The impact of low-energy total diet replacement with behavioural support for remission of type 2 diabetes on disordered eating (ARIADNE): Protocol for a non-inferiority randomised controlled trial.

INTRODUCTION: The National Health Service (NHS) in England is currently piloting a weight loss programme for remission of newly diagnosed type 2 diabetes (T2D), where participants replace all food with low-energy nutritionally complete formula products for 12 weeks (total diet replacement, TDR) and receive behavioural support. In a clinical trial, this programme led to remission in nearly half the participants. However, this weight loss programme might also worsen disordered eating and prompt eating disorders in susceptible people. We aim to investigate if the TDR programme is non-inferior to standard care in terms of disordered eating in susceptible individuals. METHODS: Fifty six people with newly diagnosed T2D, BMI ≥ 27 kg/m2, and medium to high scores of disordered eating based on the Eating Disorders Examination questionnaire (EDE-Q) will be randomised 1:1 to TDR receiving remote weekly/bi-weekly dietetic support or standard care. Participants will be re-assessed remotely at 1, 3, 4, 6, and 12 months. The primary outcome will be the between-group difference in the score of the EDE-Q. If the sample size can be expanded to 150, we will reduce the non-inferiority boundary. Weight, glycated haemoglobin (HbA1c), impairment from disordered eating, and distress will be secondary outcomes. Using the recorded consultations, we will evaluate the process in observed changes in eating behaviour and disordered eating. CONCLUSIONS: If TDR for T2D remission is deemed non-inferior to standard care, more people may enrol and benefit from T2D remission. If TDR exacerbates disordered eating, screening may reduce unintended harm. TRIAL REGISTRATION: NCT05744232 (ClinicalTrials.gov, prospectively registered).

Optimization of a Neutron Long Counter Design by Monte Carlo Simulation.

In a search to optimize neutron long counter design for overall efficiency and flat energy response, Monte Carlo simulations were carried out for a variety of detector design parameters using the Monte Carlo N-Particle Extended code. Based on the standard long counter design by McTaggart, moderator diameter, moderator back length, and longitudinal hole diameter were sequentially varied, and the sensitivity of each parameter to the long counter response was systematically analyzed. For each design, simulations were done in the neutron energy range of 1 keV to 10 MeV. From the simulation results, it turned out that out of the three moderator parameters, the moderator diameter is most sensitive for optimizing the long counter response. As the last design parameter, the effect of the central slow-neutron counter was investigated, which showed a significant difference in the response. The investigation of each design parameter gave clear insight on its effect on the long counter response and enabled one to determine the optimum condition.

Coffee and depression in Korea: the fifth Korean National Health and Nutrition Examination Survey.

BACKGROUND/OBJECTIVES: There is substantial interest in the health effects of coffee because it is the leading worldwide beverage after water. Existing literature on the connection between depression and coffee is scarce, and studies have yielded inconsistent results. The aim of this study was to examine the association between coffee consumption and depression in the Korean population. SUBJECTS/METHODS: We conducted a cross-sectional study in 10,177 Korean individuals aged 20-97 years who participated in the fifth Korean National Health and Nutrition Examination Survey. Consumption of coffee and depression were assessed using a questionnaire. Multiple logistic regression analysis was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for depression. RESULTS: The lifetime prevalence of self-reported depression was 14.0% and that of self-reported clinical depression was 3.7%. After adjustment for potential confounders, the adjusted ORs for self-reported depression across coffee consumption categories were 1.00 (reference) for less than one cup/week, 0.84 (95% CI: 0.66, 1.07) for one to six cups/week, 0.63 (95% CI: 0.51, 0.79) for one cup/day, 0.69 (95% CI: 0.54, 0.88) for two cups/day and 0.58 (95% CI: 0.44, 0.76) for three or more cups/day (P for trend, <0.01). A similar association was observed for self-reported clinical depression, for which the multiple-adjusted ORs were 1.00 (reference) for less than one cup/week, 0.61 (95% CI: 0.40, 0.92) for one to six cups/week, 0.51 (95% CI: 0.34, 0.74) for one cup/day, 0.57 (95% CI: 0.39, 0.84) for two cups/day and 0.41 (95% CI: 0.24, 0.70) for three or more cups/day, respectively (P for trend, <0.01). CONCLUSIONS: These findings support a possible protective effect of coffee on the risk of depression.

Low transferrin saturation is associated with impaired fasting glucose and insulin resistance in the South Korean adults: the 2010 Korean National Health and Nutrition Examination Survey.

AIMS: The associations of transferrin saturation with diabetes have not been well evaluated and conflicting results have been reported. The purpose of this study is to examine the association of iron indices (serum ferritin and transferrin saturation) with risk of impaired fasting glucose and insulin resistance. METHODS: We conducted a cross-sectional study in 2413 individuals (1150 men and 1263 women) aged 20-50 years who participated in the 2010 Korean National Health and Nutrition Examination Survey. Participants were free of diabetes, malignancy, liver cirrhosis, chronic renal failure, anaemia, pregnancy and menopause. Fasting plasma glucose, insulin and the homeostasis model assessment of insulin resistance (HOMA-IR) were measured as the outcomes. RESULTS: Impaired fasting glucose was more prevalent in the highest compared with the lowest serum ferritin quartile among men (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.20-3.24) after adjustment for multiple covariates. Following the same adjustment, impaired fasting glucose was less prevalent in the highest compared with the lowest transferrin saturation quartile among men (OR, 0.45; 95% CI, 0.25-0.80) and women (OR, 0.33; 95% CI, 0.14-0.77). Moreover, a higher ferritin level was significantly associated with higher HOMA-IR after adjusting for confounders in men. Lower transferrin saturation was also significantly associated with higher insulin levels and HOMA-IR in both sexes. CONCLUSIONS: Lower transferrin saturations were associated with an increased risk of impaired fasting glucose and insulin resistance among general South Korean population.

Prevalence and risk factors of tinnitus: the Korean National Health and Nutrition Examination Survey 2010-2011, a cross-sectional study.

OBJECTIVES: The aim of this study was to examine the association between tinnitus and several potential risk factors in Korean population. DESIGN: A cross-sectional study. SETTING: Based on data from the fifth Korean National Health and Nutrition Examination Survey. PARTICIPANTS: The study included 10,061 Korean individuals. MAIN OUTCOME MEASURES: Tinnitus was assessed by using a questionnaire, and otorhinolaryngologic examination was conducted. Risk factors associated with tinnitus were evaluated using a multiple logistic regression analysis. RESULTS: Of the 10,061 participants ranging from 20 to 97 years old, the overall prevalence of any tinnitus was 21.4% and annoying tinnitus was 7.3%. In a multivariable logistic regression model, the following factors were associated with having tinnitus: occupational noise exposure [any tinnitus, odd ratio (OR) = 1.34; annoying tinnitus, OR = 1.47], non-occupational noise exposure (any tinnitus, OR = 1.48; annoying tinnitus, OR = 2.02), hearing impairment (any tinnitus, OR = 2.27; annoying tinnitus, OR = 3.61), chronic otitis media (any tinnitus, OR = 1.53; annoying tinnitus, OR = 1.36), chronic rhinosinusitis (any tinnitus, OR = 1.38; annoying tinnitus, OR = 1.38), temporomandibular disorder (any tinnitus, OR = 1.69; annoying tinnitus, OR = 1.90), depression (any tinnitus, OR = 1.44; annoying tinnitus, OR = 1.70), and higher stress level (any tinnitus, OR = 1.28; annoying tinnitus, OR = 1.76). CONCLUSIONS: These results suggest that tinnitus is common in Korea and may be associated with some avoidable risk factors.

Anticipatory postural activity of the deep trunk muscles differs between anatomical regions based on their mechanical advantage.

The functional differentiation between regions of psoas major (PM) and quadratus lumborum (QL) may underlie a mechanical basis for recruitment of motor units across the muscle. These mechanically unique fascicle regions of these complex multifascicular muscles, PM and QL, are likely to be controlled independently by the central nervous system (CNS). Fine-wire electrodes recorded the electromyographic activity of the PM fascicles arising from the transverse process (PM-t) and vertebral body (PM-v) and the anterior (QL-a) and posterior (QL-p) layers of QL on the right side during a postural perturbation associated with rapid arm movements. The findings of this study indicate that the CNS coordinates the activity of specific regions of PM and QL independently as a component of the anticipatory postural adjustments that precedes the predictable challenge to the spine associated with limb movements. The spatial and temporal features of discrete activity of different regions within PM and QL matched their differing mechanical advantage predicted from their anatomy. These findings suggest that the CNS differentially activates individual regions within complex spine muscles to control the three-dimensional forces applied to the spine. The data also point to a sophisticated control of muscle activation that appears based on mechanical advantage.

Managing anxiety in eating disorders with knitting.

OBJECTIVE: Recovery from anorexia nervosa (AN) is often confounded by intrusive, anxious preoccupations with control of eating, weight and shape. These are distressing and represent a potential barrier to psychological change. Theoretical and empirical evidence suggests that performing a concurrent visuospatial task reduces the emotional intensity of distressing images. We assessed whether the visuospatial task of knitting influences the anxious preoccupation experienced by inpatients with AN. METHOD: Prospective interventional cohort. SUBJECTS: Thirty-eight women with AN admitted to a specialized eating disorder unit. INTERVENTION: All subjects were given knitting lessons and free access to supplies. MEASURE: Subjects were asked to report the qualitative effects of knitting on their psychological state using a self-report questionnaire. RESULTS: Patients reported a subjective reduction in anxious preoccupation when knitting. In particular, 28/38 (74%) reported it lessened the intensity of their fears and thoughts and cleared their minds of eating disorder preoccupations, 28/38 (74%) reported it had a calming and therapeutic effect and 20/38 (53%) reported it provided satisfaction, pride and a sense of accomplishment. DISCUSSION: This preliminary data suggests that knitting may benefit inpatients with eating disorders by reducing their anxious preoccupations about eating, weight and shape control. The specificity of this effect is yet to be determined. This preliminary outcome requires further controlled study in AN subjects. From a clinical perspective, knitting is inexpensive, easily learned, can continue during social interaction, and can provide a sense of accomplishment. The theoretical and empirical rationale for this observation, and implications for deriving alternative strategies to augment treatment in AN, are discussed.

Self-devaluative dysphoric experience and the prediction of persistent first-episode major depressive disorder in adolescents.

BACKGROUND: The quality of subjective experience of dysphoria may predict persistence of depression, independently of severity. This is tested in a clinic sample of adolescents with first episode of major depression using the Depressed States Checklist adapted for adolescents. METHOD: Ninety-four adolescents with DSM-IV major depressive disorder (MDD) were followed up at 12 months. Self-devaluative components of dysphoric experience, ruminative style, over-general autobiographical memory, and self-reported and observer-rated measures of depression severity were assessed at presentation and evaluated as predictors of persistent MDD. RESULTS: Persistent MDD was predicted by the independent additive effects of the higher self-devaluative component of dysphoria, lower general intelligence and greater observer-rated severity of depression at presentation. Neither self-reported depression score, overgeneral memory retrieval nor ruminative style contributed. CONCLUSIONS: High levels of self-devaluative dysphoric experience increase the liability for persistence of first-episode MDD. Other affective-cognitive components also contribute. The adolescent version of the Depressed States Checklist is a useful brief measure of cognitive vulnerability for persistence in currently depressed young people.

Effects of induced rumination and distraction on mood and overgeneral autobiographical memory in adolescent Major Depressive Disorder and controls.

BACKGROUND: In adults there is evidence that the affective-cognitive processes of rumination and overgeneral autobiographical memory retrieval may play a part in maintaining depression. This study investigated the effects of induced rumination as compared to distraction on mood and categoric overgeneral memory in adolescents with first episode Major Depressive Disorder (MDD), and the specificity of any effects to MDD. METHOD: Three subject groups; adolescents with first episode MDD (N = 75), non-depressed psychiatric participants (N = 26) and community controls (N = 33) were recruited. An experimental design was used, with repeated measures of 'in the moment' depressed mood and categoric overgeneral memory before and after rumination and distraction, induced on separate occasions and counterbalanced in order across participants. RESULTS: In adolescents with MDD, induced rumination as compared to distraction differentially increased depressed mood. There were no significant differences in this effect between full current MDD participants and those in partial remission. This differential effect was also seen in community controls but was absent in non-MDD psychiatric participants. In addition, rumination as compared to distraction increased overgeneral memories to negative cues in MDD participants, but this increase was not significantly related to mood change, and was specific to MDD, being absent in non-MDD psychiatric and community control groups. CONCLUSIONS: Experimentally induced rumination as compared to distraction increases depressed mood and negative categoric memories in adolescents with first episode MDD. These results suggest that rumination has a deleterious effect on mood and memory retrieval processes in adolescents with first episode MDD. Increased negative overgeneral memories with rumination may be a process of particular importance for adolescents with MDD rather than psychiatric disorder in general. The findings imply that strategies to interrupt ruminative processes may be helpful in minimising persistence of first episode MDD in adolescence.

Children's representation of family mealtime in the context of maternal eating disorders.

BACKGROUND: Recent research provides evidence for specific disturbance in feeding and growth in children of mothers with eating disorders. AIM: To investigate the impact of maternal eating disorders during the post-natal year on the internal world of children, as expressed in children's representations of self and their mother in pretend mealtime play at 5 years of age. METHODS: Children of mothers with eating disorders (n = 33) and a comparison group (n = 24) were videotaped enacting a family mealtime in pretend play. Specific classes of children's play representations were coded blind to group membership. Univariate analyses compared the groups on representations of mother and self. Logistic regression explored factors predicting pretend play representations. RESULTS: Positive representations of the mother expressed as feeding, eating or body shape themes were more frequent in the index group. There were no other significant group differences in representations. In a logistic regression analysis, current maternal eating psychopathology was the principal predictor of these positive maternal representations. Marital criticism was associated with negative representations of the mother. CONCLUSIONS: These findings suggest that maternal eating disorders may influence the development of a child's internal world, such that they are more preoccupied with maternal eating concerns. However, more extensive research on larger samples is required to replicate these preliminary findings.

Categoric overgeneral autobiographical memory in adolescents with major depressive disorder.

BACKGROUND: Categoric, overgeneral autobiographical memory is more common in depressed adults than controls and predicts persistence of depression. This cross-sectional study investigated whether, compared with non-depressed psychiatric cases and community controls, first episode major depressive disorder (MDD) in adolescents is associated with categoric overgeneral memory retrieval. METHODS: Ninety-six clinically referred adolescents (aged 12-17 years) with MDD, 26 non-depressed psychiatric cases and a sample of 33 community controls were recruited. All subjects were assessed using the Kiddie-Schedule for Schizophrenia and Affective Disorders, and completed Williams' cued Autobiographical Memory Test and the Mood and Feelings Questionnaire. Hamilton Depression Rating Scales were completed with MDD subjects, as an index of depression severity. RESULTS: Adolescents with current first episode MDD retrieved more categoric overgeneral memories than controls, but not than non-depressed psychiatric cases. Adolescents in full remission from a recent episode of MDD retrieved more categoric memories to positive cues than controls. Categoric memory in MDD was related to observer-rated and self-reported severity, but not to the pattern of co-morbid diagnoses. There were negative correlations between IQ and categoric memories in both clinical cases and controls. A positive correlation between categoric memory to negative cues and self-reported depressive symptoms was found in clinical cases (but not controls). CONCLUSIONS: In adolescents, increased categoric overgeneral memory is associated with, but not specific to first episode MDD. Positive categoric memories are also increased in fully remitted MDD as compared to controls.

Pervasive developmental disorder and obstetric complications in children and adolescents with tuberous sclerosis.

Children with autism have an increased risk for obstetric complications but it is not known whether these are of primary aetiological significance. It is also unclear whether obstetric complications play a secondary role in shaping phenotypic expression in individuals at genetic risk for autism. We investigated this question by studying the role of obstetric complications in determining phenotypic manifestations in tuberous sclerosis, a single gene disorder frequently associated with autism spectrum disorders. Obstetric histories of 43 children with non-familial TS and 40 unaffected siblings were obtained using a structured parent interview. ADI-R, ADOS-G and IQ evaluations were undertaken. Children with TS experienced more obstetric complications than their unaffected siblings, but these were related to mild rather than severe adversities. No differences in obstetric complications were found in children with and without autism spectrum disorders and there was no positive correlation between obstetric adversities and severity of autism spectrum disorders or intellectual impairments.

Effects of cataract extraction with intraocular lens placement on scanning laser polarimetry of the peripapillary nerve fiber layer.

PURPOSE: To determine the effects of cataract extraction with intraocular lens placement on scanning laser polarimetry of the peripapillary nerve fiber layer. DESIGN: Cohort study. METHODS: Thirty-four eyes of 33 patients undergoing phacoemulsification cataract surgery with intraocular lens were imaged using the GDx Nerve Fiber Analyzer within 4 weeks before and at least 4 weeks after cataract surgery. Preoperative and postoperative mean images were compared. The effects of cataract severity and type, and intraocular lens material, were also examined. RESULTS: Comparison of preoperative and postoperative mean scanning laser polarimetry measurements revealed that eyes in which acrylic intraocular lenses (n = 11) were placed had a significant increase in scanning laser polarimetry for the total band circumference, and superior, inferior, and nasal quadrants (P < or =.041). Placement of silicone (n = 15) and polymethylmethacrylate (n = 8) intraocular lenses did not result in statistically significant changes in scanning laser polarimetry measurements. However, eight of 34 eyes (23.5%) had changes of 15% or more postoperatively in the total circumference measurement, including eyes with acrylic, silicone, and polymethylmethacrylate intraocular lenses. CONCLUSIONS: Cataract extraction with intraocular lens was associated with a statistically significant change in mean scanning laser polarimetry values in eyes that received an acrylic intraocular lens. In individual patients, clinically important changes (15% or greater) in scanning laser polarimetry measurements were not uncommon irrespective of intraocular lens type. New baseline scanning laser polarimetry measurements may be warranted in eyes that undergo cataract extraction with intraocular lens.

Possible role of cortisol and dehydroepiandrosterone in human development and psychopathology.

BACKGROUND: The characteristics of adrenal hormone secretion change markedly during infancy. Disturbances in basal levels may precipitate psychological dysfunction and are associated with psychopathology in young people. AIMS: To relate three aspects of behavioural endocrinology: developmental changes in cortisol and dehydroepiandrosterone (DHEA), the role of these hormones in the psychopathology of young people, and the action of these steroids in the brain. METHOD: A selective review from the human developmental, psychiatric and neurosciences literature. RESULTS: There are developmentally mediated changes in brain sensitivity following excess exposure to cortisol. This may result in impairments of mental and behavioural function. DHEA and gonadal steroids may modulate the actions of cortisol. CONCLUSIONS: Steroid hormones contribute to shaping behavioural function during early development and act as risk factors for psychopathology.

Psychosocial and endocrine features of chronic first-episode major depression in 8-16 year olds.

BACKGROUND: Psychoendocrine processes may have a role in explaining individual differences in the outcome of major depression in 8-16-year-old school children. METHODS: Salivary cortisol and dehydroepiandrosterone (DHEA) levels at 8:00 AM and 8:00 PM, life events, and comorbidity were assessed at presentation, 36, and 72 weeks in 47 (60%) of 78 clinically referred subjects with a first episode of major depression. Comparisons were made between chronic and nonchronic major depression. RESULTS: Chronic depression was characterized by being older, cortisol hypersecretion at 8:00 PM at all three assessments, increasing depression-dependent life events over the follow-up period, and comorbid obsessive-compulsive disorder (OCD) at presentation and at 36 weeks. Chronicity may be best predicted by increasing depression-dependent events over the 72-week period. Such events are more likely in cases with evening cortisol hypersecretion at entry and persistent OCD. Variations in DHEA levels were not associated with chronicity or increasing life events. CONCLUSIONS: During adolescence, but not childhood, the persistence of major depression may occur through an increase of risk for further and particular types of depression-dependent undesirable life events (personal disappointments and/or dangers to the self), that are more likely in those subjects with persisting cortisol hypersecretion and unresolved comorbid OCD.

"Mended or ended?" Football injuries and the British and American medical press, 1870-1910.

'Playing Hurt/Playing Tough', a dominant ideology in today's football (soccer, rugby, American 'gridiron'), is by no means new. Many books, monographs, and articles have examined the historical development of these games, but the attention given to them in the medical press during the late 1800s/early 1900s has been overlooked. The Lancet, Journal of the American Medical Association, and other turn-of-the-century medical publications regularly included accounts and descriptions of injuries and deaths. More telling were the many editorials in which physicians in both Britain and the United States expressed enthusiasm while also lamenting the games' physical and morale effects upon players, asking whether 'football' should be mended or ended.

Clinical guidelines for depressive disorders in childhood and adolescence.

Major depressive and dysthymic disorders are recurrent and sometimes persistent unipolar mood disorders, which often present in childhood and adolescence. Depressive episodes may increase in severity and duration with recurrence and are associated with substantial morbidity and risk of suicide. The role of child and adolescent mental health services in early intervention and management is thus of major importance. This paper draws together current research evidence and common clinical practice, in guidelines for the specialist management of depressive disorders in childhood and adolescence. Both psychotherapy and pharmacotherapy have been found to be beneficial for the acute treatment of children and adolescents with depressive disorders. Based on current evidence, psychotherapy may be the first treatment for most depressed youngsters, but antidepressants should be considered for those with severe depression. All patients need continuation therapy, and some will need maintenance treatment. Evidence supporting the efficacy of psychological and psychopharmacological treatments are reviewed. An integration of approaches is suggested as a guideline for treatment planning.

Visual field progression in patients with initially unilateral visual field loss from chronic open-angle glaucoma.

PURPOSE: To investigate visual field progression in patients with initially unilateral glaucomatous visual field loss, and to determine risk factors for progression. DESIGN: Retrospective observational case series. PARTICIPANTS: Forty-eight consecutive patients with primary open-angle glaucoma, pseudoexfoliative glaucoma, or pigmentary glaucoma, seen over an 18-month period, who initially had unilateral visual field loss as defined by use of modified Anderson criteria. Patients were followed with standard Humphrey perimetry for a minimum of 2 years. METHODS: Progression was defined by use of modified Anderson criteria, and Advanced Glaucoma Intervention Study (AGIS) and Collaborative Initial Glaucoma Treatment Study scores. MAIN OUTCOME MEASURE: Visual field progression. RESULTS: Three patients (6.2%) had fellow eye progression over a mean follow-up of 76 months and duration of disease of 8.7 years. Fellow eye progression correlated with progression of the first-affected eye (P = 0.044). Ten patients (21%) had progression of the first-affected eye; these eyes had a larger initial cup/disc ratio compared with stable eyes (P = 0.041). Increasing initial AGIS score was associated with progression (P: = 0.003). Kaplan-Meier survival analysis estimated the risk of progression at 5 years to be 25% in first-affected eyes and 7.2% in fellow eyes. CONCLUSIONS: In this population, the risk of fellow eye progression in patients with initially unilateral visual field loss from open-angle glaucoma is low. Progression is higher in eyes with visual field loss at initial testing, and the risk of progression increases as the level of initial visual field loss increases.

Results of a community-based low-literacy nutrition education program.

A nutrition intervention focused on low-fat eating pattern changes was conducted among low-literacy participants in a Twin Cities Metropolitan area Expanded Food and Nutrition Education Program (EFNEP). A total of 134 EFNEP participants who participated in the intervention were compared to 70 comparison participants who received EFNEP nutrition education materials. Associations between changes in outcome variables specific to the intervention were evaluated using mixed-model regression analyses. The principal effects seen for this program were related to changes in eating pattern scales. More modest effects were seen in scales related to attitudes of low-fat eating, and although changes in dietary fat intake as measured by 24-hour dietary interviews suggested a positive intervention effect, this did not approach statistical significance.