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The reference human genome sequence set the stage for studies of genetic variation and its association with human disease, but epigenomic studies lack a similar reference. To address this need, the NIH Roadmap Epigenomics Consortium generated the largest collection so far of human epigenomes for primary cells and tissues. Here we describe the integrative analysis of 111 reference human epigenomes generated as part of the programme, profiled for histone modification patterns, DNA accessibility, DNA methylation and RNA expression. We establish global maps of regulatory elements, define regulatory modules of coordinated activity, and their likely activators and repressors. We show that disease- and trait-associated genetic variants are enriched in tissue-specific epigenomic marks, revealing biologically relevant cell types for diverse human traits, and providing a resource for interpreting the molecular basis of human disease. Our results demonstrate the central role of epigenomic information for understanding gene regulation, cellular differentiation and human disease.

Integrative analysis of 111 reference human epigenomes

The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication

Self-esteem has become a household word. Teachers, parents, therapists, and others have focused efforts on boosting self-esteem, on the assumption that high self-esteem will cause many positive outcomes and benefits-an assumption that is critically evaluated in this review. Appraisal of the effects of self-esteem is complicated by several factors. Because many people with high self-esteem exaggerate their successes and good traits, we emphasize objective measures of outcomes. High self-esteem is also a heterogeneous category, encompassing people who frankly accept their good qualities along with narcissistic, defensive, and conceited individuals. The modest correlations between self-esteem and school performance do not indicate that high self-esteem leads to good performance. Instead, high self-esteem is partly the result of good school performance. Efforts to boost the self-esteem of pupils have not been shown to improve academic performance and may sometimes be counterproductive. Job performance in adults is sometimes related to self-esteem, although the correlations vary widely, and the direction of causality has not been established. Occupational success may boost self-esteem rather than the reverse. Alternatively, self-esteem may be helpful only in some job contexts. Laboratory studies have generally failed to find that self-esteem causes good task performance, with the important exception that high self-esteem facilitates persistence after failure. People high in self-esteem claim to be more likable and attractive, to have better relationships, and to make better impressions on others than people with low self-esteem, but objective measures disconfirm most of these beliefs. Narcissists are charming at first but tend to alienate others eventually. Self-esteem has not been shown to predict the quality or duration of relationships. High self-esteem makes people more willing to speak up in groups and to criticize the group's approach. Leadership does not stem directly from self-esteem, but self-esteem may have indirect effects. Relative to people with low self-esteem, those with high self-esteem show stronger in-group favoritism, which may increase prejudice and discrimination. Neither high nor low self-esteem is a direct cause of violence. Narcissism leads to increased aggression in retaliation for wounded pride. Low self-esteem may contribute to externalizing behavior and delinquency, although some studies have found that there are no effects or that the effect of self-esteem vanishes when other variables are controlled. The highest and lowest rates of cheating and bullying are found in different subcategories of high self-esteem. Self-esteem has a strong relation to happiness. Although the research has not clearly established causation, we are persuaded that high self-esteem does lead to greater happiness. Low self-esteem is more likely than high to lead to depression under some circumstances. Some studies support the buffer hypothesis, which is that high self-esteem mitigates the effects of stress, but other studies come to the opposite conclusion, indicating that the negative effects of low self-esteem are mainly felt in good times. Still others find that high self-esteem leads to happier outcomes regardless of stress or other circumstances. High self-esteem does not prevent children from smoking, drinking, taking drugs, or engaging in early sex. If anything, high self-esteem fosters experimentation, which may increase early sexual activity or drinking, but in general effects of self-esteem are negligible. One important exception is that high self-esteem reduces the chances of bulimia in females. Overall, the benefits of high self-esteem fall into two categories: enhanced initiative and pleasant feelings. We have not found evidence that boosting self-esteem (by therapeutic interventions or school programs) causes benefits. Our findings do not support continued widespread efforts to boost self-esteem in the hope that it will by itself foster improved outcomes. In view of the heterogeneity of high self-esteem, indiscriminate praise might just as easily promote narcissism, with its less desirable consequences. Instead, we recommend using praise to boost self-esteem as a reward for socially desirable behavior and self-improvement.

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Does High Self-Esteem Cause Better Performance, Interpersonal Success, Happiness, or Healthier Lifestyles?

25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.

Multiple Imputation for Nonresponse in Surveys

OBJECTIVE
This systematic review examines age transition issues specific to young people with eating disorders, including the extent of, and reasons for, problematic transition. Suggested solutions are examined, with focus on age-integrated services.


METHOD
PsycINFO, Medline and SCOPUS databases were searched on 4 April, 2022 using two inclusion criteria: (1) a peer-reviewed journal article in English, (2) focus on service transition caused by moving from childhood to adulthood for people with eating disorders. A narrative integration of the content was used.


RESULTS
Of the 17 non-overlapping studies located in the review, 6 involved quantitative data. Problematic transition between age-based services was indicated, where a substantial minority of young people who still require help lose contact with speciality services. A variety of reasons for this problematic transition were identified, including differing and sometimes adversarial cultures between age-based services. While a variety of solutions have been suggested, the least explored was the development of age integrated services; only 3 papers focussed primarily on this.


CONCLUSION
The consideration of the advantages of integration and the similarities between age-based services suggested that these potentially outweigh the barriers to integration. An implementation science research agenda is required to test this hypothesis.

A systematic review: Solutions to problems caused by age transition between eating disorder services.

OBJECTIVE
The rate of screening for eating disorders (EDs) by general practitioners (GPs) in primary health care is low. We examined an approach to increase screening and the impact on referrals.


METHOD
Low cost assessment/treatment pathways were established in February 2019 for patients with an ED. Between October 2020 and June 2021 information was sent to GP practices about screening for EDs, along with provision of an online screening tool and training.


RESULTS
Of the 44 GP practices invited to participate in the screening initiative, 42 (95.5%) agreed. Only 12 (27%) had referred patients before the initiative, 53 patients over 19 months (2.8/month). Over the 10-month initiative 90 patients were referred and started treatment from 50% of the practices (8.2/month); 73 (81%) had an ED and six had disordered eating but not an ED. Qualitative feedback from GPs suggested they would not screen for a condition if there were no readily identifiable treatment pathway available.


DISCUSSION
Results suggest that the three elements of the initiative (provision of assessment and treatment pathways, access to a screening tool, provision of information on screening) increased the likelihood that GPs would use a screening tool, leading to an almost three-fold increase in referrals.


PUBLIC SIGNIFICANCE
An initiative used to translate screening for an eating disorder to treatment in primary health care had three components. First, provision of an easy referral process to assessment as well as treatment. Second, screening tools were made available on computer desktops. Third, information and training provided to GPs was used to support their clinical observation and increase confidence in initiating screening. Adoption of this initiative almost tripled referrals for assessment.

Turning eating disorders screening in primary practice into treatment: A clinical practice approach.

BACKGROUND People experiencing psychological distress after a cardiac event may require special follow-up and targeted interventions in order to effectively decrease levels of distress. AIMS Men who were judged to be experiencing poor emotional adjustment post-myocardial infarction (MI) were invited to a cognitive behaviour therapy group. The current study examines the attendance at such a group and the consequent feasibility of such interventions. METHOD The content of the group aimed to help men deal with the uncomfortable psychosocial issues that had arisen since having a MI. RESULTS Of the 26 men approached only 30% were interested in attending and only 11% actually completed the group. Two men who were committed to attending the group could not complete all the sessions, as heart bypass operations became available to them. CONCLUSION Ways of involving men in interventions targeting psychological distress requires ongoing investigation.

Feasibility of a cognitive-behavioural group intervention for men experiencing psychological difficulties after myocardial infarction.

This editorial reports on an anonymous survey question posed to eating disorders researchers about changes the International Journal of Eating Disorders (IJED) should implement to support the eating disorders research community affected by COVID-19. The editorial accompanies an IJED article that details responses to the larger survey focusing more broadly on COVID-19-related research disruptions. Survey invitations were sent to editorial board members of eating disorders journals, members of eating disorder scientific organizations (e.g., Eating Disorders Research Society), and individuals who provided at least three IJED reviews in the prior 12 months. We reviewed the responses of 187 participants and identified three categories of changes that: (a) had already been implemented by the journal, (b) cannot be implemented because they fall outside the scope of IJED, or (c) will be implemented in coming weeks or months. The latter category includes publishing topical COVID-19 papers, making some COVID-19-related content available open access, revising statistical guidelines, and issuing author guidance on reporting protocol changes caused by COVID-19-related disruptions. IJED recognizes the disruptive impacts that COVID-19 has on all activities in our field, including clinical work, teaching, and advocacy, and is committed to supporting authors during this difficult time while striving to publish high-quality research.

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IJED support for eating disorders research in the time of COVID-19.

This study represents the first longitudinal investigation of distal psychosocial predictors of pregnancy risk-taking in young Australian women. Participants were from the Australian Longitudinal Study on Women's Health. Two mail-out surveys assessing sociodemographic, education/competence, psychosocial wellbeing, and aspiration/identity factors, were completed at ages 18 and 22 by 1647 young women in emerging adulthood, and a third survey assessing pregnancy risk-taking behaviour was completed by a subsample of 90 young women at age 24. Higher psychosocial distress at age 22 was a risk factor for pregnancy risk-taking at age 24 (beta=0.29-0.38). Post hoc analyses suggested that the strongest component of psychosocial distress when predicting pregnancy risk-taking was higher depressive symptoms (beta=0.44-0.68). Demographic, education, unemployment, and future aspirations factors at age 18 and 22 were unrelated to pregnancy risk-taking at age 24.

Psychosocial risk factors for pregnancy risk-taking in young women in emerging adulthood: evidence from the Australian Longitudinal Study on Women's Health

Tracey D. Wade

Papers

A systematic review: Solutions to problems caused by age transition between eating disorder services.

Turning eating disorders screening in primary practice into treatment: A clinical practice approach.

Feasibility of a cognitive-behavioural group intervention for men experiencing psychological difficulties after myocardial infarction.

IJED support for eating disorders research in the time of COVID-19.

Psychosocial risk factors for pregnancy risk-taking in young women in emerging adulthood: evidence from the Australian Longitudinal Study on Women's Health