What is needed for eating disorder prevention for transgender and gender diverse young adults? Findings from asynchronous online focus groups.

Transgender and gender diverse (TGD) young adults face higher risk of eating disorder (ED) symptoms than cisgender peers. Evidence-based ED prevention programs exist but must be adapted to meet the needs of diverse TGD populations. We conducted eight asynchronous online focus groups in 2019 with 66 ethnically and gender diverse TGD young adults (18-30 years) living in the United States. Participants were recruited online; groups took place over four consecutive days. We conducted inductive thematic analysis of participant responses to three prompts about ED prevention needs and advice for program developers. Findings fell into three domains. In Domain 1: Developing Program Content, themes included (1.1) need to address multiple dimensions of gender; (1.2) intersectional representation matters; (1.3) limitations of ED research; (1.4) being responsive to trauma. Domain 2: Program Delivery Considerations, included preferences for (2.1) group composition, (2.2) intervention modality, and (2.3) program leadership. Domain 3: Cultivating Affirming Spaces included themes addressing the need for programs to (3.1) create judgment-free environments and (3.2) center lived experience. TGD young adults in this study described a range of needs and recommendations for ED prevention content and delivery, with relevance to clinicians, program designers, and ED prevention advocates.

Triggers for eating disorder onset in youth with anorexia nervosa across the weight spectrum.

To aid in more targeted eating disorder (ED) prevention efforts, we sought to identify sociodemographic and weight-related risk factors for identified triggers for the onset of anorexia nervosa (AN) in youth. We conducted a retrospective chart review of youth admitted for medical treatment of AN between January 2015 and February 2020. From multidisciplinary admission notes, we extracted patient-reported reasons for diet/exercise changes. We used qualitative thematic analysis to identify ED triggers, then categorized each trigger as binary variables (presence/absence) for logistic regression analysis of risks associated with each trigger. Of 150 patients, mean (SD) age was 14.1(2.3) years. A total of 129 (86%) were female and 120 (80%) were Non-Hispanic White. Triggers included environmental stressors (reported by 30%), external pressures of the thin/fit ideal (29%), internalized thin/fit ideal (29%), weight-related teasing (19%), and receiving health education (14%). Younger age was associated with higher odds of weight-related teasing (p = .04) and health education (p = .03). Males had greater odds of internalized thin/fit ideal than females (p = .04). Those with premorbid body mass indices ≥85th percentile for age and sex had greater odds of reporting positive reinforcement (p = .03) and weight-related teasing (p = .04) than those with weights <85th percentile. We use these findings to detail potential targets for advancing ED prevention efforts.

Adolescent and emerging adult perceptions of eating disorder severity and stigma.

OBJECTIVE: Eating disorders are one of the deadliest mental health conditions, yet most individuals with eating disorders never receive treatment. Previous research has explored barriers to treatment among individuals diagnosed with eating disorders, but little is known about general adolescent and emerging adult perceptions of eating disorders, as compared to other mental health illnesses, a population at greatest risk for developing an eating disorder, and a population that may be important sources of information or support for peers. METHOD: A sample of adolescents and emerging adults aged 14-24 years (mean age 19 years) from MyVoice, a national text-message-based cohort (53% female, 38% male, 9% other, race/ethnicity 63% White, 10% Black or African American, 13% Asian, 9% Mixed Race, and 5% Other) provided open-ended responses to questions on the severity of eating disorders as compared to other mental health diagnoses, others' perceptions of eating disorders and potential treatment barriers. Responses were collected using a secure online platform and analyzed using content analysis. RESULTS: Among respondents (n = 792/1283), 91% felt that eating disorders were a mental health condition and 65% felt that eating disorders were as serious as other mental health conditions, while 21% said they were more serious than other mental health conditions. Responses to questions related to perception and barriers illustrated that beliefs of eating disorders involve blame, stigma, and overall lack of understanding. DISCUSSION: Findings from this study illustrate that there is a lack of understanding around eating disorders that could be addressed in youth-focused initiatives. PUBLIC SIGNIFICANCE: Adolescents and emerging adults understand that eating disorders are severe mental illnesses that are not taken seriously by others, especially in comparison with other mental health diagnoses. Adolescents and emerging adults report that individuals with eating disorders are blamed for their condition and face shame and stigma. The lack of understanding around eating disorders should be addressed in youth-focused prevention initiatives.

Content analysis of the impact of COVID-19 on weight and shape control behaviors and social media content of U.S. adolescents and young adults.

OBJECTIVE: The current study examines impacts of the COVID-19 pandemic on weight/shape control behaviors among adolescents and young adults in the U.S., and perceived changes to related social media content. METHOD: A sample of youth (14-24 years) from MyVoice, a national text-message-based cohort, provided open-ended responses to questions on changes in eating and exercise habits due to concern about weight/shape, and social media content related to weight/shape, during the pandemic. Responses were collected using a secure online platform and analyzed using content analysis. RESULTS: Among respondents (n = 939/1153, response rate = 81%), 40.0% adopted behaviors for the purpose of weight/shape control during the pandemic. Nearly half (49.2%) reported seeing posts about weight/shape on social media during the pandemic. DISCUSSION: Findings from this study indicate that weight/shape concerns among adolescents and young adults in the U.S. may have increased due to the COVID-19 pandemic, with social media content as a potentially contributing factor.

Little time, lasting impact: Bereaved caregiver perceptions of legacy in perinatal and infant loss.

BACKGROUND: Legacy interventions are standard in most children's hospitals, but little is known about how bereaved parents understand and describe the concept of legacy that these interventions are designed to Address. The aim of this qualitative study was to understand the legacy experiences and perceptions of parents who have experienced perinatal or early infant (less than three months of age) loss. METHODS: Grounded in constructionist epistemology and phenomenological qualitative traditions, ten bereaved parents completed an in-depth phenomenological interview regarding their perceptions of and experiences with the legacy of their deceased child. Interviews were transcribed verbatim and analyzed using an open, inductive coding process to illuminate the essence of participants' experiences. RESULTS: Three themes were identified: 1) legacies are composed of memories and experiences that have a lasting effect on others; 2) healthcare experiences both generate and participate in infants' legacies; and 3) parents' legacy perceptions are shaped by cultural conceptions, spiritual beliefs, and grief experiences. Parents described experiences and interactions with community members and healthcare providers that honored or challenged their perceptions of their child's unique legacy. CONCLUSIONS: In the context of perinatal or early infant loss, bereaved parents describe legacy as enduring, unique to each child and family, and heavily influenced by healthcare experiences and staff relationships. Parent-led, legacy-oriented interventions are needed in maternal/fetal, labor/delivery, and neonatal intensive care settings to support parent coping with loss.

Preferences and comfort of maternal fetal medicine fellows in the United States with operative vaginal deliveries.

OBJECTIVE: The objective of this study was to determine the current landscape of vacuum and forceps-assisted vaginal delivery (FAVD) preferences and comfort across maternal fetal medicine (MFM) fellows in the United States (U.S.). METHODS: A survey was sent to MFM fellowship program directors for distribution to current MFM fellows across U.S. Geographic regions, as determined using Census Bureau-designated regions. The survey looked at comfort and experience with FAVDs and vacuum-assisted vaginal deliveries (VAVD) throughout their post-graduate training. Descriptive statistics were used to analyze survey responses. Respondents were compared by post-graduate year (PGY) and region. RESULTS: One hundred six MFM fellows (32%) completed the survey. 22.6% of MFM fellows had performed greater than 30 FAVDs, with 33% having performed ≤10 FAVDs. In comparison, 35.8% of fellows had performed more than 30 VAVDs. While 95.2% of fellows feel prepared to perform a VAVD independently, only 59.4% feel prepared to do FAVDs independently. Never the less, 53% of MFM fellows favor performing a FAVD. While some regional differences were seen, there was no significant difference in the percent of fellows by geographic region who have performed >30 FAVD (p = .87). MFM fellows in the West are most likely to have performed >30 FAVD at 57.8%, compared to 42.3, 35, and 11.4% in the Midwest, South, and Northeast, respectively. CONCLUSION: MFM fellows are more confident with VAVD compared to FAVD. Despite feeling less confident performing FAVD (versus VAVD), the majority of MFM fellows feel comfortable performing FAVDs independently. Region of training fellowship training does not significantly affect one's confidence in FAVDs. A coordinated nationwide effort to increase exposure to and confidence for FAVDs should be considered.

Impacts of dietary self-monitoring via MyFitnessPal to undergraduate women: A qualitative study.

The present study explored college women's perceptions of how dietary self-monitoring alters eating and body image-related cognitions and behaviors. The sample consisted of undergraduate women (N = 20), aged ≥ 18 (mean = 21.9 ±â€¯6.6 years) from a cross-sectional qualitative study using semi-structured interviews conducted upon participants' completion of a randomized controlled trial testing the effects of dietary self-monitoring via the smartphone app, MyFitnessPal. Inductive content analysis was utilized to identify participants' perceptions of how engaging in dietary self-monitoring for one month impacted them. Participants' experiences dietary self-monitoring was highly variable, with some participants reporting increased negative feelings (n = 9), positive feelings (n = 7), or both (n = 2). Other notable findings included increases in weight and/or shape concerns (n = 10) and a number of changes in dietary intake and other behaviors. Participants indicated that dietary self-monitoring may be helpful when trying to lose weight but harmful if the behavior becomes obsessive or if the user has poor body image. Individual experiences with dietary self-monitoring varies widely, and while dietary self-monitoring may be a useful tool for some college women, use should be monitored to avoid possible harmful side effects.

The set point: weight destiny established before adulthood?

PURPOSE OF REVIEW: Although the set point is one of the best understood weight defense mechanisms, how and when a set point is established and what causes its disruption are not well understood. The purpose of this review is to address these gaps in the literature by exploring studies on the establishment of the set point theory and the underlying metabolic processes that support its existence. RECENT FINDINGS: Research suggests that weight loss achieved through restricted energy intake and increased energy expenditure is difficult to maintain and is often followed by greater weight gain over time. It is hypothesized that such weight gain is driven by an individual's set point, a weight range in which the body seeks to remain by adjusting metabolism (e.g. by moderating energy expenditure based on energy intake in times of diet or energy fluctuation). Similar to adults, weight loss in adolescence results in decreased resting metabolic rate (RMR), and that the RMR remains suppressed even with weight restoration. SUMMARY: Recommending weight loss in youth results in metabolic adaptations to restore weight and weight inclusive approaches may be more appropriate to protect their health and wellbeing.

Forceps-assisted vaginal delivery: the landscape of obstetrics and gynecology resident training.

OBJECTIVE: The objective of this study was to determine the current landscape of forceps-assisted vaginal delivery (FAVD) training in the USA (US) amongst obstetrics and gynecology (OB/GYN) residents. We investigated national and regionalization of resident interest by trainee level and skill acquisition in a climate of FAVD decline. STUDY DESIGN: An anonymous 20-question survey was distributed to US OB/GYN residency programs. Census Bureau-designated regions were used. Descriptive statistics were used to analyze survey responses. Respondents were compared by postgraduate year (PGY) and region. RESULTS: The survey was completed by 434 OB/GYN residents over one academic year with representation from all US regions. PGY-3 and PGY-4 residents completed statistically significant more FAVDs compared to PGY-1 and PGY-2 residents combined (p < 0.0001). By region, there was a significant difference in the number of FAVDs completed. The Midwest performed the most and Northeast performed the least (p < .0001). There was a statistically significant difference in simulation experiences by PGY (p < .0001) and by region (p = .0003) and in selfreported preparedness to perform FAVDs independently by PGY and by region. CONCLUSIONS: Residents are motivated to learn FAVD. Our study is the first to demonstrate that residents are not obtaining adequate experience irrespective of geographic region. Current training should implement simulation and continued acquisition of training in FAVD.

Weight bias among public health trainees.

OBJECTIVE: To explore explicit beliefs about the controllability of obesity and the internalisation of negative weight-related stereotypes among public health trainees. DESIGN: Cross-sectional online survey assessing explicit beliefs about the controllability of obesity using the Beliefs About Obese Persons Scale (BAOP) and internalisation of weight bias using the Modified Weight Bias Internalization Scale (WBIS-M). Bivariate associations between BAOP and WBIS-M scores and demographic characteristics were examined using t tests or ANOVA with post hoc Tukey's tests. SETTING: School of Public Health at a large, Midwestern University. PARTICIPANTS: Public health students (n 322). RESULTS: Relative to students who identified as male, those who identified as female had a stronger belief that obesity is not within the control of the individual (P = 0·03), yet had more internalisation of weight bias (P < 0·01). Greater weight bias internalisation was also seen among students who perceived themselves to be of a higher weight status (P < 0·001) and those who were at risk for food insecurity (P < 0·01). CONCLUSIONS: Public health trainees may be more attuned to the complexities of weight relative to trainees in other health-related fields, but are still susceptible to internalisation of negative weight-related stereotypes.

"It's Healthy Because It's Natural." Perceptions of "Clean" Eating among U.S. Adolescents and Emerging Adults.

Definitions for the culturally trendy "clean" eating phenomenon vary: whereas some characterize it as natural and healthy, others adopt more restrictive, moralizing, and affectively-laden definitions that may reflect disordered eating. We examined levels of familiarity with "clean" eating, sources of information, and perceptions of this dietary trend among a large, diverse sample of U.S. adolescents and emerging adults recruited from the National MyVoice Text Message Cohort (n = 1266; ages 14-24 years). Participants answered five questions assessing knowledge of "clean" eating, definitions, perceived healthiness vs. harm, and willingness to adopt "clean" eating, and responses were coded by three trained researchers. Results indicate that 55% of respondents had previously heard of "clean" eating, most commonly through social media, other online sources, and peers. Definitions were heterogeneous, with 40% offering "non-processed" or "whole foods" and 13% noting "non-GMO" or "organic" components. Few respondents (0.6%) expressed outright skepticism about "clean" eating, but many (30%) identified dietary avoidance and restriction as part of the definition. Overall, 71% characterized "clean" eating as a healthy approach, whereas 6% flagged it as "unhealthy", and 18% noted elements of both healthfulness and harm. Notably, 41% reported they "probably would" try "clean" eating themselves, with greater willingness to try "clean" eating among cisgender women. Present findings highlight high levels of awareness and positive attitudes toward "clean" eating among young people in the U.S., with little recognition of the potential risks of dietary restriction. Further research should examine actual dietary behaviors to clarify potential risks of "clean" eating and related trends and thus inform strategies for eating disorder prevention.

Sexual function in hook-up culture: The role of body image.

Hook-up mobile apps are increasing in popularity and research suggests sexual function may be lower among those who hook-up compared to those who have sex in a longer-term relationship. Sexual function is an important predictor of well-being; however, we know little about the psychosocial antecedents of sexual function, such as body image, among those who use hook-up apps. The current study aims to examine two measures of positive body image and one measure of body image self-consciousness during intimate activity among a sample of adult women and men who have hooked up in the previous month using a hook-up mobile app (N = 243). Our results suggest that higher body image self-consciousness during intimate activity was related to lower sexual function composite score and several specific domains (i.e., pain, arousal, orgasm, and lubrication) among women. Higher body appreciation was related to higher sexual satisfaction among women. Higher body image self-consciousness during intimate activity was related to higher erection difficulty, but not ejaculation difficulty, among men. These findings highlight the nuanced nature of body image and sexual function and provide further evidence that interventions for women and men aiming to improve some body image constructs may improve sexual function as well.

Simulation to Improve Trainee Skill and Comfort with Forceps-Assisted Vaginal Deliveries.

Objective Simulation training is a powerful learning tool for low frequency events. Forceps-assisted vaginal deliveries (FAVD) are an important tool in reducing cesarean deliveries. The aim of this study is to create a high-fidelity simulation-based curriculum for residency education and investigate pre- and posttest skill and confidence. Methods A prospective cohort study was conducted involving obstetrics and gynecology residents over 2 academic years. Residents participated in one to three FAVD simulation trainings. All sessions involved video, didactic, and hands-on practice. Pre- and postsurvey and skills assessment were conducted to assess confidence, ability to consent, and perform a FAVD. Wilcoxon's signed-rank tests and Kruskal-Wallis tests were used. Results Thirty residents (73%) completed at least one forceps simulation training session. Participants demonstrated significant improvement in confidence ( p < 0.005) following training. Before the intervention, there was a disparity in confidence by postgraduate level ( p < 0.005); however, this difference was not seen postsimulation ( p = 0.24). Residents demonstrated significant improvement in their FAVD skills ( p < 0.05), as well as their ability to consent ( p < 0.01). Conclusion Simulation training improves residents' perceived confidence in FAVD. Simulation helped to better equalize confidence across classes. FAVD simulations improves resident confidence, skill, and more broadly broadened the armamentarium to decrease the cesarean delivery rate.

Fundamental arthroscopic skill differentiation with virtual reality simulation.

PURPOSE: The purpose of this study was to investigate the use and validity of virtual reality modules as part of the educational approach to mastering arthroscopy in a safe environment by assessing the ability to distinguish between experience levels. Additionally, the study aimed to evaluate whether experts have greater ambidexterity than do novices. METHODS: Three virtual reality modules (Swemac/Augmented Reality Systems, Linkoping, Sweden) were created to test fundamental arthroscopic skills. Thirty participants-10 experts consisting of faculty, 10 intermediate participants consisting of orthopaedic residents, and 10 novices consisting of medical students-performed each exercise. Steady and Telescope was designed to train centering and image stability. Steady and Probe was designed to train basic triangulation. Track and Moving Target was designed to train coordinated motions of arthroscope and probe. Metrics reflecting speed, accuracy, and efficiency of motion were used to measure construct validity. RESULTS: Steady and Probe and Track a Moving Target both exhibited construct validity, with better performance by experts and intermediate participants than by novices (P < .05), whereas Steady and Telescope did not show validity. There was an overall trend toward better ambidexterity as a function of greater surgical experience, with experts consistently more proficient than novices throughout all 3 modules. CONCLUSIONS: This study represents a new way to assess basic arthroscopy skills using virtual reality modules developed through task deconstruction. Participants with the most arthroscopic experience performed better and were more consistent than novices on all 3 virtual reality modules. Greater arthroscopic experience correlates with more symmetry of ambidextrous performance. However, further adjustment of the modules may better simulate fundamental arthroscopic skills and discriminate between experience levels. CLINICAL RELEVANCE: Arthroscopy training is a critical element of orthopaedic surgery resident training. Developing techniques to safely and effectively train these skills is critical for patient safety and resident education.

Exploring attention-based explanations for some violations of Hick's law for aimed movements.

Choice reaction time generally increases linearly with the logarithm of the number of potential stimulus-response alternatives, a regularity known as Hick's law. Two apparent violations of this generalization, which have been reported for aimed eye movements (Kveraga, Boucher, & Hughes, Experimental Brain Research, 146, 307-314, 2002), and arm movements (Wright, Marino, Belovsky, & Chubb, Experimental Brain Research, 179, 475-496, 2007), occurred when the indicator stimulus was an abrupt change at the location that was the target of the to-be-made movement. We report two experiments that examined and rejected the hypothesis that these abrupt-onset indicator stimuli triggered a shift in exogenous attention and that this led to unusually small uncertainty effects. Each experiment compared this indicator stimulus with a single alternative: Experiment 1 tested an indicator stimulus at all locations other than the target; Experiment 2 tested a central pointer to the target. Neither alternative led to an uncertainty effect for pointing responses that was of the size typically observed for other responses using the same stimuli.