Eating Disorders “Mental Health Literacy” in Low Risk,High Risk and Symptomatic Women: Implications for Health Promotion Programs

Attitudes and beliefs concerning the nature and treatment of bulimia nervosa (BN) were compared among young adult women at low risk of an eating disorder (n = 332), at high risk (n = 83), or already showing symptoms (n = 94). Participants completed a self-report questionnaire that included a measure of eating disorder symptoms. A vignette of a fictional person suffering from BN was presented, followed by a series of questions addressing the nature and treatment of the problem described. High-risk and symptomatic participants were more likely than low-risk participants to report that they would not approach anyone for advice or help, were they to have BN or a similar problem, because they would not want anyone to know. Symptomatic participants were more likely to believe that someone with BN would be discriminated against, more likely to consider bulimic behaviors to be acceptable, and more likely to view BN as being common among women in the community, than low-risk participants, participants in the high-risk group being intermediate on each of these questions. The findings suggest that the attitudes and beliefs of individuals with eating disorder symptoms differ systematically from those of individuals at high risk, but who do not yet have symptoms, and from those at low risk. They also indicate specific attitudes and beliefs that may need to be addressed in prevention and early intervention programs. The potential benefits of assessing individuals' attitudes and beliefs concerning the nature and treatment of eating-disordered behaviour and tailoring program content accordingly may be worthy of investigation.     

The Mediating Effects of Alexithymia,Intolerance of Uncertainty,and Anxiety on the Relationship Between Sensory Processing Differences and Restricted and Repetitive Behaviours in Autistic Adults

Distress caused by sensory processing differences for autistic individuals may be reduced by repetitive behaviours (RRB), including repetitive motor (RMB) and insistence on sameness (ISB) behaviours. Intolerance of uncertainty (IU) and anxiety mediate the relationship between sensory processing and RRB in autistic children. We replicated this model in autistic adults, extending it to include alexithymia. Serial mediation, using data from 426 autistic adults, identified significant direct effects from sensory processing to RMB and ISB, and indirect effects through alexithymia-IU-anxiety for RMB, and IU alone, and alexithymia-IU for ISB. Different mechanisms may underpin RMB and ISB. Alexithymia alongside, IU and anxiety, should be considered when understanding the relationship between sensory processing and RRB, and when offering interventions to support autistic people.

     

Multivariate Cholesky Models of Human Female Fertility Patterns in the NLSY

Substantial evidence now exists that variables measuring or correlated with human fertility outcomes have a heritable component. In this study, we define a series of age-sequenced fertility variables, and fit multivariate models to account for underlying shared genetic and environmental sources of variance. We make predictions based on a theory developed by Udry [(1996) Biosocial models of low-fertility societies. In: Casterline, JB, Lee RD, Foote KA (eds) Fertility in the United States: new patterns, new theories. The Population Council, New York] suggesting that biological/genetic motivations can be more easily realized and measured in settings in which fertility choices are available. Udry’s theory, along with principles from molecular genetics and certain tenets of life history theory, allow us to make specific predictions about biometrical patterns across age. Consistent with predictions, our results suggest that there are different sources of genetic influence on fertility variance at early compared to later ages, but that there is only one source of shared environmental influence that occurs at early ages. These patterns are suggestive of the types of gene–gene and gene–environment interactions for which we must account to better understand individual differences in fertility outcomes. Edited by John Hewitt and Wendy Slutske     

Research for leveraging food policy in universal eating disorder prevention

Policy and legislation have emerged as important levers for universal prevention efforts in the context of eating disorders. However, to date, little attention has been paid to generating research that will inform opportunities to regulate the food environment, specifically the way that food is produced and marketed. The present paper aims to lay out a framework for research that will examine (1) the ways in which food industry may influence risk for eating disorders and (2) the impact of legislative efforts on eating disorder cognitions and behaviors. For these two pathways, specific examples of research that would serve to inform policy efforts aiming to decrease the risk for eating disorders by targeting the food environment are proposed. Overall, the present paper aims to issue a call for the eating disorder field to become involved in food policy and regulation.     

School dental screening does not increase dental attendance rates or reduce disease levels

DESIGN: This was a cluster randomised controlled trial, in which the unit of randomisation was the school. INTERVENTION: Three models of screening were tested against a control. A 'new' model of school dental screening incorporated a consensus view, from clinicians in the northwest of England, on a set of clinical criteria that would prompt a referral following a screening examination. A 'traditional' model involved the delivery of the existing school dental screening programme according to the principle that a child is referred if, in the opinion of the screening dentist, dental care is required. The third intervention tested was a dental information leaflet, distributed via the schools, which encouraged parents to examine their child's mouth and to take their child to a dentist if any problems were noted. Children a ttending the control schools received no intervention during the study period. OUTCOME MEASURE: The main outcome measures were prevalence of teeth with active caries and mean number of teeth with active caries in the permanent or primary dentition. Secondary outcome measures were prevalence of oral sepsis, gross plaque or calculus, and dental trauma to incisor teeth. RESULTS: Seventeen thousand and ninety-eight children in 169 clusters (schools) were eligible for inclusion in the study. One school was withdrawn from the study because of failure to agree to follow the trial protocol. Of the total, 15 004 children were available for baseline examination in 168 schools and 13 570 children received a baseline and outcome examination, representing 80.5% of the eligible population. After adjustment for clustering of children in schools, there was no significant difference in the reduction from baseline in untreated caries between the study groups in either the primary or permanent dentition. Similarly there were no significant differences across the four arms of the study in the secondary outcome measures of prevalence of sepsis, presence of gross plaque or calculus, and trauma to the permanent incisor teeth. In the traditional arms, 42% of children attended a dentist during the study period, with 41% in the new-model arm, 37% in the information-leaflet arm and 38% in the control arm. Although more children in the traditional and new-model arms of the study attended a dental appointment these differences were not statistically significant.CONCLUSIONS: School dental screening delivered according to three different models was not effective at reducing levels of active caries and increasing dental attendance in the population under study.     

A Cryptic Cause of Cardiac Arrest

Background

RIPPLY2-associated spondylocostal dysostosis is a rare disorder that leads to segmentation defects of the vertebrae. These vertebral defects can result in severe instability of the cervical spine, leading to cardiac arrest after only minor whiplash injury.

Optimal cannula positioning of HeartMate 3 left ventricular assist device

Cannula position in HeartMate II and HeartWare left ventricular assist devices (LVADs) is associated with clinical outcome. This study aimed to investigate the clinical implication of the device positioning in HeartMate 3 LVAD cohort. Consecutive patients who underwent HeartMate 3 LVAD implantation were followed for one year from index discharge. At index discharge, chest X-ray parameters were measured: (a) cannula coronal angle, (b) height of pump bottom, (c) cannula sagittal angle, and (d) cannula lumen area. The association of each measurement of cannula position with one-year clinical outcomes was investigated. Sixty-four HeartMate 3 LVAD patients (58 years old, 64% male) were enrolled. In the multivariable Cox regression model, the cannula coronal angle was a significant predictor of death or heart failure readmission (hazard ratio 1.27 [1.01-1.60], P = .045). Patients with a cannula coronal angle ≤28° had lower central venous pressure (P = .030), lower pulmonary capillary wedge pressure (P = .027), and smaller left ventricular size (P = .019) compared to those with the angle >28°. Right ventricular size and parameters of right ventricular function were also better in the narrow angle group, as was one-year cumulative incidence of death or heart failure readmission (10% vs. 50%, P = .008). Narrow cannula coronal angle in patients with HeartMate 3 LVADs was associated with improved cardiac unloading and lower incidence of death or heart failure readmission. Larger studies to confirm the implication of optimal device positioning are warranted.