to threat appraisals and anxiety on the control day. Greater threat appraisals were associated with higher pre-exam anxiety and a steeper anxiety decrease on the exam day, which in turn, was related to better performance. CONCLUSIONS: High levels of self-efficacy may reduce threat appraisals and anxiety in the lead up to an exam, which are related to the intensity and decline of anxiety on the exam day. A steeper decline of anxiety may be beneficial to performance.

Assédio moral no trabalho: uma abordagem multidisciplinar / Moral harassment at work: a multidisciplinary approach

Objetivo: investigar, em periódicos on-line, como o fenômeno assédio moral no trabalho está sendo abordado em pesquisas científicas. Método: trata-se de um estudo bibliográfico, tipo revisão integrativa, no qual se utilizaram textos publicados na Biblioteca Virtual de Saúde e indexados nas bases de dados LILACS, MEDLINE e BDENF, entre os anos de 2014 a 2016. Realizou-se, para a análise dos dados, uma divisão nas áreas de conhecimento as quais os artigos pertenciam. Resultados: encontraram-se 11 estudos, em três diferentes áreas de conhecimento, atendendo aos critérios de inclusão e exclusão da pesquisa e ao objetivo do estudo. Conclusão: conclui-se que o tema assédio moral no trabalho é uma temática emergente na sociedade pós-moderna retratada por diferentes áreas de conhecimento como: Serviço Social, Enfermagem e Psicologia. Mostrou-se, em cada área de conhecimento, a interação que há entre o assédio moral e o ambiente de trabalho, prestando-se maior visibilidade a este dano ético, moral e psicológico.(AU)

Objective: to investigate, in online journals, how the phenomenon of workplace bullying is being addressed in scientific research. Method: this is a bibliographic study, integrative review type, in which texts published in the Virtual Health Library and indexed in the LILACS, MEDLINE and BDENF databases were used, from 2014 to 2016. A review was performed, for data analysis, a division into the areas of knowledge to which the articles belonged. Results: 11 studies were found in three different areas of knowledge, meeting the inclusion and exclusion criteria of the research and the objective of the study. Conclusion: it is concluded that the issue of bullying at work is an emerging theme in postmodern society portrayed by different areas of knowledge such as: Social Work, Nursing and Psychology. In each area of knowledge, the interaction between bullying and the work environment was shown, giving greater visibility to this ethical, moral and psychological damage.(AU)

Objetivo: investigar, en revistas en línea, cómo se aborda el fenómeno del acoso laboral en la investigación científica. Método: se trata de un estudio bibliográfico, tipo de revisión integradora, en el que se utilizaron textos publicados en la Biblioteca Virtual en Salud e indexados en las bases de datos LILACS, MEDLINE y BDENF, de 2014 a 2016. Se realizó para análisis de datos, una división en las áreas de conocimiento a las que pertenecían los artículos. Resultados: se encontraron 11 estudios en tres áreas diferentes de conocimiento, cumpliendo los criterios de inclusión y exclusión de la investigación y el objetivo del estudio. Conclusión: se concluye que el tema del acoso moral en el trabajo es un tema emergente en la sociedad posmoderna representado por diferentes áreas de conocimiento, tales como: Trabajo Social, Enfermería y Psicología. En cada área de conocimiento, se mostró la interacción entre el acoso moral y el lugar de trabajo, dando mayor visibilidad a este daño ético, moral y psicológico.(AU)

Processo saúde-doença e qualidade de vida do residente multiprofissional / Health-disease process and quality of life of the multiprofessional resident

Objetivo: refletir sobre a relação da Residência Multiprofissional em Saúde no processo saúde-doença e na qualidade de vida do profissional de saúde residente. Método: trata-se de um estudo qualitativo, do tipo reflexivo. Refere-se a coleta de dados a uma pesquisa documental e à revisão de literatura com busca nas bases de dados PUBMED/MEDLINE, LILACS, e biblioteca virtual SCIELO com 16 artigos submetidos à análise. Resultados: destacam-se as categorias "Condicionantes legislativos da residência e a interface na saúde do trabalhador" e "Residência versus qualidade de vida". Conclusão: percebem-se condicionantes negativos sobre a residência que podem influenciar o adoecimento do residente. Espera-se, porém, que esta pesquisa contribua para gerar subsídios tanto de políticas públicas sobre a residência, como de material para aperfeiçoar o regulamento interno dos cursos, políticas essas que ofereçam diretrizes que favoreçam o desenvolvimento de boas práticas em formação e saúde.(AU)

The effectiveness of contingency management in the treatment of patients with anorexia nervosa: A systematic review.

Contingency management in stipulating weight gain is routinely used in the treatment of anorexia nervosa, however, empirical investigations concerning its effectiveness have been scarce. This systematic review was conducted according to the PRISMA statement. Of N = 973 hits, 42 full-texts were included in the qualitative synthesis (11 theoretical texts, 19 case reports, 12 descriptive, cohort, and controlled trials). A central topic in the included publications concerns the enhancement of patients' autonomy through participation in the contingency management process. This heightened autonomy is achieved by using contingency contracts. Positive short-term effects on weight gain were shown, whereas follow-up results were heterogeneous. Although contingency contracts are widely used in clinical practice, our systematic review shows that empirical evidence on underlying mechanisms and efficacy is still scarce. Using an explicit treatment contract can enhance patients' motivation, compliance, and autonomy. Clinical practice should see further development including innovative motivation enhancing and conflict dissolving techniques in addressing the pronounced ambivalence often shown by patients with anorexia nervosa.

Centro Psiquiátrico Eduardo Ribeiro: Revisitando a História e Compartilhando Memórias / Eduardo Ribeiro Psychiatric Center: Revisiting History and Sharing Memories

Este estudo propõe identificar e registrar as memórias que integram as Representações Sociais dos Trabalhadores de um centro psiquiátrico na capital do Amazonas. Com abordagem qualitativa foram entrevistados 24 profi ssionais com tempo médio de 20 anos de trabalho na instituição. Os resultados foram analisados por meio da análise de conteúdo de Bardin e categorizados em dois períodos distintos na história da instituição. Primeiramente, período entre 1970-1980, quando os elementos marcantes das memórias sobre o cuidado destacam aspectos como medo, insegurança, precariedade estrutural e de recursos humanos, sendo o cuidado lembrado como (des)humano. E posteriormente, entre 1980-1990, quando os trabalhadores apontam memórias sobre um cuidado compartilhado, com inclusão de atividades laborais e reformas na estrutura física da instituição. Concluiu-se que revisitar as memórias dos trabalhadores permitiu-nos pensar em novos tempos, buscando novos caminhos, onde ciência e cuidado se movimentam à medida que as certezas e imobilizações de conceitos sobre a crise, os agravos, os transtornos, e as doenças mentais se deslocam no olhar dos que buscam um viver saudável no cotidiano da vida.

[Impulsivity-focused Group Intervention to reduce Binge Eating Episodes in Patients with Binge Eating Disorder - A Group Training Program]. / Impulsivitätsbezogene Verhaltensmodifikation zur Reduktion von Essanfällen bei Patienten mit Binge-Eating-Störung ­ Ein Trainingsprogramm für Gruppen.

Binge Eating Disorder (BED) is an eating disorder where cognitive behavioural therapy (CBT) could already show reliable efficacy. Relying on basic research, CBT interventions which especially focus on impulsivity could be effective, because binge eating episodes represent highly impulsive eating behaviour. For this reason, we developed a treatment concept about an impulsivity-focused behavioural group intervention for patients with BED, called IMPULS. The efficacy of IMPULS is currently investigated in a randomised controlled trial 1. IMPULS is drafted as a weekly group training programme with 5-6 participants per group. The essential interventions are food-related cue exposure with response prevention and the development of self-control strategies. These interventions are adapted onto the impulsivity concept from conventional treatment of addictive disorders and BED.

Impulsivity-focused group intervention to reduce binge eating episodes in patients with binge eating disorder: study protocol of the randomised controlled IMPULS trial.

INTRODUCTION: The core symptom of binge eating disorder (BED) is recurrent binge eating that is accompanied by a sense of loss of control. BED is frequently associated with obesity, one of the main public health challenges today. Experimental studies deliver evidence that general trait impulsivity and disorder-specific food-related impulsivity constitute risk factors for BED. Cognitive-behavioural treatment (CBT) is deemed to be the most effective intervention concerning BED. We developed a group intervention based on CBT and especially focusing on impulsivity. We hypothesise that such an impulsivity-focused group intervention is able to increase control over impulsive eating behaviour, that is, reduce binge eating episodes, further eating pathology and impulsivity. Body weight might also be influenced in the long term. METHODS AND ANALYSIS: The present randomised controlled trial investigates the feasibility, acceptance and efficacy of this impulsivity-focused group intervention in patients with BED. We compare 39 patients with BED in the experimental group to 39 patients with BED in the control group at three appointments: before and after the group intervention and in a 3-month follow-up. Patients with BED in the experimental group receive 8 weekly sessions of the impulsivity-focused group intervention with 5-6 patients per group. Patients with BED in the control group receive no group intervention. The primary outcome is the binge eating frequency over the past 4 weeks. Secondary outcomes comprise further eating pathology, general impulsivity and food-related impulsivity assessed by eye tracking methodology, and body weight. Additionally, we assess binge eating and other impulsive behaviour weekly in process analyses during the time period of the group intervention. ETHICS AND DISSEMINATION: This study has been approved by the ethics committee of the medical faculty of Eberhard Karls University Tübingen and the University Hospital Tübingen. Data are monitored by the Centre of Clinical Studies, University Hospital Tübingen. TRIAL REGISTRATION NUMBER: German Clinical Trials Register, DRKS00007689, 14/01/2015, version from 11/06/2015, pre-results.

High Levels of Physical Activity in Anorexia Nervosa: A Systematic Review.

High level physical activity is a frequent symptom in patients with anorexia nervosa (AN), influencing the development, maintenance, complications, treatment success, relapse rate and severity of the disease. Accelerometry is assumed to be an objective method to assess physical activity (PA) in AN. We aimed to review objectively measured levels of PA in AN and to give an overview for clinical practice and future research. Data were searched in PubMed and PsychINFO until April 2015 following the preferred reporting items for systematic reviews and meta-analyses statement. Twenty studies fulfilled the inclusion criteria. A notable heterogeneity of measurements, outcomes, participants and settings was found. Overall, HLPA is not adressed enough by current evidence. A common valid terminology of HLPA is not available, and accurate criteria of different levels of PA must be defined to create comparability of future studies. Further objective PA assessments are needed to improve treatment outcome and relapse rate.