Objective: Internet-based guided self-help (GSH-I) is an efficacious treatment for adults with binge-eating disorder (BED) and overweight or obesity. Although broadly accessible, high dropout from GSH-I has been reported. However, little is known about the factors explaining dropout from GSH-I, including patients' adherence to treatment.Method: Within a randomized trial on the treatment of BED, adherence to 4-month GSH-I was objectively assessed in N = 89 patients with BED and overweight or obesity. Objective adherence and subjective treatment evaluation were evaluated as predictors of dropout from GSH-I, defined as having accessed 5 or less of 11 modules.Cutoffs with optimal sensitivity and specificity were derived using Receiver Operating Characteristics curves analysis, and baseline sociodemographic and clinical correlates were determined.Results: According to our definition, n = 22 (24.7%) patients were defined as dropouts. Results of the full logistic regression model accounted for 72% of the variance in dropout and all objective adherence parameters (i.e., number of messages exchanged, days with a completed food diary, and days spent per module), but not patients' subjective GSH-I evaluation significantly predicted dropout. Specifically, not completing the food diary in week 7 had maximized sensitivity and specificity in predicting dropout. Patients' body mass index was positively associated with the number of messages exchanged between patients and coaches. No other associations between baseline variables and objective adherence were found.Martina de Zwaan and Anja Hilbert contributed equally to this study.

To evaluate psychological treatments for adolescent binge‐eating disorder (BED), reliable information on therapeutic process factors is needed. This study examines therapist adherence and therapeutic alliance and their associations in cognitive‐behavioural therapy (CBT) for adolescents with BED. In a randomised‐controlled efficacy trial, adherence and alliance were objectively determined based on 247 audio‐taped CBT sessions from a sample of N = 64 adolescents with BED. Variability of adherence and alliance, explained by treatment module, patient, and therapist were examined using multilevel modeling. Although adherence and alliance were excellent and unaffected by treatment module and therapist, there was significant between‐patient variability for both concepts. Adherence was negatively associated with patient's treatment expectation. Alliance was negatively associated with the number of loss of control eating episodes and positively associated with adherence. Excellent adherence supported the internal validity of CBT for adolescent BED. Associations between process factors and patient characteristics demand adequate supervision in CBT.

<b><i>Introduction:</i></b> Individuals suffering from overweight or obesity frequently experience weight-based stigmatization. The widespread belief that weight is a matter of personal will and self-control results in various weight-based stereotypes (e.g., laziness, lack of self-discipline, or neglect). <b><i>Objective:</i></b> Based on the modified version of the Weight Bias Internalization Scale (WBIS-M), a short form for the economic assessment of weight bias internalization in the general population was compiled and validated. <b><i>Methods:</i></b> A three-item short form (WBIS-3) was derived based on data from a representative sample of the German population (<i>n</i> = 1,092). This new short form was validated in a second representative population sample (<i>n</i> = 2,513). Item characteristics and internal consistency were obtained. Measurement invariance was tested. Construct validity was established via the correlation with theoretically related constructs (depression, anxiety, eating behavior, discrimination, weight status). To establish scale validity, all analyses were performed for the whole sample as well as for the subsample of individuals with overweight. Age- and gender-specific population norms were provided. <b><i>Results:</i></b> The WBIS-3 exhibited excellent psychometric properties. Internal consistency was α = 0.92. Strong measurement invariance was confirmed regarding age, gender, discrimination, and weight status in both the whole sample as well as the overweight subsample. <b><i>Conclusions:</i></b> The WBIS-3 constitutes a valid and economical tool for the assessment of weight bias internalization in epidemiological contexts. Measurement invariance allows for an unbiased comparison of means, correlation coefficients, and path coefficients within structural equation modeling across groups.

Background: During the transition to parenthood, a complex network of relationships unfolds between father, mother and the child. Expectant parents begin bonding with their unborn child, with this antenatal process supposedly being predictive for later postnatal attachment and child mental health. At the same time, couples may experience a change in partnership quality. While the majority of previous studies focused on associations between psychopathology, partnership quality and attachment from the perspective of mothers, the changes in partnership quality and attachment from the perspective of fathers has gained far less attention.Methods: Data were derived from the Maternal Anxiety and it's Relation to Infants' Development (MARI) study. N = 109 expectant fathers were recruited during mid-pregnancy (22 to 26 week of gestation). Lifetime anxiety and depressive disorders (DSM-IV) were assessed with a standardized diagnostic interview (CIDI). Paternal partnership characteristics and father-to-child attachments were assessed using standardized questionnaires at the second trimester, 10 days after delivery and 4 months after delivery in N = 76 fathers. Analyses were based on bivariate, robust and multivariate regression analyses.Results: Fathers did not report an overall decrease in partnership quality during the peripartum period. However, fathers with comorbid anxiety and depressive disorders reported lower partnership satisfaction at postpartum, as compared to unaffected fathers. Fathers with pure depressive disorders reported lower intensity of antenatal attachment. Paternal antenatal partnership quality was positively associated with antenatal father-to-child attachment. Furthermore, antenatal father-to-child attachment, as well as ante- and postnatal partnership quality in fathers, were positively related to postnatal father-to-child attachment.Conclusions: Antenatal father-to-child-attachment and paternal partnership quality appear to be promising targets for the prevention of postnatal attachment problems in fathers. The associations between partnership quality and attachment to the child further support an interpersonal approach in perinatal research, treatment and intervention, and may also feed into awareness programs that encourage expectant fathers to actively engage in relationships as early as during pregnancy—both with the mother and the unborn child.

Ziel der retrospektiven Aufarbeitung war die Bestimmung der Sensitivität, Spezifität und Treffsicherheit der Galaktographie bezüglich des Nachweises einer intraduktalen Läsion. Zudem wurde überprüft, inwieweit die Galaktographie eine korrekte artdiagnostische Zuordnung erlaubt. Material und Methodik: Zugrunde gelegt wurden 207 Galaktogramme von 173 Patientinnen mit ein-oder beidseitiger Mamillensekretion. 105 Befunde wurden mittels Verlaufskontrollen über einen Zeitraum von mindestens 3 Jahren validisiert (Gruppe 1). Bei 102 Galaktogrammen lag eine histologische Sicherung des Befundes vor (Gruppe 2). Ergebnisse: Beide Gruppen zusammengefaßt ergaben eine Sensitivität von 95%, eine Spezifität von 87% und eine Treffsicherheit von 90%. Eine korrekte artdiagnostische Festlegung gelang für die Diagnosen "solitäres Papillom" in 18/28, und für "multiple Papillome" in 15/19 Fällen. "Duktale Karzinome" wurden in 9/12 Fällen richtig diagnostiziert. Schlußfolgerung: Die Galaktographie kann mit hoher Sicherheit eine intraduktale Läsion nachweisen oder ausschließen. Eine sichere artdiagnostische Zuordnung der Läsionen gelingt mittels Galaktographie häufig nicht. Dies ist jedoch ohne klinische Relevanz, da jede intraduktale Läsion operativ abgeklärt werden muß. Die vorgelegte Untersuchung untermauert, daß die Galaktographie auch 20 Jahre nach ihrer Einführung weiterhin berechtigter, integraler Bestandteil einer differenzierten Diagnostik der pathologischen Mammasekretion ist. Neuere Techniken wie Duktalsonographie und MRT müssen den Beweis ihrer Aussagekraft bei dieser Fragestellung erst noch antreten.

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