Psychiatric disorders and symptom severity in referred versus non-referred overweight children and adolescents

Background: This study aimed firstly to investigate whether youngsters referred for overweight treatment differ from non-referred overweight youngsters on the prevalence of psychiatric disorders and psychological symptoms. Secondly, the potentially moderating role of age, gender, socio-economic status and degree of overweight in the association of referral status and mental disorder in overweight youth was explored. Methods: Participants were 155 overweight youngsters enrolled in an obesity treatment programme (mean age = 13.76; mean BMI  = 33.99) and 73 non-referred overweight youngsters (mean age = 13.74; mean BMI  = 27.35). The Structured Clinical Interview for DSM-IV-Childhood version and the Child version of the Eating Disorder Examination were administered and participants filled out the Children’s Depression Inventory, the Spence Children’s Anxiety Scale and the Youth Self Report. Parents were asked to complete the Child Behavior Checklist. Results: In the referred group 37.50% and in the non-referred group 23.29% of the participants met criteria for at least one mental disorder. In both groups, anxiety disorders were most prominent. Overall, a higher prevalence of mental disorders was found in the referred group. Referred youth displayed significantly more ‘full blown’ eating disorders and binge eating than non-referred youngsters and exhibited a significantly greater severity of self- and parent-reported internalizing symptoms. Referral was also associated with a significantly higher degree of overweight and significantly lower SES. After controlling for these pre-existing differences in degree of overweight and SES, only the greater severity of parent-reported internalizing symptoms in referred youth remained significant. Older age was generally predictive for the presence of mental disorders and in the non-referred group SES was positively associated with psychiatric disorder. Conclusions: A substantial proportion of overweight youngsters suffer from mental disorders. Referral status and age are associated with the presence of psychopathology. However, differences between referred and non-referred youngsters are not as pronounced as expected on the basis of earlier research in the field

Drop-out bij de behandeling van kinderen met overgewicht

Probleemstelling. De behandeling van overgewicht bij kinderen kampt met problemen zoals vroegtijdig stoppen. Deze pilootstudie exploreert de redenen die gezinnen zelf aangeven om een behandeling te stoppen, gebaseerd op het ‘Barrières tot Behandeling’ model van Kazdin en collega’s (1997) en onderliggende mechanismen voorgesteld door Garcia en Weisz (2002). Methode. Kind- en gezinskarakteristieken werden verzameld van 72 gezinnen die behandeling zochten voor een kind met overgewicht, 47 van hen vulden ook na afloop vragenlijsten in m.b.t. waargenomen barrières. Resultaten. Barrièrescores verschilden weinig tussen gezinnen die de behandeling afwerkten en gezinnen die uitvielen. Kinderen die vroegtijdig stopten, waren ouder, hadden meer overgewicht, en vertoonden meer gewichtsverlies. Deze gezinnen ervaarden de behandeling als minder noodzakelijk. Gezinnen met een lage SES raporteerden meer problemen van praktische aard die het volgen van een behandeling bemoeilijkten. Discussie. Hindernissen in de motivatie worden besproken. Verder betekent voor sommige jongeren het stopzetten van een behandeling niet noodzakelijk een falen van de therapie

Age and sex associate with outcome in older AML and high risk MDS patients treated with 10-day decitabine

Treatment choice according to the individual conditions remains challenging, particularly in older patients with acute myeloid leukemia (AML) and high risk myelodysplastic syndrome (MDS). The impact of performance status, comorbidities, and physical functioning on survival is not well defined for patients treated with hypomethylating agents. Here we describe the impact of performance status (14% ECOG performance status 2), comorbidity (40% HCT-comorbidity index ≥ 2), and physical functioning (41% short physical performance battery  76 years was significantly associated with reduced OS (HR 1.58; p = 0.043) and female sex was associated with superior OS (HR 0.62; p = 0.06). We further compared the genetic profiles of these subgroups. This revealed comparable mutational profiles in patients younger and older than 76 years, but, interestingly, revealed significantly more prevalent mutated ASXL1, STAG2, and U2AF1 in male compared to female patients. In this cohort of older patients treated with decitabine age and sex, but not comorbidities, physical functioning or cytogenetic risk were associated with overall survival

Inferior outcome of addition of the aminopeptidase inhibitor tosedostat to standard intensive treatment for elderly patients with aml and high risk mds

Treatment results of AML in elderly patients are unsatisfactory. We hypothesized that addition of tosedostat, an aminopeptidase inhibitor, to intensive chemotherapy may improve outcome in this population. After establishing a safe dose in a run-in phase of the study in 22 patients, 231 eligible patients with AML above 65 years of age (median 70, range 66–81) were randomly assigned in this open label randomized Phase II study to receive standard chemotherapy (3+7) with or without tosedostat at the selected daily dose of 120 mg (n = 116), days 1–21. In the second cycle, patients received cytarabine 1000 mg/m2 twice daily on days 1-6 with or without tosedostat. CR/CRi rates in the 2 arms were not significantly different (69% (95% C.I. 60–77%) vs 64% (55–73%), respectively). At 24 months, event-free survival (EFS) was 20% for the standard arm versus 12% for the tosedostat arm (Cox-p = 0.01) and overall survival (OS) 33% vs 18% respectively (p = 0.006). Infectious complications accounted for an increased early death rate in the tosedostat arm. Atrial fibrillation w