The First Episode Rapid Early Intervention for Eating Disorders - Upscaled study: Clinical outcomes

BACKGROUND: First Episode Rapid Early Intervention for Eating Disorders (FREED) is a service model and care pathway for emerging adults aged 16 to 25‐years with a recent onset eating disorder (ED) of <3 years. A previous single‐site study suggests that FREED significantly improves clinical outcomes compared to treatment‐as‐usual (TAU). The present study (FREED‐Up) assessed the scalability of FREED. A multi‐centre quasi‐experimental pre‐post design was used, comparing patient outcomes before and after implementation of FREED in participating services. METHODS: FREED patients (n = 278) were consecutive, prospectively ascertained referrals to four specialist ED services in England, assessed at four time points over 12 months on ED symptoms, mood, service utilization and cost. FREED patients were compared to a TAU cohort (n = 224) of similar patients, identified retrospectively from electronic patient records in participating services. All were emerging adults aged 16–25 experiencing a first episode ED of <3 years duration. RESULTS: Overall, FREED patients made significant and rapid clinical improvements over time. 53.2% of FREED patients with anorexia nervosa reached a healthy weight at the 12‐month timepoint, compared to only 17.9% of TAU patients (X2 [1, N = 107] = 10.46, p < .001). Significantly fewer FREED patients required intensive (i.e., in‐patient or day‐patient) treatment (6.6%) compared to TAU patients (12.4%) across the follow‐up period (X2 [1, N = 40] = 4.36, p = .037). This contributed to a trend in cost savings in FREED compared to TAU (−£4472, p = .06, CI −£9168, £233). DISCUSSION: FREED is robust and scalable and is associated with substantial improvements in clinical outcomes, reduction in inpatient or day‐patient admissions, and cost‐savin

Insecure attachment style is associated with chronic widespread pain

Individuals with "insecure" adult attachment styles have been shown to experience more pain than people with secure attachment, though results of previous studies have been inconsistent. We performed a cross-sectional study on a large population-based sample to investigate whether, compared to pain free individuals, subjects with chronic widespread pain were more likely to report insecure adult attachment style. Subjects in a population-based cross-sectional study completed a self-rated assessment of adult attachment style. Attachment style was categorised as secure (i.e., normal attachment style); or preoccupied, dismissing or fearful (insecure attachment styles). Subjects completed a pain questionnaire from which three groups were identified: pain free; chronic widespread pain; and other pain. Subjects rated their pain intensity and pain-related disability on an 11 point Likert scale. Subjects (2509) returned a completed questionnaire (median age 49.9 years (IQR 41.2-50.0); 59.2% female). Subjects with CWP were more likely to report a preoccupied (RRR 2.6; 95%CI 1.8-3.7), dismissing (RRR 1.9; 95%CI 1.2-3.1) or fearful attachment style (RRR 1.4; 95%CI 1.1-1.8) than those free of pain. Among CWP subjects, insecure attachment style was associated with number of pain sites (Dismissing: RRR 2.8; 95%CI 1.2-2.3, Preoccupied: RRR=1.8, 95%CI 0.98-3.5) and degree of pain-related disability (Preoccupied: RRR=2.1, 95%CI 1.0-4.1), but not pain intensity. These findings suggest that treatment strategies based on knowledge of attachment style, possibly using support and education, may alleviate distress and disability in people at risk of, or affected by, chronic widespread pain

A procedurális emlékezet szerepe a testkép zavaraiban = The role of procedural memory in trouble of body picture

Az evészavarok egyik vezető betegségfenntartó tényezője a betegek torzult, diszfunkcionális kogníciója. Ezen belül is kiemelendők a táplálékfelvételi viselkedés zavaraival és a testélménnyel kapcsolatban lévő, a zavarok létrejöttében kulcsszerepet játszó kognitív disztorziók, melyek az információfeldolgozási folyamatokon belül elsősorban a perceptuális élményfeldolgozást érintik és evészavaros betegeknél a testkép speciális zavarában mutatkoznak meg. A kognitív információfeldolgozást a sémák irányítják, amelyekben a selfről való komplex tudás szerveződik. A sémák procedurális ismeretanyagot is hordoznak, úgy mint motoros készségeket, szokásokat, szabályokat, célképzeteket, döntéshozatali stratégiákat. Ezek alapján felmerül, hogy az evészavarokra jellemző viselkedéses rutincselekvések, mint például a diétázás, falásroham, önhánytatás a testkép sémáján belül procedurális élményanyagként kódolódhat és a munkamemóriában automatikusan a többi explicit tudással és emlékkel együtt aktiválódik. Elméleti áttekintésünkben ezeknek a prekognitív folyamatoknak keressük a helyét és szerepét az evészavaros betegekre jellemző kognitív információfeldolgozási jellegzetességek kialakításában

Recognition of Human Proinsulin Leader Sequence by Class I–Restricted T-Cells in HLA-A*0201 Transgenic Mice and in Human Type 1 Diabetes

OBJECTIVE— A restricted region of proinsulin located in the B chain and adjacent region of C-peptide has been shown to contain numerous candidate epitopes recognized by CD8+ T-cells. Our objective is to characterize HLA class I–restricted epitopes located within the preproinsulin leader sequence

Chemical and Microbiological Contamination in Limpet (Patella spp.) of the Portuguese Coast

Coastal production areas can be impacted by anthropogenic contamination from urban, agro-industrial and leisure activities. Some contaminants, such as chemical substances might also have a telluric origin. Non filter feeding univalve mollusks, such as limpets, which are collected in rocky shores either for sale or for auto-consumption, are very appreciated in Portugal, but have been excluded from provisions on the classification of production areas, although can present relevant contamination. Thus, the aim of this study was to assess the microbiological and toxic metal contaminations in limpets (Patella spp) of the Portuguese coast, taking into account the production area and seasonal variation, and comparing their contamination levels with those occurring in bivalve mollusk indicator species, mussel (Mytilus edulis). The risks associated to the consumption of limpet meals were also assessed. For that, microbial total and fecal levels and cadmium, lead and mercury contents in limpets and mussels samples from three coastal areas over several months were analyzed based on standard methodologies. Contents of mercury and lead in limpets from the three areas studied, were always below the limits of 0.50 mg kg-1 and 1.5 mg kg-1 allowed by the EU, respectively. Regarding cadmium, levels in limpet were always above the limit of 1.0 mg kg-1, reaching about 3.0 mg kg-1 in some samples. These values probably indicate contamination from telluric origin (soil or rocks) in the coastal studied areas. Results indicated that microbiological contamination of fecal origin was low and in general below the detection level. Contamination levels did not show a clear seasonal pattern. The two mollusk species, limpets and mussels, differed statistically in all contaminants analyzed, being cadmium the most of concern, and always higher in limpets than in mussel samples. Thus, the potential risk associated with limpet consumption, taking into account the cadmium tolerable weekly intake (TWI), was investigated, being possible to reach a reliable recommendation of less than a monthly meal of 160 g. As recreational picking of limpets is common in Portugal, official 4recommendations of maximum periodic human consumption should be published and enforcement increased in forbidden areasinfo:eu-repo/semantics/acceptedVersio

Restraint of appetite and reduced regional brain volumes in anorexia nervosa: a voxel-based morphometric study

<p>Abstract</p> <p>Background</p> <p>Previous Magnetic Resonance Imaging (MRI) studies of people with anorexia nervosa (AN) have shown differences in brain structure. This study aimed to provide preliminary extensions of this data by examining how different levels of appetitive restraint impact on brain volume.</p> <p>Methods</p> <p>Voxel based morphometry (VBM), corrected for total intracranial volume, age, BMI, years of education in 14 women with AN (8 RAN and 6 BPAN) and 21 women (HC) was performed. Correlations between brain volume and dietary restraint were done using Statistical Package for the Social Sciences (SPSS).</p> <p>Results</p> <p>Increased right dorsolateral prefrontal cortex (DLPFC) and reduced right anterior insular cortex, bilateral parahippocampal gyrus, left fusiform gyrus, left cerebellum and right posterior cingulate volumes in AN compared to HC. RAN compared to BPAN had reduced left orbitofrontal cortex, right anterior insular cortex, bilateral parahippocampal gyrus and left cerebellum. Age negatively correlated with right DLPFC volume in HC but not in AN; dietary restraint and BMI predicted 57% of variance in right DLPFC volume in AN.</p> <p>Conclusions</p> <p>In AN, brain volume differences were found in appetitive, somatosensory and top-down control brain regions. Differences in regional GMV may be linked to levels of appetitive restraint, but whether they are state or trait is unclear. Nevertheless, these discrete brain volume differences provide candidate brain regions for further structural and functional study in people with eating disorders.</p

Can Phlorotannins Purified Extracts Constitute a Novel Pharmacological Alternative for Microbial Infections with Associated Inflammatory Conditions?

Bacterial and fungal infections and the emerging multidrug resistance are driving interest in fighting these microorganisms with natural products, which have generally been considered complementary to pharmacological therapies. Phlorotannins are polyphenols restricted to brown seaweeds, recognized for their biological capacity. This study represents the first research on the antibacterial, antifungal, anti-inflammatory and antioxidant activity of phlorotannins purified extracts, which were obtained from ten dominant brown seaweeds of the occidental Portuguese coast