Changes in Eating Attitudes and Risk for Developing Disordered Eating Behaviors in College Students with Subthreshold Eating Disorders: A Cohort Study.

INTRODUCTION: The number of young adults with eating disorders or subthreshold eating disorders has increased recently. Although disordered eating behaviors persist once they appear, there have been relatively few studies on factors that might cause disordered eating behaviors. The purpose of this study was to investigate how the eating attitudes of young adults change over time and the risk factors that increase disordered eating behaviors. METHODS: A total of 1,141 college students, 639 males and 502 females, participated. We investigated changes in eating attitudes (using EAT-26 and BITE), depressive symptoms (using BDI-II), and stress coping (using CISS, which has three subscales) between 2 time points: at college entrance and in the fourth year of college. We divided the students into three groups (clinical, subthreshold, and healthy) based on EAT-26 scores and compared their BDI-II and CISS scores. Next, we identified students who developed disordered eating behaviors, both clinical and subthreshold, during their time at college (exacerbated students) and compared depressive symptoms and stress coping styles between exacerbated students and healthy students (unchanged students). RESULTS: The students in the subthreshold group (both males and females) scored significantly higher on the BDI-II and emotion-oriented coping (CISS-E) than the students in the healthy group at college entrance. Additionally, the exacerbated students (both males and females) scored significantly higher on the CISS-E in the fourth year than unchanged students. The female exacerbated students scored significantly higher on the BDI-II than female unchanged students at both time points. CONCLUSIONS: Our results show that depressive symptoms and nonadaptive stress coping are associated with an increased risk of disordered eating behaviors. This study suggests that early intervention may be necessary for both the clinical and subthreshold groups. The key to early intervention may be to manage not only eating behaviors but also depressive symptoms and stress coping.

Knowledge of common cancers among new-entry health science students in Japan and Vietnam.

BACKGROUND: The incidence and mortality rates of cancer are rapidly increasing worldwide. This study aimed to assess the knowledge of common cancers among new-entry health science students in Japan and Vietnam, thereby providing insights for implementing appropriate medical educational interventions. METHODS: This cross-sectional study was conducted among new-entry health science students at Hiroshima University, Japan, and the University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam. A printed predesigned questionnaire consisting of eleven questions was distributed to the participants during the freshmen health screening at the beginning of the academic year to assess their knowledge of cancer. RESULTS: A total of 2,748 new-entry health science students participated in the study, including 394 (14.3%) Japanese students and 2,354 (85.7%) Vietnamese students. Most cancer knowledge levels in Japanese students were significantly higher than those in Vietnamese students (p < 0.001), except for human papillomavirus (HPV) infection awareness. For this understanding, only 14.8% of Japanese students selected the correct answer, which was significantly lower than the 22.4% of Vietnamese students (p = 0.001). Both the Japanese and Vietnamese students had limited knowledge regarding the connection between HPV infection and cancer and the link between estrogen-progestogen menopausal therapy and breast cancer. Additionally, female students had better knowledge about breast, skin, and endometrial cancers than male students. CONCLUSIONS: Japanese students generally exhibited higher levels of cancer knowledge than Vietnamese students, except for HPV infection recognition. Both groups had limited knowledge regarding the connection between HPV infection and cancer and the relationship between estrogen-progestogen menopausal therapy and breast cancer.

Behavioral activation for late adolescents with subthreshold depression: a randomized controlled trial.

The main behavioral characteristic of subthreshold depression that is observed in adolescents is the low frequency of exposure to environmental rewards. Therefore, it was considered that a simple intervention conducted in short sessions, focusing on increasing access to positively reinforcing activities, would be efficacious in increasing the availability of rewards. We conduct a randomized controlled trial to examine the efficacy of such a behavioral activation program that was conducted weekly for 5 weeks in 60-min sessions. Late adolescent university students aged 18-19 years with subthreshold depression were randomly allocated to a treatment (n = 62) or a control group (n = 56). The primary outcome of the study was the Beck Depression Inventory-II score. Results indicated that late adolescent students in the treatment group showed significant improvements in their depressive symptoms (effect size -0.90, 95 % CI -1.28 to -0.51) compared to the control group. Students in the treatment group also showed significant improvements in self-reported rating of quality of life and in behavioral characteristics. It is concluded that this intervention had a large and significant effect despite being short and simple and that this low-intensity cognitive behavioral therapy program could be conducted in many different types of institutions. It is suggested that the long-term effects of the treatment program should be targeted for investigation in future studies.

[Cognitive function in eating disorders].

Eating disorders are characterized by uncontrolled eating behaviors. The core psychopathology is expressed in a variety of ways: body image distortion, preoccupation with food and weight, fear of weight gain, and so on. Brain-imaging techniques provide many opportunities to study neural circuits related symptoms in eating disorder. The present article focuses studies about functional magnetic resonance imaging (fMRI) of eating disorders. Studies of anorexia nervosa suggest 1) relationship between amygdala activation and fear of weight gain, 2) relationship between prefrontal cortex activity and cognitive flexibility. Studies of bulimic eating disorder (bulimia nervosa, binge eating disorder, and so on) suggest 1) relationship between brain reward system and overeating, 2) relationship between prefrontal cortex activity and impulse control.

Effects of the COVID-19 Pandemic on Depressive Symptoms, Including Clinical and Subthreshold Levels, and Eating Behaviors in First-Year University Students.

Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, university students experienced unusual environmental stresses, and the number of university students with depressive symptoms increased. The pandemic had a profoundly negative impact on the mental health of first-year students because they were not prepared to face academic and social stresses. The purpose of this study was to investigate the effect of the COVID-19 pandemic on depressive symptoms, eating behaviors, and stress-coping ability among first-year university students. Methods: A total of 8,424 first-year students, 2,043 males and 1,636 females who entered university in Japan in 2021-2022 (during the pandemic) and 2,912 males and 1,833 females who entered university in Japan in 2018-2019 (before the pandemic), participated. We investigated the differences in depressive symptoms (using Beck Depression Inventory II [BDI-II]), eating behaviors (using Eating Attitudes Test-26 [EAT-26] and Bulimic Inventory Test, Edinburgh [BITE]), and stress coping (using Coping Inventory for Stressful Situations [CISS], which has three subscales) between first-year students before and during the pandemic. We divided the students into three categories (clinical, subthreshold, and nonsymptomatic) according to depressive symptoms and eating behaviors based on BDI-ll and EAT-26 scores and compared the frequencies of the three categories at two time points. Results: First-year students during the pandemic showed a higher percentage of depressive symptoms, including clinical and subthreshold levels, than first-year students before the pandemic but did not show disordered eating behaviors. Additionally, the CISS task-oriented score was significantly lower for students with depressive symptoms, including clinical and subthreshold levels, during the pandemic than before the pandemic in females. Conclusions: This study suggests that it may be important to provide first-year university students with more information about depressive symptom awareness, including clinical and subthreshold levels, and to provide appropriate ways for stress coping from many angles and early support in pandemic conditions.

Prevalence and associated factors of chronic constipation among Japanese university students.

Background: Chronic constipation (CC) is one of the most frequently reported gastrointestinal disorders in the general population and a prominent problem among university students. The study aimed to evaluate the prevalence and the associated factors of CC among Japanese university students. Methods: This cross-sectional study was conducted among university students at Hiroshima University, Japan. Students answered the web questionnaire when making a web reservation for the health checkup (April 1 to May 31, 2023). The web questionnaire consisted of four sections, including baseline characteristics, lifestyle factors, family history of CC, and three scales to assess depression and eating disorders: the Beck Depression Inventory (BDI), Eating Attitudes Test (EAT)-26 and Bulimic Investigatory Test (BITE). CC was diagnosed using Rome IV criteria. The multivariate logistic regression model was used to determine CC-related factors. Results: Out of 10,500 individuals who participated in the annual health checkup, 7,496 participants answered the web questionnaire, of whom 5,386 answered all the survey questions. The mean age of the students was 21.1 ± 4.1 years. The male-to-female ratio was 1:1.17. The prevalence of CC was 13.7%. Factors significantly associated with CC in the multivariate model were first-degree family members with CC [Odd ratio (OR): 2.77, 95% confidence interval (CI): 2.31-3.31], severe depression according to BDI scale (OR: 2.59, 95% CI: 1.96-3.43), female sex (OR: 2.00, 95% CI: 1.69-2.36), and short sleep duration of 6 hours or less per day (OR: 1.28, 95% CI: 1.09-1.50). Lack of physical exercise tended to be associated with CC (OR: 1.19, 95% CI: 1.00-1.40). Conclusions: CC is prevalent among Japanese university students. Significant risk factors for CC included the first-degree family history of CC, severe depression, female sex, and short sleep duration. Lack of physical exercise tended to be associated with CC. This may contribute to implementing suitable education health programs, health care professionals, and public health policies to identify individuals at risk for CC to prevent and treat CC effectively.

Is a booster dose of COVID-19 vaccines effective on newly dominant omicron subvariants among university students? Comparison between BA.1 and BA.2 dominancy.

BACKGROUND: Although the COVID-19 Omicron BA.1 subvariant was initially predominant, the BA.2 subvariant has now replaced it. Effectiveness of a booster dose vaccination for BA.2 remains unclear among university students. METHODS: We enrolled 562 Japanese university students who became a close contact and underwent polymerase chain reaction testing. We compared infection rates and cumulative incidence rates of severe fever among the students according to the COVID-19 vaccine doses received between BA.1-dominant (January 1-March 31, 2022) and BA.2-dominant (April 1-July 31, 2022) periods. RESULTS: Infection rates for BA.1 were 32% with 3 doses, 49% with 2 doses, and 68% in the unvaccinated (P = .008). The odds ratio (OR) for infection following 3 doses during BA.1 was 0.46 (95% confidence interval [CI] = 0.25-0.82, P = .009). Infection rates for BA.2 were 45% with 3 doses, 62% with 2 doses, and 64% in the unvaccinated (P = .02). The OR for infection following 3 doses during BA.2 was 0.50 (95% CI = 0.31-0.82, P = .006). Effectiveness of vaccine for BA.2 tended to decrease for both 3 (45% vs 32%, P = .06) and 2 doses (62% vs 49%, P = .07) compared with those for BA.1. CONCLUSIONS: Booster dose effectiveness tended to decrease but remained significant against BA.2 subvariant predominancy among Japanese university students.

Brain activation during the perception of stressful word stimuli concerning interpersonal relationships in anorexia nervosa patients with high degrees of alexithymia in an fMRI paradigm.

Several studies have reported that anorexia nervosa (AN) patients have high levels of alexithymia. However, relatively little is known about the underlying neurobiological relationships between alexithymia and AN. We used functional magnetic resonance imaging to examine the brain responses in 30 AN patients and 20 healthy women during the processing of negative words concerning interpersonal relationships. We investigated the relationship between alexithymia levels and brain activation in AN. AN patients showed significant activation of the orbitofrontal cortex, dorsolateral prefrontal cortex and medial prefrontal cortex while processing negative words concerning interpersonal relationships, as compared to the processing of neutral words. Moreover, the subjective rating of unpleasantness with negative words and neural activities in the amygdala, posterior cingulate cortex (PCC) and anterior cingulate cortex (ACC) negatively correlated with the level of alexithymia in AN. Our neuroimaging results suggest that AN patients tend to cognitively process negative words concerning interpersonal relationships, resulting in activation of the prefrontal cortex. Lower activation of the amygdala, PCC and ACC in response to these words may contribute to the impairments of emotional processing that are hallmarks of alexithymia. Functional abnormalities associated with alexithymia may be involved in the emotional processing impairments in AN patients.

No association of brain-derived neurotrophic factor Val66Met polymorphism with anorexia nervosa in Japanese.

The Met66 allele of the Val66Met polymorphism in the brain-derived neurotrophic factor (BDNF) gene has been reported to be associated with anorexia nervosa (AN), and also lower minimum body mass index (BMI) and higher harm avoidance in AN. We genotyped the Val66Met polymorphism (rs6265) in 689 AN cases and 573 control subjects. There were no significant differences in the genotype or allele frequencies of the Val66Met between AN and control subjects (allele wise, odds ratio = 0.920, 95% CI 0.785-1.079, P = 0.305). No difference was found in minimum BMIs related to Val66Met in AN (one-way ANOVA, P > 0.05). Harm avoidance scores on the Temperament and Character Inventory were lower in the Met66 allele carriers (P = 0.0074) contrary to the previous report. Thus we were unable to replicate the previous findings that the Met66 allele of the BDNF is associated with AN and that the minimum BMI is lower or the harm avoidance score is higher in AN patients with the Met66 allele.

Attitudes and Behavior toward COVID-19 Vaccination in Japanese University Students: A Cross-Sectional Study.

BACKGROUND: It is said that safe and effective vaccination is an important tool to end the COVID-19 pandemic. However, recent studies have reported hesitation, especially in young adults. Promoting the vaccination of university students, who represent the young adults, will lead to infection prevention measures. The purpose of this study was to clarify to compare the vaccination rates, attitudes toward vaccines, and post-vaccination behavior of students and faculty members in order to understand the actual situation of young population. METHODS: We conducted large-scale vaccination of Hiroshima University from 21 June to 18 September 2021. This cross-sectional survey was conducted via e-mail from 27 September to 3 October 2021. RESULTS: The number of second inoculations was 10,833 /14,154 students (76.5%), and 2240/2583 staff members (86.7%). Regarding the impressions after vaccination, the most common answer was "I was able to prevent worsening of the disease even if I was infected". Many students answered that their range of activities had expanded after vaccination. However, many students (n = 1799, 87.8%) answered as having "no change after vaccination" regarding infection prevention. CONCLUSION: The high vaccination rate in this survey was thought to be due to the increased sense of security and confidence in the vaccine. The fact that young adults who perform a wide range of activities are careful about infection prevention may be one of the factors that prevents the explosive spread of infection in Japan.

Real-World Effectiveness of a Booster Dose of the COVID-19 Vaccines among Japanese University Students.

With the spread of the Coronavirus disease 2019 (COVID-19), missing learning opportunities due to COVID-19 has been raised as a major concern for university education. We aimed to examine the effectiveness of a booster dose of COVID-19 vaccines among Japanese university students during the spread of the Omicron variant. We enrolled 249 students who became a close contact and 294 COVID-19-infected students though the Hiroshima University COVID-19 registration system. Infection rates of people in close contact with sick individuals and symptoms of infected students were examined. Close contacts who had received a booster dose showed a significantly lower infection rate (31%) compared with those with two doses (50%, p = 0.02) and the unvaccinated (71%, p = 0.002). Age- and sex-adjusted odds ratios of receipt of a booster dose vs. two doses and unvaccinated were 0.40 (95% confidence interval [CI], 0.23−0.70, p = 0.001) and 0.44 (95% CI, 0.25−0.77, p = 0.004), respectively. The incidence of severe fever (38.5°C or higher) was significantly less prevalent in those with a booster dose (16%) compared with two doses (40%, p = 0.002) and those who were unvaccinated (75%, p < 0.0001). Booster doses reduced infection rates among close-contact students and can help students to avoid missing learning opportunities.

Surgical resection combined with perioperative chemotherapy for a patient with locally recurrent, previously stage IV thymic small-cell carcinoma: A case report.

An 83-year-old Japanese man visited our hospital with dyspnea and general fatigue. Computed tomography (CT) revealed a tumor in the anterior mediastinum, bilateral pleural effusion, pericardial fluid, and multiple liver nodules. We performed a CT-guided tumor biopsy, and the patient was diagnosed with thymic small-cell carcinoma, Masaoka-Koga stage classification IVb. The patient received four cycles of carboplatin and etoposide, and all lesions disappeared on CT. However, after 6 months, CT revealed a recurrent tumor in the anterior mediastinum. After one cycle of rechallenge chemotherapy, we performed extended total thymectomy followed by another three cycles of chemotherapy. More than 2.5 years after the last chemotherapy session, the patient's carcinoma did not recur. Thus, this case suggests that salvage surgery may be a treatment option for local recurrence of thymic carcinoma after complete remission with chemotherapy, even in patients with stage IV cancer.

Complete response of squamous cell carcinoma of the lung following treatment with pembrolizumab in an elderly patient: A case report.

Complete response of non-small cell lung cancer (NSCLC) with immune checkpoint inhibitor (ICI) monotherapy is rare. Here, we encountered an elderly patient who showed complete response of NSCLC following treatment with pembrolizumab. An 84-year-old man with a history of bloody sputum for several weeks visited a general physician. At that time, a chest X-ray revealed a tumor shadow in the left middle lung field, and the patient was referred to our hospital. Following transbronchial biopsy, he was diagnosed with squamous cell carcinoma of the lung. Expression of programmed death ligand 1 (PD-L1) in tumor cells was 80% or more by immunostaining. Based on the above, immunotherapy with pembrolizumab was performed as first-line therapy. The cancer cells completely disappeared at the end of the fifth cycle. There were no side effects during the therapeutic course. Treatment with pembrolizumab continued for two years and was then discontinued at the patient's request. Since then, no tumor recurrence has been detected for about one and a half years without treatment. There have been few reports of lung cancer disappearing after treatment with pembrolizumab. In conclusion, in elderly NSCLC patients with PD-L1 expression of 50% or more, pembrolizumab should be considered as first-line treatment with the treatment period, and mechanism suggested in this report.

Neural processing of negative word stimuli concerning body image in patients with eating disorders: an fMRI study.

Eating disorders (EDs) are associated with abnormalities of body image perception. The aim of the present study was to investigate the functional abnormalities in brain systems during processing of negative words concerning body images in patients with EDs. Brain responses to negative words concerning body images (task condition) and neutral words (control condition) were measured using functional magnetic resonance imaging in 36 patients with EDs (12 with the restricting type anorexia nervosa; AN-R, 12 with the binging-purging type anorexia nervosa; AN-BP, and 12 with bulimia nervosa; BN) and 12 healthy young women. Participants were instructed to select the most negative word from each negative body-image word set and to select the most neutral word from each neutral word set. In the task relative to the control condition, the right amygdala was activated both in patients with AN-R and in patients with AN-BP. The left medial prefrontal cortex (mPFC) was activated both in patients with BN and in patients with AN-BP. It is suggested that these brain activations may be associated with abnormalities of body image perception. Amygdala activation may be involved in fearful emotional processing of negative words concerning body image and strong fears of gaining weight. One possible interpretation of the finding of mPFC activation is that it may reflect an attempt to regulate the emotion invoked by the stimuli. These abnormal brain functions may help provide better accounts of the psychopathological mechanisms underlying EDs.

Brain activation during the perception of distorted body images in eating disorders.

Eating disorder (ED) patients have severe disturbances in the perception of body shape and weight. The authors investigated brain activation patterns during the perception of distorted body images in various subtypes of ED. Participants comprised 33 patients with EDs (11 with restricting-type anorexia nervosa (AN-R), 11 with binging-purging type anorexia nervosa (AN-BP), 11 with bulimia nervosa (BN)) and 11 healthy women. Functional magnetic resonance imaging was used to examine cerebral response to morphed images of subjects' own bodies, as well as that of another woman. The amygdala was significantly activated in AN-R patients, AN-BP patients, and healthy women in response to their own fat-image, but this did not occur in BN patients. The prefrontal cortex (PFC) was significantly activated in AN-BP patients and healthy women, but not in AN-R and BN patients. Our results showed that the various EDs are different with respect to significant activation of the amygdala and PFC during the processing of participants' own fat-image. Brain activation pattern differences between the various EDs may underlie cognitive differences with respect to distorted body image, and therefore might reflect a general failure to represent and evaluate one's own body in a realistic fashion.

[Cognitive function in eating disorders and therapeutic approach].

We examined brain activation in the presence of eating disorders while processing unpleasant words concerning body images using functional magnetic resonance imaging (fMRI). Anorexia nervosa restricting type (AN-R) and anorexia nervosa binge-eating/ purging type (AN-BP) patients showed significant amygdala activation. Farther, AN-BP and bulimia nervosa (BN) patients showed significant medial prefrontal cortex activation. Next, we conducted short-term integrated group therapy for eating disorders. After treatment, depressive scores of POMS and emotional-oriented coping scores of CISS were significantly decreased, and EAT scores and self-esteem scores of RSES were significantly increased.

Early Initiation of Awake Veno-Venous Extracorporeal Membrane Oxygenation Can Attenuate Muscle Atrophy and Weakness in Acute Respiratory Distress Syndrome.

Patients with acute respiratory distress syndrome (ARDS) exhibit prominent muscle atrophy and weakness. Although these patients often require deep sedation to perform lung-protective ventilation, extracorporeal membrane oxygenation (ECMO) can keep patients awake and make mobilization possible. A 60-year-old man was treated with ECMO due to ARDS. A multidisciplinary team conducted mobilization with standing on day 3. During intensive care unit (ICU) stay, catabolism was ongoing (urinary titin: 24.1-38.4 pmol/mg Cr), but the rectus femoris muscle, measured by ultrasound, moderately decreased by 5.3%, 10.8%, and 13.0% on days 3, 5, and 7, respectively, with maintained Medical Research Council score of 58-60. Diaphragm thickness remained unchanged. On day 5, he was separated from ECMO. After ambulation training, he was discharged from ICU on day 7. He returned home without prominent physical dysfunction. Our experience indicates early initiation of awake ECMO can accompany mobilization and attenuate muscle atrophy and weakness in ARDS.

Cohort survey of college students' eating attitudes: interventions for depressive symptoms and stress coping were key factors for preventing bulimia in a subthreshold group.

BACKGROUND: The aim of this study was to examine the necessity of early intervention for students with potential bulimia by investigating how the eating attitudes of college students change and examining the relation between bulimic symptoms and depressive symptoms or the ability to cope with stress. METHODS: The study participants were students who entered Hiroshima University in 2014. This study was conducted at two time points: Time-1 in 2014 and Time-2 in 2017. The Eating Attitudes Test-26 (EAT-26), Bulimic Inventory Test, Edinburgh (BITE), Beck Depression Inventory-II (BDI-II), and Coping Inventory for Stressful Situations (CISS) were administered at Times 1 and 2, and the responses were compared between the time points. Next, we compared the BDI-II scores of the BITE improved and worsened groups. In addition, we divided the participants into a clinical group, subthreshold group, and healthy group based on the BITE score at Time-1to compared their depressive symptoms and the ability to cope with stress. RESULTS: Significantly higher BITE and BDI-II scores were recorded for both males and females at Time-2 than at Time-1. The BDI-II score at Time-1 was significantly higher in the BITE worsened group than in the BITE improved group. The BDI-II scores at Time-1 were significantly higher for both males and females in the subthreshold group than in the healthy group. Furthermore, significantly higher CISS-T and CISS-E scores were recorded at Time-1 for females in the subthreshold group than for females in the healthy group. CONCLUSIONS: Based on these results, intervention for students the subthreshold group is important, and the key to intervention may be to address not only eating behaviors but also depressive symptoms and stress coping. TRIAL REGISTRATION: UMIN000029474 Registered 9 October, 2017 (retrospectively).

Effects of behavioral activation program without psychotropic medication treatment for depression in late adolescence: case report.

BACKGROUND: A Japanese study revealed that 20.7% of first-year undergraduate students had a major depressive episode during the previous 12 months: first-year undergraduate students with depression need early support. Reportedly, antidepressant medication use during adolescence is associated with modestly increased risk of suicidality. This case study of a late-adolescent woman with depression illustrates the effects of behavioral activation without psychotropic medication. CASE PRESENTATION: A first-year undergraduate student was diagnosed as having major depressive disorder. From earlier studies, we developed a behavioral activation program for late-adolescent people with major depressive disorder. Behavioral activation administered in 10 weekly 60-minute sessions decreased depressive symptoms, avoidant behaviors, and rumination. Moreover, the Beck Depression Inventory, second version score was 1 at 1-year follow-up. CONCLUSION: Results of this case study show that behavioral activation is effective without psychotropic medication. Future studies of large samples must be conducted to assess the effectiveness of behavioral activation without psychotropic medication for depression in late adolescence.