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1.
PLoS One ; 15(8): e0237511, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785278

RESUMO

Eating disorder is highly associated with obesity and it is related to brain dysfunction as well. Still, the functional substrates of the brain associated with behavioral traits of eating disorder are underexplored. Existing neuroimaging studies have explored the association between eating disorder and brain function without using all the information provided by the eating disorder related questionnaire but by adopting summary factors. Here, we aimed to investigate the multivariate association between brain function and eating disorder at fine-grained question-level information. Our study is a retrospective secondary analysis that re-analyzed resting-state functional magnetic resonance imaging of 284 participants from the enhanced Nathan Kline Institute-Rockland Sample database. Leveraging sparse canonical correlation analysis, we associated the functional connectivity of all brain regions and all questions in the eating disorder questionnaires. We found that executive- and inhibitory control-related frontoparietal networks showed positive associations with questions of restraint eating, while brain regions involved in the reward system showed negative associations. Notably, inhibitory control-related brain regions showed a positive association with the degree of obesity. Findings were well replicated in the independent validation dataset (n = 34). The results of this study might contribute to a better understanding of brain function with respect to eating disorder.


Assuntos
Mapeamento Encefálico/métodos , Encéfalo/fisiopatologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Imagem por Ressonância Magnética/métodos , Neuroimagem/métodos , Adulto , Índice de Massa Corporal , Função Executiva , Comportamento Alimentar , Transtornos da Alimentação e da Ingestão de Alimentos/patologia , Feminino , Humanos , Masculino , Estudos Retrospectivos
2.
Cuad. psicol. deporte ; 20(3): 55-64, jul. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-193540

RESUMO

Binge-eating disorder (BED) is linked to several psychiatric disorders, such as anxiety disorders. Approximately 50-60% of BED patients are resistant to the traditional treatments available, and thus, strategies supporting the treatment of BED are needed, such as physical activity (PA). It seems to be an interesting strategy to reduce BED and anxiety symptoms. Thus, since PA has a role in reducing BED episodes and improving anxiety symptoms, then more research is needed to clarify the role of PA on BED, as correlations between anxiety-BED and anxiety-PA are established. Therefore, our aim is to examine the relationship between PA and anxiety in patients with BED. Thirty two patients we submitted to psychological and PA questionnaires. A Pearson's correlation coefficient and a multiple linear regression analysis were performed to relate eating disorder behaviour, anxiety and PA. The correlation coefficients between the dimensions of BED and anxiety were almost all significant (except restriction), positive and moderate (p < 0.001). Thus, the higher the eating disorder values, the higher the anxiety levels (p < 0.01). In conclusion, our findings support that PA correlates with anxiety in patients with BED, suggesting that PA may decrease symptoms, such as the appetite, weight and body shape concerns


El trastorno de compulsión alimentar periódico (TCAP) está vinculado a varios trastornos psiquiátricos, como los de ansiedad. Aproximadamente el 50-60% de los pacientes con TCAP son resistentes a los tratamientos tradicionales disponibles y, por lo tanto, se necesitan estrategias que apoyen el tratamiento de TCAP, como la actividad física (AF). La práctica de AF parece ser una estrategia interesante para reducir TCAP y síntomas de ansiedad. Por lo tanto, dado que la AF tiene un papel en la reducción de los episodios de TCAP y en la mejora de los síntomas de ansiedad, entonces se necesita más investigación para aclarar el rol moderador de la AF en la TCAP, ya que se establecen correlaciones entre ansiedad-TCAP y ansiedad-AF. Por lo tanto, el objetivo de este estudio fue examinar la asociación entre AF y ansiedad en pacientes con TCAP. Treinta y dos pacientes fueron sometidos a cuestionarios psicológicos y de AF. Se realizaron un coeficiente de correlación de Pearson y un análisis de regresión lineal múltiple para relacionar el comportamiento del TCAP, la ansiedad y la AF. Los coeficientes de correlación entre las dimensiones del TCAP y ansiedad fueron casi todos significativos (excepto restricción), positivos y moderados (p <0.001). Por lo tanto, cuanto más altos sean los valores del TCAP, mayores serán los niveles de ansiedad (p <0.01). En conclusión, nuestros hallazgos respaldan que la PA se correlaciona con la ansiedad en pacientes con BED, lo que sugiere que la PA puede disminuir los síntomas, como las preocupaciones sobre el apetito, el peso y la forma del cuerpo


O transtorno da compulsão alimentar periódica (TCE) está ligado a vários transtornos psiquiátricos, como os transtornos de ansiedade. Aproximadamente 50-60% dos pacientes com TCAP são resistentes aos tratamentos tradicionais disponíveis e, portanto, são necessárias estratégias de apoio ao tratamento, como a atividade física (AF). Parece ser uma estratégia interessante para reduzir os sintomas da TCAP e da ansiedade. Assim, como a AF tem um papel na redução de episódios de TCAP e melhora dos sintomas de ansiedade, são necessárias mais pesquisas para esclarecer o papel da AF na TCAP, à medida que são estabelecidas correlações entre ansiedade-TCLE e ansiedade-PA. Portanto, nosso objetivo é examinar a relação entre AF e ansiedade em pacientes com TCAP. Trinta e dois pacientes foram submetidos a questionários psicológicos e de AF. Um coeficiente de correlação de Pearson e uma análise de regressão linear múltipla foram realizadas para relacionar comportamento de transtorno alimentar, ansiedade e AF. Os coeficientes de correlação entre as dimensões do TCAP e ansiedade foram quase todos significativos (exceto restrição), positivos e moderados (p <0,001). Assim, quanto maiores os valores do transtorno alimentar, maiores os níveis de ansiedade (p <0,01). Em conclusão, nossos achados sustentam que a AF se correlaciona com a ansiedade em pacientes com TCAP, sugerindo que a AF pode diminuir os sintomas, como preocupações com apetite, peso e forma corporal


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Transtornos de Ansiedade/terapia , Transtornos de Ansiedade/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Inquéritos e Questionários , Análise de Regressão , Estudos Transversais
3.
Am J Clin Nutr ; 112(4): 941-947, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32534455

RESUMO

BACKGROUND: Eating disorders affect 13% of females and contribute to functional impairment and mortality, but few studies have identified risk factors that prospectively correlate with future onset of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD). Identifying risk factors specific to each eating disorder is critical for advancing etiologic knowledge and designing effective prevention programs. OBJECTIVES: This study examined whether weight suppression (the difference between a person's highest past weight at their adult height and their current weight) correlates with future onset of AN, BN, BED, and PD. METHODS: Data from 1165 young women with body image concerns (mean ± SD age: 21.9 ± 6.4 y) who completed annual diagnostic interviews over a 3-y follow-up period were examined. Logistic regression models evaluated the relation of baseline weight suppression to onset risk of each eating disorder controlling for age, dietary restraint, and intervention condition. RESULTS: Elevated weight suppression predicted future onset of AN (OR: 1.36; 95% CI: 1.03, 1.80), BN (OR: 1.34; 95% CI: 1.11, 1.62), PD (OR: 1.46; 95% CI: 1.23, 1.74), and any eating disorder (OR: 1.32; 95% CI: 1.12, 1.56), but not BED (OR: 1.10; 95% CI: 0.89, 1.37). Highest past weight correlated with future onset of BN and PD but not onset of AN, BED, or any eating disorder, and baseline current weight was inversely related to future AN onset only, implying that women with the largest difference between their highest past weight and current weight are at greatest risk of eating disorders. CONCLUSIONS: The results provide novel evidence that weight suppression correlates with future onset of eating disorders characterized by dietary restriction or compensatory weight control behaviors and suggest weight-suppressed women constitute an important risk group to target with selective prevention programs.These trials were registered at clinicaltrials.gov as NCT01126918 and NCT01949649.


Assuntos
Anorexia Nervosa/etiologia , Transtorno da Compulsão Alimentar/etiologia , Peso Corporal , Bulimia Nervosa/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Adulto , Imagem Corporal , Feminino , Humanos , Modelos Logísticos
4.
PLoS One ; 15(5): e0232979, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32407345

RESUMO

OBJECTIVES: This project examined risk factors of disordered eating in athletes by adapting and applying a theoretical model. It tested a previously proposed theoretical model and explored the utility of a newly formed model within an athletic population across gender, age, and sport type to explain disordered eating. DESIGN: The design was cross-sectional and the first phase in a series of longitudinal studies. METHODS: 1,017 athletes completed online questionnaires related to social pressures, internalisation, body dissatisfaction, negative affect, restriction, and bulimia. Structural equation modelling was employed to analyse the fit of the measurement and structural models and to do invariance testing. RESULTS: The original theoretical model failed to achieve acceptable goodness of fit (χ2 [70, 1017] = 1043.07; p < .0001. CFI = .55; GFI = .88; NFI = .53; RMSEA = .12 [90% CI = .111-.123]). Removal of non-significant pathways and addition of social media resulted in the model achieving a parsimonious goodness of fit (χ2 [19, 1017] = 77.58; p < .0001. CFI = .96; GFI = .98; NFI = .95; RMSEA = .055 [90% CI = .043-.068]). Invariance tests revealed that the newly revised model differed across gender, age, level, competition status, and length of sport participation. CONCLUSION: This study showed that the formation of disordered eating symptomology might not be associated with sport pressures experienced by athletes. It revealed that disordered eating development varies across gender, competition level, sport type, and age, which must be considered to prevent and treat disordered eating in athletes.


Assuntos
Atletas/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Adolescente , Adulto , Afeto , Imagem Corporal/psicologia , Bulimia/etiologia , Bulimia/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Modelos Psicológicos , Fatores de Risco , Fatores Sexuais , Mídias Sociais , Esportes/psicologia , Estresse Psicológico , Inquéritos e Questionários , Adulto Jovem
5.
Encephale ; 46(3S): S43-S52, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32370983

RESUMO

The psychological effects of isolation have already been described in the literature (polar expeditions, submarines, prison). Nevertheless, the scale of confinement implemented during the COVID-19 pandemic is unprecedented. In addition to reviewing the published studies, we need to anticipate the psychological problems that could arise during or at a distance from confinement. We have gone beyond the COVID-19 literature in order to examine the implications of the known consequences of confinement, like boredom, social isolation, stress, or sleep deprivation. Anxiety, post-traumatic stress disorder, depression, suicidal or addictive behaviours, domestic violence are described effects of confinement, but the mechanisms of emergence of these disorders and their interrelationships remain to be studied. For example, what are the mechanisms of emergence of post-traumatic stress disorders in the context of confinement? We also remind the reader of points of vigilance to be kept in mind with regard to eating disorders and hallucinations. Hallucinations are curiously ignored in the literature on confinement, whereas a vast literature links social isolation and hallucinations. Due to the broad psychopathological consequences, we have to look for these various symptoms to manage them. We quickly summarize the diagnostic and therapeutic approaches already in place, such as telemedicine, which is undergoing rapid development during the COVID-19 crisis.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Isolamento de Pacientes/psicologia , Pneumonia Viral , Isolamento Social/psicologia , Adulto , Transtornos de Ansiedade/etiologia , Transtornos de Ansiedade/psicologia , Comportamento Aditivo/etiologia , Comportamento Aditivo/psicologia , Tédio , Criança , Maus-Tratos Infantis , Infecções por Coronavirus/psicologia , Assistência à Saúde , Depressão/etiologia , Depressão/psicologia , Violência Doméstica/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , França , Alucinações/etiologia , Alucinações/psicologia , Acesso aos Serviços de Saúde , Humanos , Serviços de Saúde Mental/organização & administração , Pneumonia Viral/psicologia , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/psicologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Suicídio/psicologia , Telemedicina
6.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32350022

RESUMO

A 16-year-old girl presented to her primary care physician with a one-month history of decreased appetite and abdominal pain. She had normal bowel movements and no vomiting, but her periumbilical pain limited her ability to finish most meals. She had gradual weight loss over the previous 2 years, and during the previous 4 years, she intermittently received counseling for depression after the loss of her mother. Her initial physical examination and laboratory evaluation were unremarkable. She was referred to a nutritionist, adolescent medicine, and pediatric gastroenterology. Her presentation evolved over time, which ultimately led to a definitive diagnosis.


Assuntos
Dor Abdominal/diagnóstico , Apetite/fisiologia , Doença de Crohn/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Perda de Peso/fisiologia , Dor Abdominal/etiologia , Dor Abdominal/metabolismo , Adolescente , Doença de Crohn/complicações , Doença de Crohn/metabolismo , Diagnóstico Diferencial , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/metabolismo , Feminino , Humanos , Complexo Antígeno L1 Leucocitário/metabolismo
8.
Plast Reconstr Surg ; 145(4): 803e-813e, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221229

RESUMO

BACKGROUND: Macroglossia, a cardinal feature of the (epi)genetic disorder Beckwith-Wiedemann syndrome, is associated with obstructive sleep apnea, speech and/or feeding difficulties, and dental or jaw malalignment. These sequelae may be treated and/or prevented with tongue reduction surgery; the authors sought to determine whether certain Beckwith-Wiedemann syndrome patients may benefit from early surgical intervention before age 12 months. METHODS: The authors conducted a retrospective review of patients with Beckwith-Wiedemann syndrome who underwent tongue reduction from 2014 to 2019. The authors assessed primary outcomes of change in obstructive sleep apnea by polysomnography, respiratory support required, and feeding route before and after tongue reduction, and reviewed postoperative complications and the need for repeated tongue reduction. RESULTS: Of the 36 patients included, the median age at tongue reduction was 9.5 months (interquartile range, 3.8 to 22.8 months). For those with severe obstructive sleep apnea, there was a significant reduction in the obstructive apnea hypopnea index from 30.9 ± 21.8 per hour to 10.0 ± 18.3 per hour (p =0.019) and improvement in nadir oxyhemoglobin saturation from 72 ± 10 percent to 83 ± 6 percent (p =0.008). Although there was no significant change in overall supplemental feeding tube or respiratory support, there were specific patients who experienced clinically meaningful improvement. Of note, these positive outcomes applied equally to those who underwent surgery at a younger age (<12 months). To date, only one patient required a repeated tongue reduction. CONCLUSION: Based on improved polysomnographic findings and rarity of surgical complications or repeated surgery, the authors' data support the safety and efficacy of this early intervention when clinical indications are present and an experienced multidisciplinary team is available for consultation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Síndrome de Beckwith-Wiedemann/cirurgia , Glossectomia/métodos , Macroglossia/congênito , Complicações Pós-Operatórias/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Síndrome de Beckwith-Wiedemann/complicações , Síndrome de Beckwith-Wiedemann/genética , Pré-Escolar , Estudos de Viabilidade , Métodos de Alimentação/estatística & dados numéricos , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/prevenção & controle , Feminino , Seguimentos , Glossectomia/efeitos adversos , Humanos , Lactente , Macroglossia/complicações , Macroglossia/genética , Macroglossia/cirurgia , Masculino , Polissonografia/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Sistema de Registros/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologia , Distúrbios da Fala/etiologia , Distúrbios da Fala/prevenção & controle , Tempo para o Tratamento , Língua/cirurgia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(12): e19650, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195974

RESUMO

RATIONALE: Mutations of the NKX2-1 gene are associated with brain-lung-thyroid syndrome, which is characterized by benign hereditary chorea, hypothyroidism, and pulmonary disease with variable presentation. Surfactant protein C (SFTPC) gene mutations result in chronic interstitial lung disease in adults or severe neonatal respiratory distress syndrome. PATIENT CONCERNS: Recurrent hypoxemia was observed shortly after birth in a baby at a gestational age of 40 weeks and birth weight of 3150 g. The need for respiratory support gradually increased. He had hypothyroidism and experienced feeding difficulties and irritability. DIAGNOSIS: Genetic examination of the peripheral blood revealed combined mutations of the NKX2-1 and SFTPC genes. INTERVENTIONS: The patient was administered respiratory support, antibiotics, low-dose dexamethasone, supplementary thyroxine, venous nutrition, and other supportive measures. OUTCOMES: The patient's guardian stopped treatment 3 months after commencement of treatment, due to the seriousness of his condition and the patient died. LESSONS: Combined mutations of NKX2-1 and SFTPC genes are very rare. Thus, idiopathic interstitial pneumonia with hypothyroidism and neurological disorders require special attention.


Assuntos
Atetose/genética , Coreia/genética , Hipotireoidismo Congênito/genética , Proteína C/metabolismo , Surfactantes Pulmonares/metabolismo , Síndrome do Desconforto Respiratório do Recém-Nascido/genética , Fator Nuclear 1 de Tireoide/genética , Atetose/sangue , Atetose/diagnóstico , Atetose/terapia , Coreia/sangue , Coreia/diagnóstico , Coreia/terapia , Hipotireoidismo Congênito/sangue , Hipotireoidismo Congênito/diagnóstico , Hipotireoidismo Congênito/terapia , Evolução Fatal , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/etiologia , Hipóxia/diagnóstico , Hipóxia/etiologia , Recém-Nascido , Cariotipagem , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/etiologia , Masculino , Mutação , Cuidados Paliativos/métodos , Recidiva , Síndrome do Desconforto Respiratório do Recém-Nascido/sangue , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia
10.
BMC Cardiovasc Disord ; 20(1): 149, 2020 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-32213175

RESUMO

BACKGROUND: Cardiac myxoma (CM) is the most common type of primary cardiac tumors. The prevalence of primary cardiac tumors is 0.0017-0.28% in various autopsy studies. The clinical symptoms of CM which includes embolism, intracardiac obstruction, general or constitutional manifestations and infected myxoma are largely depended on the size, growing speed, location and pedicle length of the tumor. The following case reported a missed diagnostic case of a right atrial myxoma firstly presented digestive, systemic symptoms and immunologic disorder, leading to emergent tricuspid valves obstruction situation. CASE PRESENTATION: We reported a critical case of a 51-year-old female with CM was firstly admitted to the gastroenterology clinical department because of poor appetite, marked fatigability and weight loss for 2 months. The physician diagnosed her as chronic gastritis and treated her with some symptomatic treatment such as ilaprazole and magnesium aluminum carbonate. After months without definitive diagnosis, this right atrial myxoma grew into right ventricle and obstructed the tricuspid valves, causing her dyspnea, sweating, dizziness, feeling of impending death when she was sleeping. Transthoracic echocardiogram revealed a 6.1 × 4.2 × 3.7 cm2 mass adjacent to tricuspid valves. The patient underwent surgical excision and pathology revealed a primary cardiac myxoma. CONCLUSION: This case reported a critical result of missed diagnosis of right atrial myxoma and showed its systematic symptoms and immunologic disorder, highlighting the importance of systematic examinations on patients. Furthermore, it appeals early diagnosis of CM and consideration of drug targets to suppress CM development.


Assuntos
Fadiga/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Perda de Peso , Regulação do Apetite , Erros de Diagnóstico , Fadiga/fisiopatologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Feminino , Átrios do Coração , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Humanos , Pessoa de Meia-Idade , Mixoma/complicações , Mixoma/cirurgia , Valor Preditivo dos Testes , Resultado do Tratamento
11.
Am J Hum Genet ; 106(2): 246-255, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32004447

RESUMO

Ral (Ras-like) GTPases play an important role in the control of cell migration and have been implicated in Ras-mediated tumorigenicity. Recently, variants in RALA were also described as a cause of intellectual disability and developmental delay, indicating the relevance of this pathway to neuropediatric diseases. Here, we report the identification of bi-allelic variants in RALGAPA1 (encoding Ral GTPase activating protein catalytic alpha subunit 1) in four unrelated individuals with profound neurodevelopmental disability, muscular hypotonia, feeding abnormalities, recurrent fever episodes, and infantile spasms . Dysplasia of corpus callosum with focal thinning of the posterior part and characteristic facial features appeared to be unifying findings. RalGAPA1 was absent in the fibroblasts derived from two affected individuals suggesting a loss-of-function effect of the RALGAPA1 variants. Consequently, RalA activity was increased in these cell lines, which is in keeping with the idea that RalGAPA1 deficiency causes a constitutive activation of RalA. Additionally, levels of RalGAPB, a scaffolding subunit of the RalGAP complex, were dramatically reduced, indicating a dysfunctional RalGAP complex. Moreover, RalGAPA1 deficiency clearly increased cell-surface levels of lipid raft components in detached fibroblasts, which might indicate that anchorage-dependence of cell growth signaling is disturbed. Our findings indicate that the dysregulation of the RalA pathway has an important impact on neuronal function and brain development. In light of the partially overlapping phenotype between RALA- and RALGAPA1-associated diseases, it appears likely that dysregulation of the RalA signaling pathway leads to a distinct group of genetic syndromes that we suggest could be named RALopathies.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Proteínas Ativadoras de GTPase/genética , Hipotonia Muscular/etiologia , Mutação , Proteínas do Tecido Nervoso/genética , Transtornos do Neurodesenvolvimento/etiologia , Espasmos Infantis/etiologia , Alelos , Movimento Celular , Proliferação de Células , Pré-Escolar , Família , Transtornos da Alimentação e da Ingestão de Alimentos/patologia , Feminino , Humanos , Lactente , Masculino , Hipotonia Muscular/patologia , Transtornos do Neurodesenvolvimento/patologia , Fenótipo , Espasmos Infantis/patologia
12.
Dis Esophagus ; 33(1)2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31907526

RESUMO

Although eating problems have been described as long-term morbidities of esophageal atresia (EA), there have been few studies exploring eating outcomes in children born with EA as primary aim. Parents of children operated on for EA in our Institution from January 2012 to January 2016, answered a telephone structured interview developed specifically to conduct the present study, assessing eating skills at 3 years of age. Clinical data were collected from children's medical records. Parents (45 mothers and 6 fathers) of 51 children (male = 34; female = 17) with a median age of 3.5 years form the object of the study. Considering eating problems, parents reported that 23 children (45%) still have episodes of choking during meals at 3 years of age, 9 (45%) of these have more than one episode a week, and 19 parents (39%) reported higher levels of anxiety during mealtimes. Forty-four children (86%) were described by their parents as able to eat alone, 32 (65%) accepted all food textures and 45 (90%) was described as curious about food (3 years). Forty-three (86%) parents let their children eat with other people. Correlations showed that weaning age was significantly associated with number of dilatations (rs = 0.35, P = 0.012), days of mechanical ventilation (rs = 0.40, P < 0.001), and presence of gastrostomy tube at discharge (rs = 0.45, P < 0.001). Chewing age resulted associated with number of dilatations (rs = 0.34, P < 0.01) and days of mechanical ventilation (rs = 0.38, P < 0.01). Presence of choking episodes was associated with curiosity about food (rs = 0.29, P < 0.05), while frequent choking episodes were associated with higher parental anxiety during mealtimes (rs = 0.45, P < 0.05). In order to prevent delay in the achievement of eating developmental milestones in children operated on of EA, we advocate a dedicated preventive intervention from birth to follow-up.


Assuntos
Obstrução das Vias Respiratórias/epidemiologia , Atresia Esofágica/fisiopatologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Obstrução das Vias Respiratórias/etiologia , Pré-Escolar , Atresia Esofágica/complicações , Atresia Esofágica/terapia , Comportamento Alimentar/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Feminino , Humanos , Masculino , Mastigação/fisiologia , Pais , Inquéritos e Questionários
13.
Strahlenther Onkol ; 196(1): 48-57, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31418046

RESUMO

PURPOSE: Published results of quality of life (QoL) studies mostly concern whole brain radiotherapy for limited or multiple brain metastases. This prospective multicentre study was designed to compare the QoL of patients with limited (1-3) brain metastases treated with either whole brain (WBRT) or stereotactic radiotherapy (SRT). METHODS: From 01/2007-03/2011, 90 limited brain metastases patients who were previously untreated (n = 77) or had undergone primary surgery (n = 13) were recruited at 14 centres in Germany and Austria. QoL was measured with the EORTC-QLQ-C15-PAL and BN20 brain modules before the start of radiotherapy and after 3 months. RESULTS: Fifty-two patients (58%) received WBRT and 38 (42%) received SRT. At 3 months, 67 patients (74%) were still living, and 92.6% of the 3­month survivors completed the second set of questionnaires. Analysis of the QLQ-C15-PAL and BN20 scales revealed significant deterioration in patients treated with WBRT and SRT in physical function (p < 0.001 and p = 0.007), fatigue (p < 0.001 and p = 0.036), nausea (p = 0.003 and p = 0.002), appetite loss (p < 0.001 and p = 0.025), drowsiness (p < 0.001 and p = 0.011), hair loss (p = 0.019 and p = 0.023) and itchy skin (p = 0.030 and p = 0.018). Motor dysfunction (p < 0.001), communication deficits (p = 0.002) and leg weakness (p < 0.001) declined significantly only in patients treated with WBRT. Comparing the two radiotherapy techniques over time, the results showed significant differences in symptom scores for future uncertainty, fatigue and appetite loss. CONCLUSIONS: QoL data as an outcome of the paper should be considered in decision making on the irradiation technique in patients with small number of brain metastases. Larger studies are required to verify the results according to subgroups.


Assuntos
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Irradiação Craniana/efeitos adversos , Qualidade de Vida/psicologia , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Atividades Cotidianas/classificação , Alopecia/etiologia , Áustria , Neoplasias Encefálicas/psicologia , Transtornos da Comunicação/etiologia , Fadiga/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Seguimentos , Alemanha , Humanos , Debilidade Muscular/etiologia , Estudos Prospectivos
14.
Muscle Nerve ; 61(2): 230-234, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31650547

RESUMO

BACKGROUND: Loss of appetite has been reported to affect up to half of people with amyotrophic lateral sclerosis (ALS) and to be associated with weight loss. We wished to test whether loss of appetite correlates with reduced dietary intake independent of dysphagia. METHODS: Appetite was measured repeatedly using the Council on Nutrition Appetite Questionnaire (CNAQ) in participants in the Electronic health Application To Measure Outcomes REmotely study. Dietary intake and weight were compared to appetite, ALS Functional Rating Scale-Revised total and bulbar scores (dysphagia). RESULTS: The average baseline CNAQ score was 30.4 (n = 61; SD = 3.9) with 18.0% scoring <28 points (severe loss of appetite). Lower CNAQ scores correlated with greater weight loss since diagnosis (Pearson correlation coefficient, r = -0.34; P = 0.009) and lower baseline energy intake (P = 0.007), independent of dysphagia. CONCLUSIONS: Our results support an association between loss of appetite and decreased calorie intake and weight in ALS which is independent of dysphagia.


Assuntos
Esclerose Amiotrófica Lateral/complicações , Transtornos de Deglutição/complicações , Ingestão de Energia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Perda de Peso , Idoso , Dieta , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Inquéritos e Questionários
15.
J Pediatr Surg ; 55(1): 187-193, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31759653

RESUMO

BACKGROUND: We compared the cost-effectiveness of the common surgical strategies for the management of infants with feeding difficulty. METHODS: Infants with feeding difficulty undergoing gastrostomy alone (GT), GT and fundoplication, or gastrojejunostomy (GJ) tube were enrolled between 2/2017 and 2/2018. A validated GERD symptom severity questionnaire (GSQ) and visual analog scale (VAS) to assess quality of life (QOL) were administered at baseline, 1 month, and every 6 months. Data collected included demographics, resource utilization, diagnostic studies, and costs. VAS scores were converted to quality adjusted life months (QALMs), and costs per QALM were compared using a decision tree model. RESULTS: Fifty patients initially had a GT alone (71% laparoscopically), and one had a primary GJ. Median age was 4 months (IQR 3-8 months). Median follow-up was 11 months (IQR 5-13 months). Forty-three did well with GT alone. Six (12%) required conversion from GT to GJ tube, and one required a fundoplication. Of those with GT alone, six (14%) improved significantly so that their GT was removed after a mean of 7 ±â€¯3 months. Overall, the median GSQ score improved from 173 at baseline to 18 after 1 year (p < 0.001). VAS scores also improved from 70/100 at baseline to 85/100 at 1 year (p < 0.001). ED visits (59%), readmissions (47%), and clinic visits (88%) cost $58,091, $1,442,139, and $216,739, respectively. GJ tube had significantly higher costs for diagnostic testing compared to GT (median $8768 vs. $1007, p < 0.001). Conversion to GJ tube resulted in costs of $68,241 per QALM gained compared to GT only. CONCLUSIONS: Most patients improved with GT alone without needing GJ tube or fundoplication. GT and GJ tube were associated with improvement in symptoms and QOL. GJ tube patients reported greater gains in QALMS but incurred higher costs. Further analysis of willingness to pay for each additional QALM will help determine the value of care. STUDY AND LEVEL OF EVIDENCE: Cost-effectiveness study, Level II.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/economia , Transtornos da Alimentação e da Ingestão de Alimentos/cirurgia , Fundoplicatura/economia , Derivação Gástrica/economia , Refluxo Gastroesofágico/cirurgia , Gastrostomia/economia , Análise Custo-Benefício , Serviço Hospitalar de Emergência/economia , Nutrição Enteral/economia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Feminino , Seguimentos , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/economia , Humanos , Lactente , Intubação Gastrointestinal/economia , Masculino , Visita a Consultório Médico/economia , Readmissão do Paciente/economia , Qualidade de Vida , Reoperação , Estudos Retrospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários
16.
Sultan Qaboos Univ Med J ; 19(3): e257-e261, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31728226

RESUMO

Foregut cystic developmental malformations (FCDM) are a type of rare cystic lesion. The occurrence of FCDM is exceedingly uncommon in the intraoral location. We report three cases of FCDM with intraoral location who presented at Chacha Nehru Bal Chikitsalaya, New Delhi, India, in 2016, 2017 and 2018 with symptoms of respiratory distress and feeding difficulties. Two patients were male and one was female with an age range of 29 days to eight years. The clinical differential diagnosis included mucocele, ranula, dermoid, lymphangioma, teratoma, thyroglossal duct cyst, etc. All patients were treated with simple surgical excision and diagnosed, based on histopathology, with FCDM. These should be considered as differential diagnosis of head and neck midline cystic mass lesions. This case report aimed to discuss differential diagnosis and appropriate terminology for these cystic masses as there is varied and ambiguous nomenclature.


Assuntos
Otorrinolaringopatias/congênito , Cisto Tireoglosso/congênito , Criança , Pré-Escolar , Diagnóstico por Imagem , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Feminino , Humanos , Índia , Lactente , Masculino , Otorrinolaringopatias/fisiopatologia , Otorrinolaringopatias/cirurgia , /fisiopatologia , Cisto Tireoglosso/fisiopatologia , Cisto Tireoglosso/cirurgia , Resultado do Tratamento
17.
Sci Rep ; 9(1): 17373, 2019 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-31758009

RESUMO

Animal studies suggest that obesity-related diets induce structural changes in the hypothalamus, a key brain area involved in energy homeostasis. Whether this translates to humans is however largely unknown. Using a novel multimodal approach with manual segmentation, we here show that a higher body mass index (BMI) selectively predicted higher proton diffusivity within the hypothalamus, indicative of compromised microstructure in the underlying tissue, in a well-characterized population-based cohort (n1 = 338, 48% females, age 21-78 years, BMI 18-43 kg/m²). Results were independent from confounders and confirmed in another independent sample (n2 = 236). In addition, while hypothalamic volume was not associated with obesity, we identified a sexual dimorphism and larger hypothalamic volumes in the left compared to the right hemisphere. Using two large samples of the general population, we showed that a higher BMI specifically relates to altered microstructure in the hypothalamus, independent from confounders such as age, sex and obesity-associated co-morbidities. This points to persisting microstructural changes in a key regulatory area of energy homeostasis occurring with excessive weight. Our findings may help to better understand the pathomechanisms of obesity and other eating-related disorders.


Assuntos
Índice de Massa Corporal , Hipotálamo/diagnóstico por imagem , Hipotálamo/ultraestrutura , Obesidade/diagnóstico por imagem , Adulto , Idoso , Estudos de Coortes , Metabolismo Energético/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/metabolismo , Transtornos da Alimentação e da Ingestão de Alimentos/patologia , Feminino , Humanos , Hipotálamo/patologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Obesidade/complicações , Obesidade/patologia , Obesidade/psicologia , Tamanho do Órgão , Caracteres Sexuais , Adulto Jovem
18.
Behav Res Ther ; 123: 103501, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31733812

RESUMO

The adolescent developmental stage appears to be a sensitive period for the onset of several particular forms of mental disorder that are characterised by heightened emotionality and social sensitivity and are more common in females than males. We refer to these disorders (social anxiety disorder, generalised anxiety disorder, eating disorders, major depression) collectively as the social-emotional disorders. The aim of this paper is to address an important question in the understanding of social-emotional disorders - why do these disorders commonly begin during adolescence? We present a conceptual model that describes some of the key changes that occur during adolescence and that addresses some hypothesised ways in which these changes might increase risk for the development of social-emotional disorders. An overview of the extant empirical literature and some possible directions for future research are suggested. The model points to interesting links between psycho-social risk factors that should highlight potentially fruitful directions for both psychopathology research and early intervention programs.


Assuntos
Desenvolvimento do Adolescente , Transtornos de Ansiedade/etiologia , Transtorno Depressivo Maior/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Adolescente , Humanos , Modelos Psicológicos , Fatores de Risco
19.
Nutrients ; 11(10)2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31614777

RESUMO

(1) Background: Research on parental feeding practices and non-normative eating behavior including loss of control (LOC) eating and eating disorder psychopathology indicated separate associations of these variables with child weight status, especially in early childhood. This study cross-sectionally examined interaction effects of restriction, monitoring, pressure to eat, and children's weight status on disordered eating in children aged 8-13 years. (2) Methods: A population-based sample of N = 904 children and their mothers completed the Eating Disorder Examination Questionnaire for Children and the Child Feeding Questionnaire. Child anthropometrics were objectively measured. Hierarchical linear and logistic regression analyses were conducted for cross-sectionally predicting global eating disorder psychopathology and recurrent LOC eating by feeding practices and child weight status for younger (8-10 years) and older (11-13 years) ages. (3) Results: Restriction x Child weight status significantly predicted global eating disorder psychopathology in younger children and recurrent LOC eating in older children. Monitoring x Child weight status significantly predicted eating disorder psychopathology in older children. A higher versus lower child weight status was associated with adverse eating behaviors, particularly in children with mothers reporting high restriction and monitoring. (4) Conclusions: Detrimental associations between higher child weight status and child eating disorder symptomatology held especially true for children whose mothers strongly control child food intake.


Assuntos
Peso Corporal , Comportamento Infantil , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Pais , Adolescente , Criança , Coleta de Dados , Feminino , Humanos , Masculino , Relações Pais-Filho , Inquéritos e Questionários
20.
Expert Rev Neurother ; 19(12): 1265-1270, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31601136

RESUMO

Background: This study aims to investigate the current status of feeding intolerance (FI) among patients with severe neurological conditions and to further determine the correlation between FI and their poor prognosis.Methods: This study performed a retrospective analysis of the medical data of 58 patients from January 2017 to December 2017. Patients were divided into two groups according to modified Rankin Scale (mRS) scores. Logistic regression was used to analyze the relevant factors for the poor prognosis of these patients.Results: General data analysis showed that age and diagnosis(stroke) were significantly different between the two groups (P < 0.05). Univariate analysis showed that APACHE II score, vomiting within 3 days of NICU admission, gastrointestinal bleeding within 3 days of NICU admission and occurrence of FI within 3 days of NICU admission were all risk factors for a poor prognosis of these patients(P < 0.05). Multivariate logistic regression analysis showed that FI within 3 days of NICU admission(OR 8.026, 95%CI(1.550-26.039)) and diagnosis(stroke)(OR 10.654, 95%CI (1.746-21.291)) were independent factors for a poor prognosis of patients with severe neurological conditions.Conclusion: The incidence of early FI in stroke patients is correlated with a poor prognosis.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/diagnóstico , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico
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