Obesity,binge eating and psychopathology: Are they related?

Obese female subjects with binge eating disorder BED; (N = 107) completed the Beck Depression Inventory, Symptom Checklist-90, Inventory of Interpersonal Problems, and Rosenberg Self-Esteem Scale. Subjects were divided into moderate or severe binger on the basis of scores on the Binge Eating Scale, and grouped into moderately or severely obese by performing a median split on their weights. Spearman correlational analyses were performed to determine the relationship between psychopathol-ogy and obesity and psychopathology and binge eating. Analyses of variance (ANO-VAs) were then performed using scores on the psychological measures with subjects grouped both by severity of obesity and severity of binge eating. The results indicated that in our sample, obesity and scores on the measures of psychiatric symptomatology were unrelated. However, a significant positive relationship was found between binge eating severity and degree of psychiatric symptomatology. We suggest that binge eating may account for the observed relationship between obesity and psychopathology reported in previous studies. We discuss the importance of assessing BED when conducting research with obese individuals. © 1994 by John Wiley & Sons, Inc.     

'Light' and 'mild' cigarettes: who smokes them? Are they being misled?

Using two population-based surveys of Ontarians, we examined the proportions of smokers who smoke 'light' and 'mild' cigarettes (L/M). We compared L/M smokers to regular cigarette smokers regarding demographic, health knowledge, and smoking characteristics and examined their health-related perceptions of L/M and reasons for smoking them. Use of these cigarettes increased from 71% in 1996 to 83% in 2000. Those who smoked L/M were more likely to be female, to be less addicted, and to be more advanced toward quitting. In 1996, one in five believed that smoking L/M lowers the risk of cancer and heart disease. In 1996 and 2000, respectively, 44% and 27% smoked L/M to reduce health risks, 41% and 40% smoked them as a step toward quitting, and 41% in both years said they would be more likely to quit if they learned L/M could provide the same tar and nicotine as regular cigarettes. These data provide empirical support for banning 'light' and 'mild' on cigarette packaging.     

Worldwide associations between air quality and health end-points: Are they meaningful?

Objectives

The World Health Organization (WHO) provides data on national indices of health, environment and economy. When we were asked, why air pollution is negatively correlated with cancer mortality, our first response (presumably the mortality data are not age-adjusted) was not sufficient to explain the paradox.

Material and Methods

A table including all-cause, cancer and childhood mortality, life expectancy, gross national product per person, smoking prevalence, physician density and particulate matter (PM₁₀) per country (N = 193) was developed. For explorative purposes weighted cross-sectional multiple linear regressions models were built.

Results

Air pollution is positively correlated with infant and overall mortality and negatively with life expectancy. This might not only depict a true causal effect of PM₁₀ because air quality is also an indicator of a country’s prosperity and general state of environment. Cancer mortality is negatively correlated with PM₁₀. However, this association turns positive when economic or health system indicators are controlled.

Conclusions

The World Health Organization’s world-wide data sets demonstrate the large disparity of our world. A careful and professional approach is needed as interpretation is difficult, especially for lay persons. Therefore, with publicly available data WHO should also provide interpretation and guidance.     

Medicaid and managed care: a lasting relationship?

The Medicaid program made a major commitment to managed care during the past decade. Following turbulent early years, the marriage matured and stabilized because managed care models responded well to a number of the states' goals and Medicaid purchasers were willing to make key trade-offs on behalf of their beneficiaries that conformed to the designs of managed care products. The relative tranquility in Medicaid managed care contrasts sharply with turmoil in both the commercial and Medicare sectors. But continuing changes in the managed care marketplace and financial distress in state budgets present new challenges to the strength and durability of this relationship.     

Identifying Patient Readmissions: Are Our Data Sources Misleading?

BackgroundThe accuracy of data is vital to identifying hospitalization outcomes for clinical trials. Patient attrition and recall bias affects the validity of patient-reported outcomes, and the growing prevalence of Medicare Advantage (MA) could mean Fee-for-Service (FFS) claims are less reliable for ascertaining hospital utilization. Statewide health information exchanges (HIEs) may be a more complete data source but have not been frequently used for research.DesignSecondary analysis comparing identification of readmissions using 3 different acquisition approaches.SettingRandomized controlled trial of heart failure (HF) disease management in 37 skilled nursing facilities (SNFs).ParticipantsPatients with HF discharged from the hospital to SNF.MeasuresReadmissions up to 60 days post-SNF admission collected by patient self-report, recorded by nursing home (NH) staff during the SNF stay, or recorded in the state HIE.ResultsAmong 657 participants (mean age 79 ± 10 years, 49% with FFS), 295 unique readmissions within 60 days of SNF admission were identified. These readmissions occurred among 221 patients. Twenty percent of all readmissions were found using only patient self-report, 28% were only recorded by NH staff during the SNF stay, and 52% were identified only using the HIE. The readmission rate (first readmission only) based only on patient self-report and direct observation was 18% rather than 34% with the addition of the enhanced HIE method.Conclusions and implicationsMore than one-quarter (34%) of HF patients were rehospitalized within 60 days post SNF admission. Use of a statewide HIE resulted in identifying an additional 153 admissions, 52% of all the readmissions seen in this study. Without use of an HIE, nearly half of readmissions would have been missed as a result of incomplete patient self-report or loss to follow-up. Thus, HIEs serve as an important resource for researchers to ensure accurate outcomes data.     

A comparison of homeless and high-risk young adults: Are they one and the same?

Although experiencing poor parenting has been linked to high-risk behaviors and negative outcomes among different populations, very little research has been conducted on whether inadequate parenting has the same detrimental consequences for homeless and high-risk young adults. As such, this article compares homeless and marginally housed young adults to see if the associations between poor parenting (e.g. lower monitoring, neglect and physical abuse) and negative outcomes including depressive symptoms, victimization, delinquency and substance use are similar for these two groups. The sample consisted of 199 homeless and high-risk young adults from the Midwestern United States. Multivariate results revealed that childhood sexual abuse was correlated with physical and sexual victimization and delinquency among marginally housed young adults. Among homeless individuals, neglect and physical abuse were associated with physical victimization and delinquency, respectively. Caretaker monitoring was linked with delinquency and substance use among both groups. Finally, caretaker substance misuse was related positively with higher levels of substance use, but only among marginally housed individuals. The results are discussed in terms of policy implications.     

Are Building-Level Characteristics Associated with Indoor Allergens in the Household?

Building-level characteristics are structural factors largely beyond the control of those who live in them. We explored whether building-level characteristics and indoor allergens in the household are related. We examined the relationship between building-level characteristics and indoor allergens: dust mite, cat, cockroach, and mouse. Building-level characteristics measured were presence of pests (seeing cockroaches and rodents), building type (public housing, buildings zoned commercially and residentially, and building size), and building condition (building age and violations). Allergen cutpoints were used for categorical analyses and defined as follows: dust mite: >0.25 μg/g; cat: >1 μg/g; cockroach: >1 U/g; mouse: >1.6 μg/g. In fully adjusted linear analyses, neither dust mite nor cat allergen were statistically significantly associated with any building-level characteristics. Cockroach allergen was associated with the presence of cockroaches (2.07; 95% CI, 1.23, 3.49) and living in public housing (2.14; 95% CI, 1.07, 4.31). Mouse allergen was associated with the presence of rodents (1.70; 95% CI, 1.29, 2.23), and building size: living in a low-rise (<8 floors; 0.60; 95% CI, 0.42, 0.87) or high-rise (8 + floors; 0.50; 95% CI, 0.29, 0.88; compared with house/duplex). In fully adjusted logistic analyses, cat allergen was statistically significantly associated with living in a high-rise (6.29; 95% CI, 1.51, 26.21; compared with a house/duplex). Mouse allergen was associated with living in public housing (6.20; 95% CI, 1.01, 37.95) and building size: living in a low-rise (0.16; 95% CI, 0.05, 0.52) or high-rise (0.06; 95% CI, 0.01, 0.50; compared with a house/duplex). Issues concerning building size and public housing may be particularly critical factors in reducing asthma morbidity. We suggest that future research explore the possible improvement of these factors through changes to building code and violations adherence, design standards, and incentives for landlords.     

Child nutrition and growth: butterfly effects?

The international symposium organised by the Danone Institute as a pre-congress satellite of the European Nutrition Societies Congress, in Paris, in July 2007, brought together experts of child nutrition and behaviour. These experts coming from several countries of Europe and North America shared their views on the impact of numerous factors affecting child eating and health in present-day developed societies. Topics included nutritional influences during foetal life, early life development of food likes and dislikes, neophobia, ability for energy regulation, impact of media and advertisement, etc. Most contributions addressed the obesity epidemics and the problems associated with body weight control. Other aspects of child health were also considered, for example the nutritional challenge of adequately feeding children with type 1 diabetes. The nine speakers were asked to underline practical strategies to improve nutrition in early life, so as to maximise health, growth and quality of life in today's environment. The present paper is a summary of the ideas expressed by the experts, highlighting agreements, convergences, and occasional disagreements between expert opinions.     

Constructed wetlands – Are they safe in reducing protozoan parasites?

Constructed wetlands have been promoted in recent literature for use in rural communities in developed as well as in developing countries as an appropriate technology to be handled with low operational maintenance costs. Within a joint project supported by BMBF (Project No O2WA0107 and No 02WA0108) research was done concerning the sanitation effect of constructed wetlands on wastewater effluents. This article will focus on the detection and the removal of cysts of Cryptosporidium parvum and Giarda lamblia, those being the most frequently identified pathogenic protozoan parasites worldwide with increasing medical and economical consequences.     

Realist methods in medical education research: what are they and what can they contribute?

Medical Education 2012: 46: 89–96 Context Education is a complex intervention which produces different outcomes in different circumstances. Education researchers have long recognised the need to supplement experimental studies of efficacy with a broader range of study designs that will help to unpack the ‘how’ and ‘why’ questions and illuminate the many, varied and interdependent mechanisms by which interventions may work (or fail to work) in different contexts. Methods One promising approach is realist evaluation, which seeks to establish what works, for whom, in what circumstances, in what respects, to what extent, and why. This paper introduces the realist approach and explains why it is particularly suited to education research. It gives a brief introduction to the philosophical assumptions underlying realist methods and outlines key principles of realist evaluation (designed for empirical studies) and realist review (the application of realist methods to secondary research). Discussion The paper warns that realist approaches are not a panacea and lists the circumstances in which they are likely to be particularly useful.     

Fathering: The Relationship Between Fathers’ Residence, Fathers’ Sociodemographic Characteristics, and Father Involvement

Literature and research examining father involvement has focused primarily on outcomes associated with the well-being and development of children. The contextual factors associated with fathers, and how these factors shape fathers’ involvement with their young children, have received limited attention in this literature. Addressing this limitation, this study focuses on the relationship between fathers’ residential status, age, race and ethnicity, educational attainment, financial status and father involvement. Results of the regression models indicate that fathers who reside with their children and fathers who are older are more involved with their children. Given these findings, policymakers, practitioners, and researchers have an opportunity to create and enhance policies and programs that may assist and support fathers in their development as parents and their involvement with their children.     

Probiotics and zinc in acute infectious gastroenteritis in children: are they effective?

OBJECTIVE: Several studies in recent decades have assessed the effects of different probiotics in acute gastroenteritis, showing that specific strains of Lactobacilli (mainly Lactobacillus casei GG) and Saccharomyces boulardii may exert some beneficial therapeutic actions, mainly when used in rotavirus gastroenteritis, at a high dose, and in the early phase. The mechanisms of action of probiotics are not completely elucidated but seem to involve a complex interaction among epithelial, molecular, metabolic, and immune responses. Data on the prevention of community-acquired, nosocomial, and travelers' diarrhea are currently conflicting. Because each micro-organism has different properties, an accurate selection of the strain, dose, and patient should be cautiously considered. METHODS AND RESULTS: Several reports from developing countries have demonstrated that supplements of zinc also provide significant reduction in stool output and duration, persistency, and severity of diarrhea. In view of the published data and of the different actions of zinc (such as improvement of the immune status, intestinal permeability, epithelial and enzymatic function, and electrolyte transport), the use of zinc as adjunctive therapy to oral rehydration solution has the potential to improve the management of diarrhea and decrease complications in children worldwide. In contrast to probiotics, which most trials in the developed world have used, there has been no trial with zinc performed in developed countries. CONCLUSION: Data on the effect of a combined administration of zinc and probiotics in acute gastroenteritis are urgently needed.