Motivators and deterrents to blood donation among Black South Africans: a qualitative analysis of focus group data.

BACKGROUND AND OBJECTIVES: South Africa has a markedly skewed representation where the majority of blood (62%) is presently collected from an ethnically White minority. This study seeks to identify culturally specific factors affecting motivation of donors in South Africa. MATERIALS AND METHODS: We performed a qualitative study to evaluate motivators and deterrents to blood donation among Black South Africans. A total of 13 focus groups, comprising a total of 97 Black South Africans, stratified by age and geographic location were conducted. Transcripts of the interviews were analysed using a coding framework by Bednall & Bove. RESULTS: Participants made 463 unique comments about motivators focusing primarily on promotional communications (28%), incentives (20%) and prosocial motivation (16%). Participants made 376 comments about deterrents which focused primarily on fear (41%), negative attitudes (14%) and lack of knowledge (10%). CONCLUSION: Although prosocial motivation (altruism) was the most frequently mentioned individual motivator, promotional communication elicited more overall comments by participants. As reported by many authors, fear and lack of awareness were strong deterrents, but scepticism engendered by perceived racial discrimination in blood collection were unique to the South African environment.

The slippery slope: prediction of successful weight maintenance in anorexia nervosa.

BACKGROUND: Previous research has found that many patients with anorexia nervosa (AN) are unable to maintain normal weight after weight restoration. The objective of this study was to identify variables that predicted successful weight maintenance among weight-restored AN patients. METHOD: Ninety-three patients with AN treated at two sites (Toronto and New York) through in-patient or partial hospitalization achieved a minimally normal weight and were then randomly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy (CBT) for 1 year. Clinical, demographic and psychometric variables were assessed after weight restoration prior to randomization and putative predictors of successful weight maintenance at 6 and 12 months were examined. RESULTS: The most powerful predictors of weight maintenance at 6 and 12 months following weight restoration were pre-randomization body mass index (BMI) and the rate of weight loss in the first 28 days following randomization. Higher BMI and lower rate of weight loss were associated with greater likelihood of maintaining a normal BMI at 6 and 12 months. An additional predictor of weight maintenance was site; patients in Toronto fared better than those in New York. CONCLUSIONS: This study found that the best predictors of weight maintenance in weight-restored AN patients over 6 and 12 months were the level of weight restoration at the conclusion of acute treatment and the avoidance of weight loss immediately following intensive treatment. These results suggest that outcome might be improved by achieving a higher BMI during structured treatment programs and on preventing weight loss immediately following discharge from such programs.

Excess counterion accumulation around branched nucleic acids.

Many nucleic acids of biological importance possess elements of tertiary structure in which the regional phosphate charge density dramatically exceeds that of linear duplex DNA, as in the inter-helix junctions found in tRNAs, ribosomal RNAs, and Holliday intermediates in general recombination. However, despite a long-standing awareness that such structures have special counterion requirements for stability few studies have focused on their level of counterion association. In order to gauge the influence of high regional phosphate charge density on the extent of counterion association, we have defined the degree of "excess counterion association" for a four-branch DNA junction as the number of additional counterions (over the relevant linear DNA value) that are associated with the junction in a Donnan equilibrium dialysis experiment. Grand canonical Monte Carlo computations were used to determine the Donnan distribution (preferential interaction) coefficients, employing a "primitive model" description of the nucleic acid and the 1:1 electrolyte. We have determined that at least 24 excess counterions are associated with the junction in the long branch limit. The subsequent release of a portion of these additional counterions during the process of ligand binding is therefore likely to provide a strong directional influence on the binding of proteins and cationic ligands, with preferred binding near or on the junction vertex or near other elements of tertiary structure (e.g. pseudo-knots or triplexes) even if the ligands do not directly recognize the structural elements themselves. Moreover, excess counterion association is expected to play a significant role in determining the relative stabilities of alternative tertiary structures.

Weight-related other evaluation in eating disorders.

Weight-related self-evaluation has been described as the fundamental maladaptive cognitive feature of disordered eating. It is not clear, however, whether the process of determining personal-worth based on an evaluation of body size is specific to the self, or whether it is relevant to the evaluation of people in general. Thirty-three eating disordered patients and 54 undergraduates read an article about a woman who was described as either overweight or slender and evaluated the woman on several dimensions. Both undergraduates and eating disordered patients rated the heavy woman as less attractive than the thin woman. However, the patients' evaluation of the overweight target's attractiveness was significantly more negative than the undergraduates'. Patients also rated the overweight woman as less popular and claimed that they liked the overweight woman less than the thin woman. These effects were not present among the undergraduate students. Finally, the eating disorder participants rated the overweight woman as more overweight and less intelligent than did the undergraduate students. The results suggest that weight-related evaluation in eating disorders extends beyond the self to include the evaluation of other people.

Pharmacotherapy of bulimia nervosa with fluoxetine: assessment of clinically significant attitudinal change.

OBJECTIVE: The authors used an individual change model to examine the clinically significant effect of pharmacotherapy with fluoxetine on the attitudes and beliefs characteristic of bulimia nervosa. METHOD: Three hundred eighty-two women meeting DSM-III-R criteria for bulimia nervosa participated in a multicenter, double-blind, randomized clinical trial of placebo, 20 mg of fluoxetine, and 60 mg of fluoxetine for 8 weeks. Behavioral change was assessed with self-monitored measures of binge eating and purging, and psychological change was measured with the self-rating Eating Disorder Inventory and the Hamilton Rating Scale for Depression. A specific statistical method was used to determine clinically significant change in psychological measures. RESULTS: On the majority of psychological measures, more of the subjects receiving active drug than those receiving placebo showed clinically significant change. Behavioral improvement was significantly associated with the likelihood of demonstrating clinically significant psychological change. The observed effect of pharmacotherapy on attitudinal change was not related to the presence of depression at baseline. These results compare favorably with other interventions for bulimia nervosa. CONCLUSIONS: Measures of change in treatment studies should reflect clinical as well as statistical significance. In the short-term, treatment of bulimia nervosa with fluoxetine appears to produce clinically significant attitudinal and behavioral changes.

Rate and prediction of relapse in bulimia nervosa.

OBJECTIVE: The purpose of this study was to provide an estimate of the rate of relapse in patients with bulimia nervosa and to attempt to identify indexes of functioning before or after treatment that predicted subsequent relapse. METHOD: The subjects were 48 female patients with bulimia nervosa who achieved symptom control while attending a specialized day hospital treatment program for eating disorders. The subjects were assessed before treatment, after treatment, and at a 2-year follow-up interview with respect to their eating symptoms and psychosocial functioning. RESULTS: A relapse rate of 31% was observed during the 2-year follow-up period, and the vast majority of relapses occurred within the first 6 months after treatment. The strongest predictors of relapse were younger age, higher vomiting frequency, and a higher score on the bulimia subscale of the 26-item Eating Attitudes Test before treatment and higher vomiting frequency and a higher score on the interpersonal distrust subscale of the Eating Disorder Inventory at the end of treatment. Measures of binge eating frequency, self-esteem, depression, and social adjustment were not significant predictors of relapse. CONCLUSIONS: Vomiting frequency, even at subthreshold levels, appears to be an important prognostic indicator and may be one of the best barometers of residual symptoms in these patients.

Comparison of cognitive-behavioral and supportive-expressive therapy for bulimia nervosa.

OBJECTIVE: The authors compared the effectiveness of 4 months (18 sessions) of cognitive-behavioral and supportive-expressive therapy for bulimia. METHOD: Sixty patients obtained from clinical referrals to an eating disorders program who met modified DSM-III-R criteria for bulimia nervosa were randomly assigned to the two conditions. Treatments were delivered in an individual format, on an outpatient basis, by experienced therapists using treatment manuals. The primary outcome measures were self-induced vomiting, binge eating, and attitudes toward body weight and shape, which were assessed by self-report and structured interview. RESULTS: Fifty patients completed treatment, 25 in each condition. Both treatments led to significant improvements in specific eating disorder symptoms and in psychosocial disturbances. Supportive-expressive therapy was just as effective as cognitive-behavioral therapy in reducing binge eating. Where treatment differences were found, they favored cognitive-behavioral therapy. Cognitive-behavioral therapy was marginally superior in reducing the frequency of self-induced vomiting; 36% of the patients who received cognitive-behavioral therapy and 12% of those who received supportive-expressive therapy abstained from vomiting in the last month of treatment. Cognitive-behavioral therapy was significantly more effective in ameloriating disturbed attitudes toward eating and weight, depression, poor self-esteem, general psychological distress, and certain personality traits. CONCLUSIONS: These results moderately favor cognitive-behavioral therapy over supportive-expressive therapy for bulimia nervosa, but follow-up is required to determine the durability of outcome with both modalities. The findings must be interpreted with caution since the selected clinical sample in this study may not represent the bulimia nervosa population.

Thyroid function in psychosis following childbirth.

Postpartum thyroiditis has been suggested as a cause of psychosis following pregnancy. However, 30 hospitalized psychotic postpartum women and 30 control subjects matched for age and time since delivery showed no significant differences in thyroid function or the presence of thyroid antibodies.

Similarities among bulimic groups selected by different weights and weight histories.

Four groups of bulimic patients with different weights and weight histories were compared on measures of eating and psychological functioning. Results with the Eating Disorder Inventory and Eating Attitudes Test indicated that groups were similar in terms of attitudes toward food, eating and body dissatisfaction as well as other traits which have been identified as relevant to eating disorder patients. Results also indicated that the referral patterns of patients with different weight histories have changed over time; previously, most patients had anorexia nervosa either currently or historically but more recently many patients are presenting with symptoms of equal severity but with no history of anorexia nervosa. It is concluded that diagnostic categories for bulimia formed solely on the basis of weight variables may not be clinically useful.

Brief group psychoeducation for bulimia nervosa: assessing the clinical significance of change.

Forty-one women with bulimia nervosa completed a brief intervention that was designed to promote symptom management. Cutoff scores for the determination of reliable and clinically significant change were calculated for several psychometric instruments that are commonly used as outcome measures in the field of eating disorders. Using these statistical procedures to assess therapeutic change, this study documents the diversity of outcomes that individuals reported following their participation in the intervention. As expected, there was a differential reporting of clinically significant change in favor of specific eating psychopathology relative to personality features and associated psychopathology.

Eating problems and the observed quality of mother-daughter interactions among girls with type 1 diabetes.

This study examined how eating problems are linked to autonomy and intimacy in the observed interactions of 88 diabetic girls (M = 14.9 years) and their mothers. On the basis of self-reported symptoms, teens were classified as having no eating problems (n = 40), mild eating problems (n = 30), and frequent eating problems (n = 18). Mothers and daughters participated in 2 videotaped problem-solving tasks (1 diabetes related and I a general parent-teen issue) that were rated with a macroanalytic coding system (Autonomy and Intimacy Rating System). Compared with interactions among mothers and daughters with no eating problems, interactions among mothers and daughters with eating problems simultaneously constrained the expression of autonomy and intimacy. Findings support clinical theory that links eating problems to emotional misattunement in the mother-daughter relationship, which is postulated to interfere with the teen's capacity for individuation.

Therapist competence ratings in relation to clinical outcome in cognitive therapy of depression.

This study reports on the relationship of therapist competence to the outcome of cognitive-behavioral treatment in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Outpatients suffering from major depressive disorder were treated by cognitive-behavioral therapists at each of 3 U.S. sites using a format of 20 sessions in 16 weeks. Findings provide some support for the relationship of therapist competence (as measured by the Cognitive Therapy Scale) to reduction of depressive symptomatology when controlling for therapist adherence and facilitative conditions. The results are, however, not as strong or consistent as expected. The component of competence that was most highly related to outcome is a factor that reflects the therapist's ability to structure the treatment.

Matching patient variables to treatment intensity. The continuum of care.

This article has reviewed what is currently known regarding the relationship between specific patient variables and treatment response in AN, BN, and BED. Matching patient variables to treatment intensity remains an important and fruitful area for future research. There is a need for established guidelines for clinicians regarding the choice of the appropriateness of treatment settings and type of interventions delivered in those settings. These guidelines should be evidence based, with clear clinical indicators for each of the recognized eating disorders and their subclinical variants.

The effect of nucleic acid geometry on counterion association.

The very high axial charge density of nucleic acids is a physical characteristic that substantially influences the thermodynamics of virtually all processes in which they are involved. This arises from long range electrostatic interacts between nucleic acids and the counter- and co-ions in solution so that salt concentration dramatically effects the activities of both reactants and products. A significant contributor to the resulting salt dependence for processes involving nucleic acids (e.g. ligand binding to a choice of nucleic acid substrates or a structural change), is the difference in arrangement of the sugar-phosphate backbone of competing structures. This article reviews the results of a set of Grand Canonical Monte Carlo (GCMC) simulations that explores the effect of nucleic acid geometry, varied as a function of oligomer length and four-way junction branch length, on counterion association and therefore many nucleic acid processes. These GCMC simulations, which utilize a "primitive" model description of the nucleic acid, are complemented by a number of simulations which numerically solve the non-linear Poisson-Boltzmann equation utilizing detailed models for nucleic acids and proteins. Simulations of this kind are particularly useful for the study of systems that have been well characterized structurally, as well as thermodynamically. What is sought in the current article is insight into how an extremely general feature of DNA, namely the geometric arrangement of its phosphate charges surrounded by an exclusion surface, might play a role in determining nucleic acid processes.

Obesity, externality, and susceptibility to social influence: an integrated analysis.

A pilot study indicated that overweight subjects are more likely to order a particular dessert in a restaurant when the waitress provides an appetizing description of that dessert and encourages the diner to order it; subjects who were not overweight were much less affected by the waitress's behavior. This effect may be interpreted in terms of the greater "externality' of overweight persons (i.e., their greater reactivity to salient food cues); alternatively, it may be seen as evidence for greater compliance by deviant (overweight) individuals. The present study examined these alternatives by separating the perceptual-cues component of the waitress's behavior from the social-influence component in a replication of the pilot study. The results indicated that both the externality and compliance interpretations were tenable. The authors suggest that these two mechanisms may be seen as facets of a more general concern on the part of overweight people to secure behavioral guidance from the external environment, physical or social.

Eating disturbances, diabetes and the family: an empirical study.

This study of 113 adolescent females with IDDM and their mothers investigated whether: (1) interaction patterns are more dysfunctional in families of girls with eating disturbances than in those without; and (2) the relationship between family functioning and metabolic control is mediated by an eating disturbance. Based on self-reported eating attitudes and behaviors, subjects were categorized as Nondisturbed (N = 56), Mildly Disturbed (N = 37), and Highly Disturbed (N = 20). Mothers and daughters rated overall family functioning (FES), and daughters rated parental relationships (IPPA, MFP). Metabolic control was assessed using HbA1c levels. MANCOVA illustrated that eating disturbances are associated with the perception of poor communication with mothers and fathers, a lack of trust in their accessibility and responsiveness, and overall family environments perceived to be conflictual and inadequate in support and structure. Regression analyses revealed that the presence and severity of an eating disturbance mediates the influence of family functioning on metabolic control.

Efficacy of a brief group psychoeducational intervention for bulimia nervosa.

This study compared a brief group treatment that was designed to be purely educational (ED) with a longer course of individual cognitive-behavioural (CB) therapy intended to represent more standard clinical care. Participants were 65 women who sought treatment at Toronto General Hospital, met DSM-III criteria for bulimia nervosa at a normal weight and reported vomiting at least twice weekly. Results indicated that the CB treatment, as expected, was generally more effective than the ED intervention, but on several important outcome indices both treatments appeared to be equally effective for the healthiest 25-45% of the sample. The more intensive individual CB treatment was associated with greater improvement in patients who were more severely symptomatic. However, the ED intervention proved significantly more cost-effective and it was suggested that a sequential treatment program might achieve the superior benefits associated with the longer individual CB treatment at a reduced cost.

A randomized controlled trial of fluoxetine and cognitive behavioral therapy for bulimia nervosa: short-term outcome.

This study compared and combined fluoxetine and individual cognitive behavioral therapy in the treatment of bulimia nervosa. Participants were 76 women who sought treatment at the Eating Disorders Program of the Toronto Hospital and who met DSM-III-R criteria for bulimia nervosa. Subjects were randomly assigned to receive fluoxetine alone, cognitive behavior therapy alone, or the two in combination and were treated over 16 weeks. Short-term outcome revealed that all three treatment conditions were associated with clinical improvement across a wide range of parameters. The combination of pharmacotherapy and psychotherapy was superior to pharmacotherapy alone on specific parameters and there was no statistically significant advantage to the combination over psychotherapy alone. Limitations to the study include the absence of a placebo pill group and a waiting list control group as well as a substantial dropout rate across all three treatment conditions.

Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study.

OBJECTIVE: To determine the prevalence of eating disorders in adolescent females with type 1 diabetes mellitus compared with that in their non-diabetic peers. DESIGN: Cross sectional case-control led study. SETTING: Diabetes clinics and schools in three Canadian cities. SUBJECTS: 356 females aged 12-19 with type 1 diabetes and 1098 age matched non-diabetic controls. MAIN OUTCOME MEASURE: Eating disorders meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. RESULTS: Eating disorders that met DSM-IV criteria were more prevalent in diabetic subjects (36, 10%) than in non-diabetic controls (49, 4%) (odds ratio 2.4, 95% confidence interval 1.5 to 3.7; P<0.001). Subthreshold eating disorders were also more common in those with diabetes (49, 14%) than in controls (84, 8%) (odds ratio 1.9, 95% confidence interval 1.3 to 2.8; P<0.001). Mean haemoglobin A(1c) concentration was higher in diabetic subjects with an eating disorder (9.4% (1.8)) than in those without (8.6% (1.6)), P=0.04). CONCLUSIONS: DSM-IV and subthreshold eating disorders are almost twice as common in adolescent females with type 1 diabetes as in their non-diabetic peers. In diabetic subjects, eating disorders are associated with insulin omission for weight loss and impaired metabolic control.