The Contribution of BMI,Body Image Inflexibility,and Generalized Anxiety to Symptoms of Eating Disorders and Exercise Dependence in Exercisers

1) Background: The common factors which potentially contribute to the development of eating disorders and exercise dependence during early adulthood are still relatively unclear. The present study aimed to examine the role of BMI, body image inflexibility, and generalized anxiety in these two behavioral problems in a sample of college students. 2) Methods: In total, 878 habitual exercisers (58.1% male with BMI = 22.12 ± 2.39; 41.9% female with BMI = 20.55 ± 2.21) with age of 20.09 ± 1.76 years participated in this study. The main outcomes of interest are exercise dependence symptoms, eating disorders symptoms, body image inflexibility, and symptoms of generalized anxiety (as measured by Exercise Dependence Scale-Revised, Eating Disorder Examination-Questionnaire-Short Form, Body Image Acceptance and Action Questionnaire, and Generalized Anxiety Disorder-7, respectively). Pearson correlation, path analysis, and model fit information were tested. 3) Results: After controlling for age, gender, and field of study, lower BMI was linked to more exercise dependence symptoms but this association was not statistically significant, while a greater BMI was significantly associated with a higher risk of developing eating disorders (β = −0.08, p < 0.001). Moreover, higher body image inflexibility significantly and positively contributed to severe exercise dependence (β = 0.26, p < 0.001) as well as abnormal eating attitudes and behaviors (β = 0.74, p < 0.001). Furthermore, generalized anxiety is a significant contributor to exercise dependence symptoms (β = 0.14, p < 0.001) but not eating disorders symptoms. 4) Conclusion: Based on our finding that body image inflexibility is a common risk factor for the development of exercise dependence and eating disorders, the prevention and treatment of these two disorders should involve the improvement of psychological flexibility. In addition, the individual with a higher BMI is more vulnerable to developing eating disorders, while those who have severer generalized anxiety symptoms should be given more attention when screening for exercise dependence.     

Exercise,Depression, and Anxiety in Young People: A Cross-Sectional Survey

Background: Depression and anxiety are highly prevalent among adolescents and have multiple negative effects on their physical and mental health. While exercise can reduce the symptoms of depression and anxiety, the relationship between mental disorders among American university students has been rarely reported. Accordingly, this study aimed to explore the association between exercise, depression and anxiety among American university students in the 2018–2019 academic year. Methods: In this cross-sectional study, the association between exercise, depression and anxiety was investigated in a large representative sample of American university students. In the 2018–2019 academic year, university students aged 18+ years old from 79 institutions participated in this school-based study. The questionnaire included measurements of demographic characteristics, exercise, and validated screen instructions for depression (PHQ-9) and anxiety (GAD-7). The multivariable logistic regression model was applied to explore the association between exercise, depression and anxiety. Results: A total of 62026 individuals (31.9% males) participated in this survey, and the prevalence of exercising at least 5 h each day was 24.6%. The prevalence of depression and anxiety was 25.7% and 22.3%, respectively. In the multivariable logistic regression model, compared to exercise at least 5 h daily, participants whose exercise less than 1 h daily (OR = 1.31 [1.29, 1.33], p < 0.05), 2 to 3 h daily (OR = 1.13 [1.11, 1.15], p < 0.05), 3 to 4 h daily (OR = 1.04 [1.02, 1.06], p < 0.05), were correlated with greater odds of depression, while exercise less than 1 h daily (OR = 1.23 [1.21, 1.25], p < 0.05), 2 to 3 h daily (OR = 1.10 [1.08, 1.12], p < 0.05) were significantly correlated with greater odds of anxiety. Conclusion: Higher levels of exercise are associated with lower risk of depression and anxiety among American university students. Community and school interventions should focus on increasing exercise participation in university populations to promote both physical and mental health.     

A comparison of the oxygen cost of locomotion in children with and without developmental coordination disorder

Aim The aim of this study was to compare the oxygen cost (V?o ₂) of walking and running, as well as aerobic fitness, in children with and without developmental coordination disorder (DCD). Method Thirty‐one males (17 with DCD and 14 in a comparison group; mean age 8y 7mo, SD 1y 3mo and 8y 5mo, SD 1y 2mo respectively) were tested on two separate occasions at least 1 week apart. On the first visit, motor proficiency was assessed by the McCarron Assessment of Neuromuscular Development instrument, which was followed by the determination of maximal aerobic capacity (V?o _2max). The second visit involved 4‐minute bouts of treadmill walking (at 4.3km/h and 5.8km/h) and running (at 7.8km/h and 8.4km/h). Oxygen consumption, heart rate, respiratory exchange ratio, rating of perceived exertion (RPE), step rate, and qualitative assessment of locomotion were obtained for each speed. Results Despite poorer locomotion proficiency, there was no significant difference in the oxygen cost of walking or running between males with and without DCD. However, the DCD group had significantly higher RPE while running at 7.8km/h (p=0.011) and had greater difficulty achieving V?o _2max, resulting in significantly lower scores for aerobic fitness. Interpretation The differences in locomotion proficiency between children with and without DCD are not large enough to affect the oxygen cost of locomotion. However, children with DCD are more likely to withdraw from exercising at higher intensities before achieving peak performance.     

Specific Types of Screen-Based Sedentary Time and Depressive Symptoms in Adolescents

Purpose: Screen-based sedentary behavior (SSB) has been identified as risk factor for mental disorders in most of adolescents. However, there is little literature pertaining to the specific kinds of SSB and its connections with depressive symptoms in most of adolescents. In the present study, we are going to find out the connections between specific types of SSB and depressive symptoms in Chinese adolescents. Methods: A cross-sectional data based on 996 study participants of middle school students in Guangdong Province. SSB was evaluated by distributing the questionnaire of Health Behavior in School-aged Children, while depressive symptoms were evaluated using Chinese version of Children’s Depressive symptoms Inventory (CDI). SSB was categorized into TV/movie time, video games time and other electronic devices-based time (e.g., mobile phone, computer use). Generalized linear models was used to explore the connections between specific kinds of SSB and depressive symptoms. Results: After controlling for variables of sex, ethnicity, grade, residence, siblings, perceived family affluence, father educational level, mother educational background, body mass index (BMI), physical exercise, duration of sleep, other electronic devices-based time was positively correlated with depressive symptoms in Chinese adolescents (B = 0.557%, 95%CI: 0.187–0.926, p = 0.003). This significant connection was also found in girls (B = 0.728%, 95%CI: 0.230–1.225, p = 0.004) instead of boys (p > 0.05). The other types of SSB were not significantly in relation to depressive symptoms in adolescents regardless of sex. Conclusion: This study suggested that it might be effective in reducing or preventing depressive symptoms through limiting electronic devices-based time, like computer use or mobile phone use time. This strategy would be particularly useful in girls. Future studies should negate or replicate the research results by introducing more improved study design, which is beneficial to better understand the connections between SSB and depressive symptoms as well as then design more efficient interventions in adolescents.     

The impact of rope jumping exercise on physical fitness of visually impaired students

The main purpose of this study was to investigate the impact of rope jumping exercise on the health-related physical fitness of visually impaired students. The participants’ physical fitness was examined before and after the training. The exercise intensity of the experimental group was controlled with Rating of Perceived Exertion (RPE) (values ranging from 11 to 15), while the control group did not participate in the exercise. A dependent samples t-test indicated significant differences in both groups between pre- and post-training. Through ANCOVA analysis, there was a significant difference (p < .05) in the flexibility and aerobic capacity for the experimental group and a significant improvement on their physical fitness (p < .05).     

Inflammatory markers and negative mood symptoms following exercise withdrawal

Objective: Physical inactivity is associated with elevated inflammatory markers, but little is known about the time trajectories of reduced physical activity and inflammatory markers. Changes in inflammatory markers in response to withholding regular aerobic exercise were prospectively examined and correlated with increased negative mood symptoms and fatigue that accompany exercise withdrawal. Methods: Participants with regular exercise habits (N = 40, mean age of 31.3 ± 7.5 years, 55% women) were randomized to aerobic exercise withdrawal or to continue regular exercise for 2 weeks. Protocol adherence was documented using ambulatory actigraphy. Inflammatory markers (interleukin-6, C-reactive protein, fibrinogen and soluble intercellular adhesion molecule-1) were assessed at weekly intervals. Negative mood was measured with the Profile of Mood States (POMS) and the Beck Depression Inventory (BDI), and fatigue with the Multidimensional Fatigue Inventory (MFI). Autonomic nervous system activity was examined using heart rate variability-based indices. Results: Changes in inflammatory markers did not differ between exercise withdrawal and control groups (multivariate p interaction = 0.25). Exercise withdrawal resulted in increased negative mood symptoms and fatigue from baseline to day 14 compared to controls (p ΔPOMS = 0.008, p ΔBDI = 0.002; p ΔMFI = 0.003), but these responses were not associated with changes in inflammatory markers (p-values >0.10). Inflammatory markers were also not correlated with autonomic nervous system dysregulation (p-values >0.10). Conclusion: Inflammatory markers were not increased following 2 weeks of exercise withdrawal. Negative mood symptoms and fatigue were not accounted for by changes in inflammatory markers. Compensatory feedback mechanisms may operate among healthy individuals to promote resilience from the effects of reduced exercise.     

Closing the Gap: Characterizing Key Factors Leading to the Disparity in Suicide Rates along the Urban-Rural Continuum

Suicide is a top ten cause of mortality in the United States. In previous literature the suicide rates in rural communities have been reported to be greater than those of more urban communities. Additionally, these studies have discussed many potential causes for the unfortunate disparity in rates. One cause often discussed is lack of mental health care providers in rural communities. The data for this study was gathered from the CDC’s WONDER database and the NPPES NPI Registry. The urban-rural categorization of counties used the 2013 NCHS Urban-Rural Scheme. Statistical analysis included chi-square tests, paired t-tests, and stepwise regression analyses. Results indicate that both the number of residents per provider (r = 0.35, p ≤ 0.005), and urbanization level (r = 0.49, p ≤ 0.001) were significantly related to suicide rate. Additionally, even after controlling for provider rates, each additional level of rurality predicted an increase of 1.2 suicides per 100,000 residents. Ultimately, the number of providers may play a major role in suicide rates, but extra effort must also be made in rural communities to combat the other contextual factors leading to increased suicide rates.     

Effectiveness of Mind-Body Exercise on Burnout and Stress in Female Undergraduate Students

This study was to investigate the effects of mind-body exercise on burnout and perceived stress among female undergraduate students. A sample of 146 female undergraduate students took part in this study. They were assigned to mind-body exercise group (n = 91) and control group (n = 55). Mind-body exercise group received three 90-min sessions of Baduanjin exercise per week lasting for 12-weeks. There was no intervention in the control group. The Maslach Burnout Inventory-Student Survey was used to assess burnout level, and the 10-item perceived stress scale was used to assess stress level. Significant decreases in emotional exhaustion (p < 0.001), cynicism (p < 0.001) and perceived stress (p < 0.001) were found in the mind-body exercise group compared with control group. Furthermore after 12-week mind-body exercise, emotional exhaustion, cynicism and perceived stress had greater reduction. Mind-body exercise (Baduanjin) may be considered an alternative strategy to reduce burnout and perceived stress in female undergraduate students.     

Physical fitness assessment in multiple sclerosis patients: A controlled study

There is growing evidence to show the effectiveness of physical exercise for multiple sclerosis (MS) patients. Aim of this study was to evaluate aerobic capacity, strength, balance, and the rate of perceived exertion (RPE) after exercise, in ambulatory patients with mild MS and matched control healthy participants. Seventeen MS patients aged 48.09 ± 10.0 years, with mild MS disability (Expanded Disability Status Scale: EDSS 1.5 to 4.5) and 10 healthy sedentary age matched (41.9 ± 11.2 years) subjects volunteered for the study. MS patients underwent medical examination with resting electrocardiogram, arterial blood pressure, EDSS, and Modified Fatigue Impact Scale-MFIS. Both groups also underwent physical assessment with the Berg Balance Scale^, test (Berg), Six Minutes Walking Test (6MWT), maximal isometric voluntary contraction (MIVC) of forearm, lower limb, shoulder strength test, and the Borg 10-point scale test. The one-way ANOVA showed significant differences for MFIS (F_1.19 = 9.420; p < 0.01), Berg (F_1.19 = 13.125; p < 0.01), handgrip MIVC (F_1.19 = 4.567; p < 0.05), lower limbs MIVC (F_1.19 = 7.429; p < 0.01), and 6MWT (F_1.19 = 28.061; p < 0.01) between groups. EDSS, Berg test and Borg scores explained 80% of 6MWT variation. Mild grade EDSS patients exhibited impaired balance, muscle strength, and low self pace-6MWT scores, whereas RPE response after the exercise was similar to that of sedentary individuals. Both groups showed similar global physiological adjustments to exercise.     

Ventilatory threshold may be a more specific measure of aerobic capacity than peak oxygen consumption rate in persons with stroke

Background: After stroke, aerobic deconditioning can have a profound impact on daily activities. This is usually measured by the peak oxygen consumption rate achieved during exercise testing (VO2-peak). However, VO2-peak may be distorted by motor function. The oxygen uptake efficiency slope (OUES) and VO2 at the ventilatory threshold (VO2-VT) could more specifically assess aerobic capacity after stroke, but this has not been tested.

Objectives: To assess the differential influence of motor function on three measures of aerobic capacity (VO2-peak, OUES, and VO2-VT) and to evaluate the inter-rater reliability of VO2-VT determination post-stroke.

Methods: Among 59 persons with chronic stroke, cross-sectional correlations with motor function (comfortable gait speed [CGS] and lower extremity Fugl-Meyer [LEFM]) were compared between the different aerobic capacity measures, after adjustment for covariates, in order to isolate any distorting effect of motor function. Reliability of VO2-VT determination between three raters was assessed with intra-class correlation (ICC).

Results: CGS was moderately correlated with VO2-peak (r = 0.52, p < 0.0001) and weakly correlated with OUES (r = 0.41, p = 0.002) and VO2-VT (r = 0.37, p = 0.01). LEFM was weakly correlated with VO2-peak (r = 0.26, p = 0.055) and very weakly correlated with OUES (r = 0.19, p = 0.17) and VO2-VT (r = 0.14, p = 0.31). Compared to VO2-peak, VO2-VT was significantly less correlated with CGS (r difference = ?0.16, p = 0.02). Inter-rater reliability of VO2-VT determination was high (ICC: 0.93, 95% CI: 0.89–0.96).

Conclusions: Motor dysfunction appears to artificially lower measured aerobic capacity. VO2-VT seemed to be less distorted than VO2-peak and had good inter-rater reliability, so it may provide more specific assessment of aerobic capacity post-stroke.     

Subjective cognitive complaints and neuropsychological performance in former smokers with and without chronic obstructive pulmonary disease

Objective: This study examined the association of perceived cognitive difficulties with objective cognitive performance in former smokers. We hypothesized that greater perceived cognitive difficulties would be associated with poorer performance on objective executive and memory tasks.

Method: Participants were 95 former smokers recruited from the COPDGene study. They completed questionnaires (including the Cognitive Difficulties Scale [CDS] and the Hospital Anxiety and Depression Scale [HADS]), neuropsychological assessment, and pulmonary function testing. Pearson correlations and t-tests were conducted to examine the bivariate association of the CDS (total score and subscales for attention/concentration, praxis, delayed recall, orientation for persons, temporal orientation, and prospective memory) with each domain of objective cognitive functioning (memory recall, executive functioning/processing speed, visuospatial processing, and language). Simultaneous multiple linear regression was used to further examine all statistically significant bivariate associations. The following covariates were included in all regression models: age, sex, pack-years, premorbid functioning (WRAT-IV Reading), HADS total score, and chronic obstructive pulmonary disease (COPD) status (yes/no based on GOLD criteria).

Results: In regression models, greater perceived cognitive difficulties overall (using CDS total score) were associated with poorer performance on executive functioning/processing speed tasks (b = ?0.07, SE = 0.03, p = .037). Greater perceived cognitive difficulties on the CDS praxis subscale were associated with poorer performance on executive functioning/processing speed tasks (b = ?3.65, SE = 1.25, p = .005), memory recall tasks (b = ?4.60, SE = 1.75, p = .010), and language tasks (b = ?3.89, SE = 1.39, p = .006).

Conclusions: Clinicians should be aware that cognitive complaints may be indicative of problems with the executive functioning/processing speed and memory of former smokers with and without COPD.     

An aerobic exercise program for young people with cerebral palsy in specialist schools: A phase I randomized controlled trial

ABSTRACT

Purpose: To evaluate the safety, adherence, and estimates of effect of an aerobic exercise program in specialist schools for young people with cerebral palsy. Methods: Nineteen students with cerebral palsy were randomly allocated to an intervention group who completed an aerobic exercise program (27 sessions over nine weeks) or a control group who completed social/art activities over the same time. Results: There were no serious adverse events and the exercise program was completed with high rates of attendance (77%) and adherence to target heart rate zones (79%). Effect sizes favored the intervention group for measures of cardiovascular performance (sub-maximal treadmill test, effect size d = 0.7; muscle power sprint test, d = 0.9) and participation (Preference for Active-Physical Activities, d = 0.6). Conclusions: An aerobic exercise program in specialist schools for young people with cerebral palsy, that may improve measures of cardiovascular performance, can be completed safely, with moderately high levels of adherence.     

The Impact of Wearing a Face Mask on the Psychiatric Interview: a National Survey During the COVID-19 Pandemic

The COVID-19 pandemic has forced to rapidly encourage the use of face masks during medical consultations, with significant implication for psychiatry. This study examined the opinions and attitudes of psychiatrists toward the impact of wearing a face mask on the psychiatric interview. 513 psychiatrists and trainee psychiatrists completed an electronic survey about the impact of wearing a face mask on the psychiatric interview. Less efficiency in capturing clinical signs/symptoms, emergence of false inferences in patients and altered patient-clinician interactions were commonly reported negative impacts of face mask (66-96%). The quality of the therapeutic alliance was reported as affected by the mask by 47% of the sample. Results were mixed on the use of telepsychiatry as a potential solution to mask-related inconvenience. The use of face masks has significant negative effects on the psychiatric interview. Providing specific training to clinicians could be a potential solution for masks-induced biases.

     

Is wearing a face mask safe for people with epilepsy?

Since December 2019, the world has been experiencing a catastrophic pandemic of coronavirus disease (COVID-19) caused by SARS-CoV-2. This virus primarily targets the human respiratory system. Available information suggests that people with epilepsy (PWE) are not at higher risk of being infected by the virus, nor of more severe COVID-19 manifestations, as a result of the epilepsy alone. However, COVID-19 is a serious disease that currently has no effective treatment or vaccine. A face mask is probably effective in preventing the spread of a respiratory pathogen, at least to some extent. So, should we recommend wearing a face mask to all during a pandemic of respiratory infectious disease (eg, COVID-19) without any precautions or exemptions? While concrete evidence is lacking, if we consider that wearing a face mask may simulate hyperventilation, at least to some extent, we would probably avoid recommending this practice indiscriminately to all PWE. On the other hand, in the absence of any proven treatment or vaccine to combat COVID-19, prevention is the best available strategy and it is probably not reasonable to suggest avoid wearing face masks in PWE under any circumstances. Logically, PWE do not need to wear a face mask most of the time, as long as there is no close contact with others, especially during intense physical activities such as exercise. To the contrary, it is probably more advantageous to wear a face mask in crowded locations, with intermittent breaks in safe locations, away from others.     

Aerobic exercise improves measures of vascular health in diabetic peripheral neuropathy

Aims: Aerobic exercise improves vascular endothelial function in people with Type 2 diabetes mellitus (T2DM). There is minimal information available regarding vascular health in people with T2DM and diabetic peripheral neuropathy (DPN). Thus, the primary aim of this secondary analysis was to determine whether a 16-week aerobic exercise intervention could improve vascular health in people with T2DM and DPN. A secondary aim was to explore the relationship between changes in flow-mediated dilation (FMD) and the number of years since diagnosis of DPN. Methods: We examined whether a 16-week aerobic exercise intervention would improve vascular health in people with T2DM and DPN. We used Doppler ultrasound to assess brachial artery diameter and peak shear at baseline and post-exercise. Paired t-tests were used to determine whether the outcome measures improved from baseline to post-intervention. Pearson correlation assessed the relationship between DPN (years) and the percent change score (pre- to post-intervention) for FMD. Results: Seventeen individuals were included in the data analysis. After the intervention, peak diameter increased (3.9 (0.5) to 4.0 (0.5) mm; p = 0.07). Time to peak shear occurred at 60.5 (24.6) seconds when compared to baseline at 68.2 (22.7) seconds; p = 0.17. We found that a longer duration (in years) of DPN demonstrated a fair, negative relationship (r = ?0.41, p = 0.19) with the percent change in FMD. Conclusion: Aerobic exercise was beneficial for improving measures of vascular health but these were not statistically significant. The magnitude of change may be affected by the duration of DPN.     

Cross-Sectional Associations of Lifestyle Behaviors with Depressive Symptoms in Adolescents

This study aimed to examine the associations between lifestyle behaviors and depressive symptoms in adolescents. Self-reported data from the 2019 Youth Risk Behavior Survey (YRBS) was analyzed. Depressive symptoms were set as the outcome variable. Movement variables (physical activity, muscle-strengthening exercise, physical education attendance, sports team participation, television watching, video or computer games, and sleep), eating behaviors (fruit intake, vegetable intake, milk intake, and eating breakfast or not), and substance use (alcohol use and cigarette use) were included as explanatory variables. Binary logistic regression was used to explore the associations between lifestyle behaviors and depressive symptoms after adjusting for sex, age, grade, race, and weight status. Of 13,677 participants who completed the investigation, girls were more than boys (50.3% vs. 48.6%). The proportion of participants in grades 9, 10, 11, and 12 was 26.6, 27.2, 24.3, and 20.8, respectively. Of them, the prevalence of depressive symptoms was 36.0% (weighted%: 36.7% [35.1%, 38.3%]). Among all the lifestyle behaviors included, participating in no sports teams (OR = 1.53 [1.32, 1.77]), spending more than 2 h in video or computer games (OR = 1.64 [1.40, 1.92]), sleeping less than 8 h nightly (OR = 1.79 [1.45, 2.20]), not eating breakfast (OR = 1.56 [1.37, 1.78]), alcohol use (OR = 1.74 [1.49, 2.02]), and cigarette use (OR = 1.83 [1.42, 2.37]) were associated with higher odds of depressive symptoms. To reduce depressive symptoms in adolescents, interventions can consider encouraging adolescents to engage in team sports activity, limit time for video or computer games, sleep enough, regularly eat breakfast, and avoid using alcohol and cigarette. Future studies are encouraged to verify our research findings by using a more improved study design.     

Obesity and its association with generalised epilepsy,idiopathic syndrome,and family history of epilepsy

Aim. Previous studies support the concept that obesity is a common comorbid condition in patients with epilepsy (PWE). In this study, we present the body mass index (BMI) and data from a survey to assess physical activity in a sample of PWE from an epilepsy clinic. Methods. Between June of 2011 and January of 2013, 100 PWE from an adult epilepsy clinic were included. We obtained BMI, waist circumference, and information regarding physical activity using a standardised questionnaire. Clinical, demographic, electrographic, and imaging parameters were collected from charts. Results. Mean age of patients was 40±14 (18–77) years. The BMI distribution was as follows: 2 patients (2%) underweight, 26 (26%) normal weight, 34 (34%) overweight, 25 (25%) obese, and 13 (13%) with morbid obesity. In our study, obesity was defined as having a BMI ≥30. We found 38 (38%) patients in this range. There was no difference in the rate of drug‐resistant epilepsy between obese and non‐obese patients (55 vs. 55%; p=0.05). Leisure time habit was reported in 82% of obese patients and 79% of patients without obesity. Overall, the most frequent activity was walking (70%). Factors associated with obesity were generalised epilepsy (OR: 2.7, 1.1–6.6; p=0.012), idiopathic syndrome (OR: 2.7, 1.04–7; p=0.018), and family history of epilepsy (OR: 6.1, 1.5–24.2; p=0.002). Conclusion. Our study suggests an association between obesity, idiopathic generalised epilepsy, and family history of epilepsy. Our study shows that PWE are physically active and there is no clear relation between exercise and obesity. We could not identify any association between drug‐resistant epilepsy and obesity. Absence of direct comparison with a control non‐epileptic population; a cross‐sectional design not allowing evaluation of a causal association among variables; and reliance on self‐reported physical activity are to be considered as limitations of the present study.     

Gastric electrical stimulation versus per-oral pyloromyotomy for the treatment of nausea and vomiting associated with gastroparesis: An observational study of two cohorts

Background

Both gastric electrical stimulation (GES) and gastric-peroral endoscopic myotomy (G-POEM) can be offered to patients with gastroparesis and predominant nausea and vomiting. The study's aim was to compare GES and G-POEM efficacy on nausea and vomiting scores in patients with gastroparesis.

Methods

Two multicenter cohorts of patients with medically refractory gastroparesis with predominant nausea and vomiting (defined as a score >2 on nausea and vomiting subscale that varied from 0 to 4) were treated either with GES (n = 34) or G-POEM (n = 30) and were followed for 24 months (M). Clinical response was defined as a decrease of ≥1 point in nausea and vomiting subscale without premature exclusion due to switch from one to the other technique before M24. Changes in symptomatic scales and quality of life were also monitored.

Key Results

Patients from both groups were comparable although the mean score of nausea and vomiting subscale was higher in GES (3.0) compared to G-POEM group (2.6; p = 0.01). At M24, clinical response was achieved in 21/34 (61.7%) patients with GES and in 21/30 (70.0%; p = 0.60) patients with G-POEM. Mean scores of nausea and vomiting subscale decreased at M24 in both GES (from 3.0 to 1.6; p < 0.001) and G-POEM (from 2.6 to 1.2; p < 0.001) groups, although there was no difference between groups (difference adjusted from baseline: −0.28 [−0.77; 0.19]; p = 0.24). Likewise, symptomatic and quality of life scores improved at M24 in both groups, without difference according to treatment group.

Conclusions and Inferences

At M24, we did not observe significant difference in efficacy of GES and G-POEM in medically refractory gastroparesis with predominant nausea and vomiting.     

Effects of Mindfulness-Based Stress Reduction Intervention on Psychological Well-being and Quality of Life: Is Increased Mindfulness Indeed the Mechanism?

Background  Although several studies have reported positive effects of mindfulness-based stress reduction (MBSR) intervention on psychological well-being, it is not known whether these effects are attributable to a change in mindfulness. Purpose  The aim of this study is to compare the effects of MBSR to a waiting-list control condition in a randomized controlled trial while examining potentially mediating effects of mindfulness. Methods  Forty women and 20 men from the community with symptoms of distress (mean age 43.6 years, SD = 10.1) were randomized into a group receiving MBSR or a waiting-list control group. Before and after the intervention period, questionnaires were completed on psychological well-being, quality of life, and mindfulness. Results  Repeated measures multiple analysis of variance (MANCOVAs) showed that, compared with the control group, the intervention resulted in significantly stronger reductions of perceived stress (p = 0.016) and vital exhaustion (p = 0.001) and stronger elevations of positive affect (p = 0.006), quality of life (p = .009), as well as mindfulness (p = 0.001). When mindfulness was included as a covariate in the MANCOVA, the group effects on perceived stress and quality of life were reduced to nonsignificance. Conclusion  Increased mindfulness may, at least partially, mediate the positive effects of mindfulness-based stress reduction intervention.     

Prevalence and Factors Associated with Smartphone Addiction among Adolescents–A Nationwide Study in Malaysia

Smartphone ownership among adolescents is getting common in this decade especially in Malaysia; Adolescent are strongly devoted to their smartphone and this may lead to smartphone addiction. Studies have reported that smartphone addiction has become an emerging social and health problem especially among the youth in many countries however there is lack of study among adolescents in Malaysia. This study aimed to examine the prevalence and factors associated with smartphone addiction among adolescents in Malaysia. This was a cross-sectional study involving adolescents from 15 primary care clinics throughout the country. Respondents were assessed on their smartphone activities using the Malaysian short version of the Smartphone addiction scale (SAS-M-SV). Multiple logistic regression was used to determine the predictors of smartphone addiction among adolescents. The study was conducted among 921 adolescents with 49.6% male (n = 457). The mean age of adolescents was 16.4 ± 2.4 years. The ethnicity distribution were 74.6% Malay, 7.3% Chinese, 4.7% Indian and 13.4% other ethnicities. The prevalence of smartphone addiction was 37.1% (342/921); 37.4% in male and 36.9% in female. Based on multiple logistic regression analysis, longer duration of smartphone use per week was associated with higher odds of smartphone addiction among adolescent (odd ratio = 1.005%, 95% confidence interval = 1.000–1.009, p-value = 0.039). Smartphone addiction is present in nearly four in ten adolescents in Malaysia. Adolescents who spend longer duration in smartphone usage per week were associated with higher odds of having smartphone addiction. Parents should be more alert and vigilant about this finding. Hence, parents should limit their children from spending too much of time with smartphone in order to prevent their children from getting smartphone addiction.