Clinical validity of the descriptor. "presence of a belief that one must eat in order to get to sleep" in diagnosing the Night Eating Syndrome.

The diagnostic criteria for the Night Eating Syndrome (NES) published in 2010 require the presence of two core criteria: evening hyperphagia and/or nocturnal awakenings for ingestion of food and three of five diagnostic descriptors. One of the descriptors is as follows: "The belief that one must eat in order to fall asleep". In this study we evaluated whether this conviction is significantly more prominent in obese individuals suffering from insomnia and nocturnal eating, than among obese patients with insomnia who do not eat at night. Ninety-eight obese subjects afflicted by insomnia were included in this study. Eight were affected by NES, 33 by Binge Eating Disorder (BED), and 13 by both BED and NES. Subjects' insomnia and sleep disturbances were assessed using the Insomnia Severity Index and the Sleep Disturbance Questionnaire. The presence of the belief that one must eat at night in order to sleep was evaluated with the question: "Do you need to eat in order to get back to sleep when you wake up at night?" Patients affected by NES and by both BED and NES were convinced that nocturnal food intake was necessary in order to fall back asleep after a night time awakening. The presence of this belief seemed to be a critical factor in identifying the presence of the Night Eating Syndrome among obese subjects suffering from insomnia.

Relationship between Cognitive Function, Depression/Anxiety and Functional Parameters in Patients Admitted for Congestive Heart Failure.

UNLABELLED: Cognitive impairment, anxiety and depression have been described in patients with congestive heart failure (CHF). We analyzed in-hospital CHF patients before discharge with neuropsychological tests attempting to correlate with prognostic parameters. METHODS: All subjects underwent a mini mental state examination (MMSE), geriatric depression scale (GDS), anxiety and depression scale test (HADS). We evaluated NYHA class, brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and non-invasive cardiac output (CO). RESULTS: Three-hundred and three CHF patients (age 71.6 ys) were analysed. The mean NYHA class was 2.9±0.8, LVEF was 43.4±15.8%; BNP plasma level and CO were calculated as 579.8±688.4 pg/ml and 3.9±1.1 l/min, respectively. In 9.6% a pathological MMSE score emerged; a depression of mood in 18.2% and anxiety in 23.4% of patients were observed. A significant correlation between MMSE and age (r=0.11 p=0.001), BNP (r=0.64 p=0.03) but not between MMSE and NYHA class and LVEF was observed. GDS and HADS were inversely correlated with NYHA class (r=0.38 p=0.04) and six-minute walking test (r=0.18 p=0.01) without an association with objective parameters in CHF (BNP, LVEF and cardiac output). At multivariate analysis only MMSE and BNP are inversely correlated significantly (p=0.019 OR=-0.64, CI=-042-0.86). CONCLUSIONS: in-hospital CHF patients may manifest a reduction of MMSE and important anxiety/depression disorders. The results of the study suggest that the presence of cognitive impairment in older CHF patients with higher BNP plasma level should be considered. In admitted CHF patients anxiety and depression of mood are commonly reported and influenced the perception of the severity of illness.

[Evaluating short term efficacy of educative support in a cardiovascular rehabilitation using the MICRO-Q test: a single centre experience]. / II test MICRO-Q nella valutazione a breve termine dell'efficacia del supporto educazionale in Cardiologia Riabilitativa: esperienza in un singolo centro.

UNLABELLED: Object of this study was to evaluate the efficacy of multiprofessional meetings in order to improve patients' knowledge about cardiovascular diseases, risk factors and correct lifestyle in a Cardiovascular Rehabilitation Department. METHODS: from November 2011 to June 2012 two MICRO-Q questionnaires were given to the Fossano Cardiovascular Rehabilitation's patients before and after the educational meetings to test their improvement after having followed educational meetings. RESULTS: 73 patients have answered the questionnaires (57 males, mean age 68,5 +/-11.73ys). From these data emerged a significant improvement of knowledge about cardiovascular risk factors (75,34% vs 91,78%; p=0,01), smoke (79,45% vs 93,15%; p=0,03), stress (76,71% vs 91,78; p=0,023), diet (84,93% vs 97,26%; p=0,02), physical activity (63,01% vs 84,93%; p=0,005) and right things to do in case of chest pain (34,25% vs 52,05%; p=0,04). CONCLUSIONS: educational meetings had an important role in improve patients' knowledge about cardiovascular risk factors, correct lifestyle and diet. Moreover MICRO-Q questionnaires demonstrated to be useful tools in order to improve the educational meetings according to the real needs of our patients.

Defining the borders between Sleep-Related Eating Disorder and Night Eating Syndrome.

OBJECTIVES: Nocturnal eating is a common symptom of two clinical conditions with different pathogenesis and needing different therapeutic approaches: Sleep Related Eating Disorder (SRED) and Night Eating Syndrome (NES). The first is considered a parasomnia while the second is an eating disorder; however, the distinction between SRED and NES is still a controversial matter. The aim of this study was to better define psychological, behavioral, and polysomnographic characteristics of the two syndromes. METHODS: An eating disorders' specialist tested a group of 28 nocturnal eaters diagnosed as affected by SRED by a sleep expert, following the current criteria of the international classification of sleep disorders, to find out if any of them was affected by NES according to the criteria suggested by both sleep and eating disorders specialists during the first international meeting on Night Eating Syndrome (Minneapolis, 2009) and if they had specific psychological or polysomnographic characteristics. RESULTS: Twenty-two subjects were diagnosed to be affected by NES. They scored higher on the physical tension subscale of the Sleep Disturbance Questionnaire (SDQ) and on the mood and sleep subscale of the Night Eating Questionnaire (NEQ), but there were no other significant differences between SRED and NES patients nor for age, Body Mass Index (BMI), or gender distribution. CONCLUSIONS: The overlap between the symptomatology and the polysomnographic characteristics of the two pathologies and the difficulty in making a differential diagnosis between NES and SRED indicate the need for an update of the diagnostic criteria for SRED, as was recently done for NES.

Effects of levosimendan/furosemide infusion on plasma brain natriuretic peptide, echocardiographic parameters and cardiac output in end-stage heart failure patients.

BACKGROUND: Acute decompensation heart failure (ADHF) remains a cause of hospitalization in patients with end-stage congestive HF. The administration of levosimendan in comparison with a standard therapy in CHF patients admitted for ADHF was analysed. MATERIAL/METHODS: Consecutive patients admitted for ADHF (NYHA class III-IV) were treated with levosimendan infusion 0.1 µg/kg/min or with furosemide infusion 100-160 mg per day for 48 hours (control group). All subjects underwent determination of brain natriuretic peptide (BNP), non-invasive cardiac output (CO), and echocardiogram at baseline, at the end of therapy and 1 week after therapy. RESULTS: Seven patients admitted for 20 treatments in 16 months (age 66 years; mean admission/year 5.4) were treated with levosimendan and compared with 7 patients admitted for 15 treatments (age 69.1 years; mean admission/year 6.1). At the end of levosimendan therapy, BNP decreased (from 679.7 ± 512.1 pg/ml to 554.2 ± 407.6 pg/ml p = 0.03), and 6 MWT and LVEF improved (from 217.6 ± 97.7 m to 372.2 ± 90.4 m p = 0.0001; from 22.8 ± 9.1% to 25.4 ± 9.8% p = 0.05). Deceleration time, E/A, E/E', TAPSE, pulmonary pressure and CO did not change significantly after levosimendan therapy and after 1 week. At follow-up, only 6-min WT and NYHA class showed a significant improvement (p = 0.0001, p = 0.001 respectively). The furosemide infusion reduced NYHA class and body weight (from 3.4 ± 0.6 to 2.3 ± 0.5 p = 0.001; from 77.5 ± 8.6 kg to 76 ± 6.6 kg p = 0.04), but impaired renal function (clearances from 56.3 ± 21.9 ml/min to 41.2 ± 10.1 ml/min p = 0.04). CONCLUSIONS: Treating end-stage CHF patients with levosimendan improved BNP and LVEF, but this effect disappeared after 1 week. The amelioration of 6 MWT and NYHA class lasted longer after levosimendan infusion.

[Efficacy of team work in health promotion and secondary prevention in patients admitted for cardiovascular rehabilitation]. / Efficacia del lavoro di gruppo nella informazione sanitaria e prevenzione secondaria in pazienti afferenti alla riabilitazione cardiologica.

UNLABELLED: The object of the study was to evaluate the immediate efficacy of periodical educational meetings organized in Cardiovascular Rehabilitation Department aimed to improve knowledge about cardiovascular pathology, risk factors and correct life style. METHODS: From October 2008 a multiprofessional group organized educational meetings for patients and their relatives, using two questionnaires to explore patients' level of knowledge, before and after the meeting. RESULTS: 124 patients (90 males) answered the questionnaire 1, while questionnaire 2 was completed by 93 subjects (70 males). From the answers to questionnaire 1, a significant improvement of knowledge about coronary anatomy and cardiovascular therapy emerged. Indeed, 99% of patients vs 81% before the meeting (p=0.001) understood the coronary artery function, 69% vs 44% (p=0,0001) of participants was familiar with coronary angioplasty, 81% vs. 64% (p=0,003) demonstrated to understand the coronary artery bypass and finally 85% vs. 52% (p=0,0001) were able to distinguish mechanical from biological prosthesis. From answers to questionnaire 2, a trend in favour to an improvement of knowledge regarding coronary risk factors and correct life style emerged. Younger patients (<70 ys) had a higher baseline level knowledge (p=0,003 and p=0.001 group 1 and 2, respectively) compared to older subjects, but in the latter a trend in favour of enhanced knowledge (p=0.06) after the educational meetings emerged. CONCLUSIONS: Educational meetings are significantly correlated with an improvement of patients' knowledge regarding cardiovascular pathology and treatments independently from patients' age.

Daily and nightly anxiety among patients affected by night eating syndrome and binge eating disorder.

We tested if there were any differences about nocturnal and diurnal anxiety between patients either affected by Binge Eating Disorder (BED) or Night eating Syndrome (NES). Fifty four patients affected by BED, 13 by NES and 16 by both BED and NES were tested using the Self Rating Anxiety Scale (SAS) and the Sleep Disturbance Questionnaire (SDQ). Their nocturnal eating behavior was ascertained through the Night Eating Questionnaire (NEQ). Patients affected by both BED and NES scored significantly higher on SAS than other patients. Among NES patients we found a correlation between a SDQ subscale and two subscales of the NEQ. Among BED patients we found a correlation between SAS scores and the nocturnal ingestion subscale of the NEQ. Nocturnal eating is related to nocturnal anxiety among NES patients while it is related to diurnal anxiety among patients affected by BED. These findings support the hypothesis that BED and NES are distinct syndromes sharing overeating but with different pathways to excessive food intake.

Food is never enough: nature and nurture's influence on children's food dose evaluation.

This study investigated whether if socioeconomic factors and\or food palatability influence food amount evaluation among children. Ninety-four children, 10-15 years old, living in Mali in Africa, and 124 living in northern Italy were asked to evaluate an amount of palatable and non palatable candies. The evaluations were compared both to the real number of candies and to that given by the other group. Both Italian and Malian children underestimated the edible candies, interestingly however Malian children did not underestimate altered candies. The data suggest that food dose underestimation is a transcultural characteristic. Evaluation of palatable food is not influenced by socio cultural factors. Underestimation could be a biological protective factor against food shortage; in case of food abundance it could play a role in onset and maintenance of obesity.

Visual evaluation of food amount in patients affected by Anorexia Nervosa.

OBJECTIVE: The study compares visual evaluation of an amount of food and an amount of nonedible objects in patients affected by Anorexia Nervosa and control subjects. METHOD: 59 anorexic subjects were asked to evaluate an amount of candies and plastic bricks shown to them. Their answers were compared to both the real number of objects and the parallel evaluations given by 56 control subjects. RESULTS: There were no significant differences in stimuli evaluation between patients affected by AN and control subjects. Both groups reported a significantly lower number of both candies and bricks in comparison to their real number. DISCUSSION: In an experimental condition not related with food intake there is the same under-evaluation of the amount of presented food and nonedible objects among patients affected by AN and Control Subjects. The clinical finding of overestimation of food intake among patients affected by AN seems not to be due to a perceptive bias.