Publications by authors named "Melissa A Kalarchian"

69 Publications

Advancing research on delusions: Fostering dialogue between cognitive and phenomenological researchers.

Schizophr Res 2021 Jul 3;233:62-63. Epub 2021 Jul 3.

Duquesne University, School of Nursing, United States of America.

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http://dx.doi.org/10.1016/j.schres.2021.06.023DOI Listing
July 2021

Disordered eating following bariatric surgery: a review of measurement and conceptual considerations.

Surg Obes Relat Dis 2021 Aug 18;17(8):1510-1520. Epub 2021 Mar 18.

University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota.

Eating disorders are associated with significant medical morbidity and mortality and serious psychological impairment. Individuals seeking bariatric surgery represent a high-risk group for evidencing disordered eating and eating disorders, with some patients experiencing the persistence or onset of disordered eating postsurgery. This review synthesizes the available literature on problematic or disordered eating in the bariatric field, followed by a review of measurement and conceptual considerations related to the use of eating disorder assessment tools within the bariatric population.
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http://dx.doi.org/10.1016/j.soard.2021.03.008DOI Listing
August 2021

Eating patterns and unhealthy weight control behaviors are associated with loss-of-control eating following bariatric surgery.

Surg Obes Relat Dis 2021 May 21;17(5):976-985. Epub 2021 Jan 21.

School of Nursing, University of Rochester, Rochester, New York.

Background: Loss-of-control (LOC) eating is associated with poor weight-loss outcomes following bariatric surgery. It is not clear whether eating patterns (e.g., total number of daily meals/snacks, eating after suppertime, eating when not hungry) and unhealthy weight control behaviors (e.g., smoking, using laxatives) are associated with or predictive of LOC eating.

Objectives: To examine whether eating patterns and unhealthy weight-control behaviors are associated with LOC eating and, if so, whether they predict LOC eating in bariatric patients.

Setting: Multicenter study, United States.

Methods: This is a secondary analysis of the Longitudinal Assessment of Bariatric Surgery-2 study. Assessments were conducted before surgery and at 12, 24, 36, 48, 60, and 84 months after surgery. Logistic mixed models were used to examine the longitudinal associations between eating patterns, unhealthy weight-control behaviors, and LOC eating. Time-lag techniques were applied to examine whether the associated patterns and behaviors predict LOC eating.

Results: The participants (n = 1477) were mostly women (80%), white (86.9%), and married (62.5%). At the time of surgery, the mean age was 45.4 ± 11.0 years and the mean body mass index was 47.8 ± 7.5 kg/m. The total number of daily meals/snacks, food intake after suppertime, eating when not hungry, eating when feeling full, and use of any unhealthy weight-control behaviors were positively associated with LOC eating (P < .05). Food intake after suppertime, eating when not hungry, and eating when feeling full predicted LOC eating (P < .05).

Conclusion: Meal patterns and unhealthy weight control behaviors may be important intervention targets for addressing LOC eating after bariatric surgery.
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http://dx.doi.org/10.1016/j.soard.2021.01.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096657PMC
May 2021

Fostering Innovation in Prevention and Treatment of Obesity in Youth: Digitally Mediated Physical Play as an Exemplar.

Obesity (Silver Spring) 2021 03 4;29(3):475-477. Epub 2021 Feb 4.

Human Computer Interaction Institute, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.

Novel approaches to obesity prevention among youth are needed. Accordingly, the Office of Women's Health, Department of Health and Human Services, sponsored a challenge to create an interactive video game for obesity prevention. Our team took a theory-based, evidence-informed approach to increasing physical activity in girls. Our approach-digitally mediated physical play-allowed us to include computing-based strategies that promote activity without keeping players in front of a screen. Our prize-winning prototype app, Frolic, helps girls choose the perfect game to play in any context, engaging parents for support. The app is used to highlight some opportunities and challenges for interdisciplinary collaboration. However, much work remains to be done to deploy innovative digital obesity interventions and fully capture the contributions of these tools. In order to accelerate advances, funding is needed for projects that combine engineering design principles with traditional obesity research paradigms.
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http://dx.doi.org/10.1002/oby.23113DOI Listing
March 2021

Exploring Factors Linked to Weight Status in Salvadoran Infants.

Hisp Health Care Int 2021 Jun 25;19(2):95-104. Epub 2020 Sep 25.

14833Suffolk County Community College, Sayville, NY, USA.

Introduction: Potential risk factors of infant overweight/obesity in Salvadoran mother-infant dyads ( = 88) at routine 9- to 12-month wellbaby visits were examined in a correlational study at two pediatric offices on Long Island, New York.

Method: Maternal factors and infant feeding practices in the first 5 months were self-reported; infant birth weight, current weight/recumbent length were obtained. Bivariate logistic regression measured the relationship of the variables with infant weight status >85th percentile weight-for-length (WFL) for sex.

Results: The majority of mothers were born in El Salvador, with a mean age of 28.5 years ( = 5.9); 43% of infants had WFL >85th percentile. Infant birth weight was significantly associated with WFL >85th percentile, = .0007. After controlling for maternal age, insurance type, education, and marital status, no significant associations with infant WFL >85th percentile were found. Feeding practices during infants' first 5 months, mothers' pre-pregnancy weight, pregnancy weight gain, and history of gestational diabetes mellitus, were not associated with infant weight status.

Conclusion: This was the first study to examine infant weight status in Salvadorans. Future studies should objectively measure infant feeding practices and other potential factors among Salvadoran mother infant dyads, since nearly half of the infants had WFL >85th percentile.
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http://dx.doi.org/10.1177/1540415320959593DOI Listing
June 2021

Reported nutrient intake over 7 years after Roux-en-Y gastric bypass in the Longitudinal Assessment of Bariatric Surgery-3 (LABS-3) psychosocial study.

Surg Obes Relat Dis 2020 Aug 22;16(8):1022-1029. Epub 2020 Apr 22.

Neuropsychiatric Research Institute, Fargo, North Dakota.

Background: Bariatric surgery is the most effective therapy for severe obesity. It reduces gastric capacity and may modify regulation of appetite, satiety, insulin, and other physiologic processes, resulting in weight loss.

Objective: Long-term data on postsurgical nutrient intake are lacking.

Setting: The Longitudinal Assessment of Bariatric Surgery-3 psychosocial study.

Methods: Reported dietary intake was assessed in a subset of participants (n = 72) of the Longitudinal Assessment of Bariatric Surgery-3 psychosocial study who underwent Roux-en-Y gastric bypass surgery. Two 24-hour diet recalls at presurgery and annual assessments over 7 years were obtained. Reported diets were evaluated for energy, macro- and micronutrient intake, and assessed for adequacy by comparison to the dietary reference intakes.

Results: After surgery, reported intake of total energy, and all macronutrients were significantly reduced. At least a quarter of participants reported protein intake below the recommended dietary allowance. Over half of participants reported intake of several vitamins (C, D, A, E, thiamin, folate) and minerals (zinc, calcium) below recommended levels over 7 years. Compared with presurgery, reported energy intake was reduced over 7 years. This study was registered at ClinicalTrials.gov as NCT02495142.

Conclusions: The reduction in energy resulted in intakes below the dietary reference intakes for many micronutrients among the majority of participants and below the recommended dietary allowance for protein in a substantial subgroup. These data support continued long-term nutrition education, monitoring, and supplementation.
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http://dx.doi.org/10.1016/j.soard.2020.04.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423730PMC
August 2020

A Qualitative Exploration of Patients' Experiences with Lifestyle Changes After Sleeve Gastrectomy in China.

Obes Surg 2020 08;30(8):3127-3134

School of Nursing, Duquesne University, Pittsburgh, PA, USA.

Purpose: Sleeve gastrectomy (SG) is the most widely used surgical treatment for severe obesity worldwide. Individuals who have undergone SG usually need to change lifestyle behaviors as a response to the anatomical changes imposed by SG, and patients need to sustain lifestyle changes for long-term surgical success. Little is known about how patients experience and manage lifestyle changes following SG. In China, where SG comprises over 70% of bariatric surgical procedures, there have been no reports addressing this issue. This study aimed to describe individuals' experiences related to lifestyle changes after SG in China.

Materials And Methods: Semi-structured interviews were conducted at the Shanghai Huashan Hospital in China with adults who had undergone SG between 2012 and 2018. Two independent researchers used an interpretive thematic approach to analyze transcripts for themes and sub-themes.

Results: Interviews (N = 15) revealed three major themes of participants' experiences with postoperative lifestyle changes: advantages outweigh disadvantages; developing self-management strategies (i.e., adopting new behaviors and developing habits, continuing self-monitoring, focusing on health over weight, staying determined); and experiencing culture-specific difficulties in adherence to follow-up visits and lifestyle recommendations.

Conclusion: The data from this study provided a rich description of the postoperative experiences of patients in China. Participants reported that surgical benefits supersede the surgery-related side effects, and participants were able to develop self-management strategies in order to achieve success. However, personal and social barriers, such as the challenges of applying postoperative dietary guidelines into daily practice, may impede patients making and sustaining recommended behavioral changes.
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http://dx.doi.org/10.1007/s11695-020-04653-7DOI Listing
August 2020

Association of Prescription Opioid Exposure and Patient Factors With Prolonged Postoperative Opioid Use in Opioid-Naïve Patients.

AANA J 2020 Jan;88(1):18-26

is an associate dean of research at Duquesne University in Pittsburgh, Pennsylvania.

The purpose of this research study was to identify factors associated with prolonged postoperative opioid use in opioid-naïve patients in 2 domains: specific patient characteristics and exposure through postoperative opioid prescriptions. A retrospective analysis was conducted of electronic medical records of opioid-naïve adult orthopedic surgical patients at a large academic medical center from January 1, 2012, through December 31, 2017. In this cohort, 4% continued to refill opioid prescriptions more than 90 days after their surgical procedure. Prolonged use was associated with an initial prescription that had an oral morphine milligram equivalent above 675. Receipt of opioid prescription refills was a significant predictor for receiving additional opioid prescriptions over time. Multivariate logistic regression indicated that the independent predictors of prolonged postoperative opioid use were alcohol abuse, black race, Medicaid insurance, and the following comorbidities: diabetes, mood disorder, hypertension, and chronic kidney disease. To decrease the rate of prolonged postoperative opioid use, clinical changes can be investigated, including collaborative perioperative pain management strategies using nonopioid pain control methods; perioperative patient screening; education of patients and clinicians; and close postoperative follow-up, especially in the most vulnerable populations.
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January 2020

Examining emotion-, personality-, and reward-related dispositional tendencies in relation to eating pathology and weight change over seven years in the Longitudinal Assessment of Bariatric Surgery (LABS) study.

J Psychiatr Res 2020 01 19;120:124-130. Epub 2019 Oct 19.

Neuropsychiatric Research Institute, Fargo, ND, USA.

This study examined dispositional emotion-, personality/temperament-, and reward-related variables in relation to post-surgery eating pathology and weight-change among 107 adults who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB). As part of a prospective cohort study, annual post-surgical assessments were conducted to evaluate eating pathology, using the Eating Disorder Examination-Bariatric Surgery Version, and percent weight change from pre-surgery. Dispositional measures were administered at the 6- or 7-year assessment and included the Affect Intensity Measure, Difficulties in Emotion Regulation Scale, UPPS-P Impulsive Behavior Scale, Adult Temperament Questionnaire-Effortful Control Scale, and Sensitivity to Punishment/Sensitivity to Reward Questionnaire. Results from a series of linear mixed models revealed significant associations of emotion dysregulation, affect intensity, positive and negative urgency, effortful control, and reward sensitivity with eating pathology severity across 7 years; additionally, all but two of the subscales comprising the total scores were also significantly associated. Fewer statistically significant results were found in relation to weight change; emotion dysregulation and affect intensity (along with several subscales) were significantly associated with lower percent weight change (i.e., less weight loss), but of the reward-related and personality/temperament variables, only total effortful control emerged as significant. However, the associations of the other variables with both outcomes were consistently in the expected direction. Associations also appeared consistent across surgical procedures. Taken together, findings suggest that certain dispositional tendencies may relate to less optimal long-term outcomes following bariatric surgery and thus may be useful to assess in pre-surgical or early post-surgical evaluations to inform targeted recommendations.
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http://dx.doi.org/10.1016/j.jpsychires.2019.10.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901114PMC
January 2020

The impact of childhood trauma on change in depressive symptoms, eating pathology, and weight after Roux-en-Y gastric bypass.

Surg Obes Relat Dis 2019 07 17;15(7):1080-1088. Epub 2019 Apr 17.

Neuropsychiatric Research Institute, Fargo, North Dakota.

Background: History of childhood trauma is associated with increased risk of mental disorders, eating pathology, and obesity.

Objective: To examine associations between childhood trauma and changes in depressive symptoms, eating pathology, and weight after Roux-en-Y Gastric Bypass (RYGB).

Setting: Three U.S. academic medical centers.

Method: Adults undergoing bariatric surgery (2007-2011) were enrolled in a cohort study. Participants (96 of 114; 86%) completed the Beck Depression Inventory-1 (BDI-1) to assess depressive symptomology, the interviewer-administered Eating Disorder Examination (EDE) to assess subthreshold eating pathology, weight assessment before and 6 months and annually after RYGB for ≥7 years, and the Childhood Trauma Questionnaire (CTQ) once post-RYGB.

Results: Presurgery, median age was 46 years, and median body mass index was 47 kg/m; 79% were female. Data completeness across 7-year follow-up was 78% to 90%, 66% to 91%, and 93% to 100% for the BDI-1, EDE, and weight, respectively. Using mixed models, presence/severity of childhood emotional abuse, emotional neglect, and physical neglect, but not sexual abuse or physical abuse, were significantly associated (P < .05) with change (i.e., less improvement/worsening) in the BDI-1 and EDE global scores, as were higher total CTQ score and more types of moderate-intensity trauma. All CTQ measures were associated (P < .05) with less improvement or worsening in the EDE eating concern and shape concern scores. CTQ measures were not significantly related to weight loss or regain.

Conclusions: Although childhood trauma did not affect weight outcomes after RYGB, those who experienced childhood trauma had less improvement in depressive symptomology and eating pathology and therefore might benefit from clinical intervention.
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http://dx.doi.org/10.1016/j.soard.2019.04.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702081PMC
July 2019

Predictors of weight regain after sleeve gastrectomy: an integrative review.

Surg Obes Relat Dis 2019 Jun 20;15(6):995-1005. Epub 2019 Mar 20.

Department of Health and Community Sciences, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.

Background: Sleeve gastrectomy (SG) is one of the most effective treatments for severe obesity, but weight regain after surgery is a challenging issue. The mechanism of postoperative weight relapse is barely understood because of the lack of long-term data.

Objectives: To review and synthesize current evidence related to factors that contribute to weight regain after SG.

Methods: Whittemore and Knafl's integrative method guided the research. The databases PubMed, EMBASE, and CINAHL, as well as 2 selected journals, were searched through October 2018 to gather English-language journal articles on the potential predictors of post-SG weight regain among adult populations. Only articles with sample size ≥10 were included. A narrative synthesis was used to analyze the 17 studies included in the review.

Results: In recent years there has been an upward trend in the published reports of SG on longer-term outcomes. After a review of 6863 records, 17 eligible studies were identified, reporting various definitions of weight regain and 3 main categories of predictors: surgical/anatomic factors, hormonal/metabolic imbalance, and behavioral/mood factors. The 17 studies used quantitative (n = 16) and qualitative methods (n = 1).

Conclusion: There is a dearth of available literature addressing predictors of weight regain after SG, and the inconsistency in the definition of regain limited the comparability between studies. Besides the surgical/anatomic factors that have been reported as significant predictors, other modifiable factors such as behavioral and psychosocial determinants need to be further investigated.
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http://dx.doi.org/10.1016/j.soard.2019.02.009DOI Listing
June 2019

The relationship between childhood maltreatment and psychopathology in adults undergoing bariatric surgery.

Surg Obes Relat Dis 2019 02 15;15(2):295-303. Epub 2018 Nov 15.

Neuropsychiatric Research Institute, Sanford Neuroscience Clinic, Fargo, North Dakota; University of North Dakota, Grand Forks, North Dakota. Electronic address:

Background: A history of childhood maltreatment and psychopathology are common in adults with obesity.

Objectives: To report childhood maltreatment and to evaluate associations between severity and type of childhood maltreatment and lifetime history of psychopathology among adults with severe obesity awaiting bariatric surgery.

Setting: Four clinical centers of the Longitudinal Assessment of Bariatric Surgery Research Consortium.

Methods: The Childhood Trauma Questionnaire, which assesses presence/severity (i.e., none, mild, moderate, severe) of physical abuse, mental abuse, physical neglect, mental neglect, and sexual abuse, was completed by 302 female and 66 male bariatric surgery patients. Presurgery lifetime history of psychopathology and suicidal ideation/behavior were assessed with the Structured Clinical Interview for DSM-IV and the Suicidal Behavioral Questionnaire-Revised, respectively. Presurgery lifetime history of antidepressant use was self-reported.

Results: Two thirds (66.6%) of females and 47.0% of males reported at least 1 form of childhood trauma; 42.4% and 24.2%, respectively, at greater than or equal to moderate severity. Among women, presence/greater severity of childhood mental or physical abuse or neglect was associated with a higher risk of history of psychopathology (i.e., major depressive disorder, posttraumatic stress disorder, other anxiety disorder, alcohol use disorder, binge eating disorder), suicidal ideation/behavior and antidepressant use (P for all ≤ .02). These associations were independent of age, race, education, body mass index, and childhood sexual abuse. Childhood sexual abuse was independently associated with a history of suicidal ideation/behavior and antidepressant use only (P for both ≤ .05). Statistical power was limited to evaluate these associations among men.

Conclusion: Among women with obesity, presence/severity of childhood trauma was positively associated with relatively common psychiatric disorders.
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http://dx.doi.org/10.1016/j.soard.2018.11.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481306PMC
February 2019

Mental disorders and weight change in a prospective study of bariatric surgery patients: 7 years of follow-up.

Surg Obes Relat Dis 2019 May 1;15(5):739-748. Epub 2019 Feb 1.

Neuropsychiatric Research Institute, Fargo, North Dakota.

Background: Long-term, longitudinal data are limited on mental disorders after bariatric surgery.

Objective: To report mental disorders through 7 years postsurgery and examine their relationship with changes in weight and health-related quality of life.

Setting: Three U.S. academic medical centers.

Method: As a substudy of the Longitudinal Assessment of Bariatric Surgery Consortium, 199 adults completed the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4 Edition prior to Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric band. Participants who completed ≥1 follow-up through 7 years postsurgery are included (n = 173; 86.9%). Mixed models were used to examine mental disorders over time, and among the RYGB subgroup (n = 104), their relationship with long-term (≥4 yr) pre- to postsurgery changes in weight and health-related quality of life, measured with the Short Form-36 Health Survey, and with weight regain from nadir.

Results: Compared with presurgery (34.7%), the prevalence of having any mental disorder was significantly lower 4 years (21.3%; P < .01) and 5 years (19.2%; P = .01), but not 7 years (29.1%; P = .27) after RYGB. The most common disorders were not related to long-term weight loss postRYGB. However, independent of weight change, mood and anxiety disorders, both pre- and postRYGB, were significantly related to less improvement in mental (but not physical) health-related quality of life. Having a concurrent mood disorder appeared to be associated with greater weight regain (6.4% of maximum weight lost, 95% confidence interval, -.3 to 13.1), but this was not statistically significant (P = .06).

Conclusions: Bariatric surgery does not result in consistent long-term reductions in mental disorders. Mood disorders may impact long-term outcomes of bariatric surgery.
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http://dx.doi.org/10.1016/j.soard.2019.01.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045720PMC
May 2019

Correction to: Psychosocial Concerns Following Bariatric Surgery: Current Status.

Curr Obes Rep 2019 03;8(1):10

Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

A word was inadvertently omitted in the original version of this article.
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http://dx.doi.org/10.1007/s13679-019-0329-zDOI Listing
March 2019

Eating pathology and associations with long-term changes in weight and quality of life in the longitudinal assessment of bariatric surgery study.

Int J Eat Disord 2018 12 6;51(12):1322-1330. Epub 2018 Dec 6.

Neuropsychiatric Research Institute, Fargo, North Dakota.

Objective: This study examines the course of eating pathology and its associations with change in weight and health-related quality of life following bariatric surgery.

Method: Participants (N = 184) completed the eating disorder examination-bariatric surgery version (EDE-BSV) and the medical outcomes study 36-Item short form health survey (SF-36) prior to and annually following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) for up to 7 years.

Results: The prevalence of ≥ weekly loss of control (LOC) eating, picking/nibbling, and cravings declined post-RYGB and remained lower through 7 years (LOC: 5.4% at Year-7 vs. 16.2% pre-RYGB, p = .03; picking/nibbling: 7.0% vs. 32.4%, p < .001; and cravings: 19.4% vs. 33.6%, p = .02). The prevalence of picking/nibbling was significantly lower 7 years following LAGB vs. pre-LAGB (29.4% vs 45.8%, p = .049), while cravings (p = .13) and LOC eating (p = .95) were not. EDE-BSV global score and ratings of hunger and enjoyment of eating were lower 7 years following both RYGB and LAGB versus pre-surgery (p's for all <.05). LOC eating following RYGB was associated with less long-term weight loss from surgery (p < .01) and greater weight regain from weight nadir (p < .001). Higher post-surgery EDE-BSV global score was associated with less weight loss/greater regain (both p < .001) and worsening/less improvement from surgery in the SF-36 mental component summary scores (p < .01).

Discussion: Initial improvements in eating pathology following RYGB and LAGB were sustained across 7 years of follow-up. Individuals with eating pathology post-RYGB, reflected by LOC eating and/or higher EDE-BSV global score, may be at risk for suboptimal long-term outcomes.
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http://dx.doi.org/10.1002/eat.22979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876117PMC
December 2018

Perceptions and experiences of appetite awareness training among African-American women who binge eat.

Eat Weight Disord 2020 Apr 16;25(2):275-281. Epub 2018 Sep 16.

School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.

Introduction: Binge eating may contribute to the prevalence of obesity in African-American women. Yet, there has been scant intervention research on the treatment of binge eating in this population. We tested the feasibility of an appetite awareness training (AAT) intervention in a sample of African-American women with binge and overeating behaviors. Participants who completed AAT were recruited to participate in focus groups to elicit information about their perceptions and experiences with this intervention to inform the design of future interventions to treat binge eating and obesity in African-American women.

Methods: African-American women, aged 18-70 years, who had completed an 8-week randomized AAT intervention, were invited to attend a focus group discussion. Session content was recorded and transcribed. Data were analyzed by use of open coding. Themes were identified that described their perceptions and experiences of participating in the intervention.

Results: Seventeen women participated in three focus group discussions. Pertinent themes identified included: paying attention to internal cues of hunger and satiety, influence of culture on eating patterns, breaking patterns of disordered eating, and perceptions about weight. Overall, participants were satisfied with their experience of AAT, and reported they found it valuable to learn about listening to biological signals of hunger and satiety and to learn specific strategies to reduce maladaptive eating patterns.

Conclusion: AAT was acceptable and provided helpful eating behavior instruction to African-American women with reported binge and overeating behaviors. Future research should examine the potential of AAT to improve weight management in this underserved population.

Level Of Evidence: Level V, qualitative descriptive study.
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http://dx.doi.org/10.1007/s40519-018-0577-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420865PMC
April 2020

Defining Adherence to Dietary Self-Monitoring Using a Mobile App: A Narrative Review.

J Acad Nutr Diet 2018 11 13;118(11):2094-2119. Epub 2018 Aug 13.

Understanding how adherence to dietary self-monitoring with apps has been defined is a first step toward examining the relationship between adherence and weight loss. The purpose of this review was to explore how adherence to dietary self-monitoring has been defined in the empirical literature that addresses weight loss app use by overweight and obese adults. The integrative review method and the preferred reporting items for systematic reviews and meta-analyses guided this review. Scientific databases (n=5) were searched, which yielded 29 studies. Studies were screened, evaluated for data quality, and then analyzed according to the constant comparison method. Most studies were weak to moderate quality. Results indicated that adherence was operationally defined in two ways. Adherence was defined as either adherent or nonadherent based on the completion of recording a minimum amount of calorie intake or a calorie amount within a specific range of calories. Another way that adherence was defined was the frequency of dietary self-monitoring, which included the frequency of dietary intake recording, interaction with apps, and the timing of recording. Some studies defined adherence in both ways. Most included studies lacked diversity in study samples. Until a consensus is reached, it may be prudent to study multiple indicators of adherence to dietary self-monitoring using apps, and their respective relationships with weight loss. Studies are needed that address the type and degree of adherence to dietary self-monitoring with an app that is associated with weight loss in diverse populations.
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http://dx.doi.org/10.1016/j.jand.2018.05.011DOI Listing
November 2018

The feasibility of a binge eating intervention in Black women with obesity.

Eat Behav 2018 Apr 9;29:83-90. Epub 2018 Mar 9.

Schools of Social Work and Nursing, University of Pittsburgh, 2117 Cathedral of Learning, Pittsburgh, PA 15260, United States.

Introduction: U.S. Black women have the highest rates of obesity and report frequent binge eating behaviors. To our knowledge, no intervention research has aimed to treat binge eating specifically among Black women. The purpose of this study was to investigate the feasibility and preliminary effect of Appetite Awareness Treatment (AAT), an 8-week cognitive-behavioral binge eating intervention, among Black women with obesity, and who report binge eating.

Methods: Participants (N = 31), had a mean (±SD) age of 48.8 ± 12.8 years, a body mass index of 33.7 ± 3.9 kg/m, and reported at least one binge eating episode monthly over the last three months. Using a randomized controlled trial design, Black women were randomized to AAT or a wait-list control group (WAIT) group. We examined recruitment, attendance, retention, and adherence. Linear mixed models explored preliminary differences between the AAT and WAIT on the primary outcome variables of binge eating and eating self-efficacy measured at baseline and 8-weeks.

Results: Approximately one-third of screened participants were eligible and did enroll. Participants completed 55% of homework assignments, and attended 59% of intervention sessions. Retention to AAT was 87.5%. Compared to participants in the WAIT group, AAT participants had greater decreases in binge eating scores and greater improvements in eating self-efficacy scores at the end of Week 8.

Conclusion: Results suggest that AAT is feasible among Black women with binge eating behaviors, with evidence of preliminary efficacy, providing a rationale for a trial of AAT in a larger sample of Black women.
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http://dx.doi.org/10.1016/j.eatbeh.2018.03.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5935580PMC
April 2018

Applying Ecological Frameworks in Obesity Intervention Studies in Hispanic/Latino Youth:: A Systematic Review.

Hisp Health Care Int 2017 09;15(3):130-142

1 Suffolk County Community College, Brentwood, NY, USA.

Introduction: In the United States, Hispanic children have higher rates of obesity compared with non-Hispanic White children. An ecological framework provides a holistic view of the environment to which Hispanic/Latino children are exposed that can potentially inform prevention and treatment initiatives for this vulnerable population.

Method: This systematic review examines the existing evidence on the use of an ecological framework in intervention studies targeting overweight and obesity in Hispanic youth from birth to 8 years. Key terms guided the search of PubMed, Google Scholar, CINAHL, and EBSCOhost databases from 1997 to 2016. Results were organized using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method.

Results: Seven studies met the inclusion and exclusion criteria. Significant improvements in body mass index z scores in treatment children were evident in five of the seven studies. Increases in fruit, water, and vegetable consumption and physical activity levels were reported in four of the seven studies.

Conclusion: Multilevel interventions targeting a child's home and community suggest efficacy in reducing or preventing obesity; increasing fruit, water, and vegetable consumption; and increasing physical activity in overweight/obese young Hispanic children. Future research is needed to explore the sustainability of multilevel obesity prevention interventions in this vulnerable population.
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http://dx.doi.org/10.1177/1540415317731069DOI Listing
September 2017

The case for stepped care for weight management after bariatric surgery.

Surg Obes Relat Dis 2018 01 20;14(1):112-116. Epub 2017 Jul 20.

Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Among carefully screened patients, bariatric surgery has proven safe and efficacious in the management of clinically severe obesity and poorly controlled type 2 diabetes. Nonetheless, individual outcomes vary, suggesting the need for interventions to maximize and sustain the health benefits of surgery. In this short review, we synthesize findings from the extant research literature to suggest the potential utility of a stepped care approach to optimize the postsurgery weight trajectory, which requires further research using adaptive designs. Starting with low-intensity, cost-effective interventions, such as self-weighing and self-monitoring, interventions that increase in intensity, such as counseling, meal replacements, or weight loss medications, could be added strategically according to predetermined decision rules based on patient weight change. Interventions could subsequently be withdrawn if no longer indicated, or reinstituted when appropriate, allowing for efficient allocation of resources in a personalized approach to postsurgery weight management over time.
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http://dx.doi.org/10.1016/j.soard.2017.07.023DOI Listing
January 2018

Surgery-related gastrointestinal symptoms in a prospective study of bariatric surgery patients: 3-year follow-up.

Surg Obes Relat Dis 2017 Sep 4;13(9):1562-1571. Epub 2017 Apr 4.

Neuropsychiatric Research Institute, Fargo, North Dakota.

Background: Having accurate information on bariatric surgery-related gastrointestinal (GI) symptoms is critical for patient care.

Objective: To report on surgery-related GI symptoms over the first 3 years following Roux-en-Y gastric bypass and laparoscopic adjustable gastric band.

Setting: Three academic medical centers in the United States.

Methods: As a substudy of the Longitudinal Assessment of Bariatric Surgery Consortium, 183 participants (pre-surgery median body mass index = 45.1 kg/m; median age = 46 yr; 83.1% female). completed the Eating Disorder Examination-Bariatric Surgery Version interview at≥1 annual assessment. Patients self-reported frequency of dysphagia, dumping syndrome, and spontaneous vomiting.

Results: Prevalence of dysphagia at least once weekly decreased post-laparoscopic adjustable gastric band surgery from 43.9% (95% confidence interval [CI], 32.2-55.6) in year 1 to 27.5% (95% CI, 15.2-39.9) in year 3 (P = .02). Dysphagia and dumping at least once weekly also appeared to decrease in years 1-3 post-Roux-en-Y gastric bypass (i.e., from 16.7% [95% CI, 9.4-24.1] to 10.9% [95% CI, 4.0-17.8] and from 9.9% [95% CI, 4.3-15.5] to 6.3% [95% CI, 1.7-10.9], respectively), but power was limited to evaluate trends. Vomiting at least once weekly was rare (<6%) in years 1-3 following both procedures. Controlling for potential confounders and surgical procedure, loss of control eating at least once weekly was associated with higher risk of at least once weekly dysphagia (relative risk = 2.01, 95% CI, 1.36-2.99, P = .001).

Conclusions: The prevalence of bariatric surgery-related GI symptoms appears to decrease across follow-up. Symptoms were associated with loss of control eating, suggesting a target for clinical intervention.
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http://dx.doi.org/10.1016/j.soard.2017.03.028DOI Listing
September 2017

Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study.

Surg Obes Relat Dis 2017 Aug 7;13(8):1337-1346. Epub 2017 Apr 7.

Neuropsychiatric Research Institute, Fargo, North Dakota; Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota.

Background: Limited evidence suggests bariatric surgery may not reduce opioid analgesic use, despite improvements in pain.

Objective: To determine if use of prescribed opioid analgesics changes in the short and long term after bariatric surgery and to identify factors associated with continued and postsurgery initiated use.

Setting: Ten U.S. hospitals.

Methods: The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study. Assessments were conducted presurgery, 6 months postsurgery, and annually postsurgery for up to 7 years until January 2015. Opioid use was defined as self-reported daily, weekly, or "as needed" use of a prescribed medication classified as an opioid analgesic.

Results: Of 2258 participants with baseline data, 2218 completed follow-up assessment(s) (78.7% were female, median body mass index: 46; 70.6% underwent Roux-en-Y gastric bypass). Prevalence of opioid use decreased after surgery from 14.7% (95% CI: 13.3-16.2) at baseline to 12.9% (95% CI: 11.5-14.4) at month 6 but then increased to 20.3%, above baseline levels, as time progressed (95% CI: 18.2-22.5) at year 7. Among participants without baseline opioid use (n = 1892), opioid use prevalence increased from 5.8% (95% CI: 4.7-6.9) at month 6 to 14.2% (95% CI: 12.2-16.3) at year 7. Public versus private health insurance, more pain presurgery, undergoing subsequent surgeries, worsening or less improvement in pain, and starting or continuing nonopioid analgesics postsurgery were significantly associated with higher risk of postsurgery initiated opioid use.

Conclusion: After bariatric surgery, prevalence of prescribed opioid analgesic use initially decreased but then increased to surpass baseline prevalence, suggesting the need for alternative methods of pain management in this population.
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http://dx.doi.org/10.1016/j.soard.2017.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568488PMC
August 2017

Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study.

Surg Obes Relat Dis 2017 Aug 31;13(8):1392-1402. Epub 2017 Mar 31.

Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.

Background: Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) after bariatric surgery is limited.

Objective: To report SUD-related outcomes after RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes.

Setting: 10 U.S. hospitals METHODS: The Longitudinal Assessment of Bariatric Surgery-2 is a prospective cohort study. Participants self-reported past-year AUD symptoms (determined by the Alcohol Use Disorders Identification Test), illicit drug use (cocaine, hallucinogens, inhalants, phencyclidine, amphetamines, or marijuana), and SUD treatment (counseling or hospitalization for alcohol or drugs) presurgery and annually postsurgery for up to 7 years through January 2015.

Results: Of 2348 participants who underwent RYGB or LAGB, 2003 completed baseline and follow-up assessments (79.2% women, baseline median age: 47 years, median body mass index 45.6). The year-5 cumulative incidence of postsurgery onset AUD symptoms, illicit drug use, and SUD treatment were 20.8% (95% confidence interval (CI): 18.5-23.3), 7.5% (95% CI: 6.1-9.1), and 3.5% (95% CI: 2.6-4.8), respectively, post-RYGB, and 11.3% (95% CI: 8.5-14.9), 4.9% (95% CI: 3.1-7.6), and .9% (95% CI: .4-2.5) post-LAGB. Undergoing RYGB versus LAGB was associated with higher risk of incident AUD symptoms (adjusted hazard ratio or AHR = 2.08 [95% CI: 1.51-2.85]), illicit drug use (AHR = 1.76 [95% CI: 1.07-2.90]) and SUD treatment (AHR = 3.56 [95% CI: 1.26-10.07]).

Conclusions: Undergoing RYGB versus LAGB was associated with twice the risk of incident AUD symptoms. One-fifth of participants reported incident AUD symptoms within 5 years post-RYGB. AUD education, screening, evaluation, and treatment referral should be incorporated in pre- and postoperative care.
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http://dx.doi.org/10.1016/j.soard.2017.03.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568472PMC
August 2017

Wise Choices: Nutrition and Exercise for Older Adults: A Community-Based Health Promotion Intervention.

Fam Community Health 2016 Oct-Dec;39(4):263-72

Duquesne University School of Nursing, Pittsburgh, Pennsylvania (Drs Turk, Resick, and Kalarchian); and Westat Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Elci).

Effective interventions for older adults are needed to address lifestyle behaviors linked to chronic illnesses. We implemented a 12-week group behavioral intervention for 118 racially diverse older adults at 6 community-based senior centers to improve eating and physical activity. Assessments were completed pre- and postintervention, with 85.6% retention. We documented increases in fruit, vegetable, and whole grain intake; pace of walking; number of city blocks walked; daily steps walked; functional mobility; and self-rated general health (P < .05). Findings indicate that a relatively low-intensity lifestyle intervention can effectively be implemented for community-dwelling older adults. Further development of this approach is warranted.
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http://dx.doi.org/10.1097/FCH.0000000000000116DOI Listing
September 2017

Structured dietary intervention to facilitate weight loss after bariatric surgery: A randomized, controlled pilot study.

Obesity (Silver Spring) 2016 09 28;24(9):1906-12. Epub 2016 Jul 28.

Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA.

Objective: To evaluate the potential utility of a structured dietary intervention to assist bariatric surgery patients with weight management.

Methods: Participants who underwent Roux-en-Y gastric bypass surgery 1 year previously were randomly assigned to a structured dietary intervention incorporating portion-controlled foods (intervention, n = 20) or a comparison group (control, n = 20). Both groups received instruction in behavioral weight loss (one 60-min session) followed by four monthly coaching telephone calls. Assessments were conducted at baseline, 4 months (post-intervention), and 6 months.

Results: Participants were 85% female and 80% White. Average age was 46.9 (11.1) years, and body mass index was 31.3 (5.4) kg/m(2) at enrollment. Percent weight change from enrollment was significantly greater for intervention compared with control participants at 4 months [-4.56% vs. -0.13%, t(30)  = -3.29, P = 0.003] and 6 months [-4.07% vs. -0.14%, t(31)  = -2.03, P = 0.05]. Change in average daily calorie intake was greater among intervention compared with control [-108 vs. 116, t(30)  = -2.01, P = 0.05] at 4 months only.

Conclusions: A structured dietary intervention increased weight loss and reduced calorie intake when initiated 1 year following Roux-en-Y gastric bypass. This approach holds promise for optimizing postsurgery lifestyle change.
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http://dx.doi.org/10.1002/oby.21591DOI Listing
September 2016

Eating pathology and experience and weight loss in a prospective study of bariatric surgery patients: 3-year follow-up.

Int J Eat Disord 2016 Dec 18;49(12):1058-1067. Epub 2016 Jul 18.

Neuropsychiatric Research Institute, Fargo, North Dakota.

Objective: Bariatric surgery results in significant long-term weight loss, albeit with considerable variability. This study examines the prognostic significance of eating pathology as determined by a structured interview, the Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV).

Method: Participants (N = 183) in this substudy of the Longitudinal Assessment of Bariatric Surgery (LABS) Research Consortium were assessed using the EDE-BSV, independent of clinical care, presurgery and annually postsurgery. We examined eating pathology and experiences at several frequency thresholds (present, ≥ monthly, ≥ weekly) over 3 years, and utilized mixed models to test their associations with percentage weight loss from baseline at years 1, 2, and 3.

Results: The prevalence of several forms of eating pathology declined pre- to 1-year postsurgery, including ≥weekly objective bulimic episodes (11.6-1.3%), loss of control (LOC) eating (18.3-6.2%) and picking/nibbling (36.0-20.2%) (P for all <0.01), and regular evening hyperphagia (16.5-5.0%, P = 0.01), but not cravings (P = 0.93). Mean EDE global score, and hunger and enjoyment scores, also declined (P for all <0.01). These metrics remained lower than baseline through year-3 (P for all <0.01). Presurgery eating variables were not related to weight loss (P for all ≥0.05). However, postsurgery higher EDE global score and greater hunger were independently associated with less weight loss postsurgery (P for both ≤0.01), while cravings were associated with greater weight loss (P = 0.03).

Discussion: Pathological eating behaviors and experiences are common presurgery and improve markedly following surgery. Postsurgery pathological eating-related experiences and attitudes and hunger may contribute to suboptimal weight loss. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1058-1067).
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http://dx.doi.org/10.1002/eat.22578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5161707PMC
December 2016

Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial.

JAMA Intern Med 2016 Apr;176(4):443-52

Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Importance: Most women who quit smoking during pregnancy will relapse postpartum. Previous efforts to prevent postpartum relapse have been unsuccessful at increasing rates of sustained abstinence.

Objective: To evaluate the relative efficacy of 2 different approaches to prevent postpartum smoking relapse.

Design, Setting, And Participants: Pregnant women who recently had quit smoking were recruited before the end of pregnancy. Intervention sessions were conducted through a combination of telephone calls and in-person visits beginning at delivery and continuing through 24 weeks postpartum. Participants completed assessments at the prenatal baseline and at 12, 24, and 52 weeks postpartum. Participants were recruited between March 2008 and December 2012. The dates of the analysis were April 2014 to February 2015.

Interventions: Women received postpartum-adapted, behavioral smoking relapse prevention intervention and were randomly assigned to an enhanced cognitive behavioral intervention that included additional specialized strategies and content focused on women's postpartum concerns about mood, stress, and weight (Strategies to Avoid Returning to Smoking [STARTS]) or a supportive, time and attention-controlled comparison (SUPPORT). Intervention began before delivery and continued through 24 weeks postpartum.

Main Outcomes And Measures: The primary outcome was biochemically confirmed sustained tobacco abstinence at 52 weeks postpartum. Secondary outcomes were self-reported mood, levels of perceived stress, and degree of concern about smoking-related weight gain.

Results: The study cohort comprised 300 participants (150 randomly assigned to each group). Their mean (SD) age was 24.99 (5.65) years. Overall, 38.0% (114 of 300), 33.7% (101 of 300), and 24.0% (72 of 300) of the sample maintained abstinence at 12, 24, and 52 weeks' postpartum, respectively. There were no differences between the intervention groups in abstinence or time to relapse. Self-reported depressive symptoms and perceived stress significantly improved over time, and improvements were similar for both intervention groups. Women with more depressive symptoms and higher levels of perceived stress were more likely to relapse (hazard ratio, 1.02; 95% CI, 1.00-1.04; P = .04 for depressive symptoms and hazard ratio, 1.04; 95% CI, 1.01-1.07; P = .003 for stress).

Conclusions And Relevance: An intervention designed to address women's concerns about mood, stress, and weight did not differentially improve rates of sustained tobacco abstinence postpartum compared with a time and attention-controlled comparison. Women in STARTS and SUPPORT reported postpartum improvements in mood and stress, and the experience of fewer depressive symptoms and less perceived stress was related to sustained abstinence. Given that most pregnant quitters will relapse within 1 year postpartum and that postpartum smoking has negative health consequences for women and children, effective interventions that target postpartum mood and stress are needed.

Trial Registration: clinicaltrials.gov Identifier: NCT00757068.
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http://dx.doi.org/10.1001/jamainternmed.2016.0248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333234PMC
April 2016

Retention and attrition in bariatric surgery research: an integrative review of the literature.

Surg Obes Relat Dis 2016 Jan 21;12(1):199-209. Epub 2015 Sep 21.

Gumberg Library, Duquesne University, Pittsburgh, Pennsylvania.

Background: Bariatric surgery research, often longitudinal, bears the challenge of maintaining retention and decreasing attrition of participants to avoid bias.

Objectives: To explore factors influencing the retention and attrition for bariatric surgical research participants.

Methods: Databases searched included: PubMed, CINAHL, Scopus, and others. As a secondary aim, studies reporting on retention/attrition factors in clinical follow-up visits were included.

Results: Of the 1145 articles retrieved, 44 met inclusion criteria, and underwent qualitative analysis. Four descriptive articles focused on longitudinal research participation and 40 on clinical follow-up visits. Willingness to participate in research was high (92%) and decreased with more invasive procedures or extra visits. A large observational longitudinal study presented 24-month retention/attrition data (92% for some data and 66% visit completion) and the retention strategies employed. One study indicated that research follow-up possibly increased clinical follow-up and another demonstrated a higher retention by increasing compensation. No consistent, modifiable demographic or psychosocial variables associated or predictive of retention or attrition in clinical follow-up were identified.

Conclusions: Research on factors related to participant retention and attrition is sparse. It is essential for studies to document retention/attrition data. Existing research has demonstrated a patient willingness to participate in research and that retention strategies have been successful in the short term. Further research should explore the motivations, perspectives and attitudes of bariatric surgical research participants regarding participation and explore predictors to develop evidence-based retention strategies. Research has yet to identify consistent and modifiable demographic or psychosocial variables predictive of clinical follow-up, possibly due to the heterogeneity of follow-up across studies. Further investigation into follow-up definition, content, counseling approaches, and new telemedicine technologies may prove helpful in developing predictors and evidence-based strategies. The relationship between research and clinical retention and attrition deserves further characterization.
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http://dx.doi.org/10.1016/j.soard.2015.09.006DOI Listing
January 2016
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