Patterns of Nutritional Supplement Use in Children with Tourette Syndrome.

Very little is known about the use of nutritional supplements in children with Tourette syndrome. The current study aimed to address the frequency of nutritional supplements and the use of special diets in children with Tourette syndrome and typically developing children. Additional data also sought to address the motivations behind using them, their cost and perceived benefits. A total of 76 responses from an anonymous online survey (Tourette syndrome = 42; typically developing = 34) were completed and analyzed. Fifty-six per cent of children with Tourette syndrome compared to 15% of typically developing children were currently taking nutritional supplements, with the majority take two or more. Thirty-five per cent of the Tourette syndrome compared to 6% typically developing were currently or had previously adopted a special diet. Supplements most used for children with TS included probiotics, omega-3, multivitamins and magnesium. For children with TS, supplementation often began around the age of eight, for a duration on average of 35 months. The average cost was £32.44 a month compared to £8.25 for typically developing children. Seventy-five per cent of supplement users in the Tourette syndrome group noted improvement, mainly in motor and vocal tics, sleep quality and anxiety reduction. Most caregivers learned of supplements through the Internet. In almost 42% of the Tourette syndrome group, their pediatrician was unaware of the supplement use and this rose to 65% for special diets. Given the popularity of nutritional supplements, more research on the effectiveness and safety of such interventions is crucial.

An exploration of eating behaviours and caregiver mealtime actions of children with Tourette syndrome.

Food avoidant behaviours are common concerns amongst individuals with Tourette syndrome, with high levels of food selectivity reported in children and food neophobia and avoidant restrictive eating behaviours in adults. However, less is known about food approach behaviours. The current study aimed to explore differences in food approach and food avoidant eating behaviours in children with Tourette syndrome (TS) and their relationship to caregiver mealtime actions. Thirty-seven caregivers of children with Tourette syndrome were compared with children with Autism Spectrum Disorders, children with Attention-Deficit/Hyperactivity Disorder and a control group. Caregivers completed the Child Eating Behaviour Questionnaire and Parent Mealtime Action Scale-Revised. Caregiver-reported findings revealed that children with Tourette syndrome exhibited more food approach behaviours, specifically greater food responsiveness, emotional overeating and desire to drink, compared to controls. Children from the three neurodiverse groups had similar levels of emotional overeating and food selectivity, which were all significantly higher than the control group. Positive persuasion was uniquely identified as a mealtime strategy adopted by caregivers of children with Tourette syndrome. The results suggest that children with Tourette syndrome are at more risk of showing a broader array of food difficulties than previously reported, including food avoidant and approach behaviours. It is encouraged that clinicians monitor eating behaviour in appointments with children with Tourette syndrome.

Relationships between feeding problems, eating behaviours and parental feeding practices in children with Down syndrome: A cross-sectional study.

BACKGROUND: Research investigating feeding problems in children with Down syndrome is scarce. This study investigated feeding problems, eating behaviours and parental feeding practices in children with Down syndrome (n = 40), and typically developing (TD) children of the same age and sex (n = 40). METHOD: Parents of children aged 6-months to 5-years in the UK completed questionnaires assessing their child's feeding problems and eating behaviours and parental feeding practices. RESULTS: For children with Down syndrome, feeding problems were: significantly greater than for TD children; negatively associated with breast milk duration and appetite during exclusive milk feeding; and positively associated with drinking more slowly. For both groups, feeding problems were significantly correlated with more food avoidant eating behaviours. CONCLUSIONS: This study provides new information about the relationships between feeding problems and eating behaviours in early development. Longitudinal research is needed to further investigate these relationships, so that effective support can be developed for families.

A comparison of food avoidant behaviours and sensory sensitivity in adults with and without Tourette syndrome.

Food selectivity has been shown to be more persistent and severe in children with Tourette syndrome (TS) compared to their typically developing peers. The current study aimed to examine differences in food selectivity, food neophobia and Avoidant Restrictive Food Intake Disorder (ARFID)-associated behaviours, between adults with and without TS. Fifty-three adults diagnosed with TS were compared to 53 neurotypical adults and completed the following measures online: Adult Eating Behaviour Questionnaire (AEBQ), Nine-Item Avoidant/Restrictive Food Intake disorder screen (NIAS), Food Neophobia Scale (FNS) and the Sensory Perception Quotient (SPQ). Higher levels of food avoidant behaviours, in terms of food fussiness, food neophobia and ARFID-associated behaviours, were identified in adults with TS compared to adults without TS. While heightened sensory sensitivity failed to predict food fussiness, greater sensitivity to taste was found to be predictive of food neophobia in TS. These are the first findings to suggest that food avoidant behaviours are more prevalent for adults with TS and signal a need to address health implications.

The relationship between sensory sensitivity, food fussiness and food preferences in children with neurodevelopmental disorders.

Heightened sensitivity to sensory information has been associated with food fussiness in both atypical and typical development. Despite food fussiness and sensory dysfunction being reported as common concerns for children with neurodevelopmental disorders, the relationship that exists between them, and whether they differ between disorders, has yet to be established. The current study aimed to examine sensory sensitivity as a predictor of food fussiness in three different neurodevelopmental disorders, whilst controlling for comorbidity amongst these disorders. Ninety-eight caregivers of children with Attention Deficit Hyperactivity Disorder (ADHD; n = 17), Tourette Syndrome (TS; n = 27), Autism Spectrum Disorder (ASD; n = 27), and typical development (TD; n = 27) were compared using parental reports of child food fussiness, food preferences and sensory sensitivity. Children with neurodevelopmental disorders were reported to have significantly higher levels of both food fussiness and sensory sensitivity, with children with ASD and TS also showing significantly less preference for fruit than children with TD. Importantly, higher levels of taste/smell sensitivity predicted food fussiness for all four groups of children. In addition, taste/smell sensitivity fully mediated the differences in food fussiness between each group of neurodevelopmental disorders compared to the TD group. The findings highlight that food fussiness is similar across these neurodevelopmental disorders despite accounting for comorbidity, and that greater sensitivity to taste/smell may explain why children with neurodevelopmental disorders are more likely to be fussy eaters.

The role of sensory sensitivity in predicting food selectivity and food preferences in children with Tourette syndrome.

Tourette syndrome (TS) is a neurodevelopmental disorder characterised by involuntary, repetitive and non-rhythmic motor and vocal tics. Despite suggestion that diet may affect tics, and the substantial research into children's diet, eating behaviours and sensory processing in comorbid disorders (e.g. ASD), research in TS is lacking. The present study examined differences between children with and without TS in parental reports of child selective eating, food preferences and sensitivity, and aimed to examine sensory sensitivity as a predictor of food selectivity outcomes in children with and without TS. Thirty caregivers of children with TS (M = 10 years 8 months [SD = 2.40]) and the caregivers of 30 age- and sex-matched typically developing (TD) children (M = 9 years 9 months [SD = 2.50]) completed the following measures online: Short Sensory Profile, Food Preference Questionnaire for Children, Child Eating Behaviour Questionnaire. Children with TS were reported to have significantly higher levels of food selectivity and sensory sensitivity, and less preference for fruit and vegetables than TD children. Importantly, while higher levels of overall sensory sensitivity predicted eating outcomes in the TS group, only sensitivity to taste/smell was found to be a predictor of food selectivity and preference for vegetables for both groups of children. The findings suggest that efforts to address food selectivity in children with TS may be enhanced by including strategies that address atypical sensory processing.

Quasi-experimental pilot study of intervention to increase participant retention and completed home visits in the nurse-family partnership.

We evaluated an intervention to increase participant retention and engagement in community practice settings of the Nurse-Family Partnership (NFP), an evidence-based program of nurse home visiting for low-income, first-time parents. Using a quasi-experimental design (6 intervention and 11 control sites that delivered the NFP), we compared intervention and control sites on retention and number of completed home visits during a 10-month period after the intervention was initiated. Nurses at the five intervention sites were guided in tailoring the frequency, duration, and content of the visits to participants' needs. NFP nurses at the control sites delivered the program as usual. At the intervention sites, participant retention and completed home visits increased from the pre-intervention to intervention periods, while at the control sites, these outcomes decreased from the pre-intervention to intervention periods, leading to a significant intervention-control difference in change in participant retention (hazard ratio, 0.42; p = 0.015) and a 1.4 visit difference in change in completed home visits (p < 0.001, ES = 0.36). We conclude that training nurse home visitors to promote adaptation of program dosage and content to meet families' needs shows promise as a way to improve participant retention and completed home visits.

Adjuvant therapy with tamoxifen compared to aromatase inhibitors for 257 male breast cancer patients.

To determine the impact of adjuvant treatment with tamoxifen and aromatase inhibitors (AI) on the survival of men with breast cancer. We analyzed 257 male patients with hormone-receptor-positive breast cancer from numerous German population-based cancer registries treated with tamoxifen (N = 207) or aromatase inhibitors (N = 50). The median follow-up was 42.2 (range 2-115) months. Median age at diagnosis was 68 (range 36-91) years. Thirty-seven (17.9 %) patients treated with tamoxifen and 16 (32.0 %) patients treated with AI died (log rank p = 0.007). After the adjustment for the patient's age, tumor size, node status, and tumor grading, the AI treatment was linked to a 1.5-fold increase in risk of mortality compared to tamoxifen (HR 1.55; 95 % CI: 1.13-2.13; p = 0.007). The overall survival in male breast cancer was significantly better after adjuvant treatment with tamoxifen compared to an aromatase inhibitor. Tamoxifen should be considered as the treatment of choice for hormone-receptor-positive male breast cancer.

Role of GPR30 in endometrial pathology after tamoxifen for breast cancer.

OBJECTIVE: This study was undertaken to evaluate the potential role of G-protein-coupled estrogen receptor in endometrial pathology associated with tamoxifen treatment of breast cancer patients. STUDY DESIGN: We investigated whether G-protein-coupled estrogen receptor plays a role in mediating proliferating effect of tamoxifen in endometrial carcinoma cells. These results were compared with the G-protein-coupled estrogen receptor expression pattern in endometrial tissue from a cohort of 95 breast cancer patients, who received tamoxifen or another adjuvant therapy. RESULTS: In vitro tamoxifen significantly stimulated the mitogen-activated protein kinase phosphorylation and cell proliferation of endometrial cell lines via G-protein-coupled estrogen receptor. In vivo, there was a significant correlation between G-protein-coupled estrogen receptor expression and the tamoxifen-induced endometrial pathology (P = .006). Moreover, G-protein-coupled estrogen receptor positivity was predictive of an earlier development of symptoms, such as bleeding or suspect endometrial thickness, induced by tamoxifen therapy (P = .019). CONCLUSION: G-protein-coupled estrogen receptor plays an important role in tamoxifen-induced endometrial abnormalities.

Interval between port catheter flushing can be extended to four months.

BACKGROUND: Little is known about proper interval periods between the flushings of totally implantable access ports after completion of chemotherapy. Manufacturer guidelines recommend flushing catheters every 4 weeks. METHODS: This retrospective study examined whether flushing less than every 4 weeks conferred any benefit. RESULTS: 349 totally implanted access ports were divided into four groups based on the different durations of the intervals between flushings. Sixteen (4.6%) complications were observed in the study population. CONCLUSION: Our results demonstrate that extending the flushing interval to up to 4 months remains medically safe and drastically reduces the costs.

Methotrexate monotherapy for high-risk gestational trophoblastic neoplasia after therapy with etoposide, methotrexate, and dactinomycin: a case report.

We present a case of high-risk metastatic gestational trophoblastic neoplasia treated successfully with methotrexate monotherapy after severe toxicity from the combination chemotherapy: etoposide, dactinomycin, methotrexate, vincristine, and cyclophosphamide.

Sister Mary Joseph's nodule as the first sign of pregnancy-associated gastric cancer: a case report.

Sister Mary Joseph's nodule is an inconspicuous and uncommon clinical sign of advanced malignant disease, especially gastric cancer. Pregnancy-associated gastric cancer is an extremely rare condition and can be difficult to diagnose, due to the absence or misinterpretation of symptoms as pregnancy-related. Diagnostic aids, such as a basic chemistry panel and imaging techniques, may not show any abnormalities. We present a case of a 37-year-old pregnant patient whose umbilical nodule was the first presenting physical sign of gastric cancer, which had metastasized throughout the abdominal and pelvic regions.

Ovarian cyst torsion and extreme ovarian stimulation in a premenopausal patient treated with tamoxifen for ductal carcinoma in situ of the breast.

Tamoxifen is increasingly used in adjuvant endocrine therapy for postsurgery breast cancer patients and in chemoprevention for high-risk patients. We present a case of bilateral ovarian cyst development with consecutive unilateral cyst torsion and elevated serum estradiol in a premenopausal patient treated with tamoxifen after breast-conserving surgery.