Mental health and well-being in parents of excessively crying infants: Prospective evaluation of a support package.

BACKGROUND: During the first 4 months of age, approximately 20% of infants cry a lot without an apparent reason. Most research has targeted the crying, but the impact of the crying on parents, and subsequent outcomes, need to receive equal attention. This study reports the findings from a prospective evaluation of a package of materials designed to support the well-being and mental health of parents who judge their infant to be crying excessively. The resulting "Surviving Crying" package comprised a website, printed materials, and programme of Cognitive Behaviour Therapy-based support sessions delivered to parents by a qualified practitioner. It was designed to be suitable for United Kingdom (UK) National Health Service (NHS) use. METHODS: Parents were referred to the study by 12 NHS Health Visitor/Community Public Health Nurse teams in one UK East Midlands NHS Trust. Fifty-two of 57 parents of excessively crying babies received the support package and completed the Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7 anxiety questionnaire, as well as other measures, before receiving the support package and afterwards. RESULTS: Significant reductions in depression and anxiety were found, with numbers of parents meeting clinical criteria for depression or anxiety halving between baseline and outcome. These improvements were not explained by reductions in infant crying. Reductions also occurred in the number of parents reporting the crying to be a large or severe problem (from 28 to 3 parents) or feeling very or extremely frustrated by the crying (from 31 to 1 parent). Other findings included increases in parents' confidence, knowledge of infant crying, and improvements in parents' sleep. CONCLUSIONS: The findings suggest that the Surviving Crying package may be effective in supporting the well-being and mental health of parents of excessively crying babies. Further, large-scale controlled trials of the package in NHS settings are warranted.

Objectively measured physical activity and longitudinal changes in adolescent body fatness: an observational cohort study.

BACKGROUND: The data regarding prospective associations between physical activity (PA) and adiposity in youth are inconsistent. OBJECTIVE: The objective of this study was to investigate associations between baseline levels of objectively measured PA and changes in adiposity over 2.5 years from mid-to-late adolescence. METHODS: This was an observational cohort study in 728 school students (43% boys) from Cambridgeshire, United Kingdom. Fat mass index (FMI, kg m(-2) ) was estimated at baseline (mean ± standard deviation age: 15 ± 0.3 years) and follow-up (17.5 ± 0.3 years) by anthropometry and bioelectrical impedance. Habitual PA was assessed at baseline by ≥3 d combined heart rate and movement sensing. Average daily PA energy expenditure (PAEE) and the time (min d(-1) ) spent in light, moderate and vigorous intensity PA (LPA, MPA and VPA, respectively) was estimated. Multilevel models were used to investigate associations between baseline PA and change in FMI (ΔFMI). Adjustment for baseline age, sex, follow-up duration, area-level socioeconomic status, season of PA assessment, sedentary time, energy intake and sleep duration was made; baseline FMI was also added in a second model. RESULTS: FMI increased significantly over follow-up (0.6 ± 1.2 kg m(-2) , P < 0.001). Baseline PAEE and LPA positively predicted ΔFMI in overfat participants (P ≤ 0.030), as did VPA in initially normal fat participants (P ≤ 0.044). There were further positive associations between PAEE and ΔFMI in normal fat participants, and between MPA and ΔFMI in both fat groups, when adjusted for baseline FMI (P ≤ 0.024). CONCLUSIONS: Baseline PAEE and its subcomponents were positively associated with small and unlikely clinically relevant increases in ΔFMI. These counter-intuitive findings may be explained by behavioural changes during the course of study follow-up.

Breakfast consumption and physical activity in British adolescents.

Studies show an inverse relationship between breakfast frequency and weight gain. This may reflect poor eating habits generally and associated low physical activity (PA) or direct impacts of breakfast on mechanisms leading to lethargy and reduced PA. The relationship between breakfast frequency and PA is inconclusive. We aimed to determine whether breakfast frequency is associated with PA levels in British adolescents independent of body composition and socio-economic status (SES). Habitual breakfast frequency (self-report questionnaire) was assessed in 877 adolescents (43% male, age 14·5 (SD 0·5) years old). PA was measured over 5 d (accelerometry, average counts/ min; cpm). Associations between daily PA and breakfast frequency were assessed using linear regression adjusted for body fat percentage and SES. Effect modification by sex and associations with PA during the morning (06.00-12.00 hours) were explored. For boys, there were no significant associations between breakfast frequency and PA. For girls, less frequent breakfast consumption was significantly associated with lower PA (cpm) during the morning (occasional v. frequent b - 6·1 (95% CI - 11·1, -1·1), P = 0·017) when adjusted for body fat percentage and SES. There were no associations between PA and breakfast consumption over the whole day; however, for girls, less frequent breakfast consumption may be associated with lower PA levels during the morning, suggesting that breakfast consumption should perhaps be taken into consideration when aiming to promote PA in adolescent girls.

Diagnostic criteria for exercise dependence in women.

OBJECTIVE: To formulate diagnostic criteria for exercise dependence. METHOD: Fifty six adult female exercisers were interviewed about their exercise behaviour and attitudes. The eating disorders examination, a semistructured clinical interview, was used to diagnose eating disorders. Interviews were taped, transcribed verbatim, and analysed from a social constructionist perspective using QSR NUD*IST. Participants also completed the exercise dependence questionnaire. RESULTS: Two diagnostic criteria emerged from analysis of the interview data: impaired functioning and withdrawal. Impaired functioning was manifest in four areas: psychological, social and occupational, physical, and behavioural. Impairment in at least two areas was considered necessary for diagnosis. Withdrawal was evident as either an adverse reaction to the interruption of exercise or unsuccessful attempts at exercise control. Either sufficed for diagnosis. The absence or presence of an eating disorder was used to distinguish between primary and secondary exercise dependence. Ten women met these criteria for exercise dependence. All 10 also exhibited eating disorders and, accordingly, should be regarded as showing secondary, rather than primary, exercise dependence. Exercise dependent women had significantly higher scores on the exercise dependence questionnaire than non-dependent women. CONCLUSION: These new diagnostic criteria should now be adopted and explored further, particularly among men and individuals with possible primary exercise dependence.

Phenol sulphotransferase SULT1A1*1 genotype is associated with reduced risk of colorectal cancer.

Sulphation is an important detoxification pathway for numerous xenobiotics; however, it also plays an important role in the metabolism and bioactivation of many dietary and environmental mutagens, including heterocyclic amines implicated in the pathogenesis of colorectal and other cancers. A major sulphotransferase (SULT) enzyme in humans, SULT1A1, is polymorphic with the most common variant allele, SULT1A1*2, occurring at a frequency of about 32% in the Caucasian population. This allele codes for an allozyme with low enzyme activity and stability compared to the wild-type (SULT1A1*1) enzyme, and therefore SULT1A1 genotype may influence susceptibility to mutagenicity following exposure to heterocyclic amines and other environmental toxins. Previously, a significant association of SULT1A1*1 genotype with old age has been observed, suggesting a 'chemoprotective' role for the high-activity phenotype. Here we have compared the frequencies of the most common SULT1A1 alleles in 226 colorectal cancer patients and 293 previously described control patients. We also assessed whether SULT1A1 genotype was related to various clinical parameters in the patient group, including Duke's classification, differentiation, site, nodal involvement and survival. There was no significant difference in allele frequency between the control and cancer patient populations, nor was there a significant association with any of the clinical parameters studied. However, when the age-related difference in allele frequency was considered, a significantly reduced risk of colorectal cancer (odds ratio = 0.47; 95% confidence interval = 0.27-0.83; P = 0.009), was associated with homozygosity for SULT1A1*1 in subjects under the age of 80 years. These results suggest that the high activity SULT1A1*1 allozyme protects against dietary and/or environmental chemicals involved in the pathogenesis of colorectal cancer.

"It's exercise or nothing": a qualitative analysis of exercise dependence.

OBJECTIVES: To explore, using qualitative methods, the concept of exercise dependence. Semistructured interviews were undertaken with subjects screened for exercise dependence and eating disorders. METHODS: Female exercisers, four in each case, were allocated a priori to four groups: primary exercise dependent; secondary exercise dependent, where there was a coincidence of exercise dependence and an eating disorder; eating disordered; control, where there was no evidence of either exercise dependence or eating disorder. They were asked about their exercise and eating attitudes and behaviour, as well as about any history of psychological distress. Their narratives were taped, transcribed, and analysed from a social constructionist perspective using QSR NUD*IST. RESULTS: Participants classified as primary exercise dependent either showed no evidence of exercise dependent attitudes and behaviour or, if they exhibited features of exercise dependence, displayed symptoms of an eating disorder. Only the latter reported a history of psychological distress, similar to that exhibited by women classified as secondary exercise dependent or eating disordered. For secondary exercise dependent and eating disordered women, as well as for controls, the narratives largely confirmed the a priori classification. CONCLUSIONS: Where exercise dependence was manifest, it was always in the context of an eating disorder, and it was this comorbidity, in addition to eating disorders per se, that was associated with psychological distress. As such, these qualitative data support the concept of secondary, but not primary, exercise dependence.

The pathological status of exercise dependence.

OBJECTIVES: This study was concerned with the concept of exercise dependence. Levels of psychological morbidity, personality profiles, and exercise beliefs were compared among subjects screened for exercise dependence and eating disorders. METHOD: Adult female exercisers were allocated on the basis of questionnaire screening to one of the following groups: primary exercise dependence (n = 43); secondary exercise dependence, where there was the coincidence of exercise dependence and an eating disorder (n = 27); eating disorder (n =14); control, where there was no evidence of either exercise dependence or eating disorder (n = 110). Questionnaire assessment was undertaken of psychological morbidity, self esteem, weight and body shape dissatisfaction, personality, and exercise beliefs. RESULTS: Aside from a higher incidence of reported menstrual abnormalities, the primary exercise dependence group was largely indistinguishable from the controls. In stark contrast, the secondary exercise dependence group reported higher levels of psychological morbidity, neuroticism, dispositional addictiveness, and impulsiveness, lower self esteem, greater concern with body shape and weight, as well as with the social, psychological, and aesthetic costs of not exercising than the controls, but differed little from the eating disorder group. CONCLUSIONS: In the absence of an eating disorder, women identified as being exercise dependent do not exhibit the sorts of personality characteristics and levels of psychological distress that warrant the construction of primary exercise dependence as a widespread pathology.

How to Assess a Model's Testability and Identifiability.

Formal definitions are given of the following intuitive concepts: (a) A model is quantitatively testable if its predictions are highly precise and narrow. (b) A model is identifiable if the values of its parameters can be ascertained from empirical observations. (c) A model is redundant if the values of some parameters can be deduced from others or if the values of some observables can be deduced from others. Various rules of thumb for nonredundant models are examined. The Counting Rule states that a model is quantitatively testable if and only if it has fewer parameters than observables. This rule can be safely applied only to identifiable models. If a model is unidentifiable, one must apply a generalization of the Counting Rule known as the Jacobian Rule. This rule states that a model is quantitatively testable if and only if the maximum rank (i.e., the number of linearly independent columns) of its Jacobian matrix (i.e., the matrix of partial derivatives of the function that maps parameter values to the predicted values of observables) is smaller than the number of observables. The Identifiability Rule states that a model is identifiable if and only if the maximum rank of its Jacobian matrix equals the number of parameters. The conclusions provided by these rules are only presumptive. To reach definitive conclusions, additional analyses must be performed. To illustrate the foregoing, the quantitative testability and identifiability of linear models and of discrete-state models are analyzed. Copyright 2000 Academic Press.

Phenol sulphotransferase SULT1A1 polymorphism: molecular diagnosis and allele frequencies in Caucasian and African populations.

Sulphation, catalysed by members of the sulphotransferase (SULT) enzyme family, is an important component of the body's chemical defence mechanism, but also acts to bioactivate mutagens such as hydroxylated aryl and heterocyclic amines. A major human sulphotransferase, SULT1A1 (P-PST), metabolizes and/or bioactivates many drugs, iodothyronines and hydroxylated aromatic amines. The enzyme activity varies widely within the population and is under genetic control. We have developed an assay detecting a G-->A transition in SULT1A1 that causes an Arg213-->His substitution associated with low SULT activity and altered enzyme properties, and have used it to assess the SULT1A1 genotype in Caucasian (n=293) and African (Nigerian, n=52) populations. We show that the mutant SULT1A1*2 allele is present at frequencies of 0.321 and 0.269 in the Caucasian and African populations respectively. We also demonstrate a significant age-related difference in SULT1A1 genotype within our Caucasian population, with increasing incidence of SULT1A1*1 homozygosity and decreasing incidence of SULT1A1*2 homozygosity with increasing age, indicating a potential association of SULT1A1*1 allozyme(s) with protection against cell and/or tissue damage during aging.

Learning-forgetting independence, unidimensional memory models, and feature models: comment on Bogartz (1990).

In his recent articles, Bogartz offered a definition of what it means for forgetting rate to be independent of degree of original learning. He showed that, given this definition, independence is confirmed by extant data. Bogartz also criticized Loftus's (1985b) proposed method for testing independence. In this commentary, we counter Bogartz's criticisms and then offer two observations. First, we show that Loftus's horizontal-parallelism test distinguishes between two interesting class of memory models: unidimensional models wherein the memory system's state can be specified by a single number and multidimensional models wherein at least two numbers are required to specify the memory system's state. Independence by Loftus's definition is implied by a unidimensional model. Bogartz's definition, in contrast, is consistent with either model. Second, to better understand the constraints on memory mechanisms dictated by the mathematics of the models under consideration, we develop a simple but general feature model of learning and forgetting. We demonstrate what constraints must be placed on this model to make learning and forgetting rate independent by Loftus's and by Bogartz's definitions.

A comparison of two anaesthetic techniques for daycase arthroscopy.

A randomised, double-blind study of 100 patients admitted for daycase arthroscopy was undertaken. Fifty patients received alfentanil 500 micrograms and midazolam 5 mg, and 50 received alfentanil 500 micrograms alone, in each case 2 minutes before induction of anaesthesia with methohexitone. Anaesthesia was maintained in both groups with nitrous oxide, oxygen and enflurane. Recovery was assessed quantitatively by measuring time to when they awoke and by a comparison of pre- and postoperative performance of p-deletion and postbox tests. Qualitative assessment of recovery and of postoperative pain was also undertaken. Patients completed a questionnaire to record the incidence of any anaesthetic-related symptoms on the first and second postoperative days. Patients who received midazolam required a reduced dose of methohexitone but their initial recovery time was prolonged significantly. The incidences of anaesthetic-related side effects and postoperative pain were similar in the two groups and while the questionnaires did not reveal any statistically significant differences in symptoms on the first 2 postoperative days, the results indicated that patients who received a larger induction dose of methohexitone were subjectively drowsier on the first day after operation.

Subarachnoid blockade with bupivacaine. A comparison with cinchocaine.

Subarachnoid anaesthesia was induced in 40 patients with 0.5% bupivacaine 3 ml with no glucose, 5% glucose or 8% glucose, or with hyperbaric cinchocaine . The injections were made in the lateral position and the patients turned supine immediately. The onset, extent and duration of sensory and motor blockade, the quality of anaesthesia, cardiovascular effects, and the frequency of side-effects were studied. The hyperbaric solutions produced a greater cephalad spread (T6-T7) than the glucose-free solution (T10-T11). Cinchocaine produced a longer duration of action at T10 and T12 than the hyperbaric bupivacaine solutions. No advantage was seen when 8% rather than 5% glucose was used. The glucose-free bupivacaine produced intense blockade of long duration and was suitable when a lower level of blockade was adequate for the proposed surgery.