Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult Mediterranean population.

OBJECTIVES: To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up. METHODS: n = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control. RESULTS: The presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up. CONCLUSIONS: This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short-medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.

Subjective craving and event-related brain response to olfactory and visual chocolate cues in binge-eating and healthy individuals.

High-sugar/high-fat foods are related to binge-eating behaviour and especially people with low inhibitory control may encounter elevated difficulties to resist their intake. Incentive sensitization to food-related cues might lead to increased motivated attention towards these stimuli and to cue-induced craving. To investigate the combined influence of olfactory and visual stimuli on craving, inhibitory control and motivated attention, 20 healthy controls and 19 individuals with binge-eating viewed chocolate and neutral pictures, primed by chocolate or neutral odours. Subjective craving and electroencephalogram activity were recorded during the task. N2 and Late Positive Potential (LPP) amplitudes were analysed. Patients reported higher craving than controls. Subjective craving, N2 and LPP amplitudes were higher for chocolate versus neutral pictures. Patients showed a higher relative increase in N2 amplitudes to chocolate versus neutral pictures than controls. Chocolate images induced significant increases in craving, motivated attention and measures of cognitive control. Chocolate odour might potentiate the craving response to visual stimuli, especially in patients with binge-eating.

Cognitive behavioral therapy for compulsive buying behavior: Predictors of treatment outcome.

BACKGROUND: Compulsive buying behavior (CBB) is receiving increasing consideration in both consumer and psychiatric-epidemiological research, yet empirical evidence on treatment interventions is scarce and mostly from small homogeneous clinical samples. OBJECTIVES: To estimate the short-term effectiveness of a standardized, individual cognitive behavioral therapy intervention (CBT) in a sample of n=97 treatment-seeking patients diagnosed with CBB, and to identify the most relevant predictors of therapy outcome. METHOD: The intervention consisted of 12 individual CBT weekly sessions, lasting approximately 45minutes each. Data on patients' personality traits, psychopathology, sociodemographic factors, and compulsive buying behavior were used in our analysis. RESULTS: The risk (cumulative incidence) of poor adherence to the CBT program was 27.8%. The presence of relapses during the CBT program was 47.4% and the dropout rate was 46.4%. Significant predictors of poor therapy adherence were being male, high levels of depression and obsessive-compulsive symptoms, low anxiety levels, high persistence, high harm avoidance and low self-transcendence. CONCLUSION: Cognitive behavioral models show promise in treating CBB, however future interventions for CBB should be designed via a multidimensional approach in which patients' sex, comorbid symptom levels and the personality-trait profiles play a central role.

Modulation of Irisin and Physical Activity on Executive Functions in Obesity and Morbid obesity.

Whether the executive profile is different between obesity (OB) and morbid obesity (MO) remains unclear. Recent evidence suggests that physical activity (PA) can act as a cognitive enhancer. Irisin is a recently discovered hormone associated with some of the positive effects of PA. The objective of the study was to investigate the executive profile in OB and MO, and to explore the role of PA and irisin. 114 participants were included (21 OB, 44 MO and 49 healthy controls-HC) in the study and assessed with the Wisconsin Card Sorting Test, Stroop Color and Word Test, and Iowa Gambling Task. All participants were female, aged between 18 and 60 years. Results showed a similar dysfunctional profile on decision making in OB and MO compared with HC. Thus, no specific neuropsychological profiles between OB and MO can be clearly observed in our sample. However, a negative correlation was found between irisin and executive functioning. These results demonstrate a specific executive profile in OB and a relevant and negative modulation of irisin on executive functioning. Although irisin might be a promising target for the treatment of obesity, its effects on cognition might be considered when thinking about its therapeutic use.

Physical activity in anorexia nervosa: How relevant is it to therapy response?

OBJECTIVE: Elevated physical activity has been observed in some patients with anorexia nervosa (AN) despite their emaciated condition. However, its effects on treatment outcome remain unclear. This study aimed to examine objectively measured physical activity in this clinical population and how it might be related to a partial hospitalization therapy response, after considering potential confounders. METHOD: The sample comprised 88 AN patients consecutively enrolled in a day hospital treatment program, and 116 healthy-weight controls. All participants were female and a baseline assessment took place using an accelerometer (Actiwatch AW7) to measure physical activity, the Eating Disorders Inventory-2 and the Depression subscale of the Symptom Checklist-Revised. Outcome was evaluated upon the termination of the treatment program by expert clinicians. RESULTS: Although AN patients and controls did not differ in the average time spent in moderate-to-vigorous physical activity (MVPA) (P=.21), nor daytime physical activity (P=.34), fewer AN patients presented a high physical activity profile compared to the controls (37% vs. 61%, respectively; P=.014). Both lower levels of MVPA and greater eating disorder severity had a direct effect on a poor treatment outcome. Depression symptoms in the patients were associated with lower MVPA, as well as with an older age, a shorter duration of the disorder and greater eating disorder psychopathology. CONCLUSIONS: There is a notable variation in the physical activity profile of AN patients, characterized by either low or very high patterns. Physical activity is a highly relevant issue in AN that must be taken into account during the treatment process.

Clinical, Psychopathological, and Personality Characteristics Associated with ADHD among Individuals Seeking Treatment for Gambling Disorder.

OBJECTIVES: (1) To assess the current presence of ADHD symptoms among patients seeking treatment for gambling disorder; (2) to explore clinical and sociodemographic differences between patients who score high and low on the measure of ADHD symptoms; (3) to analyze whether the presence of ADHD symptoms is associated with more severe psychopathology and with specific personality traits; (4) to analyze the mediating role of ADHD symptoms in the relationship between novelty seeking and gambling severity. METHOD: A total of 354 consecutive patients were administered an extensive battery assessing gambling behavior, psychopathology, and personality traits. RESULTS: Male and female gamblers did not differ significantly in their mean scores on the ADHD measure. However, younger participants aged 18-35 scored higher. Higher ADHD scores were also associated with greater severity of gambling disorder and more general psychopathology. Regarding personality traits, high persistence and self-directedness were negatively related to ADHD scores, while in women alone a positive correlation was found between ADHD scores and scores on harm avoidance and self-transcendence. CONCLUSION: The presence of ADHD symptoms in both male and female gambling disorder patients may act as an indicator of the severity of gambling, general psychopathology, and dysfunctional personality traits.

Sex addiction and gambling disorder: similarities and differences.

OBJECTIVE: Recently, the DSM-5 has developed a new diagnostic category named "Substance-related and Addictive Disorders". This category includes gambling disorder (GD) as the sole behavioral addiction, but does not include sex addiction (SA). The aim of this study is to investigate whether SA should be classified more closely to other behavioral addictions, via a comparison of the personality characteristics and comorbid psychopathology of individuals with SA with those of individuals with GD, which comes under the category of addiction and related disorders. METHOD: The sample included 59 patients diagnosed with SA, who were compared to 2190 individuals diagnosed with GD and to 93 healthy controls. Assessment measures included the Diagnostic Questionnaire for Pathological Gambling, the South Oaks Gambling Screen, the Symptom CheckList-90 Items-Revised and the Temperament and Character Inventory-Revised. RESULTS: No statistically significant differences were found between the two clinical groups, except for socio-economic status. Although statistically significant differences were found between both clinical groups and controls for all scales on the SCL-90, no differences were found between the two clinical groups. The results were different for personality characteristics: logistic regression models showed that sex addictive behavior was predicted by a higher education level and by lower scores for TCI-R novelty-seeking, harm avoidance, persistence and self-transcendence. Being employed and lower scores in cooperativeness also tended to predict the presence of sex addiction. CONCLUSIONS: While SA and GD share some psychopathological and personality traits that are not present in healthy controls, there are also some diagnostic-specific characteristics that differentiate between the two clinical groups. These findings may help to increase our knowledge of phenotypes existing in behavioral addictions.

Late onset eating disorders in Spain: clinical characteristics and therapeutic implications.

OBJECTIVE: The literature on later age of onset (LAO) in women with eating disorders is scarce. We compared the severity of eating disorders, eating disorder subtype, and personality profiles in a clinical sample of consecutively assessed women with eating disorders with later age of onset (LAO, > = 25 years) to women with typical age of onset (TAO, <25 years). METHOD: All eating disorder patients met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria and were admitted to the Eating Disorder Unit of the University Hospital of Bellvitge in Barcelona, Spain. Ninety-six patients were classified as LAO and 759 as TAO. ASSESSMENT: Measures included the Eating Attitude Test-40 (EAT-40), Eating Disorders Inventory-2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist Revised (SCL-90-R), and the Temperament and Character Inventory-Revised (TCI-R), as well as other clinical and psychopathological indices. RESULTS: LAO individuals reported significantly fewer weekly vomiting episodes, fewer self-harming behaviours, less drug abuse, and lower scores on the BITE symptoms, the EDI-2 drive for thinness, and the TCI-R harm avoidance scales than TAO individuals. Conversely, the LAO group reported more current and premorbid obesity than the TAO group. CONCLUSION: LAO eating disorder patients in this sample presented with milder symptomatology and less extreme personality traits. Premorbid obesity may be more relevant to LAO than TAO eating disorders and should be routinely assessed and considered when planning treatment.

Eating-related environmental factors in underweight eating disorders and obesity: are there common vulnerabilities during childhood and early adolescence?

OBJECTIVE: This study aimed to examine whether there is an association between individual, social and family influences and dysfunctional eating patterns early in life and the likelihood of developing a subsequent underweight eating disorder (ED) or obesity. METHOD: The total sample comprised 152 individuals (underweight ED, n = 45; obese patients, n = 65; healthy controls; n = 42) from Barcelona, Spain. The Cross-Cultural Questionnaire (CCQ) was used to assess early eating influences as well as individual and family eating patterns and attitudes towards food. RESULTS: Even though a few shared eating influences emerged for both groups, unique factors were also observed. Whereas relationship with friends, teasing about eating habits by family members and the mass media were of specific relevance to the underweight ED group, the patient's own physical appearance, body dissatisfaction, teasing about eating habits by friends, teasing about body shape by family members and dysfunctional eating patterns were unique to obesity. CONCLUSIONS: Overlapping environmental risk factors provide evidence for integral prevention and intervention approaches that simultaneously tackle a range of weight-related problems. The unique factors might be important for targeting high-risk individuals.

[Bronchoplastic surgery: tumorectomy in principal left bronchial tube in a 5-month old child]. / Cirugía broncoplástica: tumorectomía en bronquio principal izquierdo en una niña de 5 meses.

INTRODUCTION: Resection of bronchial tumors usually needs resection of the lung parenchyma ventilated by the ill bronchus. Surgery over a developing child must preserve the biggest amount of lung parenchyma as possible. We show a complete resection of a benign tumor from the left main-stem bronchus, without pneumonectomy. MATERIALS AND METHODS: Case report RESULTS: A 5 month girl presented with left hypoventilation. No significant previous dates. After bronchoscopy (with negative biopsy), chest radiograph and CT, she was diagnosed of a tumor in the mainstem left bronchus (20 x 15 mm) without metastatic extension. A sleeve resection of the tumor, with carinal reconstruction was performed. It was done under unipulmonary ventilation, with selective bronchial intubation. The patient was extubated in the operating room and the hospital stay was of 5 days. Follow up bronchoscopies shows no anastomotic stricture neither leakage. The patient is doing well 2 years after surgery. CONCLUSIONS: With this report and others in literature we can say that is possible to resect bronchial tumors in infancy without parenchymal resections.

Cirugía broncoplástica: tumorectomía en bronquioprincipal izquierdo en una niña de 5 meses / Bronchoplastic surgery: tumorectomy in principal left bronchial tube in a 5-month old child 5-month old child

Introducción y objetivo. La extirpación de tumores bronquiales suele requerir la exéresis del prénquima ventilado por el bronquio afecto. En el niño en desarrollo debemos conservar la mayor cantidad posible a de parénquima pulmonar. Presentamos la resección completas in neumonectomía de un tumor en bronquio principal izquierdo que infiltraba la carina. Material y método. Caso clínico. Resultados. Niña de 5 meses que acude por hipoventilación izquierda. Sin antecedentes de interés. Tras exploración broncoscópica, con biopsias no diagnósticas, Rx y TAC se diagnostica de tumoración endo y exoluminal en bronquio principal izquierdo (20x15 mm) sin extensión metastásica. Se realiza extirpación quirúrgica en manguito, reconstruyendo la carina con una plastia deslizada (anastomosis broncobronco-traqueal). Se realiza la intervención bajo ventilación unipulmonar (intubación selectiva). Extubación en quirófano y alta en 5 días. Anatomíapatológica: tumor miofibroblástico inflamatorio. Los controles broncoscópicos posteriores no muestran estenosis ni dehiscencias enla anastomosis. La situación clínica de la paciente a los dos años de seguimiento es excelente. Conclusiones. Acompañando este caso con otros descritos en la literatura, podemos afi rmar que es posible la resección de tumores bronquiales, conservando el parénquima en niños (AU)

Introduction. Resection of bronchial tumors usually needs resection of the lung parenchyma ventilated by the ill bronchus. Surgery over ad eveloping child must preserve the biggest amount of lung parenchyma as possible. We show a complete resection of a benign tumor from the left main-stem bronchus, without pneumonectomy. Materials and methods. Case report Results. A 5 month girl presented with left hypoventilation. No significant previous dates. After bronchoscopy (with negative biopsy),chest radiograph and CT, she was diagnosed of a tumor in the main stem left bronchus (20x15 mm) without metastatic extension. A sleeve resection of the tumor, with carinal reconstruction was performed. It was done under unipulmonary ventilation, with selective bronchial intubation. The patient was extubated in the operating room and the hospital stay was of 5 days. Follow up bronchoscopies shows no anastomotic stricture neither leakage. The patient is doing well 2 years after surgery. Conclusions. With this report and others in literature we can say that is possible to resect bronchial tumors in infancy without parenchymal resections (AU)

Behavioral features of Williams Beuren syndrome compared to Fragile X syndrome and subjects with intellectual disability without defined etiology.

Williams-Beuren syndrome (WBS) is a genetically determined neurodevelopmental disorder caused by a heterozygous deletion of 26-28 genes on chromosome band 7q11.23. During the past few years, researchers and clinicians have significantly contributed to define the phenotype of the syndrome, including its cognitive and behavioral aspects. However, it is not well known yet whether the psychological problems are specific to the syndrome or secondary to the intellectual disability (ID). The aim of our study was to better define the psychopathological profile of WBS and whether or not it is related with IQ or anxiety symptoms. Twenty-five subjects (12 girls, 13 boys) with a diagnosis of WBS were compared to 27 boys with Fragile X Syndrome and to 24 boys with ID of non-specific etiology using the Child Behavior Checklist. Anxiety, depression and attention problems were the main behavioral problems found in WBS with no gender differences. Significant differences between cohorts were observed in somatic complaints, delinquent behavior, aggressive behavior, and externalizing problems. Some associations between IQ and anxiety items were found. The findings are discussed in terms of behavioral phenotypes, genetic implications and ID.

Specific eating disorder clusters based on social anxiety and novelty seeking.

While social avoidance and distress (SAD), a key aspect of social phobia related to behavioral inhibition, is high in different eating disorders (EDs), novelty seeking (NS) is mainly linked to bulimic disorders. Since heterogeneity in NS levels (low/high) exists in social phobia and in about 55% of ED with a highly disturbed personality, we examined ED types based on SAD and NS and their relationships to eating and comorbid features. Scores of 825 ED women on SAD and NS were submitted to cluster analysis. Five clinically differentiated ED clusters emerged: two without SAD (45%) and three with high SAD and low (13%), mid (34%), high NS (8%) levels. High vs. low SAD groups showed greater eating and social impairment, ineffectiveness, ascetism, suicide attempts, and lower education. Among SAD clusters, "SAD-low NS" had the lowest rate of binge eating, vomit, substance use, stealing and compulsive buying, whereas "SAD-high NS" presented the opposite pattern. However, no differences across SAD clusters were found with regard to ED diagnostic category distribution or history of treatment. Findings show that SAD-ED types present heterogeneity of NS and greater severity.

Subtyping eating disordered patients along drive for thinness and depression.

Subtyping individuals who binge eat by "diet-DT" and "depression" has yielded two valid and clinically useful subtypes that predict eating severity, comorbid psychopathology and outcome. The present study aimed to find four subtypes based on these dimensions and test their validity. Besides, it explored the distribution of eating disorder (ED) diagnoses across subtypes given their known heterogeneity, crossover and binge-eating fluctuation. Cluster analysis grouped 1005 consecutively admitted ED adult women into four subtypes, those previously described "DT" (22%), "DT-depressive" (29%), and "mild DT" (25%) and "depressive-moderate DT" (24%). Overall "mild DT" presented lower and "DT-depressive" greater eating and comorbid psychopathology than the rest, whereas "pure DT" and "depressive-moderate DT" presented no differences on bulimic symptoms but in psychopathology (p < .01). Finally, while BN-P patients were mostly and similarly distributed in the "DT" and "DT-depressive" subtypes than in the other, AN were in the new "mild DT" and "depressive-moderate DT" (p < .01). However, BN-NP, BED and EDNOS were similarly represented across subtypes. Results are discussed with regard to 1) the newly emerged subtypes that may explain cases in which DT prevents or does not predict binge eating; 2) the confluence of DT-depression that signaled greater eating and comorbid pathology, particularly self-control problems; 3) ED-DSM-diagnostic criteria.

Reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for pathological gambling.

The aim of this study was to measure the reliability, validity, and classification accuracy of a Spanish translation of a measure of DSM-IV diagnostic criteria for Pathological Gambling (PG). Participants were 263 male and 23 female patients seeking treatment for PG and a matched non-psychiatric control sample of 259 men and 24 women. A Spanish translation of a 19-item measure of DSM-IV diagnostic criteria for PG (Stinchfield 2003) was administered along with other validity measures. The DSM-IV diagnostic criteria were found to be internally consistent with a coefficient alpha of .95 in the combined sample. Evidence of satisfactory convergent validity included moderate to high correlations with other measures of problem gambling. Using the standard DSM-IV cut-score of five, the ten criteria were found to yield satisfactory classification accuracy results with a high hit rate (.95), high sensitivity (.92), high specificity (.99), low false positive (.01), and low false negative rate (.08). Lowering the cut score to four resulted in modest improvements in classification accuracy and reduced the false negative rate from .08 to .05. The Spanish translation of a measure of DSM-IV diagnostic criteria for PG demonstrated satisfactory psychometric properties and a cut score of four improved diagnostic precision.

[Temporal relationship between gastroesophageal reflux and cardiorespiratory events]. / Relación temporal entre el episodio cardiorrespiratorio y reflujo gastroesofágico.

UNLABELLED: The acid and non acidic gastroesophageal reflux can trigger apnoea, desaturation and bradicardia events, as well as chronic pulmonary pathology due to microaspirations, whereas the acute or chronic airway closing increase the intrathoracic pressure, triggering the reflux. Our aims were to measurement in preterms newborn the correlations between cardiorespiratory events and gastroesophageal reflux, find out the direction of this relation, identify the patients with association GER->CRE and decide the suitability of antireflux surgery. METHOD: The study was made in the Motility Unit and in the Intensive Neonatal Care Unit, to preterms newborns without associated pathology except apnoea and/or bradicardia and/or desaturation. MATERIAL: 3 hours manometry study in the Motility Unit. 24 hours impedance, pH and cardiorespiratory parameters monitoring (respiratory and cardiac frequent, O2 saturation and CO2) in Intensive Neonatal Care Unit. We characterised the gastroesophageal barrier, all the reflux events and the association between GER and CRE. RESULTS: We made 28 records to 28 patients with CRE. The average of the total number of reflux was 61 (22,25-103,00), 29,2% acid reflux and 70,8% weakly acidic. 12 patients had some GER associated with CRE but in only 2 cases was statistically significant (Sympton index: SI; Sympton Sensitivity Index: SSI) (SI > or = 50%; SSI > or = 10%). The surgical management was successfully in these two babies and nowadays they are asymptomatic. CONCLUSION: There is not any general association between GER and CRE, nevertheless, in a little percentage of patients, this relationship is fulfilled and it is possible to measurement with impedance, pH and cardiorespiratory parameters. In these cases, the surgical management is the right treatment.

Relación temporal entre el episodio cardiorrespiratorio y reflujo gastroesofágico / Temporal relaionship between gastroesophageal reflux and cardiorespiratory events

El reflujo gastroesofágico ácido y no-ácido puede desencadenar episodios de apnea, de desaturación y de bradicardia, así como patología pulmonar crónica debido a las microaspiraciones, mientras que el cierre agudo o crónico de las vías aéreas aumenta la presión intratorácica, favoreciendo el reflujo. Objetivos. Nuestros objetivos fueron comprobar en recién nacidos pretérminos (RNPT) con sintomatología cardiorrespiratoria, si ésta tiene relación con el episodio de reflujo y el sentido de la misma e identificarlos casos en los que ésta asociación se produzca, tratándolos médico-quirúrgicamente. Metodología. El estudio se realiza en la Unidad de motilidad Intestinal y Unidad de cuidados intensivos (UCI) neonatal, a RNPT sin patología asociada excepto apnea y/o bradicardia y/o desaturación. Material. Manometría + Impedanciometría (IM) durante 3 horas en la Unidad de Motilidad. IM+ pH+ monitorización cardiorrespiratoria(FR, FC, SO2 y ETCO2) durante 24h en la unidad de cuidados intensivos neonatal. Se determinaron las características manométricas de la barrera antirreflujo, identificación de todos los episodios de reflujo y relación episodio de reflujo-síntoma cardiorrespiratorio. Resultados. Realizamos 28 estudios en neonatos pretérminos con bradicardia, apneas y desaturaciones. La media del número total de reflujos fue de 61 (22,25-103,00), de los que el 29,2 % representan los reflujos ácidos y el 70,8 % restante son débilmente ácidos. En 12 de los 28estudios realizados se encontraron episodios cardiorrespiratorios asociados a reflujo gastroesofágico, aunque tan sólo en 2 se encontró una relación estadísticamente significativa entre ellos (Symptom index: SI; Symptom Sensitivity Index: SSI) (SI >= 50%; SSI >= 10%). En ambos casos los pacientes se han intervenido quirúrgicamente con éxito, sin volverá presentar los síntomas cardiorrespiratorios. Conclusiones. No existe asociación generalizada entre reflujo gastroesofágico y episodios cardiorrespiratorios, sin embargo, en una escaso porcentaje de pacientes, ésta relación se cumple y se puede tratar de manera justificada mediante el estudio con impedancia, pH y constantes respiratorias. En estos casos, la intervención quirúrgica precoz es el tratamiento de elección (AU)

The acid and non acidic gastroesophageal reflux can trigger apnoea, desaturation and bradicardia events, as well as chronic pulmonary pathology due to microaspirations, whereas the acute or chronic airway closing increase the intrathoracic pressure, triggering the reflux. Our aims were to measurement in preterms new born the correlations between cardiorespiratory events and gastroesophageal reflux, find out the direction of this relation, identify the patients with association GER->CRE and decide the suitability of antireflux surgery. Method. The study was made in the Motility Unit and in the Intensive Neonatal Care Unit, to preterms newborns without associated pathology except apnoea and/or bradicardia and/or desaturation. Material. 3 hours manometry study in the Motility Unit. 24 hours impedance, pH and cardiorespiratory parameters monitoring (respiratory and cardiac frequent, O2 saturation and CO2) in Intensive Neonatal Care Unit. We characterised the gastroesophageal barrier, all the reflux events and the association between GER and CRE. Results. We made 28 records to 28 patients with CRE. The average of the total number of reflux was 61(22,25-103,00), 29,2% acid reflux and 70,8% weakly acidic. 12 patients had some GER associated with CRE but in only 2 cases was statistically significant (Symptonindex: SI; Sympton Sensitivity Index: SSI) (SI >= 50%; SSI >= 10%).The surgical management was successfully in these two babies and nowadays they are asymptomatic. Conclusion. There is not any general association between GER and CRE, nevertheless, in a little percentage of patients, this relationship is fulfilled and it is possible to measurement with impedance, pH and cardiorespiratory parameters. In these cases, the surgical management is the right treatment (AU)

Enhancing global capacity in the surveillance, prevention, and control of chronic diseases: seven themes to consider and build upon.

BACKGROUND: Chronic diseases are now a major health problem in developing countries as well as in the developed world. Although chronic diseases cannot be communicated from person to person, their risk factors (for example, smoking, inactivity, dietary habits) are readily transferred around the world. With increasing human progress and technological advance, the pandemic of chronic diseases will become an even bigger threat to global health. METHODS: Based on our experiences and publications as well as review of the literature, we contribute ideas and working examples that might help enhance global capacity in the surveillance of chronic diseases and their prevention and control. Innovative ideas and solutions were actively sought. RESULTS: Ideas and working examples to help enhance global capacity were grouped under seven themes, concisely summarised by the acronym "SCIENCE": Strategy, Collaboration, Information, Education, Novelty, Communication and Evaluation. CONCLUSION: Building a basis for action using the seven themes articulated, especially by incorporating innovative ideas, we presented here, can help enhance global capacity in chronic disease surveillance, prevention and control. Informed initiatives can help achieve the new World Health Organization global goal of reducing chronic disease death rates by 2% annually, generate new ideas for effective interventions and ultimately bring global chronic diseases under greater control.

Motivation to change in eating disorders: clinical and therapeutic implications.

OBJECTIVES: The aim of this study was to understand the clinical impact of the motivational stage of change on the psychopathology and symptomatology of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). METHOD: The participants were 218 eating disorder (ED) patients (58 AN, 95 BN and 65 EDNOS), consecutively admitted to our hospital. All patients fulfilled DSM-IV criteria for these disorders. ASSESSMENT: Assessment measures included the Eating Disorders Inventory (EDI), Bulimic Investigation Test Edinburgh (BITE), Beck Depression Inventory (BDI), four analogue scales of motivational stage, as well as a number of other clinical and psychopathological indices. RESULTS: Our results indicated higher motivation for change in BN than in AN and EDNOS patients (p < 0.05). For all groups, motivation to change was predicted by chronological age (p < 0.05). However, a longer duration of illness was only predictive of the motivational levels in EDNOS (p < 0.05) patients. CONCLUSIONS: Compared to BN, AN and EDNOS patients are most resistant to change and the younger these patients are, the less likely they are to be motivated to change their disturbed eating behaviour.

Sexuality among 7th, 8th and 9th grade students in the state of Lara, Venezuela. The Global School Health Survey, 2003-2004

BACKGROUND: Effective sexual health promotion programs need to be based on evidence; this study describes a set of sexual behavioral patterns, education and other subjects related to sexual life among 71th, 8th and 9th grade students in the State of Lara, Venezuela. METHODS: During 2003 to 2004 school period, 2070 students filled out the Global School Health Survey (GSHS)--a school based cross-sectional self-administered survey that explores, among other areas, sexual behavior. RESULTS: Students who responded that ever had intercourse, males 27% and females 3.8%; by grade, males 18.2% (7th) and 37.6 % (9th), and females 1.9% (7th) and 6.2% (9th). The group who had intercourse, 54.9% males and 25.3% females had it by age 12; 59% males and 78.6% females were sexually active in the past 12 months; 59.2% males and 43.2% females used condom in the last intercourse; and 48.3% males and 21.5% females has 2 or more sexual partners in their life. A disparity is present in school-based information, >63% for AIDS and <32% for sexual abuse. CONCLUSIONS: This study shows that a substantial number of students had sexual intercourse initiation at early age (<12), history of multiple sexual partners and low prevalence of condom use. An unbalanced coverage of information on AIDS and sexual abuse is highly prevalent in the school. However, the implementation and evaluation of comprehensive programs on healthy sexual life must take into account that still a majority of students report abstinence from sexual intercourse.