Effects of distress, alexithymia and impulsivity on eating

OBJECTIVE: To improve our understanding of possible mechanisms underlying emotional overeating this study examined the effects of a distress manipulation on food intake in relation to alexithymia and impulsivity. METHOD: Participants were 86 females who were subjected to a distress manipulation (the anticipation of a public speaking task) prior to an ad lib taste task and filled out questionnaires on impulsivity and the alexithymia constructs difficulty identifying and describing feelings. RESULTS: Alexithymia significantly (p<.05) moderated the relationship between food consumption and distress. Instead of eating less in the distress condition, alexithymic females ate the same or even more, this showing a 'biological unnatural' and 'inapt' response. CONCLUSION: Findings suggest that for the 'natural' distress response (reduction of food intake) good ability to identify and describe feelings to others is required, and that the presence or absence of these abilities may predict which people respond to distress by undereating or by overeating. The results provide empirical support for Bruch's conceptualisation of poor interoceptive awareness as possible predictive factor for emotional overeating.     

Flexible,Scalable, and Efficient Targeted Resequencing on a Benchtop Sequencer for Variant Detection in Clinical Practice

The release of benchtop next‐generation sequencing (NGS) instruments has paved the way to implement the technology in clinical setting. The need for flexible, qualitative, and cost‐efficient workflows is high. We used singleplex‐PCR for highly efficient target enrichment, allowing us to reach the quality standards set in Sanger sequencing‐based diagnostics. For the library preparation, a modified NexteraXT protocol was used, followed by sequencing on a MiSeq instrument. With an innovative pooling strategy, high flexibility, scalability, and cost‐efficiency were obtained, independent of the availability of commercial kits. The approach was validated for ～250 genes associated with monogenic disorders. An overall sensitivity (>99%) similar to Sanger sequencing was observed in combination with a positive predictive value of >98%. The distribution of coverage was highly uniform, guaranteeing a minimal number of gaps to be filled with alternative methods. ISO15189‐accreditation was obtained for the workflow. A major asset of the singleplex PCR‐based enrichment is that new targets can be easily implemented. Diagnostic laboratories have validated assays available ensuring that the proposed workflow can easily be adopted. Although our platform was optimized for constitutional variant detection of monogenic disease genes, it is now also used as a model for somatic mutation detection in acquired diseases.     

The importance of identifying a back-up donor for unrelated stem cell transplantation

The importance of identifying a back-up donor, once a primary suitable unrelated stem cell donor has been found, is often underestimated. Transplant centres erroneously count on the unrelated volunteer donors to be willing, available and medically fit for actual donation. According to our data, which includes 502 unrelated donor work-up procedures performed for 425 Dutch patients between 1987 and 2002, one of 11 work-ups ended in the primary requested donor failing to donate. Of all donor-related cancellations (N=46), 78% of the procedures were deferred due to medical reasons and 22% due to nonmedical reasons. Most of the donors deferred for medical reasons were female (P=0.005). In 50% of the cases for which a back-up donor was already identified, the patients were transplanted with a delay of less then 2 weeks; when no back-up donor was available, the median delay increased to 18 weeks. We strongly encourage implementing a search for at least one back-up donor in the primary search. Identifying a back-up donor can save precious time and complicated logistic rescheduling.     

Reconsideration of the scheme of the international classification of functioning,disability and health: incentives from the Netherlands for a global debate

Purpose: The ICF (International Classification of Functioning, Disability and Health) framework (used worldwide to describe ‘functioning’ and ‘disability’), including the ICF scheme (visualization of functioning as result of interaction with health condition and contextual factors), needs reconsideration. The purpose of this article is to discuss alternative ICF schemes.

Method: Reconsideration of ICF via literature review and discussions with 23 Dutch ICF experts. Twenty-six experts were invited to rank the three resulting alternative schemes.

Results:The literature review provided five themes: 1) societal developments; 2) health and research influences; 3) conceptualization of health; 4) models/frameworks of health and disability; and 5) ICF-criticism (e.g. position of ‘health condition’ at the top and role of ‘contextual factors’). Experts concluded that the ICF scheme gives the impression that the medical perspective is dominant instead of the biopsychosocial perspective. Three alternative ICF schemes were ranked by 16 (62%) experts, resulting in one preferred scheme.

Conclusions: There is a need for a new ICF scheme, better reflecting the ICF framework, for further (inter)national consideration. These Dutch schemes should be reviewed on a global scale, to develop a scheme that is more consistent with current and foreseen developments and changing ideas on health.

• Implications for Rehabilitation

• We propose policy makers on community, regional and (inter)national level to consider the use of the alternative schemes of the International Classification of Functioning, Disability and Health within their plans to promote functioning and health of their citizens and researchers and teachers to incorporate the alternative schemes into their research and education to emphasize the biopsychosocial paradigm.

• We propose to set up an international Delphi procedure involving citizens (including patients), experts in healthcare, occupational care, research, education and policy, and planning to get consensus on an alternative scheme of the International Classification of Functioning, Disability and Health.

• We recommend to discuss the alternatives for the present scheme of the International Classification of Functioning, Disability and Health in the present update and revision process within the World Health Organization as a part of the discussion on the future of the International Classification of Functioning, Disability and Health framework (including ontology, title and relation with the International Classification of Diseases).

• We recommend to revise the definition of personal factors and to draft a list of personal factors that can be used in policy making, clinical practice, research, and education and to put effort in the revision of the present list of environmental factors to make it more useful in, e.g., occupational health care.

     

The culture of vascular access cannulation among nurses in a chronic hemodialysis unit

The native arteriovenous fistula (AVF) is the vascular access of choice for patients on chronic hemodialysis (HD) because of its longevity and lower complication rate. Yet from 2001 to 2004 in Canada, there has been a notable increase in both incident and prevalent central venous catheter (CVC) use with a corresponding decrease in AVF use over the same time period (Moist, Trpeski, Na, & Lok, 2008). A similar trend has been found in other countries (Moist, Chang, Polkinghorne, & McDonald, 2007). There are a number of contributing factors to low AVF use in patients on chronic hemodialysis. While some of these factors may be patient-related, nursing interventions specific to cannulation may be a contributor. To date, little is known about HD nurses' attitudes and experiences regarding cannulation. The purpose of this study was to describe the culture and everyday practices of vascular access cannulation of the AVF from the perspective of the HD nurse. An ethnographic research design was employed, utilizing qualitative methods. Ten HD nurses were interviewed using a semi-structured interview tool, and a number of themes were generated from the interviews. One overarching theme of "perpetual novice" was evident, acknowledging the failure to transition from novice to expert cannulator despite working in HD for a number of years. Other common themes that emerged from the interviews were a) the lack of fistulas, b) the fistula as a "hard sell" to patients, c) the skill of cannulation, and d) the assembly-line approach to care. As a result of a number of factors, HD nurses were unable to acquire the skills necessary to become an expert cannulator. Moreover, the decrease in opportunities to practise cannulation has resulted in wide variation in skill level among HD nurses. To improve cannulation skills and achieve successful cannulation of AV fistulas, HD nurses identified a number of educational strategies that should take place. They also identified the need for an improved documentation system in order to track cannulation-related problems. Results of this study may be helpful in understanding the culture of cannulation in a chronic HD unit and in directing future educational, supportive, and practice interventions for HD nurses.     

Developing specific therapeutic strategies for transfusion-related acute lung injury. An overview of potentially useful animal models

Transfusion-related (TR)- acute lung injury (ALI) is the leading cause of transfusion-related morbidity and mortality. The pathogenesis of TRALI is thought to be a "two hit"-entity: the "first hit" is (any) proinflammatory pulmonary condition (e.g., pneumonia, sepsis or lung contusion) resulting in activation of lung endothelium with sequestration of polymorphonuclear neutrophils - the "second hit" is provided by transfusion of a blood product. Either antibodies against neutrophils are thought to be implicated in the activation of the sequestrated neutrophils, or bioactive lipids (which accumulate during storage of blood products) induce the "second hit", finally resulting in lung injury. Preventive measures do not prevent all TRALI cases. Also, TRALI is most probably underdiagnosed. In this review, we call for the development of therapeutic approaches for this potentially life-threatening disease. Several interventions which are beneficial in ALI and may also be beneficial in TRALI are discussed. The application of these interventions requires the development of clinically relevant TRALI animal models. We discuss the present TRALI animal models and their shortcomings and propose future animal models, in which clinically relevant "first hits" can be applied, thereby imitating the complex clinical situation.     

Perceived parental food controlling practices are related to obesogenic or leptogenic child life style behaviors

To better understand whether the parental food controlling practices pressure and restriction to eat are obesity preventing or obesity promoting, this study examined whether these parenting practices are related to other (food or non-food) areas that are generally regarded as obesogenic or leptogenic. Are these foods controlling practices more indicative of obesogenic or leptogenic child life style behaviors? In a sample of 7–12-year-old boys and girls (n = 943) the perceived parental food controlling practices were related to various measures for unhealthy life style. Using factor analysis we assessed whether there is a constellation of lifestyle behaviors that is potentially obesogenic or leptogenic. Remarkably, perceived parental restriction and pressure loaded on two different factors. Perceived parental restriction to eat had a negative loading on a factor that further comprised potential obesogenic child life style behaviors, such as snacking (positive loading), time spend with screen media (television or computer) (positive loadings) and frequency of fruit consumption (negative loading). Perceived parental pressure to eat had a positive loading on a factor that further comprised potential leptogenic life style behaviors such as frequency of eating a breakfast meal and sporting (positive loadings). It is concluded that low perceived parental restriction in regard to food may perhaps be a sign of more uninvolved ‘neglecting’ or indulgent parenting/obesogenic home environment, whereas high perceived parental pressure to eat may be sign of a more ‘concerned’ leptogenic parenting/home environment, though more research into style of parenting is needed.     

The rat macrophage scavenger receptor CD163: expression, regulation and role in inflammatory mediator production

The monoclonal antibody ED2 is widely used to define macrophages (mphi) in the rat. We have recently identified the ED2 antigen as the rat CD163 glycoprotein. CD163 is a member of the scavenger receptor cysteine-rich group B (SRCR-B) family and functions as a scavenger receptor for hemoglobin-haptoglobin complexes. Moreover, CD163 has also been indicated as a marker for alternatively activated mphi. In the current study, we identify rat CD163/ED2-antigen as a marker for mature tissue mphi. Rat CD163 is constitutively expressed on most subpopulations of mature tissue mphi, including splenic red pulp mphi, thymic cortical mphi, Kupffer cells in the liver, resident bone marrow mphi and central nervous system perivascular and meningeal mphi, but is apparently absent from monocytes. Rat CD163 expression can be promoted by glucocorticoids, and this can be further enhanced by IL4. Finally, engagement of rat CD163 on peritoneal mphi induces the production of pro-inflammatory mediators, including NO, IL-1beta, IL-6 and TNF-alpha. Collectively, our findings identify rat CD163 as a broadly expressed macrophage scavenger receptor that may play a role in the activation of mphi during hemolytic and/or inflammatory conditions.