Who should manage care? The case for providers

Health care professionals should be the ones to make allocation decisions in the managed care setting because they are in the best position to assess outcomes, cost effectiveness, and quality of care.     

Maintenance of weight loss after obesity treatment: is continuous support necessary?

OBJECTIVE: This study examined outcome differences of 109 obese subjects, who participated in a 10-week cognitive-behavioral inpatient treatment followed by either a weight maintenance program or a follow-up period without professional support. METHODS: Self-rated weight loss, eating behaviors, and general psychopathology were assessed several months before treatment, when subjects were admitted, at discharge, and at the 6-, 12-, and 18-month follow-ups. Structured interviews for mental disorders and eating pathology were conducted additionally. RESULTS: The mean weight of the sample at baseline was 127 kg. Weight loss of the total sample amounted to 8.0 kg (6.3%) and was completely maintained during the follow-up period. Significant reductions of eating and general psychopathology were observed at the 18-month follow-up. The outcome in the maintenance condition did not significantly differ from the outcome in the control condition. CONCLUSIONS: Weight regain after obesity treatment is not inevitable, but continuous patient-therapist contacts do not distinctly improve treatment effects.     

Overweight and obese men’s experiences in a sport-based weight loss intervention for men

In Western countries, such as Australia and the UK, a significantly greater proportion of men (relative to women) are overweight and obese, yet relatively few weight loss interventions have been developed that sufficiently target men. This lack of male-focused programming may be in part because ‘traditional’ weight loss programs are unappealing for what is considered a ‘hard-to-reach’ population. One program that appears to have such appeal for men is the MAN v FAT Football (MVFF) program, based out of the United Kingdom, which is designed for men with a body mass index of (or greater than) 27.5. MVFF encourages men’s participation in a community-based weight loss program that incentivizes weight loss through participation in a football league, and since 2016 MVFF has supported the weight loss efforts of several thousand men. Using MVFF as an exemplar, our aim was to derive insight into how men experience a male-only competitive, sport-based weight loss program. We recruited twenty-seven players (Mage = 41.13, SD = 9.93), and ten coaches (Mage = 31.8, SD = 11.55) from program locations throughout the United Kingdom. Using semi-structured interviews and thematic analysis, we identified several appraisal aspects of the program that players and coaches considered important, including the appeal of sport, competition on a level playing field, being part of a team, camaraderie, accountability, men sharing issues with other men, gender-sensitized environment, likeminded and similar men, and perceptions that traditional weight loss programs are tailored towards women. Player experiences (i.e., competence and enjoyment) and functional supports in the program (e.g., player handbook, weight loss coach) were reported to drive outcomes of effective weight loss and program retention. Interventions aiming to target men may be more successful working with rather than against formulations of identity such as masculinities, and this can be achieved by tailoring program content (e.g., messaging), settings (e.g., among men sharing similar characteristics such as body-type or goals), and mode of delivery (e.g., through organized sports, and leveraging competition to drive healthy behaviours).     

Should We Treat Depression with drugs or psychological interventions? A Reply to Ioannidis

We reply to the Ioannidis's paper "Effectiveness of antidepressants; an evidence based myth constructed from a thousand controlled trials." We disagree that antidepressants have no greater efficacy than placebo. We present the efficacy from hundreds of trials in terms of the percentage of patients with a substantial clinical response (a 50% improvement or more symptomatic reduction). This meta-analysis finds that 42-70% of depressed patients improve with drug and 21%-39% improve with placebo. The response benefit of antidepressant treatment is 33%-11% greater than placebo. Ioannidis argues that it would be vanishingly smaller because systematic biasing in these clinical trials would reduce the drug-placebo difference to zero. Ioannidis' argument that antidepressants have no benefit is eroded by his failures of logic because he does not present any evidence that there are a large number of studies where placebo is substantially more effective than drug. (To reduce to zero, one would also have to show that some of the unpublished studies find placebo better than drug and have substantial systematic or methodological bias). We also present the empirical evidence showing that these methodological concerns generally have the opposite effect of what Ioannidis argues, supporting our contention that the measured efficacy of antidepressants likely underestimates true efficacy. Our most important criticism is Ioannidis’ basic underlying argument about antidepressants that if the existing evidence is imperfect and methods can be criticized, then this proves that antidepressant are not efficacious. He presents no credible evidence that antidepressants have zero effect size. Valid arguments can point out difficulties with the data but do not prove that a given drug had no efficacy. Indeed better evidence might prove it was more efficacious that originally found. We find no empirical or ethical reason why psychiatrists should not try to help depressed patients with drugs and/or with psychotherapeutic/behavioral treatments given evidence of efficacy even though our treatment knowledge has limitations. The immense suffering of patients with major depression leads to ethical, moral, professional and legal obligations to treat patients with the best available tools at our disposal, while diligently and actively monitoring for adverse effects and actively revising treatment components as necessary.     

Should We Have Children? A Decision-Making Group for Couples

The authors designed and conducted a group for couples deciding whether to have children or remain childfree. Four couples participated in various group exercises and activities. The group experience was positive for most members; in relation to this decision they gained an understanding of their own needs and attitudes, of their spouses' positions, and of the issues involved. Outcomes varied: One couple decided to wait to make the decision, two decided to have children later, and one decided to probably remain childfree.     

Are we pushing the limits of public health interventions for smoking cessation?

The phenomenon of smoking cessation that takes place outside formal programs, which serve a small proportion of smokers, is an important public health issue. Self-help strategies represent an approach to potentially cost-effective smoking intervention that can be conveniently used by large groups of smokers. In this issue of Health Psychology, Gritz, Berman, Bastani, and Wu (1992) demonstrate that the mailing of self-help smoking cessation materials to nonvolunteer women in a health maintenance organization, without any personal contact, produces little behavior change beyond what occurs in the environment without such distribution. This outcome is not surprising and does not illiminate the possibility of efficacious use of self-help materials with a nonvolunteer population. An essential question is: Could these materials have been distributed in such a way as to increase their use and eventual efficacy? Efforts to attract more smokers to use existing materials are an essential element of self-help strategies. An effective public health approach is a comprehensive one that successfully engages the individual and, through multiple channels in the community, provides reinforcement, supports, and norms for not smoking.     

Atheism in religious clothing? Accounting for atheist interventions in the public sphere

In this paper I review several recent attempts to recast atheism in religious form in Canada, the US and the UK. First, several atheists have argued for the redefinition of atheism as a creed deserving of religious protections from the state. Second, various atheist ‘churches’ have gained publicity in recent years, in part due to their appropriation of the Protestant church format and the rhetoric of religious association. Both of these expressions of atheism stand in marked contradiction to older forms of atheism which emerged in response to (and rejection of) Christianity in the West, and they also stand in contrast to popular forms of atheism today, of the kind espoused by Christopher Hitchens and Richard Dawkins. As a result, the cases reviewed here represent the ways in which contemporary atheist movements constitute several different counterpublics, and they mark a significant change in the state’s acknowledgement of atheism as a positive form of belief.     

Why is it so hard to change? The role of self-integrity threat and affirmation in weight loss

People are frequently dissatisfied with their body weight. Messages alleging that lower weight is esthetically preferable, healthier, and achievable likely trigger chronic self-integrity threat, the sense that one's personal adequacy is in doubt. We examined whether self-integrity threat, which creates stress and pressure to restore self-integrity, contributes to the challenges of weight and behavior change. Weight-dissatisfied women completed in-lab tasks including a values affirmation manipulation and two-month follow-up. Affirmed women lost weight relative to controls, replicating previous research. Effects were primarily among those with higher initial body masses. Affirmed higher-weighted women also ate more healthful foods compared to unhealthful foods in self-reports and observation. Affirmed participants reported increased exercise, and an exploratory measure showed that their cortisol awakening responses synchronized with their coping needs, suggesting more adaptive physiological function. Results suggest that self-integrity threat is an under-recognized barrier to change, and reducing it can support healthy changes.     

Should I test more babies? Solutions for transparent data peeking

Research with infants is often slow and time-consuming, so infant researchers face great pressure to use the available participants in an efficient way. One strategy that researchers sometimes use to optimize efficiency is data peeking (or “optional stopping”), that is, doing a preliminary analysis (whether a formal significance test or informal eyeballing) of collected data. Data peeking helps researchers decide whether to abandon or tweak a study, decide that a sample is complete, or decide to continue adding data points. Unfortunately, data peeking can have negative consequences such as increased rates of false positives (wrongly concluding that an effect is present when it is not). We argue that, with simple corrections, the benefits of data peeking can be harnessed to use participants more efficiently. We review two corrections that can be transparently reported: one can be applied at the beginning of a study to lay out a plan for data peeking, and a second can be applied after data collection has already started. These corrections are easy to implement in the current framework of infancy research. The use of these corrections, together with transparent reporting, can increase the replicability of infant research.     

Predatory Journals Spamming for Publications: What Should Researchers Do?

In the internet era spam has become a big problem. Researchers are troubled with unsolicited or bulk spam emails inviting them to publish. However, this strategy has helped predatory journals hunt their prey and earn money. These journals have grown tremendously during the past few years despite serious efforts by researchers and scholarly organizations to hinder their growth. Predatory journals and publishers are often based in developing countries, and they potentially target researchers from these counties by using different tactics identified in previous research. In response to the spread of predatory publishing, scientists are trying to develop criteria and guidelines to help avoid them—for example, the recently reported “predatory rate”. This article attempts to (a) highlight the strategies used by predatory journals to convince researchers to publish with them, (b) report their article processing charges, (c) note their presence in Jeffrey Beall’s List of Predatory Publishers, (d) rank them based on the predatory rate, and (e) put forward suggestions for junior researchers (especially in developing counties), who are the most likely targets of predatory journals.     

Behavioural interventions for micro-mobility adoption: Low-hanging fruits or hard nuts to crack?

This study explores the potential and challenges of applying behavioural interventions to promote micro-mobility adoption. Our online experiments with New York City residents showed that nudges and faming improved respondents’ willingness to adopt e-scooters significantly. Moreover, our experiments spanned over the pre-, during- and post- COVID-19 lockdown period in New York City. Findings from this natural experiment revealed that the effect of these behavioural interventions varied significantly during the pandemic, likely due to a heightened level of health consciousness and a new perspective regarding social interactions. Behavioural tools cannot be taken off-the-shelf and applied as a blanket policy. Individual and group characteristics have to be assessed to devise the pre-eminent behavioural interventions for a particular target audience. More experiments across a wide range of economic, social, cultural, and political settings are needed to guide the application of behavioural interventions in transportation studies.     

Ghosted?: Navigating strategies for reducing uncertainty and implications surrounding ambiguous loss

Ghosting is the unilateral dissolution process of ceasing communication through media. When ghosted, non‐initiators are often left without the ability to navigate the resulting uncertainty or impending dissolution processes. Utilizing uncertainty reduction theory and ambiguous loss, this investigation explores effective and ineffective strategies used to find answers, reduce uncertainty, and navigate post‐dissolution consequences. Employing two studies from Amazon's Mechanical Turk, a thematic analysis to delineate and affirm categories—7 effective and ineffective strategies and 11 categories of personal and relational implications after being ghosted—was used. These studies provide insight about non‐initiators process to resolve their uncertainty and highlight ramifications from ambiguity that non‐initiators experience after being ghosted. These findings discuss connections to knowledge acquisition, closure processing, and consequences of ghosting.     

Group support interventions for women with breast cancer: who benefits from what?

Research on the benefits of social support groups has been inconclusive. One reason is that individual differences in intervention responses have rarely been examined. The authors determined the extent to which individual difference variables moderated the effects of an information-based educational group and an emotion-focused peer discussion group on the mental and physical functioning of women with breast cancer (n = 230). The authors administered the SF-36 (S.E. Ware, K.K. Snow, M. Kosinski, & B. Gandek, 1993), a multidimensional quality of life instrument, pre- and postintervention. Educational groups showed greater benefits on the physical functioning of women who started the study with more difficulties compared with less difficulties (e.g., lacked support or fewer personal resources). Peer discussion groups were helpful for women who lacked support from their partners or physicians but harmful for women who had high levels of support. Implications of these results for clinical interventions are discussed.