Ultraviolet radiation exposure to the face in patients with xeroderma pigmentosum and healthy controls: applying a novel methodology to define photoprotection behaviour.

BACKGROUND: In xeroderma pigmentosum (XP), the main means of preventing skin and eye cancers is extreme protection against ultraviolet radiation (UVR). Protection is most important for the face. OBJECTIVES: We aimed to assess how well patients with XP adhere to medical advice to protect against UVR by objectively estimating the mean daily dose of UVR to the face. METHODS: We objectively estimated the UVR dose to the face in 36 patients with XP and 25 healthy individuals over 3 weeks in the summer. We used a new methodology which combined UVR dose measurements from a wrist-worn dosimeter with an activity diary record of face photoprotection behaviour for each 15-min period spent outside. A protection factor was associated with each behaviour, and the data were analysed using a negative binomial mixed-effects model. RESULTS: The mean daily UVR dose (weighted for DNA damage capacity) to the face in the patients with XP was 0·13 standard erythemal doses (SEDs) (mean in healthy individuals = 0·51 SED). There was wide variation between patients (range < 0·01-0·48 SED/day). Self-caring adult patients had a very similar UVR dose to the face as cared-for patients (0·13 vs. 0·12 SED/day), despite photoprotecting much more poorly when outside, because the self-caring adults were outside in daylight much less. CONCLUSIONS: Photoprotection behaviour varies widely within the XP group indicating that nonadherence to photoprotection advice is a significant issue. The timing and duration of going outside are as important as photoprotective measures taken when outside, to determine the UVR exposure to the face. This new methodology will be of value in identifying the sources of UVR exposure in other conditions in which facial UVR exposure is a key outcome, particularly in patients with multiple nonmelanoma skin cancers.

Prevalence and predictors of weight loss maintenance: a retrospective population-based survey of European adults with overweight and obesity.

BACKGROUND: The prevalence of weight loss attempts has increased worldwide, although the extent to which sustained weight loss is achieved is unknown. There is insufficient research into weight loss maintenance (WLM) in individuals with overweight or obesity who have recently lost clinically significant amounts of weight (≥5%), particularly in the European general population. The present study aimed to determine the prevalence and retrospective predictors of WLM in population-based samples of European adults with overweight or obesity who had made a recently completed weight loss attempt. METHODS: Participants (N = 2000) in UK, Denmark and Portugal completed an online survey about loss and regain in their most recent completed weight loss attempt, features of their attempt (duration, self-weighing, lapses, strategies), as well as loss of control and binge eating. Multiple regression analysis was used to determine factors retrospectively associated with WLM in those who achieved clinically significant weight loss (n = 1272). RESULTS: Mean (SD) self-reported weight loss was 9% (8%) and mean (SD) regain was 96.3% (9%) of participants' start weight. Twenty-three percent of the total sample had maintained weight loss of ≥5% for at least 1 month. Controlling for weight loss and time since attempt, predictors of better WLM were avoidance of a temporary lapse, infrequent/absent loss of control and binge eating, and use of a greater number of dietary strategies for WLM (r2  = 0.338, P < 0.001). PRINCIPAL CONCLUSIONS: Factors associated with recent successful WLM indicate the importance of the continued use of dietary and other strategies for WLM, particularly in the face of a lapse, as well as the need to manage dysfunctional eating behaviours.

A sham-controlled trial of left and right temporal rTMS for the treatment of auditory hallucinations.

BACKGROUND: Several studies have reported reduction of auditory hallucinations (AH) after repetitive transcranial magnetic stimulation (rTMS) to the left temporal cortex. This study explored the effects of rTMS to the left and right temporal cortex. METHOD: Eighteen subjects with schizophrenia and frequent AH were enrolled in a double-blind, cross-over trial of 3 days of active rTMS to the left or right temporal cortex, or sham rTMS to the vertex (control condition), followed by an open treatment phase. The effects on AH were assessed by a blinded rater, using the Auditory Hallucination Rating Scale (AHRS). RESULTS: During the double-blind phase, active temporal rTMS did not result in significantly greater improvement in hallucination scores than sham rTMS to the vertex, apart from a reduction in distress scores. Hallucination scores improved during the open continued treatment phase. CONCLUSIONS: This study did not demonstrate an advantage for left temporal rTMS compared to right temporal and sham stimulation, over a 3-day stimulation period, but found modest improvement in hallucinations during continued open label treatment.

Food knowledge and psychological state predict adherence to a gluten-free diet in a survey of 5310 Australians and New Zealanders with coeliac disease.

BACKGROUND: A gluten-free diet treats coeliac disease, but its efficacy depends on strict adherence. A variety of patient factors may influence adherence but have not been well described at a population level. AIM: To comprehensively assess the patient factors that influence gluten-free diet adherence in patients with coeliac disease. METHODS: Patients with coeliac disease completed an online survey comprising the validated Celiac Dietary Adherence Test in addition to data on demographics, details of diagnosis and management and assessment of diet knowledge, quality of life and psychological distress. Survey data were analysed for predictors of adherence and quality of life. RESULTS: Of 7393 responses, 5310 completed the Celiac Dietary Adherence Test and 3230 (61%) were adherent to a gluten-free diet. Multivariate regression showed older age, being male, symptoms after gluten ingestion, better food knowledge and lower risk of psychological distress were independent predictors of adherence (each P ≤ 0.008). Additionally, dietary adherence was associated with better quality of life (P < 0.001; multiple regression). Respondents who considered themselves to have poor food knowledge were more likely to incorrectly identify gluten-free foods, but could still recognise gluten-containing foods, suggesting that poor knowledge may lead to over-restriction of diet. CONCLUSIONS: Poor knowledge of a gluten-free diet and psychological wellbeing were independent modifiable risk factors for inadequate adherence to a gluten-free diet in patients with coeliac disease. Involvement of both a dietitian and mental health care professional, in the presence of psychological distress, is likely to be necessary to improve adherence and health outcomes.

Perceptual-motor development and prevention of clumsiness.

This longitudinal study, following children's development over three years, examines the developmental trends in the processes underlying perceptual-motor behaviour. Entry into the study was at first year of primary school, at age 6. The study has three aims: (1) to obtain developmental trends in kinaesthesis and motor-programming processes; (2) to examine the relationship between slow kinaesthetic and motor development; (3) to establish the effect of accelerated kinaesthetic development and prevention of perceptual-motor dysfunction (clumsiness). The results to date show that over 60% of children entering primary school have not developed the kinaesthetic ability necessary for the acquisition and learning of educationally demanded motor skills. Kinaesthetic development is accelerated spontaneously in some children as a response to educational demands; in others a single exposure to kinaesthetic input triggers significant improvement. In the remaining 17% kinaesthetic training can alleviate the kinaesthetic dysfunction. At age 5-6 years only 25 children (8.1%) performed the Perceptual-Motor Abilities Test at levels indicative of perceptual-motor dysfunction. Of these, 13 children (4.2%) were identified as having motor difficulties. These low incidence rates indicate that a low level of kinaesthetic ability has no effect on general motor function at the beginning of schooling, and that only when competence in complex motor skills is expected, from the third year of schooling, does perceptual-motor dysfunction (PMD) become manifest.

The size illusion in children from five years of age and adults.

First it was established that the size illusion occurs not only when complex patterns are presented kinaesthetically but even with simple stimuli such as straight lines and circles. Thus it was established that information overload is not the underlying cause of the illusion. The size illusion was investigated in children aged from five to twelve years and in adults. The stimulus circle was presented in passive kinaesthetic, sequential visual, in combined kinaesthetic and sequential visual, in static visual, and in combined kinaesthetic and static visual conditions either at fast or at slow speeds. A between-subjects design was used. In all conditions where the stimulus presentation included the kinaesthetic modality alone or in combination with visual or sequential visual conditions, size overestimation was found, while in the sequential visual and static visual conditions overestimation of the size of the stimulus was absent. Further, the kinaesthetic illusion was stable across the age range tested, indicating that the illusion is a property of the kinaesthetic system and is not influenced by learning, ie is hard wired.