Patterns of weight gain in a group of patients treated for anorexia nervosa

Patterns of weight gain up to matched population mean levels arising within the constraints of a specific treatment program for patients with anorexia nervosa have revealed certain group characteristics. Weight gain was most rapid initially and related to rehydration. Thereafter, maximum fluctuations occurred within the range of 44.0–48.9 kg. The authors suggest that this is related to biological and consequent experiential factors commonly arising at this level of body weight. Furthermore, the authors suggest that such weight charts reflect the individual's constitution, including her personality, her potential social coping capacities and also her ability to engage with and express her feelings, and that, as such, they may have prognostic value.     

Nature and nurture in anorexia nervosa: A study of 34 pairs of twins,one pair of triplets,and an adoptive family

This paper reports observations following on a study of anorexia nervosa in 34 twins and one set of triplets, and within which approximately half the monozygotic (MZ) twins displayed concordance, compared with 7% of the dizygotic (DZ) twins. One additional case, involving childhood adoptions, is described, wherein neither genetic nor specifically assortative selection factors seem to have been at work. The findings suggest that genetic and environmental factors can interact to contribute to the development of this apparently culture-based and multifactorially derived condition. A number of possible genetic strands to the condition are proposed; probably not all of them are specifically necessary for its development. The same may apply to experiential influences. Elsewhere it has been argued that the one essential charactistic of anorexia nervosa is avoidance behavior and the factors permitting and facilitating it (Crisp, 1980). Experiential influences, in the form of psychological maturational challenges in adolescence impinging on constitutional propensities to the point of precipitating the disorder out, would seem often themselves to have been influenced by constitutional psychological characteristics and earlier childhood experiences. A further pooling and study of all known twin and adoptive cases might now advance our knowledge of this condition further.     

Recovery in anorexia nervosa—the patient's perspective

Six recovered anorectic patients, followed-up after 20 years of the onset of their illness, described their experience of recovery. “Personality strength,” “self-confidence,” “being ready,” and “being understood” were the factors most commonly identified as important for recovery.     

Outcome of outpatient psychotherapy in a random allocation treatment study of anorexia nervosa

Ninety subjects with DSM-III-R anorexia nervosa were randomly allocated to four treatment options, one inpatient, two outpatient, and one comprising an assessment interview only. Twenty were thus offered a package of outpatient individual and family psychotherapy. At 2-year follow-up, 12 of the 20 were classed as well, or very nearly well, according to operationally defined criteria. Statistically significant improvements over time were obtained for weight, mean body mass index (BMI), and also for psychological, sexual, and socioeconomic adjustments. Weight and BMI changes were significantly better than for the assessment only group, some of whom had received extensive treatment elsewhere. The style of the outpatient therapy and compliance with it are described in some detail and prognostic indicators for the treated and untreated groups presented. Lower weights at presentation and vomiting were associated with poorer outcome, although age and length of history were not. © 1994 by John Wiley & Sons, Inc.     

Traditional and new composite endpoints in heart failure clinical trials: facilitating comprehensive efficacy assessments and improving trial efficiency

Composite endpoints are commonly used as the primary measure of efficacy in heart failure clinical trials to assess the overall treatment effect and to increase the efficiency of trials. Clinical trials still must enrol large numbers of patients to accrue a sufficient number of outcome events and have adequate power to draw conclusions about the efficacy and safety of new treatments for heart failure. Additionally, the societal and health system perspectives on heart failure have raised interest in ascertaining the effects of therapy on outcomes such as repeat hospitalization and the patient's burden of disease. Thus, novel methods for using composite endpoints in clinical trials (e.g. clinical status composite endpoints, recurrent event analyses) are being applied in current and planned trials. Endpoints that measure functional status or reflect the patient experience are important but used cautiously because heart failure treatments may improve function yet have adverse effects on mortality. This paper discusses the use of traditional and new composite endpoints, identifies qualities of robust composites, and outlines opportunities for future research.     

Pamidronate for SAPHO syndrome

SIR, Marshall et al. [1]     

Estrogen receptor-mediated down-regulation of corticotropin-releasing hormone gene expression is dependent on a cyclic adenosine 3＇ ,5＇-monophosphate regulatory element in human placental syncytiotrophoblast cells

Placental CRH plays a major role in the mechanisms controlling human pregnancy and parturition. Understanding how placental CRH production is regulated is therefore of importance. Previously we have shown that placental expression of CRH peptide and mRNA are inhibited by estrogens, in contrast to the stimulatory effects of estrogen on hypothalamic CRH production. Our current study found that in placental cells cotransfected with a CRH promoter construct and an estrogen receptor-alpha expression vector results in a differential regulation whereby 17beta estradiol (E2) decreased and the putative pure estrogen antagonist, ICI 182780,