Eating disorders and pregnancy: a review

OBJETIVO: Estudar o impacto dos transtornos alimentares nas funções reprodutivas, problemas na gestação e puerpério, e dificuldades com a alimentação dos filhos. MÉTODOS: Realizou-se revisão da literatura nos últimos 28 anos nos bancos de dados MedLine e Lilacs. Combinaram-se os descritores anorexia nervosa, bulimia nervosa, transtornos alimentares e gestação. RESULTADOS: Os estudos de revisão, estudos de caso e pesquisas realizadas com gestantes apontam uma associação entre TA e uma variedade de complicações na gestação, no parto, para o feto, com aumentado risco de morbidade perinatal, além de complicações na alimentação futura da criança. CONCLUSÕES: Observa-se uma maior necessidade de acompanhamento especializado, principalmente no pré-natal, em relação aos hábitos alimentares e preocupação com peso e forma corporais - especialmente nas mulheres que apresentam ganho ponderal inadequado, hiperêmese gravídica, picacismo, entre outros.OBJECTIVE: The objective of this study was to show the impact of eating disorders on reproductive functions, pregnancy and puerperium problems, and difficulties in feeding her babies. METHODS: Review of literature of last 28 years in MedLine and Lilacs database. The keywords used were anorexia nervosa, bulimia nervosa, eating disorders and pregnancy. RESULTS: Review and case studies, and research made with eating disorders pregnant patients demonstrate that there are an association between eating disorders and many pregnancy complications on birth, to the child with an increase risk of morbidity after the birth and some implications on food behavior of the child. CONCLUSIONS: It was noticed a need for specialized treatment, especially before the pregnancy, regarding eating habits and worries about weight and body shape, especially for women that present inadequate weight gain, hyperemesis gravidarum, pica and other eating problems

Media influence in female university students in all Brazilian regions

A mídia tem impacto na satisfação com a imagem corporal e risco para o desenvolvimento de transtornos alimentares. OBJETIVO: Avaliar a influência da mídia em universitárias e possíveis associações com idade, estado nutricional, renda e escolaridade do chefe da família. MÉTODOS: 2.489 estudantes do sexo feminino das cinco regiões do Brasil responderam à Sociocultural Attitudes Towards Appearance Scale (SATAQ-3). O escore na SATAQ foi comparado entre as regiões por meio de uma análise de variância. Uma análise de covariância foi utilizada para verificar a influência das variáveis estudadas no escore da SATAQ. Uma regressão logística foi realizada para verificar a interferência conjunta das variáveis em relação à influência da mídia. RESULTADOS: Não foram encontradas diferenças regionais na SATAQ total (p = 0,164) e subescalas Internalização atlética (p = 0,293) e Pressão (p = 0,150); houve diferença para as subescalas Internalização geral (p = 0,010) e Informação (p = 0,002). Idade, estado nutricional e renda influenciaram o resultado. CONCLUSÕES: O escore total na SATAQ foi similar entre as regiões, mas o Sul e o Nordeste apresentaram maiores pontuações para subescalas Internalização geral e Informação respectivamente. Estudantes com menos de 25 anos, com excesso de peso e maior renda foram em média mais influenciadas pela mídia.Media has been postulated to be a causal risk factor for body dissatisfaction and increases in eating disorder symptoms. OBJECTIVE: To evaluate the media influence on Brazilian undergraduate students and possible associations with age, nutritional status, income and education of family head. METHODS: 2.489 female students from five regions of Brazil answered the "Sociocultural Attitudes Towards Appearance Scale" (SATAQ-3) and its scores among regions were compared by means of a variance analysis. A covariance analysis was performed to evaluate the possible effect of studied variables in the scores. A logistic regression was done to evaluate association of variables with the media influence. RESULTS: There was no regional differences in SATAQ total score (p = 0.164), and subscales Internalization-athlete (p = 0.293) and Pressure (p = 0.150); there was difference for subscales Internalization-general (p = 0.010) e Information (p = 0.002). Age, nutritional status and income influenced the result. CONCLUSIONS: The SATAQ total score were similar among regions, but it was noticed that the South and Northeast regions of Brazil presented the highest scores at Internalization-general and Information subscales. Students under 25 years old, overweight and those with higher income were more influenced by media.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Lehramtsstudierende in Sachsen: Sonderauswertung im Rahmen der Dritten Sächsischen Studierendenbefragung

Ziel der großangelegten Onlinebefragung, bei welcher jede/r vierte sächsische Studierende befragt wurde, war die Erhebung der Studiensituation an sächsischen Hochschulen aus Sicht der Studierenden. Insbesondere durch die Umsetzung der Studienreform im Zuge des Bologna-Prozesses hat das Studium in Sachsen vielfältige Veränderungen erfahren. Eine systematische Bestandsaufnahme der Studiensituation und Studienqualität aus Sicht der Studierenden ist daher von hoher Wichtigkeit. Sie soll helfen, Stärken und Schwächen der Hochschulausbildung in Sachsen ausfindig zu machen und wichtige Informationen für die zukünftige Gestaltung der sächsischen Hochschullandschaft liefern. Dafür wurde bereits 2005 ein Erhebungsinstrument entwickelt und nunmehr aktualisiert, das auch auf die Erfahrungen des Konstanzer Studierendensurvey sowie der vom Hochschul-Informations-System (HIS) durchgeführten Studierendenbefragungen zurückgreift und somit Vergleichsmöglichkeiten offeriert. Die Studiensituation ist ein komplexes Konstrukt, welches sich aus mehreren Aspekten zusammensetzt. Der Fragebogen beinhaltet 10 Teilbereiche (u.a. zur Lehrqualität, persönlichen Belastungen oder Rahmenbedingungen des Studiums). Die Sonderauswertung Lehramt berücksichtigt dabei erstmalig ausführlich die Situation der Studierenden in den Lehramtsstudiengängen sächsischer Universitäten. Finanziert wurde diese Empirische Untersuchung durch das Sächsische Staatsministerium für Wissenschaft und Kunst

Selective eating: a nutritional approach

Selective eating is known by food refusal, lack of appetite and interest in food. It is atypical behavior of preschool, but when present in adverse family environments, can perpetuate and remain until adolescence. This paper is a case report of a patient with diagnosis of selective eating that seeks for specialized treatment center for eating disorders at 14 years old. The particularity of this case is the fast and good evolution, possibly due to the desire to treat himself and the support received by the family. The case points out the importance of identifying earlier and correctly cases of selectivity so they will be submitted as soon as possible to professionals specialized in treatment of eating disorders in different developmental stages of childhood and adolescence, resulting in a better prognosis framework.A seletividade alimentar é caracterizada por recusa alimentar, pouco apetite e desinteresse pelo alimento. É um comportamento típico da fase pré-escolar, mas, quando presente em ambientes familiares desfavoráveis, pode acentuar-se e permanecer até a adolescência. Este artigo trata de um relato de caso em que o paciente, com diagnóstico de seletividade alimentar, inicia tratamento em serviço especializado de transtornos alimentares aos 14 anos. A particularidade deste caso é a rápida e boa evolução do quadro, possivelmente decorrente do desejo próprio de se tratar e do apoio recebido pela família. A análise do caso em questão aponta para a importância de identificar os casos de seletividade de forma correta e precoce para que eles sejam encaminhados o quanto antes a profissionais habilitados no tratamento de distúrbios alimentares nos diferentes estágios de desenvolvimento da infância e adolescência, resultando em melhor prognóstico do quadro.Universidade Federal de São Paulo (UNIFESP) Departamento de Psiquiatria e Psicologia Médica Programa de Atenção aos Transtornos AlimentaresUNIFESP, Depto. de Psiquiatria e Psicologia Médica Programa de Atenção aos Transtornos AlimentaresSciEL

Teaching ultrasound in a curricular course according to certified EFSUMB standards during undergraduate medical education: a prospective study

Background: As a non-invasive and readily available diagnostic tool, ultrasound is one of the most important imaging techniques in medicine. Ultrasound is usually trained during residency preferable according to German Society of Ultrasound in Medicine (DEGUM) standards. Our curriculum calls for undergraduate training in ultrasound of medical students in their 4th year of undergraduate education. An explorative pilot study evaluated the acceptance of this teaching method, and compared it to other practical activities in medical education at Muenster University. Methods: 240 medical students in their 4th year of undergraduate medical education participated in the training and completed a pre- and post-questionnaire for self-assessment of technical knowledge, self-assurance of the procedure, and motivation in performing ultrasound using a Likert scale. Moreover, students were asked about their interest in pursuing a career in internal medicine. To compare this training to other educational activities a standardized online evaluation tool was used. A direct observation of procedural skills assessment (DOPS) for the first time applied on ultrasound aimed to independently assess the success of our teaching method. Results: There was a significant increase in technical knowledge and self-assurance (p < 0.001) of the students’ self-assessments. The clinical relevance and self-motivation of the teaching were evaluated positively. The students’ DOPS results demonstrated proficiency in the understanding of anatomic structures shown in ultrasonographic images, including terminology, machine settings, and transducer frequencies. Conclusions: Training ultrasound according to certified DEGUM standards was successful and should be offered in undergraduate medical education. The evaluation of the course affirmed the necessity, quality and clinical relevance of the course with a top ranking score of hands-on training courses within the educational activities of the Medical Faculty of Muenster.<br

Tratamento nutricional dos transtornos alimentares

Pacientes com transtornos alimentares possuem inadequações profundas no consumo, padrão e comportamento alimentar, além de diversas crenças equivocadas sobre alimentação, o que geralmente acarreta piora do estado nutricional. O tratamento nutricional visa a reverter tais alterações e promover hábitos alimentares saudáveis e melhor relação para com o alimento. Os objetivos e características do tratamento diferem para a anorexia nervosa e a bulimia nervosa, contudo, usualmente, a abordagem é dividida em duas fases: a educacional, cujas principais metas são a regularização do hábito alimentar e o aumento do conhecimento nutricional, e a experimental, que visa a propiciar maior reabilitação nutricional e mudanças mais profundas no comportamento alimentar. As evidências existentes sugerem que o tratamento nutricional promove a melhora de tais parâmetros, porém, alguns comportamentos alimentares, como a sensação de incompetência ao lidar com os alimentos, permanecem. Desta forma, mais estudos são necessários para que se possa de fato avaliar a eficácia da abordagem nutricional.Patients with eating disorders have disturbed food intake, food pattern, food behavior, and mistaken beliefs about food and nutrition, which can worsen nutritional status. The nutritional treatment aims to revert such alterations and to promote better food habits and relationship with food. The objectives and characteristics of the treatment are different for anorexia nervosa and bulimia nervosa, but usually the approach has two phases: the educational phase, whose major goals are regularization of food habits and increase of nutrition knowledge; and the experimental phase, whose targets are better nutritional rehabilitation and more complex improvements of nutritional behavior. Evidence suggests that nutritional treatment can ameliorate such parameters, but some inadequate food behaviors remain, such as feeling of incompetence while dealing with food. More studies are needed to evaluate the efficacy of the nutritional treatment

Efficacy and Toxicity of Different Chemotherapy Protocols for Concurrent Chemoradiation in Non-Small Cell Lung Cancer—A Secondary Analysis of the PET Plan Trial

(1) Background: The optimal chemotherapy (CHT) regimen for concurrent chemoradiation (cCRT) is not well defined. In this secondary analysis of the international randomized PET-Plan trial, we evaluate the efficacy of different CHT. (2) Methods: Patients with inoperable NSCLC were randomized at a 1:1 ratio regarding the target volume definition and received isotoxically dose-escalated cCRT using cisplatin 80 mg/m2 (day 1, 22) and vinorelbin 15 mg/m2 (day 1, 8, 22, 29) (P1) or cisplatin 20 mg/m2 (day 1–5, 29–33) and vinorelbin 12.5 mg/m2 (day 1, 8, 15, 29, 36, 43) (P2) or carboplatin AUC1 (day 1–5, 29–33) and vinorelbin 12.5 mg/m2 (day 1, 8, 15, 29, 36, 43) (P3) or other CHT at the treating physician’s discretion. (3) Results: Between 05/2009 and 11/2016, 205 patients were randomized and 172 included in the per-protocol analysis. Patients treated in P1 or P2 had a better overall survival (OS) compared to P3 (p = 0.015, p = 0.01, respectively). Patients treated with carboplatin had a worse OS compared to cisplatin (HR 1.78, p = 0.03), but the difference did not remain significant after adjusting for age, ECOG, cardiac function creatinine and completeness of CHT. (4) Conclusions: Carboplatin doublets show no significant difference compared to cisplatin, after adjusting for possibly relevant factors, probably due to existing selection bias

Sustained proliferation in cancer: mechanisms and novel therapeutic targets

Proliferation is an important part of cancer development and progression. This is manifest by altered expression and/or activity of cell cycle related proteins. Constitutive activation of many signal transduction pathways also stimulates cell growth. Early steps in tumor development are associated with a fibrogenic response and the development of a hypoxic environment which favors the survival and proliferation of cancer stem cells. Part of the survival strategy of cancer stem cells may manifested by alterations in cell metabolism. Once tumors appear, growth and metastasis may be supported by overproduction of appropriate hormones (in hormonally dependent cancers), by promoting angiogenesis, by undergoing epithelial to mesenchymal transition, by triggering autophagy, and by taking cues from surrounding stromal cells. A number of natural compounds (e.g., curcumin, resveratrol, indole-3-carbinol, brassinin, sulforaphane, epigallocatechin-3-gallate, genistein, ellagitannins, lycopene and quercetin) have been found to inhibit one or more pathways that contribute to proliferation (e.g., hypoxia inducible factor 1, nuclear factor kappa B, phosphoinositide 3 kinase/Akt, insulin-like growth factor receptor 1, Wnt, cell cycle associated proteins, as well as androgen and estrogen receptor signaling). These data, in combination with bioinformatics analyses, will be very important for identifying signaling pathways and molecular targets that may provide early diagnostic markers and/or critical targets for the development of new drugs or drug combinations that block tumor formation and progression

Bordetella evades the host immune system by inducing IL-10 through a type III effector, BopN

The inflammatory response is one of several host alert mechanisms that recruit neutrophils from the circulation to the area of infection. We demonstrate that Bordetella, a bacterial pathogen, exploits an antiinflammatory cytokine, interleukin-10 (IL-10), to evade the host immune system. We identified a Bordetella effector, BopN, that is translocated into the host cell via the type III secretion system, where it induces enhanced production of IL-10. Interestingly, the BopN effector translocates itself into the nucleus and is involved in the down-regulation of mitogen-activated protein kinases. Using pharmacological blockade, we demonstrated that BopN-induced IL-10 production is mediated, at least in part, by its ability to block the extracellular signal-regulated kinase pathway. We also showed that BopN blocks nuclear translocation of nuclear factor κB p65 (NF-κBp65) but, in contrast, promotes nuclear translocation of NF-κBp50. A BopN-deficient strain was unable to induce IL-10 production in mice, resulting in the elimination of bacteria via neutrophil infiltration into the pulmonary alveoli. Furthermore, IL-10–deficient mice effectively eliminated wild-type as well as BopN mutant bacteria. Thus, Bordetella exploits BopN as a stealth strategy to shut off the host inflammatory reaction. These results explain the ability of Bordetella species to avoid induction of the inflammatory response