Out of the loop: Taking a one-week break from social media leads to better self-esteem and body image among young women.

This study experimentally tested the effects of taking a one-week break from social media (SM) on body image and self-esteem among young women. Female undergraduate students (N = 66) were randomly assigned to either take a one-week break from SM or continue their normal use (control condition). State self-esteem and body satisfaction were measured at baseline (Time 1) and one week later (Time 2). As predicted, participants in the break condition reported higher body satisfaction and higher state self-esteem (total, performance, social, and appearance domains) at Time 2 than did those in the control condition, controlling for Time 1 scores. The benefits of taking a break from SM on body satisfaction were especially pronounced for women with higher baseline levels of thin-ideal internalization. The findings demonstrate the short-term benefits of taking a break from SM for one week on self-esteem and body image among young women.

A Patient-Centered Approach to Collecting and Displaying Patient Identifiers.

Patient identifiers such as name, date of birth, or gender are the first line of defense to ensure the accuracy of the health data displayed in health information exchange. Health data display is the impetus for clinical decisions and patient outcomes and directly correlates with promoting interoperability and health information exchange. Therefore, constant monitoring of quality metrics is imperative for clinical leaders to keep a pulse on what is happening within their organizations. However, the electronic health records (EHRs) designer should also take precautions to ensure the visualizations are not misleading, given that EHRs have been shown in some studies to lead to increased patient safety events.

Parent, child, and family outcomes following Acceptance And Commitment Therapy for parents of autistic children: A randomized controlled trial.

LAY ABSTRACT: Parents of autistic children commonly experience difficulties with their own mental health. This study looked at the effects of a brief group-based Acceptance and Commitment Therapy program, developed for parents of autistic children, youth, and adults. ACT focuses on increasing psychological flexibility, which is the ability to be mindful and accepting of difficult thoughts and experiences, shown to be important for mental wellness. Participants included 54 parents of autistic people, ages 3-34. Parents were randomly divided into two groups: a Treatment group that received the intervention right away, and a Waitlist group that completed the program after the Treatment group completed the trial. All parents filled out questionnaires right before the program began, and at 3, 7, and 17 weeks after randomization. Compared to the group that was waiting to participate in the program, parents in the Treatment group reported greater improvements in depression and family distress, and these improvements were still present 4 months later. Parents in the Treatment group also reported short-term improvements in their positive feelings and personal goals, compared to those waiting. Results showed that ACT may help improve some aspects of mental health for parents of autistic children, but further research is recommended.

Comparison of MI-oriented versus CBT-oriented adjunctive treatments: impacts on therapeutic alliance and patient engagement during hospital treatment for an eating disorder.

BACKGROUND: Our aim was to compare MI-oriented versus CBT-oriented adjunctive treatments to test whether an MI approach is superior in terms of improving therapeutic alliance and engagement among individuals with an eating disorder. The current study was a pilot randomized controlled trial with random allocation to either MI-oriented or a CBT-oriented adjunctive treatment group completed concurrently with a hospital-based group program for adults. Both adjunctive treatment conditions consisted of three individual therapy sessions and a self-help manual. METHODS: Sixty-five outpatients receiving hospital treatment for a diagnosed eating disorder were randomly assigned to a treatment group. Measures of working therapeutic alliance, engagement, treatment completion, and clinical impairment were completed at preadmission, mid-treatment, and at the end of treatment. RESULTS: Working alliance increased equivalently in both conditions over time in treatment. Similarly, there were no differences between conditions in terms of engagement. Regardless of therapy orientation, greater use of the self-help manual predicted lowered eating disorder risk; stronger patient ratings of therapeutic alliance predicted decreased feelings of both ineffectiveness and interpersonal problems. CONCLUSION: This pilot RCT provides further evidence that both alliance and engagement are important for treatment of an eating disorder; however, there was no clear advantage of MI over CBT as an adjunctive treatment approach to improving alliance or engagement. TRIAL REGISTRATION: ClinicalTrials.gov ID #NCT03643445 (proactive registration).

Drop-out is common among eating disorder treatment programs. Patients' engagement in treatment and a positive relationship with their therapist may both be variables that are key to predicting treatment success. In this study we examined whether integrating MI-oriented individual therapy sessions plus a self-help manual would result in improved therapeutic alliance and/or engagement for adults attending a partial day hospital treatment program for an eating disorder as compared to similar CBT-oriented treatment. The MI-oriented treatment group was based on motivational interviewing principles that emphasize empathy, overcoming resistance to change, and individual's autonomy over decisions that are in line with one's values. The CBT-oriented treatment group was based on cognitive-behavioural principles that emphasize the need to change and the consequences of symptoms of an eating disorder. Patients' ratings of the quality of their relationship with their therapist increased in both conditions over time. A stronger working alliance with one's therapist was associated with lowered feelings of ineffectiveness and interpersonal problems, which are characteristics that are common among individuals with an eating disorder. Use of a self-help manual of either type showed some benefit at predicting reduced clinical impairment.

Young women's dialectical responses to fitspiration and thinspiration: A qualitative study.

With the popularity of image-based social media platforms like Instagram, researchers have begun to study relationships between social media and body image. Much of this research has used quantitative research methods, which cannot capture the rich, inner experiences of individuals. Given the dearth of qualitative research on what young women internally experience when viewing "Thinspiration" or "Fitspiration," this study used the consensual qualitative research (CQR) method, with the aim of capturing in their own words what young women feel and think in response to viewing fitspiration and thinspiration. Twelve young women viewed Fitspiration and Thinspiration profiles and were interviewed about these and similar everyday experiences. The CQR analytic team identified 10 general, 18 typical, and 11 variant domains (i.e., topic areas). An example general domain was "body image," under which the category "body dissatisfaction," fell; by viewing Thinspiration or Fitspiration, these young women were reminded how they are dissatisfied with how they see their own body or were prompted to believe others are reminded of this when viewing such content. An example typical domain was "diet/disordered eating"; several participants associated Thinspiration or Fitspiration with diet or disordered eating. From five of the 10 general domains emerged what we call an emergent dialectical theory of social media and body image. When viewing Thinspiration or Fitspiration, young women often seemed to feel or think two seemingly opposite things simultaneously within the topic areas of attainability, emotional reactions, social comparison, body image, and health.

Comprehensive genomic profiling and treatment patterns across ancestries in advanced prostate cancer: a large-scale retrospective analysis.

BACKGROUND: Men of African ancestry experience the greatest burden of prostate cancer globally, but they are under-represented in genomic and precision medicine studies. Therefore, we sought to characterise the genomic landscape, comprehensive genomic profiling (CGP) utilisation patterns, and treatment patterns across ancestries in a large, diverse, advanced prostate cancer cohort, to determine the impact of genomics on ancestral disparities. METHODS: In this large-scale retrospective analysis, the CGP-based genomic landscape was evaluated in biopsy sections from 11 741 patients with prostate cancer, with ancestry inferred using a single nucleotide polymorphism-based approach. Admixture-derived ancestry fractions for each patient were also interrogated. Independently, clinical and treatment information was retrospectively reviewed for 1234 patients in a de-identified US-based clinicogenomic database. Prevalence of gene alterations, including actionable gene alterations, was assessed across ancestries (n=11 741). Furthermore, real-world treatment patterns and overall survival was assessed in the subset of patients with linked clincogenomic information (n=1234). FINDINGS: The CGP cohort included 1422 (12%) men of African ancestry and 9244 (79%) men of European ancestry; the clinicogenomic database cohort included 130 (11%) men of African ancestry and 1017 (82%) men of European ancestry. Men of African ancestry received more lines of therapy before CGP than men of European ancestry (median of two lines [IQR 0-8] vs one line [0-10], p=0·029). In genomic analyses, ancestry-specific mutational landscapes were observed, but the prevalence of alterations in AR, the DNA damage response pathway, and other actionable genes were similar across ancestries. Similar genomic landscapes were observed in analyses that accounted for admixture-derived ancestry fractions. After undergoing CGP, men of African ancestry were less likely to receive a clinical study drug compared with men of European ancestry (12 [10%] of 118 vs 246 [26%] of 938, p=0·0005). INTERPRETATION: Similar rates of gene alterations with therapy implications suggest that differences in actionable genes (including AR and DNA damage response pathway genes) might not be a main driver of disparities across ancestries in advanced prostate cancer. Later CGP utilisation and a lower rate of clinical trial enrolment observed in men of African ancestry could affect genomics, outcomes, and disparities. FUNDING: American Society for Radiation Oncology, Department of Defense, Flatiron Health, Foundation Medicine, Prostate Cancer Foundation, and Sylvester Comprehensive Cancer Center.

Integrative Analysis of a Large Real-World Cohort of Small Cell Lung Cancer Identifies Distinct Genetic Subtypes and Insights into Histologic Transformation.

Small cell lung cancer (SCLC) is a recalcitrant neuroendocrine carcinoma with dismal survival outcomes. A major barrier in the field has been the relative paucity of human tumors studied. Here we provide an integrated analysis of 3,600 "real-world" SCLC cases. This large cohort allowed us to identify new recurrent alterations and genetic subtypes, including STK11-mutant tumors (1.7%) and TP53/RB1 wild-type tumors (5.5%), as well as rare cases that were human papillomavirus-positive. In our cohort, gene amplifications on 4q12 are associated with increased overall survival, whereas CCNE1 amplification is associated with decreased overall survival. We also identify more frequent alterations in the PTEN pathway in brain metastases. Finally, profiling cases of SCLC containing oncogenic drivers typically associated with NSCLC demonstrates that SCLC transformation may occur across multiple distinct molecular cohorts of NSCLC. These novel and unsuspected genetic features of SCLC may help personalize treatment approaches for this fatal form of cancer. SIGNIFICANCE: Minimal changes in therapy and survival outcomes have occurred in SCLC for the past four decades. The identification of new genetic subtypes and novel recurrent mutations as well as an improved understanding of the mechanisms of transformation to SCLC from NSCLC may guide the development of personalized therapies for subsets of patients with SCLC. This article is highlighted in the In This Issue feature, p. 1501.

Examining orthorexia nervosa: Using latent profile analysis to explore potential diagnostic classification and subtypes in a non-clinical sample.

Orthorexia nervosa (ON) is a proposed psychological disorder characterized by a pathological preoccupation with healthy eating. The purpose of the current study was to clarify the relationships between ON and related forms of psychopathology. In addition, we sought to explore whether there may be subtypes of ON and if ON is associated with BMI, gender, or social media use. The sample included 333 undergraduate students (72% female, Mage = 20.91) who completed measures of ON, eating disorder (ED) symptoms, obsessive compulsive disorder (OCD), obsessive compulsive personality disorder (OCPD), and health anxiety. Latent profile analysis detected three distinct groups with high ON scores. The ON/ED combined group (n = 16) was characterized by high levels of psychopathology, particularly in the areas of ON and eating disorder symptoms. In comparison, the ON/ED combined, without weight/shape concerns group (n = 35) had fewer body-related concerns. The ON only group (n = 23) reported minimal ED pathology. Regression analyses revealed those in the ON only group were more likely to be male, while the ON/ED group was associated with higher BMI. Being in the ON/ED combined, without weight/shape concerns was associated with viewing and sharing healthy eating content on social media. Our findings suggest that ON has the most overlap with ED pathology as compared to OCD, OCPD, and health anxiety, and that there may be three subtypes of ON. The first two share significant overlap with ED symptomatology while the third appears relatively distinct, characterized by less disordered eating and fewer positive emotions related to healthy eating. Future research should examine these subtypes more closely to determine whether they are clinically meaningful, potentially requiring different interventions.

Enriching sociocultural perspectives on the effects of idealized body norms: Integrating shame, positive body image, and self-compassion.

Body image is an integral aspect of the psychology of the self. Idealized body images are ubiquitous in both traditional media forms (e.g., magazines, television) and social media (e.g., Facebook, Instagram). The classic sociocultural model of body image (i.e., the Tripartite Influence Model) emphasizes pathways between idealized body norms, appearance comparisons, internalization of body ideals, and body dissatisfaction and its outcomes. We summarize the model and identify some issues to be addressed in future work, particularly in light of the immense popularity of social media. We review three topics that are not included in the sociocultural model but that provide a more complete picture of the influence of societal body norms on body image: (1) body shame, (2) positive body image, and (3) self-compassion. Research on the nature, assessment, and relevance of these constructs is reviewed in detail. In terms of clinical applications of these areas of research for individuals at risk of body dissatisfaction, we suggest assessing for and targeting body shame, cultivating facets of positive body image, and teaching strategies for developing self-compassion.

Eating and body image characteristics of those who aspire to the slim-thick, thin, or fit ideal and their impact on state body image.

The slim-thick ideal is characterized by a small waist and flat stomach, but large hips, thighs, and butt. Little research to date has examined the impact of this body-ideal on women's body image. The purpose of the current study was to investigate: 1) the impact of slim-thick, thin-, and fit-ideal imagery on women's body image, 2) the body ideals women most aspire to, and 3) eating and body image characteristics of women who aspire to each ideal. Participants were 123 female undergraduate students. Results revealed that experimental exposure to slim-thick- and fit-ideal imagery resulted in lower body satisfaction. Participants reported aspiring more to the fit and slim-thick-ideal than to the thin-ideal, and rated the slim-thick-ideal as the most attractive and desirable. Women who aspired to the thin- or slim-thick-ideal reported the greatest overall disordered eating. Women who aspired to the slim-thick-ideal reported greater dietary restraint, eating, shape and weight concerns, appearance ideal internalization, body image investment, and physical appearance perfectionism than those who aspired to the fit-ideal. Findings show that beauty ideals are shifting away from the thin-ideal toward a slim-thick-ideal. Slim-thick internalization may be harmful to women's well-being and should be addressed in body image and eating disorders interventions.

Testing a self-compassion micro-intervention before appearance-based social media use: Implications for body image.

Using social media applications can lead to increased body dissatisfaction among young women, particularly when they compare themselves to such images. One intervention for combating these harmful effects may be through self-compassion, or the ability to treat oneself as a friend. The goal of this study was to determine whether a self-compassion micro-intervention could prevent increases in body dissatisfaction after comparing themselves to thin ideal images on Instagram. In an online study, 230 women (M = 25.88, SD = 0.70) completed measures of state weight and appearance dissatisfaction before completing a brief self-compassion writing task (experimental condition) or a simple sorting task (control condition). After completing the assigned tasks, participants reported state body dissatisfaction. Next, they were asked to compare themselves to pre-selected thin ideal images of a curated Instagram profile before reporting state body dissatisfaction for a final time. The results demonstrated that the self-compassion intervention led to decreased in weight dissatisfaction and appearance dissatisfaction that were maintained after Instagram use. Those in the control condition showed increased in body image concern after Instagram use. These preliminary findings suggest that a self-compassion micro-intervention may serve as an effective buffer against certain adverse effects of social media on body image.

The effect of physical appearance perfectionism and social comparison to thin-, slim-thick-, and fit-ideal Instagram imagery on young women's body image.

Body image research to date has examined the impact of thin- and fit-ideal media on women's body image, however cultural trends in Western media have recently shifted towards a curvier body type called slim-thick, which is characterized by a large butt and thighs and small waist and flat stomach. We experimentally examined the impact of forced social comparison to slim-thick-, thin-, and fit-ideal imagery on women's body image relative to a control condition, and whether physical appearance perfectionism moderated these findings. Participants were 402 female undergraduate students. Results revealed that comparison to body-ideal imagery resulted in greater weight and appearance dissatisfaction and less overall body satisfaction, relative to the control condition. Those exposed to slim-thick imagery experienced more weight and appearance dissatisfaction and less body satisfaction than those in the thin-ideal condition. Physical appearance perfectionism moderated these results, such that women who reported moderate or high levels of physical appearance perfectionism experienced greater weight and appearance dissatisfaction and lower body satisfaction in the slim-thick condition, than in the thin-ideal, fit-ideal, or control conditions. It was concluded that drive to achieve body ideals is shifting to a slim-thick body, which maybe more detrimental to women's body image than thin-ideal imagery.

The effects of self-disclaimer Instagram captions on young women's mood and body image: The moderating effect of participants' own photo manipulation practices.

The current experiment investigated the impact of attaching self-disclaimer captions (i.e., captions about whether photos had been edited) to thin-ideal Instagram photos on young women's body image and mood. Participants were 311 undergraduate students aged 18-25 years. Participants were randomly assigned to view images of a thin woman on Instagram with no captions, or with a generic, specific, or warning self-disclaimer caption, and completed pre and post measures of body image and mood and a questionnaire about their own photo-editing practices. Across all conditions, exposure to the images resulted in decreased body satisfaction, likelihood to compare one's body to another's, happiness, confidence, and anxiety. There was no significant effect of disclaimer type on body image or mood, and therefore no type of self-disclaimer had an ameliorating effect. However, specific disclaimers were superior to the other disclaimers at reducing likelihood to compare one's body to another's, for women high on photo manipulation. Future research should be conducted in adolescent girls and men.

Young women's body image following upwards comparison to Instagram models: The role of physical appearance perfectionism and cognitive emotion regulation.

The present study examined whether trait physical appearance perfectionism moderates young women's body image following upwards appearance comparison to idealized body images on social media, and whether cognitive coping mediates the relationship between physical appearance perfectionism and resulting body image from social comparison processes. Female undergraduate students (N = 142) were randomly assigned to either 1) compare the size of their body parts to the body parts of attractive Instagram models, or 2) an appearance-neutral control condition. All participants completed measures of trait physical appearance perfectionism, pre and post measures of state body image, and state cognitive coping processes. Appearance comparison to the models resulted in lowered confidence and increased appearance and weight dissatisfaction. High trait physical appearance perfectionism predicted lower confidence and higher weight dissatisfaction and appearance dissatisfaction, and these relationships were mediated by engagement in rumination and catastrophizing. Clinical implications of the findings are discussed.

The Effects of the COVID-19 Pandemic Lockdown on Eating, Body Image, and Social Media Habits Among Women With and Without Symptoms of Orthorexia Nervosa.

The COVID-19 pandemic is negatively impacting people's mental health worldwide. The current study examined the effects of COVID-19 lockdown on adult women's eating, body image, and social media habits. Furthermore, we compared individuals with and without signs of orthorexia nervosa, a proposed eating disorder. Participants were 143 women, aged 17-73 years (M = 25.85, SD = 8.12), recruited during a COVID-19 lockdown in Canada from May-June 2020. Participants completed self-report questionnaires on their eating, body image, and social media habits during the pandemic. The Eating Habits Questionnaire (EHQ) assessed symptoms of orthorexia nervosa. Compared to the period prior to lockdown, women with higher total orthorexia nervosa scores reported eating a lot more than usual, feeling greater pressure to diet and lose weight, thinking about food more often than usual, experiencing greater weight gain, and perceiving more pressure from social media specifically to lose weight and to exercise, compared to their healthy counterparts. We examined associations between individual EHQ subscales and perceived changes to eating and weight. Women who scored high on EHQ-Problems reported seeing more weight loss content on their social media than those who reported fewer orthorexia nervosa symptoms. Conversely, those who scored low on EHQ-Feelings reported feeling a lot less pressure to lose weight, somewhat less or a lot less pressure to lose weight or to exercise from social media specifically, and trended toward less laxative use during lockdown, compared to those who scored higher on orthorexia nervosa. And those who scored low on EHQ-Knowledge reported feeling somewhat less or a lot less pressure to lose weight than those who reported more orthorexia nervosa symptoms. Together, the findings suggest that women with symptoms of orthorexia nervosa are experiencing an exacerbation of disordered eating thoughts and behaviors during COVID-19, and that social media may be a contributing factor.

Laparoscopic Resection of a Gastric Diverticulum in an Adolescent.

Gastric diverticula rarely occur in adolescence. In adults, they are predominantly congenital, asymptomatic, and are located adjacent to the gastroesophageal junction on the posterior aspect of the stomach wall. In this report we present a 14-year-old female who underwent laparoscopic gastric diverticulectomy after incidental discovery on magnetic resonance urography.

What is restrained eating and how do we identify it?

Defining and measuring such qualities as restrained eating or dieting may require more than simply administering questionnaires and assuming that we are identifying the population that we wish to study. Different questionnaires may identify different types of restrained eaters, and even deciding what restrained eating consists of is a complicated endeavor. We discuss how to define and measure restrained eating, specifying key attributes, and acknowledging the problems inherent in relying on self-report instruments. We conclude that given the difficulties in defining such constructs as restrained eating, we need to specify more clearly exactly what our research questions are, in order to be sure that we are identifying the populations with the attributes necessary to answer those questions.