Chew and spit (CHSP) in bariatric patients : a case series

Background: Studies into the disordered eating behaviour of chew and spit have alluded to several cohorts more likely to engage in the behaviour, one such group being bariatric surgery candidates and patients. Weight-loss surgery candidates have received little to no attention regarding engaging in chew and spit behaviour. Changes in pre- and post- surgery eating pathology related to chew and spit behaviour has yet to be explored and described in academic literature. Case presentation: The current study reports on three cases of individual women, aged 30, 35, and 62 respectively, who indicated engagement in chew and spit. All three cases underwent bariatric surgery (two underwent gastric bypass, one underwent vertical sleeve gastrectomy). Eating pathology—including chew and spit behaviour, anxiety and depression, and adherence to the Norwegian nutritional guidelines were examined pre-operatively and post-operatively (one and two-year follow-up). At baseline (pre-surgery), two participants reported that they engaged in chew and spit, compared to one patient post-surgery. All three cases reported that they, to at least some extent, adhered to dietary guidelines post-surgery. Subjective bingeing frequency appeared to be relatively low for all three cases, further declining in frequency at one-year follow-up. At baseline, one participant reported clinically significant depression and anxiety, with no clinically significant depression or anxiety reported at follow-ups in participants that chew and spit. Conclusions: The current study provides a starting point for the exploration of chew and spit as a pathological symptom of disordered eating in bariatric patients. It highlights the need to further explore chew and spit before and after weight-loss surgery

The impact of level of documentation on the accessibility and affordability of new drugs in Norway

Introduction: Over the preceding decade, an increasing number of drugs have been approved by the European Medicines Agency (EMA) with limited knowledge of their relative efficacy. This is due to the utilization of non-randomized, single-arm studies, surrogate endpoints, and shorter follow-up time. The impact of this trend on the accessibility and affordability of newly approved drugs in Europe remains uncertain. The primary objective of this study is to provide insights into the issues of accessibility and affordability of new drugs in the Norwegian healthcare system.Method: The presented study entails an analysis of all reimbursement decisions for hospital drugs in Norway spanning 2021–2022. The included drugs were approved by the EMA between 2014 and 2022, with the majority (91%) receiving approval between 2018 and 2022. The drugs were categorized based on the level of documentation of relative efficacy. Approval rates and costs (confidential net-prices) were compared.Results: A total of 35% (70/199) of the reimbursement decisions were characterized by limited certainty regarding relative efficacy and as a consequence the Norwegian Health Technology Assessment (HTA) body did not present an incremental cost-effectiveness ratio (ICER) in the HTA report. Within this category, a lower percentage of drugs (47%) gained reimbursement approval compared to those with a higher certainty level, which were presented with an ICER (58%). On average, drugs with an established relative efficacy were accepted with a 4.4-fold higher cost (confidential net-prices). These trends persisted when specifically examining oncology drugs.Conclusion: Our study underscores that a substantial number of recently introduced drugs receive reimbursement regardless of the level of certainty concerning relative efficacy. However, the results suggest that payers prioritize documented over potential efficacy. Given that updated information on relative efficacy may emerge post-market access, a potential solution to address challenges related to accessibility and affordability in Europe could involve an increased adoption of market entry agreements. These agreements could allow for price adjustments after the presentation of new knowledge regarding relative efficacy, potentially resolving some of the current challenges

Investigating early semantic priming : Event-related potentials as a window into the organization of word meaning in children at age 24 months.

Background and Aim: Only at the onset of the second year are children able to form stable word-object associations and this point marks the beginning of a protracted period of semantic language development of which we know relatively little. The present event-related potential study aims to establish whether the language-related N400 component can be employed as an index of semantic priming in children at age 24 months. If so, the N400 component could potentially be of great value in investigations of the organization of word meaning at an early stage in language development. To address this issue an unimodal auditory semantic priming design was used. Method: The subjects were presented for word stimuli consisting of semantically related and unrelated prime-target word pairs. In the related condition basic level words were taken from the same superordinate category (e.g. cat-horse). In the unrelated condition prime and target belonged to different superordinate categories (e.g. apple-table). The EEG was recorded with 30 silver-silverchloride electrodes attached to an elastic electrode cap. Key result: Statistical analyses revealed a significant main effect of semantic relatedness in the 600-800 ms interval after stimulus onset, where unrelated words were more negative than related words. Conclusion: The results demonstrated that in 24-month-old children target words which were preceded by a semantically unrelated word elicited a broadly distributed N400-like effect compared to target words which were primed by a semantically related word, suggesting sensitivity to semantic relatedness in this age group. The establishment of an N400-like semantic priming effect in the present experiment indicates that priming studies can be used as a functional tool in investigations of word meaning in toddlers and provides an opportunity to investigate semantic memory at a very early stage in development

Cognitive Function and Weight Loss in Surgical Treatment of Severe Obesity - A Prospective Observational Study

Bariatric surgery is a common treatment option for severe obesity, leading to substantial weight loss and improvements in obesity-related disease. However, there is considerable variability in weight loss outcomes over time. Optimal weight loss is partly dependent on the patient´s ability to initiate and sustain a permanent lifestyle change; hence, the identification of psychological factors implicated in weight loss outcomes is important. An emergent literature suggests that cognitive function, as indicated by performance on neuropsychological tests, both contribute to and are influenced by postoperative weight loss. To date, important issues in this research area remain unclear. Prior prospective surgical studies have mostly investigated direct associations between cognitive function and postoperative weight loss, excluding eating behavior as a factor in this relationship. Further, as most prior prospective studies of postoperative memory function have used data derived from a limited pool of patients, and solely assessed verbal memory, key interpretations regarding the effect of bariatric surgery on memory function remain limited and unchallenged. The current thesis adds to this growing research field by extending prior findings on these two separate research questions. Specifically, Papers I and II focus on the role of executive function on eating behavior and weight loss, both prior to and following bariatric surgery. Paper III examines changes in postoperative memory function by including measurement modalities not covered in prior studies. All papers use data from the Oslo Bariatric Surgery Study Cognitive, a 2-year prospective observational research project investigating cognitive function in a sample of bariatric surgery patients treated at the Centre for Morbid Obesity and Bariatric Surgery at Oslo University Hospital. Paper I found that two core aspects of executive function, working memory and inhibitory control, predicted preoperative weight loss and dietary adherence, respectively. Paper II showed that inhibitory control, but not working memory, predicted 1-year postoperative weight loss. In addition, grazing was associated with weight loss, but did not mediate the relationship between inhibitory control and weight loss. Paper III found that verbal and visual memory performance was poorer one year following surgery, with a subsequent return to preoperative performance levels at the 2-year follow-up. This change was not predicted by weight loss or comorbidity. Overall, findings provide preliminary data that may inspire future investigations of preand postoperative executive function and mediating factors that contribute to weight loss success following bariatric surgery, as well as future studies of the potential consequences of reduced memory after surgery. Further, findings illuminate several factors that signal the need for extended postoperative support to optimize weight loss outcomes

Electrophysiological correlates of auditory semantic priming in 24-month-olds.

While the N400 component in adults is sensitive to both semantic incongruity and semantic relatedness between stimulus items, the N400 in toddlers has only been shown as an incongruity effect so far. The present event-related potential (ERP) study aimed to investigate whether the N400 in toddlers also indexes semantic relatedness between single words. To address this issue, we developed a unimodal auditory experiment with semantically related and unrelated word pairs, comparable to behavioral semantic priming tasks used with adults. In 24-month-old children, target words which were preceded by a semantically unrelated word elicited a broadly distributed N400-like effect compared to target words which were primed by a semantically related word. For related words, toddlers displayed a negativity in the 200–400ms interval, indicating facilitated lexical-phonological processing. Results of the present study suggest that the N400 in toddlers is functionally equivalent to the adult component in indexing relatedness as well as semantic incongruity between stimulus items. Moreover, the study demonstrates an instrument for investigating semantic relatedness priming in young children, for whom behavioral tasks are often inappropriate

Confirmatory factor analysis and psychometric properties of the Norwegian version of the Repetitive Eating Questionnaire: Further evidence for two distinct subtypes of grazing behaviour

Objective: The Repetitive Eating Questionnaire, Rep(eat)‐Q, is a 12‐item self‐report measure of compulsive and noncompulsive forms of grazing behaviour (i.e., eating modest amounts of food in a repetitive and unplanned manner). The aim was to validate the proposed two‐factor model of the Rep(eat)‐Q in a community sample. Method: A total of 190 university students (78% female) were administered the Rep(eat)‐Q along with other measures of eating behaviour. Mean age was 22.6 (SD = 4.2, 19–43) and mean body mass index (BMI; kg/m2) was 22.4 (SD = 2.9, 17–37). Results: Findings revealed good fit indexes for the two‐factor model by confirmatory factor analysis, supporting the original solution. Internal consistency was excellent for the total score and two subscales (range 0.86 to 0.91). Age and BMI did not correlate significantly with the Rep(eat)‐Q. Moderate to strong correlations (rsp ≥ 0.48 to 0.61) were found between the compulsive grazing subscale and eating‐related measures, whereas weaker correlations (rsp ≥ 0.37 to 0.45) were found between the repetitive eating subscale and eating‐related measures. Conclusions: This study confirmed the proposed factor structure of the Rep(eat)‐Q in a community sample, offering additional support to the conceptual distinction between compulsive (marked by loss of control) and repetitive (noncompulsive) subtypes of grazing behaviour

Brain responses to lexical-semantic priming in children at risk for dyslexia.

Deviances in early event-related potential (ERP) components reXecting auditory and phonological processing are well-documented in children at familial risk for dyslexia. However, little is known about brain responses which index processing in other linguistic domains such as lexicon, semantics and syntax in this group. The present study investigated eVects of lexical-semantic priming in 20- and 24- month-olds at-risk for dyslexia and typically developing controls in two ERP experiments. In both experiments an early component assumed to reXect facilitated lexical processing for primed words was enhanced in the at-risk group compared to the control group. Moreover, an N400-like response which was prominent in the control group was attenuated or absent in at-risk children. Results suggest that deficiencies in young children at-risk for dyslexia are not restricted to perceptual and lower-level phonological abilities, but also affect higher order linguistic skills such as lexical and semantic processing

Executive Function, Eating Behavior, and Preoperative Weight Loss in Bariatric Surgery Candidates: An Observational Study

Background: Individual differences in executive function may influence eating behavior, weight loss (WL), and WL maintenance in obesity treatment. Executive function, which designates top-down cognitive control processes, has been related to eating behaviors which may impact weight, and has been found to be predictive of WL in both behavioral WL programs and after bariatric surgery. Currently, we lack knowledge on the role of executive function in the period before bariatric surgery. If executive function impacts eating behavior and WL in the preoperative period, it may be a target for clinical attention in this stage. Objectives: We aimed to examine the relationship between objective performance-based measures of executive function, eating patterns, and WL in the preoperative period. Method: Baseline data in an ongoing observational longitudinal study of bariatric surgery patients were used. Eighty patients completed neuropsychological testing and self-report questionnaires 4 weeks prior to surgery. Results: We found that working memory predicted WL before surgery and inhibitory control predicted adherence to dietary recommendations. Conclusion: Our study indicates that executive function may play a role in short-term WL and dietary adherence prior to surgery, suggesting that executive function in the preoperative period deserves an extended research focus

Semantic organization of basic-level words in 20-month-olds: An ERP study

In ERP studies of adults, semantic incongruities elicit a, late negative response called the N400. Recently it was demonstrated that the amplitude of the N400 is sensitive to the organization of semantic categories in memory. The present study sought to investigate whether a similar incongruity response can be identified in children in their second year of life and whether this response is sensitive to category relationships at this early stage of lexical acquisition. In a picture-word mismatch paradigm with basic-level words, 20-month-olds displayed an N400-like incongruity effect. The incongruity response was earlier and larger for between-category violations than for within-category violations when each of the two violation types was compared to a control condition. This suggests that the N400 component is already sensitive to the semantic organization of the mental lexicon in toddlers, and may-serve as a useful tool in the study of phenomena in lexical development such as overextension. Some behavioral studies have suggested that toddler's overextensions of basic-level words result from oversized conceptual categories. This is at odds-with the present finding of incongruity responses even to within-category violations. (c) 2006 Elsevier Ltd. All rights reserved