Jillon S. Vander Wal

Pilot study of a Web-based compliance monitoring device for patients with congestive heart failure

BACKGROUND Web-based home care monitoring systems can assess medication compliance, health status, quality of life, and physiologic parameters. They may help overcome some of the limitations associated with current congestive heart failure management models. OBJECTIVES This pilot study compared the effects of a self-care and medication compliance device, linked to a Web-based monitoring system, to the effects of usual care alone on compliance with recommended self-care behaviors; medication taking; quality of life; distance walked during a 6-minute walk test; and New York Heart Association Functional Class. We also assessed patient experiences living with the compliance device. METHODS We enrolled 18 patients with Functional Class II-III congestive heart failure in an urban VA Medical Center. The patients were randomized into 2 groups. Group A received usual care plus the compliance device. Group B (controls) received usual care only. Data were collected using the compliance device, the Heart Failure Self-Care Behavior Scale, pill counts, 6-minute walk test, and the Minnesota Living with Heart Failure Questionnaire at baseline and at 3 months follow-up. RESULTS At baseline and at 3 months, there were no differences between the compliance device group and the usual care group in self-care behaviors, pill counts, 6-minute walk-test distance, or Functional Class. However, quality of life improved significantly from baseline to 3-month follow-up (ANOVA, P =.006). This difference was due to an improvement in quality of life for the monitor group (P =.002) but not the usual care only group (P =.113). Patients in the compliance device group had a 94% medication compliance rate, 81% compliance with daily blood pressure monitoring, and 85% compliance with daily weight monitoring as compared to 51% for blood pressure monitoring and 79% for weight monitoring in the usual care group (P = NS). CONCLUSION These are promising pilot results that, if replicated in a larger sample, may significantly improve care and outcomes for patients with heart failure.

Eating and body image concerns among obese and average-weight children.

Research compared obese and average-weight children with regard to concerns about being or becoming overweight, history of dieting, concerns about the effects of eating food, and perceived discrepancy between real and ideal body image. Participants included 526 obese and average-weight elementary-age school children to whom questionnaires were administered. Gender (male/female), obesity status (obese/average-weight), and grade level (lower elementary/upper elementary) were considered. Obese children were significantly more likely to engage in dieting behaviors, to express concern about their weight, to restrain their eating, and to exhibit more dissatisfaction with their body image than average-weight children. Girls were more likely to exhibit these behaviors than were boys. These findings suggest the importance of studying the emergence of disordered eating habits in childhood.

Short-Term Effect of Eggs on Satiety in Overweight and Obese Subjects

Objective: To test the hypotheses that among overweight and obese participants, a breakfast consisting of eggs, in comparison to an isocaloric equal-weight bagel-based breakfast, would induce greater satiety, reduce perceived cravings, and reduce subsequent short-term energy intake. Subjects: Thirty women with BMI’s of at least 25 kg/M2 between the ages of 25 to 60 y were recruited to participate in a randomized crossover design study in an outpatient clinic setting. Design: Following an overnight fast, subjects consumed either an egg or bagel-based breakfast followed by lunch 3.5 h later, in random order two weeks apart. Food intake was weighed at breakfast and lunch and recorded via dietary recall up to 36 h post breakfast. Satiety was assessed using the Fullness Questionnaire and the State-Trait Food Cravings Questionnaire, state version. Results: During the pre-lunch period, participants had greater feelings of satiety after the egg breakfast, and consumed significantly less energy (kJ; 2405.6 ± 550.0 vs 3091.3 ± 445.5, Egg vs Bagel breakfasts, p < 0.0001), grams of protein (16.8 ± 4.2 vs 22.3 ± 3.4, Egg vs Bagel breakfasts, p < 0.0001), carbohydrate 83.1 ± 20.2 vs 110.9 ± 18.7, Egg vs Bagel breakfasts, p < 0.0001), and fat 19.4 ± 5.1 vs 22.8 ± 3.2, Egg vs Bagel breakfasts, p < 0.0001) for lunch. Energy intake following the egg breakfast remained lower for the entire day (p < 0.05) as well as for the next 36 hours (p < 0.001). Conclusions: Compared to an isocaloric, equal weight bagel-based breakfast, the egg-breakfast induced greater satiety and significantly reduced short-term food intake. The potential role of a routine egg breakfast in producing a sustained caloric deficit and consequent weight loss, should be determined.

The Cognitive Flexibility Inventory: Instrument Development and Estimates of Reliability and Validity

The cognitive flexibility inventory (CFI) was developed to be a brief self-report measure of the type of cognitive flexibility necessary for individuals to successfully challenge and replace maladaptive thoughts with more balanced and adaptive thinking. It was designed to measure three aspects of cognitive flexibility: (a) the tendency to perceive difficult situations as controllable; (b) the ability to perceive multiple alternative explanations for life occurrences and human behavior; and (c) the ability to generate multiple alternative solutions to difficult situations. The two studies presented in this manuscript describe the initial development of the CFI and a 7-week longitudinal study. Results from these studies indicate the CFI has a reliable two-factor structure, excellent internal consistency, and high 7-week test–retest reliability. Preliminary evidence was obtained for the CFI’s convergent construct validity via the CFI’s correlations with other measures of cognitive flexibility (Cognitive Flexibility Scale) and coping (Ways of Coping Checklist-Revised), respectively. Support was also demonstrated for the concurrent construct validity of the CFI via its correlation with the BDI-II. Further research is needed to investigate the reliability and validity of the CFI among clinical populations.

Psychological Complications of Pediatric Obesity

Psychological complications associated with pediatric obesity include low self-esteem, depression, body dissatisfaction, loss-of-control eating, unhealthy and extreme weight control behaviors, impaired social relationships, obesity stigma, and decreased health-related quality of life. Bioecological models offer a framework for understanding the interaction between pediatric obesity and psychological complications and illustrate system-level approaches for prevention and intervention. As the medical setting is often the first point of contact for families, pediatricians are instrumental in the identification and referral of children with psychological complications. Motivational interviewing, patient talking points, brief screening measures, and referral resources are important tools in this process.

The effects of social support and coping on the relationship between social anxiety and eating disorders

The current study examined the hypotheses that social support and coping moderate and or mediate the relationship between a broad and a narrow form of social anxiety and eating disorder symptoms. One hundred sixty-nine female undergraduates at a private Midwestern university, completed measures of social support, coping, social anxiety, fear of negative evaluation, and disordered eating attitudes and behaviors. Results of hierarchical multiple regression analyses indicated that higher levels of social support are associated with a weaker association between social anxiety and eating disorder symptomatology. Low use of task- and avoidant-oriented (distraction) coping and increased use of emotion-oriented coping are associated with a stronger association between social anxiety and eating disorder symptomatology. Implications for research and clinical intervention are discussed.

Night eating syndrome: A critical review of the literature☆

Clinical psychologists are increasingly called to participate in the treatment of obesity, a condition that affects about one-third of adults in the United States. A disorder gaining increased recognition for its role in the development and maintenance of obesity is Night Eating Syndrome (NES), a relatively novel disorder involving morning anorexia, evening hyperphagia and/or nocturnal ingestions, and insomnia. NES affects men and women from various racial groups and tends to run in families. NES tends to co-occur with mood, anxiety, eating, sleep, and substance use disorders and may have implications for weight and diabetes management. Relatively little is known about the successful treatment of NES. Limited evidence suggests that serotonergic-based pharmacological treatments may be beneficial. Psychological interventions, such as psychoeducation, eating modification, relaxation strategies, sleep hygiene, cognitive restructuring, physical activity, and social support facilitation may also yield beneficial results. The purpose of the present paper is to provide an introduction to NES, including diagnosis, clinical presentation, assessment, comorbidities, clinical implications, and pharmacological and psychological treatment approaches. Areas for further study and development are discussed. NES is an emerging area for clinical description, evaluation, and intervention.

Evening Ready-to-Eat Cereal Consumption Contributes to Weight Management

Objectives: Post dinner snacking may constitute a significant proportion of total daily energy intake and contribute to overweight and obesity in some individuals (night snackers). This study tested the hypothesis that providing a structured snack in the form of a “ready-to-eat” breakfast cereal would help regulate excess energy intake and contribute to weight loss in night snackers. Methods: Adults (18 to 65 years of age, BMI kg/m2 ≥ 25), with self-reported night snacking behaviors, were randomized into a cereal group (CR) and a no-cereal group (NC). During a period of 4 weeks, the cereal group was instructed to consume a serving of ready-to-eat cereal with low-fat milk 90 minutes after their evening meal. Concurrently, the non-cereal group continued their regular diet ad libitum. Results: At baseline, there were no significant differences between groups for age, body weight, body mass index, daily caloric intake, or evening caloric intake. There was a correlation between number of days of compliance with post-dinner cereal consumption and weight loss (r = −0.36, p = 0.057). After 4 weeks, the compliant subjects (cereal intake ≥ 20 d) lost −1.85 ± 3.56 lbs vs. −0.39 ± 3.1 lb for the NC group (p = 0.06). Compared to baseline, the compliant CR group reduced their total daily caloric intake by −396.50 ± 641.6 kcal (p < 0.02), whereas, the NC group experienced a reduction of −23.22 ± 889.60 kcal/day during the same period (p = ns). Reduction in post-dinner calorie intake for the compliant CR group was significantly greater compared to the NC group (−141.74 ± 385.58 kcal vs. 85.82 ± 374.70 kcal; p = 0.042). Conclusion: Eating ready-to-eat cereal after the evening meal may attenuate caloric intake in night snackers and promote weight loss in compliant individuals.

Unhealthy weight control behaviors among adolescents.

This article examined moderators of the association between BMI and unhealthy weight control behaviors suggested by the Dual Pathway Model among 4,529 adolescents from the Health Behavior in School-Aged Children survey. An obese classification was associated with unhealthy weight control behaviors for boys and girls. Low life satisfaction, high negative affect, and body size dissatisfaction were associated with unhealthy weight control behaviors among boys as was low life satisfaction for girls. Among girls, healthy weight classification, coupled with low negative affect or body size satisfaction, was protective against unhealthy weight control behaviors. Improved self-care may decrease obesity and unhealthy weight control behaviors.This article examined moderators of the association between BMI and unhealthy weight control behaviors suggested by the Dual Pathway Model among 4,529 adolescents from the Health Behavior in School-Aged Children survey. An obese classification was associated with unhealthy weight control behaviors for boys and girls. Low life satisfaction, high negative affect, and body size dissatisfaction were associated with unhealthy weight control behaviors among boys as was low life satisfaction for girls. Among girls, healthy weight classification, coupled with low negative affect or body size satisfaction, was protective against unhealthy weight control behaviors. Improved self-care may decrease obesity and unhealthy weight control behaviors.

Examining health-related quality of life, adaptive skills, and psychological functioning in children and adolescents with epilepsy presenting for a neuropsychological evaluation

The purpose of this study was to characterize 132 children and adolescents (mean age = 10 years, 11 months) with epilepsy in terms of psychosocial functioning and to determine the extent to which adaptive skills and psychological functioning predict health-related quality of life (HRQOL), above and beyond demographic and epilepsy-specific characteristics. A chart review was conducted to obtain demographic and epilepsy-specific information as well as caregiver responses on the Behavior Assessment System for Children, Second Edition (BASC-2) Parent Report and the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). In addition to Full Scale IQ and age at seizure onset, the BASC-2 Clinical and Adaptive Skills subscales also predicted HRQOL, indicating that this measure may be particularly helpful in predicting HRQOL above and beyond information routinely collected in a medical setting. It is imperative to evaluate children with epilepsy for psychosocial difficulties and diminished HRQOL to ensure the provision of comprehensive quality care and intervention services.