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Background: The existence of pain-related fear appears to present an obstacle for health promoting behaviour change, particularly among younger adults with obesity. Measures developed and validated for middle-and-older age groups lack validity in younger adults under 45 years of age. This paper reports on the development and psychometric properties of a new instrument, based on a conceptual framework, to measure pain-related fear in younger adults. Methods: A cross sectional survey design was employed. 236 participants aged 18 to 45 years were recruited to participate. Participants completed three existing pain-related fear instruments mapped to a conceptual framework. Exploratory and confirmatory factor analysis identified the dimensions of the new Pain-Related Fear Scale. Construct validity was assessed by comparing scores between physical activity groups; criterion validity by correlation with the Tampa Scale of Kinesiophobia and reliability by Cronbach’s alpha. Differences in scores in the Pain-Related Fear Scale were explored across BMI subgroups. Results: A four-factor model with 12 items met the most acceptability thresholds for a good fitting model (CFI = 0.983; GFI = 0.953; RMSEA = 0.046; SRMR = 0.0301). Higher mean scores on the PainRelated Fear Scale were seen among those reporting low activity compared to high activity levels (F= 4.684; P= 0.01). Modest correlation was observed between the new instrument and Tampa Scale of Kinesiophobia (r= 0.508;95% CI= 0.389-0.612). Cronbach’s alpha was 0.842. Scores were higher in the obese subgroup compared to the healthy bodyweight group (mean difference= -7.42; CI= -12.26 - -2.58; P= 0.001). Conclusion: The Pain-Related Fear Scale is a psychometrically valid measurement of pain-related fear for adults with obesity aged between 18 to 45 years. The instrument can support research relating to barriers to physical activity, and potentially has clinical utility as a screening and outcome measurement.

Obesity continues to be a growing public health problem worldwide. In adults with obesity, physical activity has health benefits beyond those directly attributable to weight loss. However, adults with obesity encounter various barriers to physical activity. Some barriers including fear, have received little academic attention, particularly in adults under 45 years. The aim of this qualitative study was to explore how fears about physical activity are experienced by, and impact on, adults with obesity aged 18 to 45 years. Semi-structured interviews were undertaken in a sample of 10 participants with a body mass index greater than 30 kg/m2. Analysis was conducted using the six phases of thematic analysis from the guidelines of Braun and Clarke. Participants gave detailed accounts of their experiences of fear and how it impacted on physical activity. Three themes were extracted: (1) fear as a barrier to physical activity; (2) threats, concerns and worries about weight underpinning fear(s) of activity; and (3) the consequences of fear(s). The findings suggest that the emotion of fear, particularly pain-related fear(s), were a frequent and important barrier to physical activity among younger adults with obesity. This is an important finding because of the risk it poses to health behaviour change. The findings provide some evidence that younger adults experience fear avoidance beliefs aligned to the conceptual principles of the Fear Avoidance Model. Further research is needed to further explore this relationship in a larger sample of younger adults with obesity, and explore its implications for promoting behaviour change in this group.

Physical activity is a health behavior contributing to successful weight management. Adults with overweight and obesity find it challenging to meet recommended activity guidelines because of a range of barriers, some of which are not yet fully understood. A barrier receiving limited consideration, compared with other literature within this field, is that of fear. The purpose of this scoping review was to establish the extent of literature on fear-related barriers to physical activity in adults with overweight or obesity and to identify gaps in this literature. The review followed the scoping review framework outlined by Arksey and O'Malley and adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The findings of the identified papers were charted thematically using a framework of fears and age group. In total, 34 studies were included that identified nine different fears related to barriers to activity in this population. However, only a small number of studies (n = 5) had explicitly intended to explore fear-related barriers. There were notable knowledge gaps including activity-related fear of pain and movement in adults under 45 years of age. There is a strong rationale to further explore these fears because they may restrict health promoting behavior.

Background Prostate cancer has been shown to be susceptible to significant stigmatisation, because to a large extent it is concealable, it has potentially embarrassing sexual symptoms and has significant impact on the psychosocial functioning. Methods This review included studies that focused on qualitative and/or quantitative data, where the study outcome was prostate cancer and included a measure of stigmatization. Electronic databases (CINAHL, Medline, PubMed, PsycInfo, Cochrane Library, PROSPERO, and the Joanna Briggs Institute) and one database for grey literature Opengrey.eu, were screened. We used thematic analysis, with narrative synthesis to analyse these data. We assessed risk of bias in the included studies using the RoBANS. Results In total, 18 studies met review inclusion criteria, incorporating a total of 2295 participants. All studies recruited participants with prostate cancer, however four studies recruited participants with other cancers such as breast cancer and lung cancer. Of the 18 studies, 11 studies evaluated perceived or felt stigma; four studies evaluated internalised or self-stigma; three studies evaluated more than one stigma domain. Discussion We found that patients living with prostate cancer encounter stigmatisation that relate to perception, internalisation, and discrimination experiences. We also identified several significant gaps related to the understanding of prostate cancer stigmatization, which provides an opportunity for future research to address these important public health issues., This project received funding from Edge Hill University to undertake this research. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The chronic fatigue syndrome (CFS) remains a contentious and controversial presentation despite decades of systematic research from a variety of medical specialties and associated disciplines. Variously championed as a condition of immunological, neurological, neurophysiological, psychiatric or psychological origin, consensus on a cogent and evidenced-based pathway has yet to be achieved. Irrespective of the ambiguity regarding aetiology, what is incontrovertible is the experience of significant depression, which often accompanies this most distressing clinical presentation. The current paper examines the potential underlying mechanisms, which may determine and explain this relationship between CFS and depression. In doing so, it offers some insights, which may be of value in the development of evidence-based and scientifically-anchored interventions in individuals experiencing this diagnosis, to improve outcomes in relation to depression specifically and quality of life more generally.

Palliative care refers to treatment and care delivered when the disease/illness is not responsive to curative treatment. The World Health Organization defines palliative care as ‘an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of an early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’ (WHO 2004). Palliative care and treatment strategies can also be used to manage the side effects of intrusive treatments within curative treatment. Often associated in the mind as being related to oncology and cancer, palliative care can be delivered to people experiencing any form of life-threatening illnesses such as chronic heart failure, respiratory disease, and neurological disorders such as motor neurone disease and multiple sclerosis. Palliative care can also be distinguished from end-of-life care. In the UK end-of-life care is written into clinical pathways concerned with the final days and hours of a person’s life (DoH 2008; LCP 2008). The key aims of these care pathways are to improve quality of care of the dying in the last hours and days of life and to improve knowledge related to the process of dying.

Individuals make dietary choices each time they consume food or drink, and assign labels to each item, such as un/healthy, high/low in calories, high/low in nutrients. These labels are thought to be snap judgments based on prior, and often limited nutritional knowledge. The aim of this study was to examine the perception of the caloric content of ‘healthy’ and ‘unhealthy’ foods. Participants (N=141) rated 53 food images on perceived healthiness/un-healthiness alongside the caloric content. Participants were subdivided into three groups: BMI (normal-weight, overweight, obese). Foods perceived as healthy were systematically underestimated in their caloric content, whereas foods perceived as unhealthy were consistently overestimated. Weight status influenced caloric estimations of foods perceived as healthy, but not to foods perceived as unhealthy. However, not all foods were consistently labeled as healthy or unhealthy, on these occasions weight salience appears not to have influenced estimations of caloric content. Findings suggest that weight status impacts participant's caloric estimation of foods perceived as healthy, but only marginally for unhealthy foods. Foods that confound the dichotomous labeling of healthy or unhealthy appear to gain a ‘branding’ that confers either greater or fewer calories than they actually contain, on these occasions weight salience does not appear to influence the labeling; implications are discussed.

Autistic spectrum disorders are a diverse group of complex, persistent and pervasive neurodevelopmental conditions which are characterized by impairments in social communication, social interaction, often restrictive and repetitive patterns of behaviour, interests or activities. Probiotics have been shown to influence microbiota composition, therefore may be a useful novel therapeutic tool to restore normal gut microbiota, reduce inflammation and ameliorate behavioral symptoms associated with autistic spectrum disorders. Once the gut becomes leaky it is therefore possible to increase intestinal permeability which may allow the passage of bacteria, toxins and other metabolites which may lead to immune activation. For many years theories have been developed which implicate the possible role of immune dysfunction in autistic spectrum disorder. Administration of probiotics has been known to influence neuronal functioning, and attenuate pro-inflammatory immune responses. Pro-inflammatory immune response has been attenuated by the administration of Bifidobacteria.

The probiotics evidence-base: Improving quality through innovation in research methodologies

Phillipou et al. (2017) assert that anorexia nervosa (AN) should be thought of as a body image disorder (BID), and not as it is currently categorized as an eating disorder (ED, American Psychiatric Association, 2013). They propose that the change in description may serve as a more valuable and accurate portrayal of the illness, and suggest that conceptualizing AN as an ED is too simplistic and thus misleading. Phillipou et al. (2017) examine the view that AN is somehow different from other eating disorders such as pica, rumination disorder, avoidance/restricted food intake disorder, binge eating disorder and bulimia nervosa, because at its core AN is fundamentally an illness of ‘body image’. A parallel objective of Phillipou et al. (2017) is to alter the general public’s perception of AN, from one in which the public believe the AN patient is principally driven by disordered eating behaviour in order to reduce body fat, to one in which the patients’ overriding stimulus is actually body image.

In a traditional operations-centered model, decisions regarding patient care are determined by cost, efficiency, and operational flow. With increasing deductibles and health care expenses, US patients are now consumers of health care and, as such, have developed consumer demands of health care service levels. This is particularly true in the US assisted reproductive technology (ART) market, where the majority of fertility treatment is self-pay. The Continuous Quality Improvement (CQI) committee consists of an interdepartmental group of employees ranging from the senior management team to medical directors and laboratory management staff. It is an integrated, continuous effort to measure, monitor, and improve patient safety and the performance of infertility and ART services. Alignment of the organization around the patient is critical to the business of any ART center. The patient experience needs to align with patient expectations and these expectations need to be carefully and thoughtfully developed.

Obesity is a heterogeneous condition with a complex and incomplete etiology; however, there is growing evidence for considering the salience of obesity for the psychiatric nomenclature. Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2013) does not adequately categorize individuals with marked distress in relation to quantifiable aesthetic concerns such as obesity.

The control-value theory of achievement emotions proposes a bidirectional relationship between learning-related emotions and achievement goals. Studies to date, however, have only provided evidence that achievement goals predict future learning-related emotions. In this study we examined the reciprocal relations between learning-related emotions and achievement goals in 434 undergraduate students in their first year of academic study. Data were collected in three waves: near the beginning of the first and second semesters of first year study and lastly near the beginning of the first semester of the second year. Reciprocal effects were found between mastery goals and both activity- and outcome-focused emotions, whereas reciprocal effects for performance goals were only shown with outcome focused emotions. These were not always present between both first and second, and between the second and third waves of measurement, which may be related to the first year undergraduate context. Our models also demonstrated stability in achievement goals and learning-related emotions between waves of measurement, which tended to be lower between the first and third points of data collection. These findings provide support for the relations between learning-related emotions and achievement goals proposed in control-value theory and that mastery goals are not solely related to activity-focused emotions.

Previous work has established how achievement emotions are related to the trichotomous model of achievement goals, and how they predict academic performance. In our study we examine relations using an additional, mastery-avoidance goal, and whether outcome-focused emotions are predicted by mastery as well as performance goals. Results showed that outcome-focused emotions were predicted by mastery approach/avoidance, and performance-avoidance goals, whereas activity-focused emotions were predicted by mastery approach/avoidance goals only. Two achievement emotions, pride and hope, mediated relations between achievement goals and academic performance. These findings show that it is important to consider the hierarchical nature of achievement goals, that is, the distinction between goals and reasons. If students use grades as a basis on which to judge their task and intrapersonal competence, then mastery goals can predict outcome-focused emotions.

Body dysmorphic disorder (BDD) is a condition in which an individual perceives an area of their body to be fundamentally flawed. Individuals may notice small imperceptible blemishes that become the epicenter for obsessional repetitive ritualistic behaviors that can force them to spend many hours in front of mirrors examining and reexamining the same area. Any area of the body may become the perceived area of attention, but in general the most frequently reported areas are hair, face, breasts, stomach, and thighs. These problem areas may be explored for up to 8 hours/day. There is a strong association with obsessive–compulsive disorder, and BDD is found in 37% of those with the condition, with a lifetime prevalence of 83%. Even though the Diagnostic and Statistical Manual of Mental Disorders has no specific diagnostic category for BDD within an obese population, evidence has shown that many individuals seeking weight loss surgery report a number of psychological and physiological reasons. Body image dissatisfaction is a major contributing factor in the motivation to elect for surgical intervention. The events that occur after bariatric surgery with regards to BDD, body image, and quality-of-life (QoL) have remained largely unexplored. However, studies suggest that the antecedents to BDD, including anxiety and depression, are reported to be much improved following bariatric surgery. Individuals who have dramatic and relatively sudden weight loss following bariatric surgery often have postoperative skin folds. The skin folds can become a source of frustration and anxiety, and can even prevent further weight loss. It is suggested that the individual’s new body image may become a source of deep frustration, shame, and even humiliation.

Sexual function (SF) disorder is common among those seeking surgical intervention for excessive weight. Symptoms of sexual dysfunction (SD) can manifest in any one of the phases of the sexual response cycle, which include desire, excitement, orgasm, and finally, resolution. Females more than males have a greater impairment in sexual quality-of-life (QoL), and greater sexual difficulties prior to weight loss surgery. For example, they may report significant impairment in most domains of SF, including sexual desire, sexual arousal, lubrication, orgasm, and sexual satisfaction. Following bariatric surgery, however, women are more likely to report that their self-esteem had increased and anxiety around sex had diminished; they also report more intense feelings of desire and arousal. SD in males manifests primarily as erectile dysfunction (ED) or premature ejaculation. Following bariatric surgery, male ED and sexual QoL tend to normalize once weight is lost; a few studies have reported variations in sperm production and quality, but more research is required.

This paper seeks to add to the discussion surrounding young adults’ relationship and engagement with learning technologies, exploring whether they naturally engage with these technologies when the use of them is either compulsory or optional.We discuss our findings in relation to whether young people are truly engaging with technologies or whether they are simply passive consumers of some technology, and unenthusiastic innovators in others. Participants in the UK (N=6, Mean Age 20.66, undergraduate psychology students) provided their responses to a short series of face–to–face interviews using open–ended questions designed to elicit a critical exploration of their learning experience with particular emphasis on learning technologies. Participants in the US (N=26, Mean Age=22.38, pre–service teachers) responded to a series of short open–ended questions submitted online using asynchronous video journals uploaded to a private classroom space on YouTube.We found that young people are generally unenthusiastic users of learning technologies, which has significant implications for the educational sector in the UK and the US, as many of our participants are pre-service teachers. At a time when great emphasis is being placed on increasing student access to technologies in the classroom to enrich the learning experience, and to offer greater opportunity for understanding and discovery of information, trainee educators seem reluctant to engage with many types of educational technologies.

This study aimed to examine the relationship between the consumption of ecstasy (3,4-methylenedioxymethamphetamine (MDMA)) and cannabis, and performance on the random letter generation task which generates dependent variables drawing upon executive inhibition and access to semantic long-term memory (LTM). The participant group was a between-participant independent variable with users of both ecstasy and cannabis (E/C group, n = 15), users of cannabis but not ecstasy (CA group, n = 13) and controls with no exposure to these drugs (CO group, n = 12). Dependent variables measured violations of randomness: number of repeat sequences, number of alphabetical sequences (both drawing upon inhibition) and redundancy (drawing upon access to semantic LTM). E/C participants showed significantly higher redundancy than CO participants but did not differ from CA participants. There were no significant effects for the other dependent variables. A regression model comprising intelligence measures and estimates of ecstasy and cannabis consumption predicted redundancy scores, but only cannabis consumption contributed significantly to this prediction. Impaired access to semantic LTM may be related to cannabis consumption, although the involvement of ecstasy and other stimulant drugs cannot be excluded here. Executive inhibitory functioning, as measured by the random letter generation task, is unrelated to ecstasy and cannabis consumption. Copyright © 2011 John Wiley & Sons, Ltd.

Forty–seven psychology undergraduates volunteered to complete diaries outliningtheir daily academic and non–academic routine, covering semester one of their first year at a post–1992 university. The aim of the research was to investigate whether diaries were an appropriate method for exploring student engagement; also we wanted to measure whether the themes found through thematic analysis corresponded with those reported in previous research or whether new themes would emerge, not previously explored.In the course of the research we found themes that related to student engagement, disengagement, withdrawal concerns, and more general concerns regarding course choice, and university choice.We also found evidence which suggested that for some students there is a conflict between what is expected of them from the institution, in regards to the amount of time they could devote to their studies and the pressure from external forces which may take them away from studying, such as social commitments and paid work.We conclude with a discussion around therelationship between these themes, and the use of diaries as a research tool.

Few studies have discussed student learning in the second-year as opposed to the first. This paper reports the results from a questionnaire study of the expectations and experiences of second-year psychology undergraduates following a single-honours (N=24 male and 128 female) or a dual-honours (N=39 male and 142 female) psychology course in two UK universities. The findings showed few differences between the single and the dual-honours students, and few sex differences. Around half of the students surveyed on both courses had experienced workload problems and many said they had not been prepared for some aspects of university study. Many of the second-year students, including almost half of those who had taken a pre-university (A-level) course in psychology, reported being surprised by certain elements of their university course, but felt that completing their A-level had been helpful. These findings are little different from those obtained with firstyear students but some suggestions for carrying out further research with second-year students are considered.

Single‐honours psychology students at an English university were asked about their expectations and experiences at the start and the end of their first year. Students without a pre‐university (A‐level) qualification in psychology (n = 37: 22%) felt less well‐prepared for studying psychology than students with an A‐level qualification (n = 132: 78%) at the beginning of the year. Both groups felt equally confident about their understanding of psychology at the end of it. Specific difficulties with research methods, statistics and the scientific nature of the course were common to both groups, and both groups reported considerably more difficulties with studying at the end of the year than they did at the start. Some possible ways of alleviating these difficulties are discussed.

Background: Although South Asian people are a significant ethnic group at increased risk of coronary heart disease and high mortality rates and experience greater delays with respect to diagnosis, referral and treatment, comparatively little is known about their quality of life during recovery from a myocardial infarction. Objectives: We sought to determine and compare the impact of ethnicity on quality of life after myocardial infarction (MI) in a mixed ethnic population (South Asian and white people) in the UK. Methods: A 2x2 mixed-group design with repeated measures on the second factor. The independent variables were ethnic group (white/South Asian) and time since MI (2 weeks/3 months). The dependent variables were the subscale scores on the Short-Form 36-item health survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Results: At 2 weeks, significant differences were observed between groups on 5 of the 8 SF-36 subscale domain scores, with the white group reporting higher quality of life. Significant improvement in reported quality of life occurred in both groups over time on all domains of the SF-36, except bodily pain. There was a significantly greater improvement in favour of the white group for the role-physical domain. There was no significant difference between groups in terms of anxiety or depression at 2 weeks. Both groups showed a significant reduction in anxiety and depression by 3 months, but the degree of reduction was not significantly different between them. At 3 months, there was no significant difference between groups in terms of anxiety scores, but the South Asian group scored significantly higher on the depression scale. Conclusions: South Asian people have significantly poorer quality of life than white people after MI. While both groups showed improvement over time, South Asian people reported significantly less improvement in physical role function and were more depressed at 3 months. Identifying the factors accounting for such differences is important to develop models of care for delivering the most effective and culturally-sensitive interventions to this group.

Background: Academic self-efficacy, when operationalized as mastery over domain-specific knowledge, has been found to be a predictor of academic achievement and emotions. Although academic emotions are also a predictor of academic achievement, there is limited evidence for reciprocal relations with academic achievement. Aims: To examine whether academic self-efficacy, when operationalized as confidence in study-related skills and behaviours, is also a predictor of academic achievement and emotions and to test reciprocal relations between academic emotions and achievement. Sample: Two hundred and six first-year undergraduate students. Methods: Academic self-efficacy was measured at the beginning of the first semester and learning-related emotions (LREs) at the beginning of the second semester. Academic performance was aggregated across assessments in semester one and semester two. Results: Self-efficacy in study-related skills and behaviours predicted: (1) better semester one academic performance and (2) more pleasant and fewer unpleasant LREs at the beginning of the second semester directly and (3) indirectly through semester one academic performance. Reciprocal relations between academic performance and emotions were supported, but only for pleasant emotions. Conclusions: Self-efficacy in study-related skills was the critical academic self-efficacy variable in this study. It may play an important role in maintaining challenge appraisals to maintain pleasant emotions and better academic performance. Accordingly, practitioners in higher education may wish to consider the value of assessing and developing students' self-efficacy in relation to their independent study skills.

This study aimed to examine the relationship between the consumption of ecstasy (3,4-methylenedioxymethamphetamine (MDMA)) and cannabis, and performance on the random letter generation task which generates dependent variables drawing upon executive inhibition and access to semantic long-term memory (LTM). The participant group was a between-participant independent variable with users of both ecstasy and cannabis (E/C group, n = 15), users of cannabis but not ecstasy (CA group, n = 13) and controls with no exposure to these drugs (CO group, n = 12). Dependent variables measured violations of randomness: number of repeat sequences, number of alphabetical sequences (both drawing upon inhibition) and redundancy (drawing upon access to semantic LTM). E/C participants showed significantly higher redundancy than CO participants but did not differ from CA participants. There were no significant effects for the other dependent variables. A regression model comprising intelligence measures and estimates of ecstasy and cannabis consumption predicted redundancy scores, but only cannabis consumption contributed significantly to this prediction. Impaired access to semantic LTM may be related to cannabis consumption, although the involvement of ecstasy and other stimulant drugs cannot be excluded here. Executive inhibitory functioning, as measured by the random letter generation task, is unrelated to ecstasy and cannabis consumption.

In this study we report the findings that we obtained when we repeated a study conducted approximately 10 years ago. In the initial study we found that mature students did as well as traditional–entry ones in first–year essays and examinations. However, they did less well initially when writing laboratory reports. In this replication study these results were reversed. This time our mature students did as well as the traditional entry–ones on their laboratory reports, better than the traditional–entry ones at essay writing, but worse on their examinations. Some possible causes for these findings are discussed, and the paper concludes by examining the final degree performance (some two years later) of these two groups of students. Here there were no significant differences between them.