Parental perceptions of body weight and appetite in infants and toddlers with cystic fibrosis.

Nutritional status has clinical relevance and is a target of guidance to parents of children with cystic fibrosis (CF). Growth is routinely monitored in CF clinics but there is no standardized way of assessing appetitive behaviors or parents' perceptions of their children's appetite. Greater understanding of these factors could improve clinical guidance regarding parent feeding behaviors. We therefore aimed to assess parent perceptions of child weight, and parent reports of child appetite using the Baby Eating Behavior Questionnaire (BEBQ), in a sample of infants and toddlers with CF, compared with a community sample. We additionally assessed relationships of parent perceptions of child weight with parent feeding behaviors in the sample with CF. Anthropometric and questionnaire data were collected for 32 infants and toddlers with CF, as well as 193 infants and toddlers drawn from RESONANCE, a community cohort study. Parents perceived children with CF to be lower in weight than their actual weight, to a greater extent than was evident in the community sample. Parents who perceived their children with CF to be underweight vs. right weight reported greater slowness in eating on the BEBQ. Parents perceived children with CF to have greater slowness in eating and lower enjoyment of food, compared to parents of children in the community sample, independent of sample differences in child weight, age, and sex. Our results demonstrate the potential utility of the BEBQ in a clinical sample and suggest it may be helpful for clinicians to assess parents' perceptions of their child's weight and appetite to promote a fuller understanding of the child's nutritional status, facilitate appropriate feeding behaviors and alleviate unnecessary concerns.

Enfermedades físicas y uso de sustancias comórbidas en el trastorno bipolar / Medical and substance use comorbidity in bipolar disorder

Objetivo. Los datos del National Comorbidity Survey indican que el trastorno bipolar se caracteriza por tasas elevadas durante la vida de trastornos de ansiedad y uso de sustancias (TUS) comórbidos. Aunque pruebas convincentes sugieren que la comorbilidad de un TUS predice la falta de respuesta al tratamiento, la relación entre la comorbilidad médica y la respuesta al tratamiento no se ha estudiado lo suficiente. En una tentativa de entender la influencia de la comorbilidad médica en el resultado del tratamiento, se efectuó un análisis para obtener información sobre la relación entre una enfermedad física comórbida, la fenomenología del trastorno bipolar y la respuesta al tratamiento con estabilizadores del humor. Método. Un total de 98 pacientes adultos ambulatorios con un trastorno bipolar I o II asociado a ciclación rápida y un TUD comórbido se trató prospectivamente con la combinación de litio y valproato durante 24 semanas. Se efectuó un análisis de regresión logística para examinar la relación entre la fenomenología, la respuesta a los estabilizadores del humor y la comorbilidad médica según lo valorado mediante la Cumulative Illness Rating Scale (CIRS). La carga de comorbilidad médica alta y baja se definió como una puntuación total de 4 y 3, respectivamente, en la CIRS. Resultados. Cada paciente reclutado en este estudio experimentaba, como mínimo, una enfermedad física (con más frecuencia respiratoria, 72%) y, como media, presentaba 4,9 enfermedades diferentes. Más de la mitad de pacientes (52%) manifestaba enfermedades de 4 o más sistemas orgánicos diferentes, un 24% experimentaba una enfermedad no controlable y la puntuación total global media en la CIRS fue de 5,56. El índice de masa corporal (IMC) era de 28,1, el 38% presentaba sobrepeso y el 29%, obesidad. Se observó una carga médica elevada en el 64%, que se predijo más potentemente por un diagnóstico de trastorno bipolar I (odds ratio [OR]: 34,9; p=0,002; intervalo de confianza [IC] del 95%, 3,9–316,1). Asimismo, los antecedentes de intentos de suicidio (OR: 10,3; p=0,01; IC del 95%, 1,7–62,0), los de malos tratos físicos (OR: 7,6; p=0,03; IC del 95%, 1,3–45,7) y la edad avanzada (OR: 1,2; p<0,001; IC del 95%, 1,1–1,3) también predijeron independientemente una carga elevada de problemas médicos generales. Sólo el 21% (n=21) de individuos reclutados en este estudio manifestó una respuesta bimodal al tratamiento con litio más valproato, y el IMC y la puntuación sumaria de la CIRS no predijeron la respuesta. Conclusión. La ciclación rápida con un TUS comórbido no sólo se asocia con una falta de respuesta a los estabilizadores del humor sino que también predice problemas médicos de gravedad. Una carga elevada de comorbilidad médica se asoció con el subtipo I del trastorno bipolar, antecedentes de intento de suicidio, antecedentes de malos tratos físicos y la edad avanzada (AU)

Objective. National Comorbidity Survey data indicate that bipolar disorder is characterized by high lifetime rates of co-occurring anxiety and substance use disorders (SUDs). Although compelling evidence suggests SUD comorbidity predicts non-response to treatment, the relationship between medical comorbidity and treatment response has not been studied adequately. In an attempt to understand the impact of medical comorbidity on treatment outcome, an analysis was conducted to inform the relationship between co-occurring medical illness, the phenomenology of bipolar disorder, and response to treatment with mood stabilizers. Method. A total of 98 adult outpatients with rapid-cycling bipolar I or II disorder and cooccurring SUDs were prospectively treated with the combination of lithium and valproate for up to 24 weeks. A logistic regression analysis was conducted to explore the relationship between phenomenology, response to mood stabilizers, and medical comorbidity as assessed by the Cumulative Illness Rating Scale (CIRS). High and low medical comorbidity burden were defined as a CIRS total score 4 and 3, respectively. Results. Every patient enrolled into this study had at least 1 medical illness (most commonly respiratory, 72%) and on average had 4.9 different medical conditions. Over half of patients (52%) exhibited illnesses across four or more different organ systems, 24% had uncontrollable medical illnesses, and the mean overall total CIRS score was 5.56. The average body mass index (BMI) was 28.1 with 38% being overweight and 29% being obese. High medical burden was observed in 64% and was most strongly predicted by a diagnosis of bipolar I disorder (OR=34.9, p=0.002, 95%CI=3.9–316.1). A history of attempted suicide (OR=10.3, p=0.01, 95%CI=1.7–62.0), a history of physical abuse (OR=7.6, p=0.03, 95%CI=1.3–45.7) and advancing age (OR=1.2, p<0.001, 95%CI=1.1–1.3) also independently predicted a high burden of general medical problems. Only 21% (N=21) of subjects enrolled into this study showed a bimodal response to treatment with lithium plus valproate, and neither BMI nor any summary CIRS measure predicted response. Conclusion. Rapid cycling with co-occurring substance use is not only associated with poor response to mood stabilizers, but is also a harbinger of serious medical problems. A high burden of medical comorbidity was associated with the bipolar I subtype, a history of attempted suicide, a history of physical abuse, and advancing age (AU)