Mediating role of depressive symptoms linking insecure attachment and disordered eating in adolescents: A multiwave longitudinal study.

Research has supported a link between insecure attachment and disordered eating in adolescents; however, how this influence is exerted remains unclear. This study explored whether depressive symptoms constitute a pathway through which insecure attachment to parents predicts subsequent development of disordered eating in the transition from childhood to adolescence. The study also examines whether there are differential effects regarding the attachment figure, child's gender, or reciprocity between variables. A community-based sample of Spanish youth (n = 904; 49.4% girls) was followed biennially from age 10 to 16 years. Attachment, depressive symptoms, and disordered eating were measured using the Inventory of Parental and Peer Attachment, Children's Depression Inventory, and Children's Eating Attitudes Test, respectively. Prospective data were analyzed using a dynamic panel model, which accounts for unmeasured time-invariant factors. Whereas insecure attachment to the father did not predict later depression or disordered eating, higher insecure attachment to the mother at ages 10 and 12 years predicted more disordered eating at ages 14 and 16 years via increased depressive symptoms at ages 12 and 14 years. No child's gender-specific or reverse mediational effects were found. This study suggests that an increase in depressive symptoms might be one mechanism by which insecure attachment exerts its influence on the development of eating disorders symptomatology in adolescence. Intervention efforts aimed at strengthening particularly the mother-child attachment relationship may reduce the vulnerability to develop depressive symptoms and disordered eating.

COVID-19 conversations: A qualitative study of majority Hispanic/Latinx youth experiences during early stages of the pandemic.

Background: Growing evidence informs about the detrimental impact that COVID-19 has had on youths' mental health and well-being. As of yet, no study has directly examined the experiences and perspectives of children and young adolescents from racial and ethnic minority groups in the U.S., despite being exposed to more adversity, which may affect coping with the many challenges posed by the pandemic. Objective: This study aimed to give voice to a mostly Hispanic/Latinx group of youth regarding the impact of COVID-19 stay-at-home measures and to identify their emotional responses and coping strategies amid the pandemic in the U.S. when restrictions were at their hardest. Method: A total of 17 youths (70.6 % Hispanic; age range = 10-14 years; 52.9 % female) participated in four virtual semi-structured focus groups for each grade level (grades 5-8). Data was transcribed and analyzed using a gold standard thematic analysis approach. Results: Seven themes were identified concerning the impact of COVID-19, centering around the impact of racism, loss of income, the role of community and family in coping with stress, information overload, home-schooling, loneliness and boredom, and lack of structured routines. Conclusions: Our findings suggest that cultural factors (e.g., collectivism and familism) in Hispanic communities may offer important buffering during COVID-19. Future research studies evaluating the implementation of structured programs that provide a space to talk about emotions and thoughts related to the impact of the pandemic and training in strategies to cope with distress during mandatory home-schooling are needed.

Attachment, mentalizing, and eating disorder symptoms in adolescent psychiatric inpatients and healthy controls: a test of a mediational model.

OBJECTIVE: Research has supported a link between insecure attachment and eating disorders (EDs) in adolescents; however, mechanisms accounting for this association remain unclear. Growing evidence suggests impaired mentalizing as a potential mechanism. Yet, little is known about the relationship between mentalizing and ED symptoms or how it relates to the link between attachment and EDs in adolescents. This study examined mentalizing deficits in adolescents with ED symptoms relative to psychiatric and healthy controls and tested a mediational model, wherein mentalizing capacity mediates the relationship between attachment and ED symptoms. METHOD: Inpatient adolescents with EDs and other pathology (n = 568) and healthy controls (n = 184) were administered the child attachment interview, the movie for the assessment of social cognition and the diagnostic interview schedule for children to assess attachment, mentalizing and ED symptoms, respectively. RESULTS: Inpatients showed lower attachment security and more hypermentalizing than healthy adolescents. Hypermentalizing explained the association between insecure attachment and ED symptoms. CONCLUSIONS: These findings suggest potential utility of targeting mentalizing in prevention and treatment of EDs in adolescents. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Prospective Bidirectional Associations between Attachment and Depressive Symptoms from Middle Childhood to Adolescence.

Insecure attachment to parents consistently correlates with adolescent depression. However, the order of cause and effect, the impact of confounding, and gender disparities in this relationship remain unresolved. The present study therefore examined the prospective associations between attachment relationships to mothers and fathers and depressive symptoms in a community sample of Spanish children (n = 904; 49.4% females) assessed biennially from age 10-16 years, net of all unmeasured time-invariant confounding. Insecure relationships predicted depressive symptoms, and more so among girls, but depressive symptoms also forecasted worsened attachment relationships. At ages 12-14, mother-child attachment proved to be more important for the development of depressive symptoms than father-child attachment. These findings reveal a pattern of reciprocal influence between attachment relationships and depressive symptoms that appears to vary as a function of the parental and child's gender and developmental period. Thus, efforts aimed at strengthening the parent-child attachment relationship-across the transition from middle childhood to adolescence-may prevent or reduce depressive symptoms, especially by targeting mothers and female adolescents.

Papel de la nutrición en la encefalopatía hepática: es tiempo de cambiar / Role of nutrition in hepatic encephalopathy: time to change

La presencia de desnutrición es frecuente en los pacientes con cirrosis hepática (CH), siendo un factor de riesgo que aumenta la mortalidad y la posibilidad de desarrollar descompensaciones clínicas. Es necesario conocer el grado de desnutrición de estos pacientes para valorar la indicación de una intervención nutricional y su eficacia, siendo la medida de la fuerza de prensión de la mano mediante dinamometría una prueba adecuada a tal fin. El desarrollo de Encefalopatía Hepática (EH) constituye una situación relevante en la historia natural de la CH que precisa una serie de medidas terapéuticas, incluida la intervención nutricional. Entre las medias nutricionales destaca un adecuado aporte energético diario (35-40 Kcl/Kg de peso) y proteico (1.2-1.5 gramos/Kg de peso), debiendo desechar la utilización de dietas hipoproteicas que solo pueden agravar la desnutrición sin presentar efectos beneficiosos sobre la EH. Por otro lado se recomiendan pequeñas ingestas distribuidas uniformemente a lo largo del día y la utilización de una colación nocturna con carbohidratos complejos, así como la promoción de una dieta rica en vegetales y fibra. Otras medidas como los aminoácidos de cadena ramificada o los probióticos no cuentan actualmente con la suficiente evidencia científica para su uso en la EH (AU)

Malnutrition is common in patients with liver cirrosis being a risk factor that increases mortality and the possibility of developing clinical decompensation. It´s important to know the degree of malnutrition in these patients to assess the indication of a nutritional intervention and its effectiveness. Hand grip dynamometer is a suitable test for this purpose. Development of Hepatic Encephalopathy is a relevant situation in the natural history of cirrhosis that requires a number of therapeutic measures, including nutritional intervention. It´s recommended to obtain an adequate daily energy intake (35-40 Kcl / Kg body weight) and protein intake (1.2-1.5 g / kg body weight) and must avoid hipoprotein diets which only aggravate malnutrition and they don´t have beneficial effects on EH. In the other hand, it’s recommended small intakes distributed throughout the day and the use of a late evening snack with complex carbohydrates, as well as the promotion of a diet rich in vegetables and fiber. The use of branched-chain amino acids or probiotics do not currently have sufficient scientific evidence for use in HE (AU)

Long-acting agonists of LH-RH in the treatment of large ovarian endometriomas.

Reversible temporary medical oophorectomy using long-acting agonist analogs of LH-RH was tried in three infertile patients suffering from large endometriomas of the ovary. These patients had stage IV disease according to the revised 1985 classification of the American Fertility Society. D-Ala6-des-Gly10-LH-RH propylamide (D-Ala6-LH-RH PA), in a dose of 125 micrograms, was administered intramuscularly every 48 hours to one patient, and daily to the other two patients, for 22, 17, and 14 weeks, respectively. Two patients subsequently received 100 micrograms of D-Trp6-LH-RH for 4 weeks in order to compare its efficacy with D-Ala6-LH-RH PA. Clinical controls, pelvic ultrasonography, and routine laboratory tests and hormone assays were done periodically. Ultrasonography images showed a reduction in the size of endometriomas after the second or third week of treatment. This reduction was maintained throughout and continued after the period of treatment. Suppression of the pituitary and estrogen responses was obtained rapidly, but some transient increments were occasionally found. Progesterone levels always decreased and remained in the range of the early follicular phase. Most intervals of uterine bleeding were prolonged. An evident improvement of abdominal pain, dysmenorrhea, and dyspareunia was found. Administration of D-Trp6-LH-RH was more effective than D-Ala6-LH-RH PA in most of the parameters tested. After discontinuation of treatment, all three patients had a prolonged follicular phase with a normal luteal phase during the first cycle. One woman became pregnant in the fourth cycle after discontinuation of D-Ala6-LH-RH PA and delivered a normal baby.(ABSTRACT TRUNCATED AT 250 WORDS)