Mental and emotional representations of "weight loss": free-word association networks in members of bariatric surgery-related social media communities

Keystrokes: A practical exploration of semantic drift in timed word association tasks

This study investigates the phenomena of semantic drift through the lenses of language and situated simulation (LASS) and the word frequency effect (WFE) within a timed word association task. Our primary objectives were to determine whether semantic drift can be identified over the short time (25 seconds) of a free word association task (a predicted corollary of LASS), and whether more frequent terms are generated earlier in the process (as expected due to the WFE). Respondents were provided with five cue words (tree, dog, quality, plastic and love), and asked to write as many associations as they could. We hypothesized that terms generated later in the task (fourth time quartile, the last 19-25 seconds) would be semantically more distant (cosine similarity) from the cue word than those generated earlier (first quartile, the first 1-7 seconds), indicating semantic drift. Additionally, we explored the WFE by hypothesizing that earlier generated words would be more frequent and less diverse. Utilizing a dataset matched with GloVe 300B word embeddings, BERT and WordNet synsets, we analysed semantic distances among 1569 unique term pairs for all cue words across time. Our results supported the presence of semantic drift, with significant evidence of within-participant, semantic drift from the first to fourth time (LASS) and frequency (WFE) quartiles. In terms of the WFE, we observed a notable decrease in the diversity of terms generated earlier in the task, while more unique terms (greater diversity and relative uniqueness) were generated in the 4th time quartile, aligning with our hypothesis that more frequently used words dominate early stages of a word association task. We also found that the size of effects varied substantially across cues, suggesting that some cues might invoke stronger and more idiosyncratic situated simulations. Theoretically, our study contributes to the understanding of LASS and the WFE. It suggests that semantic drift might serve as a scalable indicator of the invocation of language versus simulation systems in LASS and might also be used to explore cognition within word association tasks more generally. The findings also add a temporal and relational dimension to the WFE. Practically, our research highlights the utility of word association tasks in understanding semantic drift and the diffusion of word usage over a sub-minute task, arguably the shortest practically feasible timeframe, offering a scalable method to explore group and individual changes in semantic relationships, whether via the targeted diffusion of influence in a marketing campaign, or seeking to understand differences in cognition more generally. Possible practical uses and opportunities for future research are discussed.

Perceived Benefits of Bariatric Surgery: Patient Perspectives

BACKGROUND

Obesity is a chronic and complex disease characterized by the excessive accumulation of adipose tissue, which has detrimental effects on health. Evaluating the changes in quality of life (QoL) after bariatric surgery complements the medical benefits which are documented by healthcare professionals.

PURPOSE

To study the perceived health benefits 1 year after substantial weight loss induced by bariatric surgery.

METHODS

This pilot study evaluated patients 1 year after bariatric surgery using 13 questions related to the health domains of the KOSS: airway, body mass, cardiovascular risk, diabetes, economic impact, functional, gonadal impact, health status perceived, image, junction of the gastro-esophagus, kidney, liver, and medication. In addition, the patients were asked to score the most significant benefit as "1," while the least beneficial benefit was scored as "13."

RESULTS

One hundred fourteen consecutive patients were evaluated (men = 37 and women = 77). The responses were divided into functional, metabolic, and mental/social benefits. Patients ranked the functional question, "I became more active, and I can do more things" as the most important (average score of 3.7 ± 0.2), followed by a question related to metabolic status: "I am less worried about my risk of heart disease" (4.5 ± 0.3), and then a social/mental question, "My clothes fit better" (5.4 ± 0.3). The three least valuable benefits for the cohort were sexual life improvements (8.9 ± 0.3), heartburn improvements (9.0 ± 0.3), and urinary incontinence improvements (9.8 ± 0.3).

CONCLUSIONS

Our observational pilot study demonstrated that patients value functional benefits after substantial weight loss the most, but that metabolic benefits and social/mental health benefits are also considered important.

Attitudes and perceptions of affected women towards endocrine endometriosis therapy: an international survey based on free-word association networks

STUDY QUESTION

What are the attitudes and perceptions towards endocrine endometriosis therapy?

SUMMARY ANSWER

Among the study population, endocrine endometriosis therapies are associated with negative mental images and emotions and there seems to be a pre-therapeutic information deficit on the part of physicians.

WHAT IS KNOWN ALREADY

Endocrine therapies, as the current standard of conservative endometriosis treatment, have good efficacy and improve symptoms and quality of life in most patients. Nevertheless, clinical practice repeatedly shows rejection on the part of patients, which may result in reduced compliance and discontinuation of therapy.

STUDY DESIGN, SIZE, DURATION

Cross-sectional study among endometriosis patients using a multilingual questionnaire distributed via the most popular social media channels between November 2020 and February 2021. A total of 3348 women participated in the study.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Based on a pilot phase, an international, multilingual online survey was conducted among women affected by endometriosis. The questionnaire included free-word associations and questions about personal medical history, source of information, and demographic data. Mental representations were detected based on modules of the co-occurrence network of associations.

MAIN RESULTS AND THE ROLE OF CHANCE

Six modules with different dominant emotional labels emerged from the confluence of associations to endocrine endometriosis therapy mentioned by participants. Five modules reflected negative mental associations, with the most frequently mentioned words being 'side effects', 'pain', 'ineffective', 'depression', and 'uncertainty'. Of the 12 most frequently selected emotions, only 'optimistic' was positive. Side effects affecting mental health are the most important reason for deciding against endocrine therapy in our survey population. Twenty-seven percent of respondents reported knowing little about endocrine therapies for endometriosis. Social media are the most frequently used sources of information and were rated as the most useful.

LIMITATIONS, REASONS FOR CAUTION

By translating the questionnaire, questions might have been understood differently depending on the language. By using social media channels for distribution, digitally literate patients were targeted. The survey population might not be representative as patients who are critical/unhappy with therapy are more likely to seek advice from peer groups.

WIDER IMPLICATIONS OF THE FINDINGS

The findings of this study replicate the findings of a recent survey in three European countries. Given the prevalence of endometriosis and the few emerging pharmaceutical alternatives, these data point to a growing need for further research and development of non-hormonal drugs for treating endometriosis. Most endometriosis patients are young and digitally literate, and much information is obtained from alternative sources, such as social media. Careful education before starting therapy should be taken seriously, and patients' concerns should be addressed individually by health care providers. This could help reduce misunderstanding and misinformation and improve treatment adherence and satisfaction.

STUDY FUNDING/COMPETING INTEREST(S)

There is no funding or conflict of interest to declare.

TRIAL REGISTRATION NUMBER

The trial is not registered at any trial registry.

Identification of Emotional Spectrums of Patients Taking an Erectile Dysfunction Medication: Ontology-Based Emotion Analysis of Patient Medication Reviews on Social Media

BACKGROUND

Patient medication reviews on social networking sites provide valuable insights into the experiences and sentiments of individuals taking specific medications. Understanding the emotional spectrum expressed by patients can shed light on their overall satisfaction with medication treatment. This study aims to explore the emotions expressed by patients taking phosphodiesterase type 5 (PDE5) inhibitors and their impact on sentiment.

OBJECTIVE

This study aimed to (1) identify the distribution of 6 Parrot emotions in patient medication reviews across different patient characteristics and PDE5 inhibitors, (2) determine the relative impact of each emotion on the overall sentiment derived from the language expressed in each patient medication review while controlling for different patient characteristics and PDE5 inhibitors, and (3) assess the predictive power of the overall sentiment in explaining patient satisfaction with medication treatment.

METHODS

A data set of patient medication reviews for sildenafil, vardenafil, and tadalafil was collected from 3 popular social networking sites such as WebMD, Ask-a-Patient, and Drugs.com. The Parrot emotion model, which categorizes emotions into 6 primary classes (surprise, anger, love, joy, sadness, and fear), was used to analyze the emotional content of the reviews. Logistic regression and sentiment analysis techniques were used to examine the distribution of emotions across different patient characteristics and PDE5 inhibitors and to quantify their contribution to sentiment.

RESULTS

The analysis included 3070 patient medication reviews. The most prevalent emotions expressed were joy and sadness, with joy being the most prevalent among positive emotions and sadness being the most prevalent among negative emotions. Emotion distributions varied across patient characteristics and PDE5 inhibitors. Regression analysis revealed that joy had the strongest positive impact on sentiment, while sadness had the most negative impact. The sentiment score derived from patient reviews significantly predicted patient satisfaction with medication treatment, explaining 19% of the variance (increase in R2) when controlling for patient characteristics and PDE5 inhibitors.

CONCLUSIONS

This study provides valuable insights into the emotional experiences of patients taking PDE5 inhibitors. The findings highlight the importance of emotions in shaping patient sentiment and satisfaction with medication treatment. Understanding these emotional dynamics can aid health care providers in better addressing patient needs and improving overall patient care.

Investigating mental representations of psychoactive substance use and other potentially addictive behaviors using a data driven network-based clustering method

BACKGROUND AND AIMS

The aim of the present study was to examine the mental representations of the use of different substances and other potentially addictive behaviors in order to explore meaningful similarities and differences that may contribute to a better understanding of behavioral addictions' representations and diagnostic criteria.

METHODS

The authors mapped the mental and emotional representations of 661 participants (70.5% women; Mage = 35.2 years, SD = 11.7) to the concept "your most disturbing excessive activity" using free-word associations combined with a network-based clustering method.

RESULTS

The network analyses identified four distinct mental representations, three implicating dominantly negative (Guilt/Shame/Relief, Addiction/Health, and Procrastination/Boredom) and one dominantly positive emotion (Stress/Relaxation). The distribution of Addiction/Health and Procrastination/Boredom representations were different across substance use and problem behaviors, indicating meaningful differences in the underlying cognitive evaluation processes. The Addiction/Health representation was more frequent for substances, while for other addictive behaviors, the Procrastination/Boredom representation was more frequent, and its frequency increased with the self-reported intensity of the behavior. Guilt/Shame/Relief was equally common for both substances and behaviors, but importantly, for substances its' likelihood increased with the intensity of use.

CONCLUSION

The common part of representations for substance use and other potentially addictive behaviors supports the scientific viewpoint, that real addictions can exist even in the absence of psychoactive drugs. Based on the results, a novel proposition is posited, that a more appropriate indicator of tolerance for problem behaviors might be the perceived amount of time wasted on the activity rather than the actual time spent.

Attitudes of primary care physicians toward bariatric surgery: a free word association networks analysis

BACKGROUND

Primary care physicians (PCPs) hold major responsibility in referring patients with obesity eligible for bariatric surgery (BS).

OBJECTIVE

The aim was to explore PCPs' mental representation of BS in order to identify barriers and catalysts of BS referral practices.

SETTING

Switzerland.

METHODS

A total of 3526 PCPs were invited to participate in an online survey. PCPs were asked to write the first 5 words that came to their mind about the term "bariatric surgery." Additionally, they had to pick 2 emotions that best described each provided association. Demographic data and obesity-related referral patterns were collected. Mental representation network was constructed based on co-occurrence of associations, using validated data-driven methodology.

RESULTS

In all, 216 PCPs completed the study (response rate: 6.13%). Respondents were aged 55 ± 9.8 years, had an equal sex distribution, and practiced mainly in urban settings. Three mental representations of BS emerged: indication-focused (most frequent associations: "obesity," "diabetes"), treatment-focused ("gastric bypass," "weight loss"), and outcome-focused ("complications," "challenging follow-up"). The emotional label "interested" was used significantly more frequently in the treatment-focused group. Comparison of PCPs among mental modules showed that those with a treatment-focused mindset referred patients for BS most frequently and were significantly more willing to follow up with postbariatric patients (χ2 = 17.8, P = .022).

CONCLUSIONS

PCPs think about BS along 3 mental representations, and the treatment-focused attitude was coupled with the highest willingness to refer eligible patients for BS. Confidence in performing postbariatric follow-up was identified as catalyst of BS referral. Access to optimal care for patients with obesity may be improved accordingly.

Quantifying patients' expectations prior to bariatric surgery with the BODY-Q in an international multicentre cohort

Many people living with obesity may have unrealistic expectations prior to undergoing bariatric surgery. These expectations can lead to frustration, regret and even worse psychological outcomes after surgery. Prior to undergoing bariatric surgery, patients completed the BODY-Q Expectations scale. This 15-item scale asks patients to imagine what their life will be like when 2 years have passed since bariatric surgery. Scores for expectations range from 0 (low) to 100 (high). Linear regression models were used to assess which of the patient characteristics could predict patients' expectations. From 2019 to 2020, a total of 333 patients were recruited from three different countries. The mean score on the BODY-Q Expectations scale was 73.1, ±20. Out of the 15 items on the Expectation scale, people living with obesity found it most likely that bariatric surgery would make them feel better and improve their energy, while it was reported least likely that they would look good without clothes on. Younger age (p = <.01) and race (non-white) (p = .046) were found to be significant predictors for higher scores on the Expectations scale. Participants who identified as non-white from the Netherlands and United States, and those aged under 40 years reported higher expectations compared with participants who identified as white race and were 40 years of age or older. Prior to bariatric surgery, patients aged under 40 years and those who identified as non-white for race had higher expectations that their life would change after bariatric surgery. These relevant findings should be considered when giving pre-operative counselling.

Patients' and caregivers' perceptions of bariatric surgery: A France and United States comparative infodemiology study using social media data mining

Background

People are conversing about bariatric surgery on social media, but little is known about the main themes being discussed.

Objective

To analyze discussions regarding bariatric surgery on social media platforms and to establish a cross-cultural comparison of posts geolocated in France and the United States.

Methods

Posts were retrieved between January 2015 and April 2021 from general, publicly accessed sites and health-related forums geolocated in both countries. After processing and cleaning the data, posts of patients and caregivers about bariatric surgery were identified using a supervised machine learning algorithm.

Results

The analysis dataset contained a total of 10,800 posts from 4,947 web users in France and 51,804 posts from 40,278 web users in the United States. In France, post-operative follow-up (n = 3,251, 30.1% of posts), healthcare pathways (n = 2,171, 20.1% of the posts), and complementary and alternative weight loss therapies (n = 1,652, 15.3% of the posts) were among the most discussed topics. In the United States, the experience with bariatric surgery (n = 11,138, 21.5% of the posts) and the role of physical activity and diet in weight-loss programs before surgery (n = 9,325, 18% of the posts) were among the most discussed topics.

Conclusion

Social media analysis provides a valuable toolset for clinicians to help them increase patient-centered care by integrating the patients' and caregivers' needs and concerns into the management of bariatric surgery.

[Healthcare cost reimbursement without application-Experiences of a German bariatric service]

BACKGROUND

Only a small proportion of patients with morbid obesity in Germany have access to the currently most effective treatment, bariatric surgery. A major reason for this is the restrictive attitude of health insurance companies regarding the reimbursement of costs.

OBJECTIVE

To record the postoperative rate of cost coverage by health insurance companies without the currently common preoperative application for morbidly obese patients who received a guideline-indicated bariatric surgery.

METHODS

The process of postoperative reimbursement was evaluated through a prospective database over a 2-year period. Cases of primary reimbursement were correlated with respect to age, BMI, comorbidities and membership of a specific health insurance company. Rejected coverage cases were followed up for further advocacy and social court process.

RESULTS

A total of 188 patients underwent bariatric surgery as indicated in the guidelines without prior application. Primary cost coverage was achieved in 76.6% (n = 144). There was no correlation with BMI, comorbidities or health insurance affiliation. Patients over 40 years of age were significantly more likely to be covered for costs. For patients without postoperative cost coverage, an out of court settlement was reached in 7 cases, 8 cases were heard by the social courts and 29 cases were still being processed by lawyers.

CONCLUSION

Despite the relatively high rate of primary cost coverage, this analysis also shows the restrictive attitude of the health insurance companies regarding bariatric surgery with corresponding economic pressure on the service providers. The consistent implementation of application-free surgery seems necessary to increase the political pressure on health insurers and social courts.

COVID-19 contamination through food: A study with Brazilian consumers of different socioeconomic and demographic characteristics

This study aimed to investigate through free word association the perception of Brazilian consumers regarding the possibility of infection with the SARS-CoV-2 virus through food. One thousand individuals answered the questionnaire via an online platform. Most cited terms (hygiene-8%, fear-8%, caution-5%) and categories (negative attitudes and feeling-72% and sanitization-60%) were related to overall COVID-19 infection rather than their specific infection through the food. The perception of the possibility of risk of this type of cross-contamination was greater for male participants, within the food field, with high income (>10 minimum wages), and from the midwest region. Nonetheless, there are still doubts regarding this possibility, especially for participants with low income (≤10 minimum wages), females, higher education (≥secondary school), who exercise professional activity outside the food sector and from most regions of Brazil.

Practical applications

Although the SARS-CoV-2 virus was discovered 2 years ago, the emergence of new variants such as Omicron has increased infection and mortality rates worldwide. A possible way of COVID-19 infection is cross-contamination through food handling and contact surfaces if preventive measures are not applied. In this context, understanding the consumer perception from a continental-size country such as Brazil, with a wide variety of socioeconomic profiles, is crucial to minimize the severe impacts of the pandemic. Our study demonstrates the need to disseminate scientific information in different media to reduce misinformation, especially social media because most Brazilian consumers had doubts and uncertainties about the possibility of COVID-19 infection from cross-contamination through food.

Online survey on factors influencing patients' motivation to undergo bariatric surgery

Given the worldwide increasing prevalence of severe obesity and considering the amount of scientific evidence demonstrating the beneficial effects of bariatric surgery (BS), it is surprising that only a fraction of patients with obesity undergo BS. We therefore conducted an anonymized online survey among individuals with a history of BS to understand factors influencing the deciding process leading to BS. Respondents were recruited on a voluntary basis from obesity-related social media groups between April and June 2020. The self-designed, non-validated questionnaire consisted of 20 questions and was open to any participants with a history of BS. Of 851 participants who started the survey, 665 completed the questionnaire (completion rate of 78.1%). Five years after BS, still 70% of the survey-participants were very satisfied or satisfied with the surgical result. However, the majority (73.3%) would have undergone BS earlier. The main motivation to choose BS was related to health status or quality of life. Important characteristics for a bariatric surgeon to obtain patients' trust are "taking time and listen" (74.7%), empathy (64%) and sympathy (56%). Post-operative satisfaction with the surgical outcome was high and long-lasting in this large cohort of BS patients. However, most participants would retrospectively have undergone BS earlier. The main reason to choose BS as treatment for their obesity were impaired physical health or reduced quality of life. Nearby location to patients' residence and availability of surgeons with empathy were decisive motives for bariatric centre selection.