Publications by authors named "Karin Eli"

41 Publications

How active can preschoolers be at home? Parents' and grandparents' perceptions of children's day-to-day activity, with implications for physical activity policy.

Soc Sci Med 2022 Jan 6;292:114557. Epub 2021 Nov 6.

Unit for Biocultural Variation and Obesity, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.

Background: The importance of physical activity in early childhood for establishing long-term health is well understood, yet with the exception of recent WHO guidelines, public health initiatives rarely focus on children below school age. Moreover, little is known about how domestic spaces and day-to-day caring activities influence preschool-age children's physical activity. To examine this, we explore caregivers' perceptions of young children's activities within and outside the home, and we consider how lived experiences of caregiving align (or not) with current physical activity policy.

Methods: Semi-structured interviews with 49 parents and grandparents from 16 families were conducted in Oregon, USA; each family had a child aged 3-5 years. Questions focused on caregivers' perceptions of and involvement with children's body weights, activities, and food practices. The interviews were analysed using thematic analysis. Our analysis drew on a materialities framework, attending to relationships between children, caregivers, spaces in and around the home, and everyday activities.

Results: Four themes were developed: appropriateness of outside versus inside spaces for physical activity; making accommodations for physical activity in the home; active spaces of care, referring to relationships among space, activity type, and caregiver attention; and mundane movement, or the low-intensity movement of everyday life. Together, the results highlight that children's day-to-day activities cut across a spectrum of movement, mediated by available spaces and caregiving affordances.

Conclusions: Attending to the full spectrum of children's movements highlights how children's activities interlink with family routines, available indoor and outdoor spaces, and the intended uses of these spaces. These interplays between space, care, and physical activity enacted at the household level should inform an integrated, systems-level public health approach to increasing health and well-being for preschool-age children. Suggestions for improvement include coordinating policy development across multiple fields (e.g., housing design, urban planning) that structure the activities of children and their caregivers across 'home' and 'outside' spaces.
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http://dx.doi.org/10.1016/j.socscimed.2021.114557DOI Listing
January 2022

How Do Interpersonal Relationships Affect Children's Weight Management? A Qualitative Analysis of Parents' Long-Term Perceptions after Obesity Treatment.

Child Obes 2021 Nov 12. Epub 2021 Nov 12.

Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden.

Childhood obesity interventions are particularly effective during the preschool age, but little is known about parents' long-term perceptions of weight management. This study explores how parents perceive the influence of interpersonal relationships on their children's eating and physical activity 4 years after participating in a randomized controlled trial. Bronfenbrenner's ecological systems theory frames this study, with the child's environment conceptualized as interlocking microsystems that affect weight management. Interviews were conducted with 33 parents (85% mothers, 48% with university degree) of 33 children [mean age 9.3 (standard deviation 0.7), 46% girls] from Stockholm, Sweden. Interviews were analyzed using thematic analysis, focusing on parents' perceptions of interpersonal relationships: family, relatives, other children, preschool/school staff, and health care practitioners. Two main themes were developed: (1) , with the subthemes and , and (2) , with the subthemes and . Parents perceived children's weight management as a continuous orchestration of different influences across social spheres. Years after obesity treatment, parents struggled to maintain the child's healthy routines outside the home. However, when siblings, grandparents, teachers, and friends' parents acted supportively, routines were easier to maintain. The findings suggest that each microsystem in a child's environment has important influence on weight management, such that, as children grow older, children's lifestyles cannot be managed by parents alone. To facilitate weight management, more people in the child's environment should be involved early in the treatment process, and continued professional support should be offered to parents.
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http://dx.doi.org/10.1089/chi.2021.0156DOI Listing
November 2021

Associations of preschoolers' dietary patterns with eating behaviors and parental feeding practices at a 12-month follow-up of obesity treatment.

Appetite 2022 01 2;168:105724. Epub 2021 Oct 2.

Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden; Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Electronic address:

Although dietary patterns are key to the management of childhood obesity, they are rarely assessed and thus poorly understood. This study examines preschoolers' dietary patterns and correlates 12 months after the start of obesity treatment (n = 99, mean age 5.2 years, 52% girls). A food frequency questionnaire (FFQ), the Child Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire (CFQ) and Lifestyle Behavior Checklist (LBC) were answered by parents to assess children's food intake, eating behaviors, parental feeding practices, and obesity-related behaviors, respectively. Principal component analysis identified dietary patterns based on FFQ data. Through multiple linear regressions we examined correlations between a healthy (HD) and a less healthy (LHD) dietary pattern and mean scores of the CEBQ, CFQ, LBC scales as well as BMI z-scores. The reported intake of items in the LHD decreased after treatment while no differences were found for the HD. Children's eating behaviors, in particular food fussiness, showed consistent associations with diet (b = -0.39, 95% CI -0.63, -0.14 for HD and b = 0.41, 95% CI 0.15, 0.66 for LHD). Feeding practices and obesity-related behaviours were weakly associated with the dietary patterns (HD and Monitoring: b = 0.36, 95% CI 0.09, 0.62; LHD and Screen time b = 0.08, 95% CI 0.01, 0.15). Among the measured variables, eating behaviors had the largest impact on children's dietary patterns. The LHD was associated with a higher BMI z-score but no associations were found between changes in LHD intake and changes in BMI z-scores. Our findings suggest that decreasing food fussiness in children with obesity is key to positive dietary changes. Assessment of children's eating behaviors can help tailor dietary advice and provide support for families of children with obesity.
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http://dx.doi.org/10.1016/j.appet.2021.105724DOI Listing
January 2022

Parenting and childhood obesity: Validation of a new questionnaire and evaluation of treatment effects during the preschool years.

PLoS One 2021 23;16(9):e0257187. Epub 2021 Sep 23.

Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.

Objectives: Parenting is an integral component of obesity treatment in early childhood. However, the link between specific parenting practices and treatment effectiveness remains unclear. This paper introduces and validates a new parenting questionnaire and evaluates mothers' and fathers' parenting practices in relation to child weight status during a 12-month childhood obesity treatment trial.

Methods: First, a merged school/clinical sample (n = 558, 82% mothers) was used for the factorial and construct validation of the new parenting questionnaire. Second, changes in parenting were evaluated using clinical data from the More and Less Study, a randomized controlled trial (RCT) with 174 children (mean age = 5 years, mean Body Mass Index Standard Deviation Score (BMI SDS) = 3.0) comparing a parent support program (with and without booster sessions) and standard treatment. Data were collected at four time points over 12 months. We used linear mixed models and mediation models to investigate associations between changes in parenting practices and treatment effects.

Findings: The validation of the questionnaire (9 items; responses on a 5-point Likert scale) revealed two dimensions of parenting (Cronbach's alpha ≥0.7): setting limits to the child and regulating one's own emotions when interacting with the child, both of which correlated with feeding practices and parental self-efficacy. We administered the questionnaire to the RCT participants. Fathers in standard treatment increased their emotional regulation compared to fathers in the parenting program (p = 0.03). Mothers increased their limit-setting regardless of treatment allocation (p = 0.01). No treatment effect was found on child weight status through changes in parenting practices.

Conclusion: Taken together, the findings demonstrate that the new questionnaire assessing parenting practices proved valid in a 12-month childhood obesity trial. During treatment, paternal and maternal parenting practices followed different trajectories, though they did not mediate treatment effects on child weight status. Future research should address the pathways whereby maternal and paternal parenting practices affect treatment outcomes, such as child eating behaviors and weight status.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257187PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8459975PMC
November 2021

"Writing nutritionistically": A critical discourse analysis of lay people's digital correspondence with the Swedish Food Agency.

Health (London) 2021 Sep 20:13634593211038533. Epub 2021 Sep 20.

Uppsala University, Sweden.

This article analyzes lay people's use of nutritionistic discourse in written correspondence with the Swedish Food Agency, an authority responsible for dietary advice. Examining 60 food related written digital messages, we apply a critical discourse analysis to parse the lexical items and grammar people use when constructing "food" in scientific terms. The findings show how message writers place nutrients at the discursive center. Message writers' grammatical constructions instrumentalize food and eating. This is reinforced by the message writers' frequent use of terms that indicate preciseness, such as numbers and amounts. Messages therefore emphasize the what, but not the how, of eating, implying a focus on food as subject to regulation and control. As such, eating is discursively reduced to an act of ingesting nutrients that can be decontextualized and managed in isolation-as entities to increase or avoid separately. These discursive features preclude the conceptualization of food choice and eating as subjective experiences of feelings, taste, and tradition.
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http://dx.doi.org/10.1177/13634593211038533DOI Listing
September 2021

Assessing the quality of ReSPECT documentation using an accountability for reasonableness framework.

Resusc Plus 2021 Sep 29;7:100145. Epub 2021 Jul 29.

Warwick Medical School, University of Warwick, UK.

Background: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form, which supports the ReSPECT process, is designed to prompt clinicians to discuss wider emergency treatment options with patients and to structure the documentation of decision-making for greater transparency.

Methods: Following an accountability for reasonableness framework (AFR), we analysed 141 completed ReSPECT forms (versions 1.0 and 2.0), collected from six National Health Service (NHS) hospitals in England during the early adoption of ReSPECT. Structured through an evaluation tool developed for this study, the analysis assessed the extent to which the records reflected consistency, transparency, and ethical justification of decision-making.

Results: Recommendations relating to CPR were consistently recorded on all forms and were contextualised within other treatment recommendations in most forms. The level of detail provided about treatment recommendations varied widely and reasons for treatment recommendations were rarely documented. Patient capacity, patient priorities and preferences, and the involvement of patients/relatives in ReSPECT conversations were recorded in some, but not all, forms. Clinicians almost never documented their weighing of potential burdens and benefits of treatments on the ReSPECT forms.

Conclusion: In most ReSPECT forms, CPR recommendations were captured alongside other treatment recommendations. However, ReSPECT form design and associated training should be modified to address inconsistencies in form completion. These modifications should emphasise the recording of patient values and preferences, assessment of patient capacity, and clinical reasoning processes, thereby putting patient/family involvement at the core of good clinical practice. Version 3.0 of ReSPECT responds to these issues.
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http://dx.doi.org/10.1016/j.resplu.2021.100145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340300PMC
September 2021

Making Childhood Obesity a Priority: A Qualitative Study of Healthcare Professionals' Perspectives on Facilitating Communication and Improving Treatment.

Front Public Health 2021 15;9:652491. Epub 2021 Jul 15.

Department of Microscopic Morphology Genetics Discipline, Center of Genomic Medicine, Regional Center of Medical Genetics Timis, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania.

In Romania, one in four children has excess weight. Because childhood obesity is a sensitive topic, many healthcare professionals find it difficult to discuss children's excess weight with parents. This study aims to identify barriers and facilitators in childhood obesity-related communication, as perceived by healthcare professionals in Romania. As part of the STOP project, healthcare professionals (family physicians, pediatricians, and dieticians) who treat children with excess weight were invited to a telephone interview. The semi-structured questions were translated from a questionnaire previously used at the Swedish study site of the STOP project. Interviews were transcribed and then used for thematic analysis. Fifteen doctors and three dieticians (16 females and 2 males), with average 18.2 ± 10.1 years of experience, were interviewed. Four main themes were identified. Professionals reported that when children began experiencing obesity-related stigma or comorbidities, this became the tipping point of weight excess, where parents felt motivated to begin treatment. Barriers in communication were part of several layers of distrust, recognized as tension between professionals and caregivers due to conflicting beliefs about excess weight, as well as lack of trust in medical studies. Most respondents felt confident using models of good practice, consisting of a gentle approach and patient-centered care. Nonetheless, professionals noted systemic barriers due to a referral system and allocation of clinical time that hinder obesity treatment. They suggested that lack of specialized centers and inadequate education of healthcare professional conveys the system does not prioritize obesity treatment and prevention. The interviewed Romanian doctors and dieticians identified patient-centered care as key to treating children with obesity and building trust with their caregivers. However their efforts are hindered by healthcare system barriers, including the lack of specialized centers, training, and a referral system. The findings therefore suggest that, to improve childhood obesity prevention and treatment, systemic barriers should be addressed. ClinicalTrials.gov, NCT03800823; 11 Jan 2019.
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http://dx.doi.org/10.3389/fpubh.2021.652491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321411PMC
August 2021

General practitioners' experiences of emergency care and treatment planning in England: a focus group study.

BMC Fam Pract 2021 06 24;22(1):128. Epub 2021 Jun 24.

Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK.

Background: Emergency Care and Treatment Plans are recommended for all primary care patients in the United Kingdom who are expected to experience deterioration of their health. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was developed to integrate resuscitation decisions with discussions about wider goals of care. It summarises treatment recommendations discussed and agreed between patients and their clinicians for a future emergency situation and was designed to meet the needs of different care settings. Our aim is to explore GPs' experiences of using ReSPECT and how it transfers across the primary care and secondary care interface.

Methods: We conducted five focus groups with GPs in areas being served by hospitals in England that have implemented ReSPECT. Participants were asked about their experience of ReSPECT, how they initiate ReSPECT-type conversations, and their experiences of ReSPECT-type recommendations being communicated across primary and secondary care. Focus groups were transcribed and analysed using Thematic Analysis.

Results: GPs conceptualise ReSPECT as an end of life planning document, which is best completed in primary care. As an end of life care document, completing ReSPECT is an emotional process and conversations are shaped by what a 'good death' is thought to be. ReSPECT recommendations are not always communicated or transferable across care settings. A focus on the patient's preferences around death, and GPs' lack of specialist knowledge, could be a barrier to completion of ReSPECT that is transferable to acute settings.

Conclusion: Conceptualising ReSPECT as an end of life care document suggests a difference in how general practitioners understand ReSPECT from its designers. This impacts on the transferability of ReSPECT recommendations to the hospital setting.
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http://dx.doi.org/10.1186/s12875-021-01486-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224258PMC
June 2021

Material Environments and the Shaping of Anorexic Embodiment: Towards A Materialist Account of Eating Disorders.

Cult Med Psychiatry 2021 Apr 7. Epub 2021 Apr 7.

Institute of Applied Health Research, Institute for Mental Health, University of Birmingham, Birmingham, B15 2TT, UK.

Anorexia nervosa is a paradoxical disorder, regarded across disciplines as a body project and yet also an illness of disembodied subjectivity. This overlooks the role that material environments-including objects and spaces-play in producing embodied experiences of anorexia both within and outside treatment. To address this gap, this paper draws together two ethnographic studies of anorexia to explore the shared themes unearthed by research participants' engagements with objects that move across boundaries between treatment spaces and everyday lives. Demonstrating how the anorexic body is at once both phenomenologically lived and socio-medically constituted, we argue that an attention to materiality is crucial to understanding lived experiences. A materialist account of anorexia extends the literature on treatment resistance in eating disorders and offers a reconceptualisation of 'the body in treatment', showing how  objects and spaces shape, maintain, and even 'trigger' anorexia. Therefore, against the background of the high rates of relapse in eating disorders, this analysis calls for consideration of how interventions can better take account of eating disordered embodiment as shaped by material environments.
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http://dx.doi.org/10.1007/s11013-021-09715-8DOI Listing
April 2021

Childhood memories of food and eating in lower-income families in the United States: a qualitative study.

BMC Public Health 2021 03 24;21(1):586. Epub 2021 Mar 24.

Department of Food Studies, Nutrition and Dietetics, Uppsala University, SE-751 22, Uppsala, Sweden.

Background: Childhood obesity prevention initiatives emphasize healthy eating within the family. However, family-focused initiatives may not benefit children whose families lack economic and/or social resources for home cooking and shared meals. The aim of this paper is to examine how adults talk about and make sense of childhood memories of food and eating, with particular attention to understandings of family life and socioeconomic conditions.

Methods: Semi-structured interviews with 49 adults in 16 families (22 parents and 27 grandparents of young children) were conducted in Oregon, United States. Most participants had experienced socioeconomically disadvantaged childhoods. The interviews were analyzed using thematic analysis, with a focus on the participants' memories of food provision, preparation, and consumption in their childhood homes.

Results: Two main themes were developed: (1) "Food and cohesion", with the subthemes "Care and nurturance" and "Virtue transmission through shared meals", and (2) "Food and adversity", with the subthemes "Lack and neglect" and "Restriction and dominance". The first theme captures idealized notions of food in the family, with participants recounting memories of care, nurturance, and culinary pleasure. The second theme captures how participants' recollections of neglectful or rigidly restrictive feeding, as well as food discipline tipping over into dominance, upend such idealized images. Notably, the participants alternately identified poverty as a source of lack and as an instigator of creative and caring, if not always nutritionally-ideal, feeding. Thus, they remembered food they deemed unhealthy as a symbol of both neglect and care, depending on the context in which it was provided.

Conclusions: Childhood memories of food and eating may express both family cohesion and family adversity, and are deeply affected by experiences of socioeconomic disadvantage. The connection between memories of food the participants deemed unhealthy and memories of care suggests that, in the context of socioeconomic disadvantage, unhealthy feeding and eating may become a form of caregiving, with nutrition considered only one aspect of well-being. This has implications for public health initiatives directed at lower-income families.
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http://dx.doi.org/10.1186/s12889-021-10533-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992930PMC
March 2021

Why, when and how do secondary-care clinicians have emergency care and treatment planning conversations? Qualitative findings from the ReSPECT Evaluation study.

Resuscitation 2021 05 19;162:343-350. Epub 2021 Jan 19.

Warwick Medical School, University of Warwick, UK.

Background: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an emergency care and treatment planning (ECTP) process, developed to offer a patient-centred approach to deciding about and recording treatment recommendations. Conversations between clinicians and patients or their representatives are central to the ReSPECT process. This study aims to understand why, when, and how ReSPECT conversations unfold in practice.

Methods: ReSPECT conversations were observed in hospitals within six acute National Health Service (NHS) trusts in England; the clinicians who conducted these conversations were interviewed. Following observation-based thematic analysis, five ReSPECT conversation types were identified: resuscitation and escalation; confirmation of decision; bad news; palliative care; and clinical decision. Interview-based thematic analysis examined the reasons and prompts for each conversation type, and the level of detail and patient engagement in these different conversations.

Results: Whereas resuscitation and escalation conversations concerned possible futures, palliative care and bad news conversations responded to present-tense changes. Conversations were timed to respond to organisational, clinical, and patient/relative prompts. While bad news and palliative care conversations included detailed discussions of treatment options beyond CPR, this varied in other conversation types. ReSPECT conversations varied in doctors' engagement with patient/relative preferences, with only palliative care conversations consistently including an open-ended approach.

Conclusions: While ReSPECT supports holistic, person-centred, anticipatory decision-making in some situations, a gap remains between the ReSPECT's aims and their implementation in practice. Promoting an understanding and valuing of the aims of ReSPECT among clinicians, supported by appropriate training and structural support, will enhance ReSPECT conversations.
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http://dx.doi.org/10.1016/j.resuscitation.2021.01.013DOI Listing
May 2021

The role of parental depression during early childhood obesity treatment-Secondary findings from a randomized controlled trial.

Pediatr Obes 2021 06 8;16(6):e12754. Epub 2020 Dec 8.

Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.

Background: Parental depression is a risk factor for childhood obesity.

Objectives: To examine the influence of parental depression on child weight status, eating behaviours, and parental feeding practices during childhood obesity treatment.

Methods: Hundred and twenty eight children with obesity aged 4 to 6 years and their parents were randomized to a parent support program or to standard treatment. At baseline and after 12 months, children's heights and weights were measured. Parents reported levels of depression (Beck's Depression Inventory-II), feeding practices (Child Feeding Questionnaire), and children's eating behaviors (Child Eating Behavior Questionnaire). Independent and dependent paired sample t-tests and linear regressions were used to analyze data.

Results: After obesity treatment, mothers reported lower levels of depression, whereas fathers did not. No associations were found between parental level of depression and child weight status, or between baseline level of parental depression and feeding practices. Associations were found between baseline parental depression and children's food responsiveness (β = .03; P = .01; 95% CI [0.01, 0.05]), emotional overeating (β = .02; P = .02; 95% CI [0.004, 0.04]), and desire to drink (β = .02; P = .03; 95% CI [0.002, 0.04]) (adjusted for background variables).

Conclusions: Parental depression did not influence child weight status or parental feeding practices but was associated with obesity-related child eating behaviors.
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http://dx.doi.org/10.1111/ijpo.12754DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243967PMC
June 2021

A Codon Model for Associating Phenotypic Traits with Altered Selective Patterns of Sequence Evolution.

Syst Biol 2021 04;70(3):608-622

School of Plant Sciences and Food Security, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel.

Detecting the signature of selection in coding sequences and associating it with shifts in phenotypic states can unveil genes underlying complex traits. Of the various signatures of selection exhibited at the molecular level, changes in the pattern of selection at protein-coding genes have been of main interest. To this end, phylogenetic branch-site codon models are routinely applied to detect changes in selective patterns along specific branches of the phylogeny. Many of these methods rely on a prespecified partition of the phylogeny to branch categories, thus treating the course of trait evolution as fully resolved and assuming that phenotypic transitions have occurred only at speciation events. Here, we present TraitRELAX, a new phylogenetic model that alleviates these strong assumptions by explicitly accounting for the uncertainty in the evolution of both trait and coding sequences. This joint statistical framework enables the detection of changes in selection intensity upon repeated trait transitions. We evaluated the performance of TraitRELAX using simulations and then applied it to two case studies. Using TraitRELAX, we found an intensification of selection in the primate SEMG2 gene in polygynandrous species compared to species of other mating forms, as well as changes in the intensity of purifying selection operating on sixteen bacterial genes upon transitioning from a free-living to an endosymbiotic lifestyle.[Evolutionary selection; intensification; $\gamma $-proteobacteria; genotype-phenotype; relaxation; SEMG2.].
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http://dx.doi.org/10.1093/sysbio/syaa087DOI Listing
April 2021

'A holistic approach': incorporating sustainability into biopedagogies of healthy eating in Sweden's dietary guidelines.

Sociol Health Illn 2020 11 10;42(8):1785-1800. Epub 2020 Sep 10.

Warwick Medical School, University of Warwick, Warwick, UK.

Dietary guidelines can be considered a pedagogical tool, designed to promote healthy eating at the population level. In this study, we critically examine the biopedagogies implicated in Sweden's official dietary guidelines. Published in 2015, these guidelines take a potentially innovative 'holistic approach' to food and eating, addressing the challenge of formulating dietary advice that considers both human health and environmental concerns. Applying Bacchi´s 'What's the problem represented to be?' approach, we interrogate how the guidelines frame the interplay of public health concerns and environmental concerns in making food choices. We find that the biopedagogies of sustainable eating, as presented in these guidelines, implicate the subject position of the ideal eater. The ideal eater values sustainability, has high cultural capital, and draws on both taste and nutritional knowledge to make good food choices. However, while the ideal eater is expected to be aware of environmental issues, these are incorporated into the ideal eater's choices only in addition to the primary concern of health. Thus, although the guidelines frame a 'holistic approach' as the solution to both health and environmental concerns, in cases where health and environmental priorities conflict, the guidelines' biopedagogies of sustainable eating align with earlier biopedagogies of healthy eating.
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http://dx.doi.org/10.1111/1467-9566.13172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756811PMC
November 2020

Changes in parental feeding practices and preschoolers' food intake following a randomized controlled childhood obesity trial.

Appetite 2020 11 21;154:104746. Epub 2020 May 21.

Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden; Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. Electronic address:

Childhood obesity treatment involving parents is most effective during the preschool age. However, the mechanisms of change are not known. The present study reports on secondary outcomes (changes in parental feeding practices and child food intake) of early obesity treatment. The More and Less study is a randomized controlled trial conducted in Stockholm County, Sweden. Children with obesity (n = 174, mean BMI SDS 3.0, mean age 5 years, 56% girls) and their parents (60% with foreign background, 40% with a university degree) were randomized to: 1) standard treatment focusing on lifestyle recommendations (ST), 2) a parent support program with boosters (PGB), and 3) a parent support program without boosters (PGNB). The Child Feeding Questionnaire (CFQ) was used to measure parental feeding practices. Child food intake was assessed with a Food Frequency Questionnaire (FFQ). We calculated the monthly changes in CFQ practices and FFQ items based on four measurements. We did not find any significant between-group differences in parental feeding practices and child food intake over time. However, general linear models showed that changes in certain feeding practices predicted changes in child food intake. When ST was compared to the parent support groups, some associations moved in opposite directions. For example, increasing maternal restriction predicted increased consumption of cookies/buns in PGNB (b = 2.3, p < 0.05) and decreased consumption of cookies/buns in ST (b = -2.1, p < 0.05). This is among the few studies to examine the effect of parental feeding practices on child food intake and weight status after obesity treatment among preschoolers. We found no evidence that changes in feeding practices or changes in child food intake mediated child weight loss. Future studies should consider other intermediary processes related to general parenting practices and parent-child interactions.
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http://dx.doi.org/10.1016/j.appet.2020.104746DOI Listing
November 2020

Secondary care consultant clinicians' experiences of conducting emergency care and treatment planning conversations in England: an interview-based analysis.

BMJ Open 2020 01 20;10(1):e031633. Epub 2020 Jan 20.

Warwick Medical School, University of Warwick, Coventry, UK.

Objective: To examine secondary care consultant clinicians' experiences of conducting conversations about treatment escalation with patients and their relatives, using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process.

Design: Semi-structured interviews following ward round observations.

Setting: Two National Health Service hospitals in England.

Participants: Fifteen medical and surgical consultants from 10 specialties, observed in 14 wards.

Analysis: Interview transcripts were analysed using thematic analysis.

Results: Three themes were developed: (1) determining when and with whom to conduct a ReSPECT conversation; (2) framing the ReSPECT conversation to manage emotions and relationships and (3) reaching ReSPECT decisions. The results showed that when timing ReSPECT conversations, consultant clinicians rely on their predictions of a patient's short-term prognosis; when framing ReSPECT conversations, consultant clinicians seek to minimise distress and maximise rapport and when involving a patient or a patient's relatives in decision-making discussions, consultant clinicians are guided by their level of certainty about the patient's illness trajectory.

Conclusions: The management of uncertainty about prognoses and about patients' emotional reactions is central to secondary care consultant clinicians' experiences of timing and conducting ReSPECT conversations.
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http://dx.doi.org/10.1136/bmjopen-2019-031633DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044868PMC
January 2020

Planting a seed - child health care nurses' perceptions of speaking to parents about overweight and obesity: a qualitative study within the STOP project.

BMC Public Health 2019 Nov 9;19(1):1494. Epub 2019 Nov 9.

Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.

Background: Nurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many years. However, research focusing on CHC nurses' perceptions of their role in childhood overweight/obesity management is scarce. As part of the EU-funded project "Science and Technology in childhood Obesity Policy" (STOP), this study examines CHC nurses' perceptions of speaking to parents about children's overweight/obesity and of their role in referring children to treatment for overweight/obesity.

Methods: All registered CHC nurses in Stockholm County (n = 442) received an email invitation letter explaining the study. Individual face-to-face visits (n = 15) in selected centers, and phone calls (n = 24) to nurses working in these centres were also conducted. In total, 17 CHC nurses (all female, average work experience 6.7 years (SD ± 4.9 years)) from 10 municipalities (including four of the top five municipalities with the highest prevalence of overweight and obesity) in Stockholm County were interviewed. The interviews were conducted by phone, transcribed and analyzed using thematic analysis.

Results: Two main themes were developed through the analysis: 1) The relationship between the nurse and the parent and 2) Glitch in the system. Under the first theme, nurses reported that weight-related discussions were facilitated by building and maintaining trust with parents. However, nurses also said they were reluctant to address children's weights if this could compromise parents' trust. Under the second theme, nurses highlighted several organizational barriers to addressing a child's weight with parents, including insufficient cooperation with other healthcare providers and limited time for visits. Nurses also identified lack of sufficient knowledge about what to offer the family and lack of confidence in their communication skills as additional barriers.

Conclusions: We found that pediatric nurses perceive relational and organizational factors as barriers to address childhood obesity with parents. To improve care, it is necessary to provide nurses with continuing education about obesity and communication skills and organizational support to improve communication within the healthcare system.

Trial Registration: ClinicalTrials.gov NCT03800823; 11 Jan 2019, prospectively registered.
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http://dx.doi.org/10.1186/s12889-019-7852-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842180PMC
November 2019

Responding positively to "children who like to eat": Parents' experiences of skills-based treatment for childhood obesity.

Appetite 2020 02 15;145:104488. Epub 2019 Oct 15.

Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden. Electronic address:

This study aims to understand the challenges parents of preschoolers with obesity face. We assessed parents' experiences of a group treatment program focused on parenting skills; the treatment program was evaluated in a randomized controlled trial in Stockholm County. After completing the program's 10 weekly sessions, parents were invited to participate in a semi-structured interview. The interviews were audio recorded, transcribed and analyzed using thematic analysis. In total, 36 parents (67% mothers, mean age 39 years, 33% foreign background, 50% with university degree) were interviewed. Two main themes were developed: Emotional burden and Skills and strength from others. Emotional burden encompassed the parents' experiences of raising a child with obesity. Parents spoke about the difficulties of managing their child's appetite and of seeking help and treatment, as well as their feelings about the social stigma attached to obesity. Skills and strength from others encompassed the parents' experiences of participating in group treatment. Parents reported that they appreciated the practical behavior change techniques taught, especially those regarding food and how to make everyday life more predictable, and said the focus on parenting skills gave them the confidence to apply the techniques in everyday life. Parents also highlighted the strength of the group setting, saying it enabled them to discuss perceived challenges and learn from other parents. Our findings show that childhood obesity carries social and emotional implications for parents, and that an intervention that provides parents with skill-building and a discussion space can help in negotiating these implications. This suggests that childhood obesity intervention programs benefit from including a parent-based approach which offers training in parenting skills and support in managing socially and emotionally challenging situations.
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http://dx.doi.org/10.1016/j.appet.2019.104488DOI Listing
February 2020

Picky eating in an obesity intervention for preschool-aged children - what role does it play, and does the measurement instrument matter?

Int J Behav Nutr Phys Act 2019 09 3;16(1):76. Epub 2019 Sep 3.

Department of Food Studies, Nutrition and Dietetics, Uppsala University, Box 560, 751 22, Uppsala, Sweden.

Introduction: Research on picky eating in childhood obesity treatment is limited and inconsistent, with various instruments and questions used. This study examines the role of picky eating in a randomized controlled obesity intervention for preschoolers using subscales from two instruments: The Child Eating Behavior Questionnaire (CEBQ) and the Lifestyle Behavior Checklist (LBC).

Method: The study includes 130 children (mean age 5.2 years (SD 0.7), 54% girls, mean Body Mass Index (BMI) z-score 2.9 (SD 0.6)) and their parents (nearly 60% of non-Swedish background, 40% with university degree). Families were randomized to a parent-group treatment focusing on evidence-based parenting practices or to standard treatment focusing on lifestyle changes. The children's heights and weights (BMI z-score) were measured at baseline, and at 3, 6 and 12 months post baseline. At these time-points, picky eating was reported by parents using the CEBQ (Food Fussiness scale, 6 items) and 5 items from the LBC. Child food intake was reported with a Food Frequency Questionnaire (FFQ). Pearson correlation was used to study associations between baseline picky eating and baseline BMI z-scores and food intake. Mixed effects models were used to study associations between the two measurements of picky eating and changes in picky eating, to assess the effects of changes in picky eating on BMI z-scores, and to evaluate baseline picky eating as a predictor of changes in BMI z-scores.

Results: Neither the standard treatment nor the parent-group treatment reduced the degree of picky eating (measured with CEBQ or LBC). Baseline picky eating measured with the CEBQ was associated with a lower BMI z-score and lower intake of vegetables. Children with a higher degree of picky eating at baseline (measured with the CEBQ) displayed a lower degree of weight loss. When degree of picky eating was examined, for 25% of the children, the CEBQ and the LBC yielded diverging results.

Conclusions: Baseline picky eating may weaken the effectiveness of obesity treatment, and assessments should be conducted before treatment to adjust the treatment approach. Different measurements of picky eating may lead to different results. The CEBQ seems more robust than the LBC in measuring picky eating.

Trial Registration: Clinicaltrials.gov , NCT01792531. Registered 15 February 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01792531.
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http://dx.doi.org/10.1186/s12966-019-0845-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6724280PMC
September 2019

The influence of preschoolers' emotional and behavioural problems on obesity treatment outcomes: Secondary findings from a randomized controlled trial.

Pediatr Obes 2019 11 9;14(11):e12556. Epub 2019 Jul 9.

Unit of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.

Background: Few studies have explored the influence of preschoolers' behavioural problems on obesity treatment.

Objectives: To assess emotional and behavioural problems before and after an obesity intervention and examine relationships between changes in child behaviour and changes in weight status.

Method: The study included 77 children (4-6 years old, 53% girls, mean body mass index [BMI] z-score of 3.0 [SD 0.6]) who participated in the More and Less Study, a randomized controlled trial. Families were randomized to a parenting program or to standard treatment. The children's heights and weights (BMI z-score, primary outcome) were measured at baseline and 12 months post baseline. Parents rated their children's behaviours (secondary outcome) on the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years, a questionnaire that measures psychosocial health and functioning, encompassing emotional and behavioural problems. Changes in child behaviour during treatment were examined through paired samples t tests; the influence of child behaviour on treatment effects was examined through linear regressions.

Results: Child emotional and behavioural problems significantly improved after obesity treatment. Lower scores were found for Emotional Reactivity, Sleep Problems, Affective Problems, Aggressive Behaviour, Externalizing Behaviours, Oppositional Defiant Problems, and Total Problems. Child behaviour significantly affected obesity treatment results: Attention Problems and attention deficit hyperactivity disorder (ADHD) at baseline contributed to increasing BMI z-scores, whereas Oppositional Defiant Problems, Externalizing Behaviours, and a higher number of behavioural problems predicted decreasing BMI z-scores.

Conclusions: Child behaviours at baseline influenced treatment results. Child emotional and behavioural problems improved post treatment. The results suggest that obesity treatment may help in reducing emotional distress among preschoolers.
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http://dx.doi.org/10.1111/ijpo.12556DOI Listing
November 2019

Public Expressions of Trust and Distrust in Governmental Dietary Advice in Sweden.

Qual Health Res 2019 07 9;29(8):1161-1173. Epub 2019 Feb 9.

1 Uppsala University, Uppsala, Sweden.

We examine public trust and distrust in governmental food and nutrition authorities, through analyzing 727 letters sent electronically to the Swedish National Food Agency by lay people. Using thematic analysis, four themes were developed, defining public expressions of trust and distrust in official dietary advice. Trust was expressed as (a) seeking to confirm and clarify dietary advice or (b) seeking official arbitration between competing dietary advice. Distrust was expressed as (c) questioning and scrutinizing dietary advice or (d) protesting and resisting dietary advice. Notably, expressions of distrust employed discursive practices that both mirrored authoritative discourses and subverted official advice, by appealing to scientific language and "alternative" evidence. All letters positioned the agency as the ultimate authority on healthy eating; notwithstanding whether the agency's advice was to be followed or resisted. Thus, the letters revealed how the same authoritative discourses can simultaneously be a site of public trust and distrust.
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http://dx.doi.org/10.1177/1049732318825153DOI Listing
July 2019

Latin American countries lead in Google search volumes for anorexia nervosa and bulimia nervosa: Implications for global mental health research.

Authors:
Karin Eli

Int J Eat Disord 2018 12 26;51(12):1352-1356. Epub 2018 Nov 26.

Institute of Social and Cultural Anthropology, University of Oxford, Oxford, United Kingdom.

Objective: Although eating disorders occur worldwide, prevalence data beyond Euro-American contexts are sparse, and eating disorders largely remain outside global mental health agendas. This study aims to address this gap in the epidemiological literature through a global infodemiological comparison of Google search volumes for the topics "Anorexia nervosa" and "Bulimia nervosa."

Method: Data were generated through Google Trends, a tool that assesses the relative search volumes of keywords and topics. Google Trends data, collected from January 1, 2004 to December 31, 2016, were obtained for the relative search volumes of the topics "Anorexia nervosa" and "Bulimia nervosa" worldwide.

Results: The findings revealed that Latin American countries accounted for the top 10 in search volume for both topics, with Mexico ranked first until 2016, when Bolivia rose to the top of the list.

Discussion: The results suggest that eating disorders are of considerable and consistent salience across Latin America, and that population-based, nationally representative studies to assess the prevalence of eating disorders in Latin American countries should be prioritized within global mental health research agendas.
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http://dx.doi.org/10.1002/eat.22969DOI Listing
December 2018

Picky eating in Swedish preschoolers of different weight status: application of two new screening cut-offs.

Int J Behav Nutr Phys Act 2018 08 9;15(1):74. Epub 2018 Aug 9.

Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.

Background: Characteristics of picky eaters of different weight status have not been sufficiently investigated. We used two newly developed screening cut-offs for picky eating in the Food fussiness (FF) subscale of the Child Eating Behavior Questionnaire (CEBQ) to investigate the prevalence and characteristics of picky eaters in preschool-aged children with thinness, normal weight, overweight or obesity.

Methods: Data for 1272 preschoolers (mean age 4.9 years) were analyzed. The parent-reported FF subscale ranges from 1 to 5, and two screening cut-offs were applied to classify children as picky eaters (3.0 and 3.33). Structural Equation Modeling was used to study associations with other factors in the CEBQ, the Child Feeding Questionnaire (CFQ) and the Lifestyle Behavior Checklist (LBC). Scores were compared separately for each weight status group.

Results: Nearly half of the children were classified as moderate or severe picky eaters (cut-off 3.0) and 30% as severe (cut-off 3.33). For both cut-offs, prevalence was significantly lower in the obesity group. Still, one-third of children with obesity met the cut-off of 3.0 and 17% met the cut-off of 3.33. While picky eaters displayed similar patterns across weight status groups, some differences emerged. Food responsiveness was lower for picky eaters, but the difference was significant only among children with obesity. Slowness in eating was not as pronounced among picky eaters in the obesity group. In the overweight and obesity groups, parents of picky eaters did not report as high pressure to eat, as compared to the thinness or normal weight groups; in the obesity group, parents of picky eaters also perceived their children's weight as lower. In all weight status groups, parents of picky eaters were more likely to report their children had too much screen time, complained about physical activity, and expressed negative affect toward food.

Conclusions: Picky eating was less common but still prevalent among children with obesity. Future studies should investigate the potential influence of picky eating on childhood overweight and obesity. Moreover, as children with picky eating display higher emotional sensitivity, further research is needed to understand how to create positive eating environments particularly for children with picky eating and obesity.
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http://dx.doi.org/10.1186/s12966-018-0706-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085619PMC
August 2018

Anthropological Perspectives on Eating Disorders: Deciphering Cultural Logics.

Transcult Psychiatry 2018 08;55(4):443-453

University of Adelaide.

In the last three decades, anthropological analyses of eating disorders have peeled away layers of 'common sense' to reveal tacit and often contradictory forces that inhere in people's bodies, practices, and lives. From investigations of institutional practices to analyses of embodied experiences, anthropologists have developed insightful accounts of how local, shared worlds shape disordered eating, and of the grounding of disorder in social structures and relationships that tend to be obscured in clinical and popular interpretations. In this introductory essay, we offer a brief review of anthropological work on eating disorders, with particular emphasis on studies published in the last decade. Attending to person, structure, and bodily being-in-the-world, these anthropological studies reveal multiple cultural logics within which disordered eating practices are embedded. The deciphering of cultural logics forms the basis for this special issue, whose constituent papers interrogate recurring and ongoing eating disorders, with analyses that focus on relapse, ambivalence toward treatment, and the persistence of disordered eating practices. In their shared focus on long-term eating disorders, the papers offer anthropological responses to clinical questions about the low rates of treatment success. As such, the special issue conveys the potential for new productive collaborations between anthropology, policy, and clinical research and practice for the prevention of and effective intervention in eating disorders.
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http://dx.doi.org/10.1177/1363461518784385DOI Listing
August 2018

Striving for liminality: Eating disorders and social suffering.

Authors:
Karin Eli

Transcult Psychiatry 2018 08 14;55(4):475-494. Epub 2018 May 14.

University of Oxford.

In this article, I argue that eating disorders constitute a form of social suffering, in which sufferers embody liminality as a response to, and a reflection of, oppressive sociality, structural violence, and institutional constraints. Based on the illness narratives of people with anorexia nervosa, bulimia nervosa, and their subclinical variants in Israel, the analysis draws the experiential, the social, and the structural into critical focus. These narratives, which delineate lived experiences of self-starving, bingeing, and purging, and the attendant viscerality of hunger, fullness, and emptiness, reveal how participants developed an embodied drawing inward and away, being at once within and without society for extended periods of time, through eating disordered practices. This liminal positioning, I argue, was a mode through which participants cultivated alternative (if temporary) personal spaces, negotiated identities, and anesthetized pain: processes many deemed essential to survival. Embedding the participants' narratives of eating disordered experiences within familial, societal, and political-economic forces that shaped their individual lives, I examine the participants' striving for liminality as at once intimately embodied and structurally mapped. The analysis suggests that policy initiatives for eating disorder prevention must address the social suffering that eating disorders manifest: suffering caused by structures and institutions that reinforce social inequality, violence, and injustice.
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http://dx.doi.org/10.1177/1363461518757799DOI Listing
August 2018

Perceived child eating behaviours and maternal migrant background.

Appetite 2018 06 10;125:302-313. Epub 2018 Feb 10.

Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden; Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Electronic address:

The Child Eating Behaviour Questionnaire (CEBQ) is a well-established instrument in the study of obesity-related eating behaviours among children. However, research using the CEBQ in multicultural samples is limited. This study aims to identify and examine differences in child eating behaviours as reported by Swedish-born and non-Swedish-born mothers living in Sweden. Mothers (n = 1310, 74 countries of origin, mean age 36.5 years, 63.6% with higher education, 29.2% with overweight or obesity) of children aged 3-8 years (mean age 4.8 years, 18.1% with overweight or obesity) completed the CEBQ. Responses were analysed using CEBQ subscales Food Responsiveness, Emotional Overeating, Enjoyment of Food, and Desire to Drink, clustering into Food Approach, and subscales Satiety Responsiveness, Slowness in Eating, Emotional Undereating, and Food Fussiness, clustering into Food Avoidance. Data were compared across seven regional groups, divided by maternal place of birth: (1) Sweden (n = 941), (2) Nordic and Western Europe (n = 68), (3) Eastern and Southern Europe (n = 97), (4) the Middle East and North Africa (n = 110), (5) East, South and Southeast Asia (n = 52), (6) Sub-Saharan Africa (n = 16), and (7) Central and South America (n = 26). Crude, partly and fully adjusted linear regression models controlled for child's age, gender and weight status, and mother's education, weight status and concern about child weight. The moderation effect of maternal concern about child weight was examined through interaction analyses. Results showed that while Food Approach and Food Avoidance behaviours were associated with maternal migrant background, associations for Food Fussiness were limited. Notably, mothers born in the Middle East and North Africa reported higher frequencies of both Food Approach (except for Enjoyment of Food) and Food Avoidance. The study highlights the importance of examining how regionally-specific maternal migrant background affects mothers' perceptions of child eating behaviours.
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http://dx.doi.org/10.1016/j.appet.2018.02.010DOI Listing
June 2018

Sequence analysis of malacoherpesvirus proteins: Pan-herpesvirus capsid module and replication enzymes with an ancient connection to "Megavirales".

Virology 2018 01 21;513:114-128. Epub 2017 Oct 21.

Department of Cell Research and Immunology, George S. Wise Faculty of Life Sciences, Tel-Aviv University, Tel-Aviv 69978, Israel.

The order Herpesvirales includes animal viruses with large double-strand DNA genomes replicating in the nucleus. The main capsid protein in the best-studied family Herpesviridae contains a domain with HK97-like fold related to bacteriophage head proteins, and several virion maturation factors are also homologous between phages and herpesviruses. The origin of herpesvirus DNA replication proteins is less well understood. While analyzing the genomes of herpesviruses in the family Malacohepresviridae, we identified nearly 30 families of proteins conserved in other herpesviruses, including several phage-related domains in morphogenetic proteins. Herpesvirus DNA replication factors have complex evolutionary history: some are related to cellular proteins, but others are closer to homologs from large nucleocytoplasmic DNA viruses. Phylogenetic analyses suggest that the core replication machinery of herpesviruses may have been recruited from the same pool as in the case of other large DNA viruses of eukaryotes.
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http://dx.doi.org/10.1016/j.virol.2017.10.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172337PMC
January 2018

Distinct and Untamed: Articulating Bulimic Identities.

Authors:
Karin Eli

Cult Med Psychiatry 2018 Mar;42(1):159-179

Institute of Social and Cultural Anthropology, University of Oxford, 51-53 Banbury Road, Oxford, OX2 6PE, UK.

Bulimia nervosa and anorexia nervosa are inextricably linked, with substantial clinical and epidemiological overlaps. Yet, while anorexia has been analyzed extensively in medical anthropology, bulimia remains under-theorized. This is, perhaps, because, compared to self-starvation, binge eating presents a logic of practice that is difficult to reconcile with culturally reified notions of self-control, transcendence, and hard work. Thus, although anthropologists have analyzed anorexic subjectivities as imbued with a sense of cleanliness and purity, moral superiority, and heroics, similar analyses have not been extended to bulimic subjectivities; instead, bulimia has been subsumed, as a tangential disorder, into analyses of anorexia. In this paper, I aim to move bulimic identities from the margins to the centre of anthropological analysis. Based on participant narratives, I analyze bulimic identity as articulated by six Israeli women who identified as bulimic and received treatment for bulimia. The women's narratives show that bulimic identity is aligned with concepts of distinct selfhood. For these women, to be bulimic was to be framed as 'abnormal'; but this 'abnormality', albeit a source of social stigma and shame, held meanings that went beyond pathology. Through the claiming of bulimic identity, the women positioned themselves as untamed, non-conforming subjects, who acted against gendered and classed expectations-and even against the limitations of the body. Their constructions of bulimic distinction highlight the need for anthropological work that situates bulimia not as a footnote to anorexia, but as a structurally and culturally meaningful condition in its own right.
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http://dx.doi.org/10.1007/s11013-017-9545-8DOI Listing
March 2018

Water, juice, or soda? Mothers and grandmothers of preschoolers discuss the acceptability and accessibility of beverages.

Appetite 2017 05 12;112:133-142. Epub 2017 Jan 12.

Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, 141 57 Huddinge, Sweden; Department of Food, Nutrition and Dietetics, Uppsala University, Box 560, 751 22 Uppsala, Sweden. Electronic address:

Intake of sugary beverages is strongly associated with weight gain and obesity among children; however, differences between mothers' and grandmothers' attitudes and practices concerning young children's beverage consumption remain unclear. This is notable since about a quarter of families in the US and the UK rely on grandparents as the main providers of informal childcare. The aim of this study is to examine mothers' and maternal grandmothers' attitudes, knowledge, and practices regarding preschool aged children's beverage consumption. The analysis focuses on identifying intergenerational similarities and differences, given the potential impact that such differences might have on young children's beverage consumption habits. Twenty-two semi-structured interviews, representing eleven families, were analyzed using thematic analysis. The sample included all mother - maternal grandmother dyads from The Grandparents Study, which took place in Eugene, Oregon, USA. More than half of mothers and grandmothers met overweight/obesity criteria. Among the children (mean age 4.7 years; five girls and six boys), seven met overweight/obesity criteria. Most mothers and grandmothers were unemployed, and most reported an annual household income below 30,000 USD. The analysis identified three thematic categories: 1) mothers and grandmothers agree about the hierarchy of healthiness between and within beverages, though juice occupies an ambivalent position; 2) mothers and grandmothers cite role modeling and the home environment as important in regulating preschoolers' beverage intake; 3) mothers and grandmothers balance between restricting sugary beverages and using these beverages as treats. The results suggest that when mothers and grandmothers use soda, juice, and juice-drinks as treats, they do so within a wider dynamic of balancing practices, and within two intersecting domains: the hierarchy of beverages, including the still ambivalent status of juice as healthy or unhealthy, and the definition of 'special occasion'.
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http://dx.doi.org/10.1016/j.appet.2017.01.011DOI Listing
May 2017

Controlling feeding practices and maternal migrant background: an analysis of a multicultural sample.

Public Health Nutr 2017 04 21;20(5):848-858. Epub 2016 Nov 21.

1Department of Food,Nutrition and Dietetics,Uppsala University,Box 560,751 22 Uppsala,Sweden.

Objective: Parental feeding practices shape children's relationships with food and eating. Feeding is embedded socioculturally in values and attitudes related to food and parenting. However, few studies have examined associations between parental feeding practices and migrant background.

Design: Cross-sectional study. Parental feeding practices (restriction, pressure to eat, monitoring) were assessed using the Child Feeding Questionnaire. Differences were explored in four sub-samples grouped by maternal place of birth: Sweden, Nordic/Western Europe, Eastern/Southern Europe and countries outside Europe. Crude, partly and fully adjusted linear regression models were created. Potential confounding variables included child's age, gender and weight status, and mother's age, weight status, education and concern about child weight.

Setting: Malmö and Stockholm, Sweden.

Subjects: Mothers (n 1325, representing seventy-three countries; mean age 36·5 years; 28·1 % of non-Swedish background; 30·7 % with overweight/obesity; 62·8 % with university education) of pre-school children (mean age 4·8 years; 50·8 % boys; 18·6 % with overweight/obesity).

Results: Non-Swedish-born mothers, whether European-born or non-European-born, were more likely to use restriction. Swedish-born mothers and Nordic/Western European-born mothers reported lower levels of pressure to eat compared with mothers born in Eastern/Southern Europe and mothers born outside Europe. Differences in monitoring were small. Among the potential confounding variables, child weight status and concern about child weight were highly influential. Concern about child weight accounted for some of the effect of maternal origin on restriction.

Conclusions: Non-European-born mothers were more concerned about children being overweight and more likely to report controlling feeding practices. Future research should examine acculturative and structural factors underlying differences in feeding.
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http://dx.doi.org/10.1017/S1368980016002834DOI Listing
April 2017
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