Children's Attention-Deficit/Hyperactivity Disorder Symptoms Predict Lower Diet Quality but Not Vice Versa:Results from Bidirectional Analyses in a Population-Based Cohort

BACKGROUND: As an adjuvant for medication, dietary changes focused on specific nutrients have been proposed to prevent or reduce attention-deficit/hyperactivity disorder (ADHD) symptoms. However, whether an overall healthy dietary pattern is associated with ADHD symptom severity during childhood remains unclear. Furthermore, it is not clear what the direction of this association is. OBJECTIVES: We aimed to examine the association between dietary patterns and ADHD symptoms in school-aged children. In addition, we aimed to identify the temporal direction of this association-that is, whether dietary patterns predict ADHD symptoms or vice versa. METHODS: We analyzed data from 3680 children participating in the Generation R Study, a prospective cohort in Rotterdam, Netherlands. ADHD symptoms were assessed with parent-report questionnaires at ages 6 and 10 y using the Child Behavior Checklist. Dietary intake was assessed at the age of 8 y with a validated food-frequency questionnaire. We computed a diet quality score reflecting adherence to dietary guidelines. We examined bidirectional associations of diet quality with ADHD symptom scores using multivariable linear regression analysis and cross-lagged modeling. RESULTS: Linear regressions showed that more ADHD symptoms at age 6 y were associated with a lower diet quality score at age 8 y (SD score = -0.08; 95% CI: -0.11, -0.05) but that diet quality at age 8 y was not associated with ADHD symptoms at age 10 y. Cross-lagged models confirmed a unidirectional relation from ADHD symptoms to diet quality but not vice versa. Associations did not differ by overweight status or between boys and girls. CONCLUSION: Our study suggests that children with more ADHD symptoms may be at higher risk of an unhealthy diet but that overall diet quality does not affect ADHD risk

Prevalence and Characterization of Avoidant Restrictive Food Intake Disorder in a Paediatric Population

Peer reviewedPublisher PD

Longitudinal association between preschool fussy eating and body composition at 6 years of age: The Generation R Study

Background: Children's fussy eating behavior has been related to both underweight and overweight in cross-sectional studies, but the direction of these associations and the relation with more detailed measures of body composition remains unclear. We aimed to examine whether fussy eating at age 4 years is longitudinally related to body mass index (BMI), fat mass index (FMI) and fat-free mass index (FFMI) at 6 years of age. Methods: This study was embedded in Generation R, a population-based, prospective cohort. Data were available for 4191 children. The Children's Eating Behaviour Questionnaire (CEBQ), administered at age 4 years, was used to derive a fussy eating profile. This profile is characterized by high scores on food avoidant scales and low scores on food approach scales. At age 6 years, height and weight were measured at our research center. Body fat and fat-free mass were measured using Dual-energy-X-ray absorptiometry. We used age- and sex-specific standard deviation scores (SDS) for all outcomes. Results: After adjustment for confounders, the fussy eating profile was related to lower BMI-SDS (B=-0.37, 95 % CI: -0.47;-0.26), lower FMI-SDS (B=-0.22, 95 % CI: -0.33;-0.12) and lower FFMI-SDS (B=-0.41, 95 % CI: -0.54;-0.29). When adjusting for baseline BMI at 4 years, the fussy eating profile predicted a 0.11 lower BMI-SDS at age 6 (95 % CI: -0.19;-0.04). This change in BMI was mainly due to a decrease in FFMI (B=-0.19, 95 % CI: -0.29;-0.09). Fussy eaters also had a higher risk of becoming underweight than non-fussy eaters (OR=2.28, 95 % CI: 1.34;3.87). Conclusions: Our findings suggest that young fussy eaters are at risk of having a lower fat free mass and of becoming underweight over a 2-year period. This implies that fussy eaters may benefit from careful monitoring to prevent an adverse growth development

Ectopic pregnancy: when is expectant management safe?

This study was conducted to evaluate expectant management in asymptomatic patients with an initial serum beta-hCG titer of <2,500 IU/l and to determine the independent ability of initial serum beta-hCG titers and trend of serum beta-hCG to predict successful expectant management. A cohort of patients (N = 418) with suspected ectopic pregnancy (EP) between January 1991 and July 2008 is described. Three groups were defined: group I (n = 182), immediate surgical intervention (<24 h); group IIa (n = 130), unsuccessful expectant management (surgical intervention during follow-up), and group IIb (n = 99), successful expectant management (spontaneous regression of trophoblast). Hospital protocol was not complied in 35 cases (Table 1). Beta-hCG levels >3,000 IU/l occur in our expectant management group; however, none of these cases were successful. Unnecessary surgery was prevented in 14% (n = 7) of asymptomatic patients with initial beta-hCG of >2,000 IU/l. The success rate of expectant management was 49%, without a rise in complication rate or number of acute cases. In conclusion, the initial serum beta-hCG cutoff level of 2,000 IU/l is not a rigid upper limit for accepting expectant management in suspected EP and best practice is case specific. In asymptomatic patients, the serum beta-hCG cutoff level of at least 2,500 IU/l can be used for expectant management. This cutoff could be higher, but interpretation is limited due to censure in follow-up inherent to the predefined clinical protocol. There is no gain in including patients for expectant management with initial serum beta-hCG level >3,000 IU/l

Associations of family feeding and mealtime practices with children's overall diet quality: Results from a prospective population-based cohort

Food parenting practices are considered to have a key influence on children's dietary habits, with potential long term effects. In this study, we explored the associations of parental feeding practices and family mealtime practices in early childhood with children's overall diet quality at school age among 3626 parents and their children in a population-based cohort study in Rotterdam, the Netherlands. Parental feeding practices (monitoring, pressure to eat, and restriction) and family mealtime practices (meal skipping behaviors and family meal frequency) at age 4 years were assessed by parental questionnaires. Children's dietary intake was assessed at age 8 years using a food-frequency questionnaire, from which diet quality scores (range 0–10) were calculated, reflecting adherence to age-specific dietary guidelines. Using multivariable linear regression models, we found that monitoring was associated with higher diet quality of children (β = 0.12; 95%CI: 0.08, 0.16), whereas pressure to eat was associated with lower diet quality (β = −0.08; 95%CI: −0.12, −0.04)), both independent of child BMI. Restriction was associated with a higher child diet quality, but this associati

Diagnostic hysteroscopy and saline infusion sonography in the diagnosis of intrauterine abnormalities: an assessment of patient preference

This study was conducted to assess whether women would prefer to undergo saline infusion sonography (SIS) or office hysteroscopy for the investigation of the uterine cavity. In a randomised controlled trial, 100 patients underwent SIS or office hysteroscopy for assessing patients' pain scores. After the investigation, 92 of them were asked to fill out an anonymous questionnaire addressing their preference regarding the method of evaluation and treatment of the uterine cavity. A control group, consisting of 50 women who never underwent SIS or office hysteroscopy, was also asked to complete an identical questionnaire. The questionnaire was completed by 113 women (83.7%). Twenty-four (21.2%) women would opt for SIS, whereas 52 (46.0%) would opt for office hysteroscopy, and 37 (32.7%) had no preference. If therapy would be necessary, 48.7% of the women would opt for an outpatient treatment, whereas 33.0% of the women would prefer treatment under general anaesthesia. Despite the fact that SIS is less painful, the majority of the women prefer office hysteroscopy. Additionally, therapy in an outpatient setting is preferred to a day case setting

Diet quality in early and mid-childhood in relation to trajectories of growth and body composition.

Background: A balanced diet in childhood is important for growth and development. We aimed to examine associations of overall diet quality in both early and mid-childhood with trajectories of growth and body composition until age 10 years. Methods: We included 3991 children from the Generation R Study, a population-based, prospective cohort in Rotterdam, the Netherlands. At child's ages of 1 and 8 years, dietary intake was assessed using food-frequency questionnaires to calculate diet quality scores (0e10), which measure adherence to agespecific dietary guidelines. Height and weight were measured repeatedly between ages 1 and 10 years. Body composition was assessed using dual-energy X-ray absorptiometry at ages 6 and 10 years. We calculated sex- and age-specific SD-scores for body mass index (BMI), fat mass index (FMI), fat-free mass index (FFMI), and body fat percentage (BF%). Results: After adjustment for socioeconomic and lifestyle factors, results from linear mixed models showed that higher diet quality at 1 year was associated with higher height, weight, and BMI up to age 10 years. Using linear regression analyses, similar associations were observed for diet quality at 8 years. For diet quality at both time points, positive associations with BMI were fully driven by a higher FFMI (b

Exploring new Saccharomyces cerevisiae strains suitable for the production of cellulosic bioethanol

Thesis (PhD)--Stellenbosch University, 2019.ENGLISH ABSTRACT: Natural Saccharomyces cerevisiae strains display an enhanced robustness that is associated with the environment they occupy. This robustness is expressed through complex biological networks and provides the organism with the ability to maintain cell viability during adverse environmental conditions. In this study, the natural diversity of S. cerevisiae was exploited to obtain strains with phenotypic characteristics beneficial for second-generation bioethanol production. Artificial hybridisation was employed to increase the genetic, and thus the phenotypic diversity of these strains, whereafter transcriptomics were utilised to elucidate the molecular mechanisms that allow adaptation to an increase in temperature and survival in an environment containing inhibitory compounds that are associated with the degradation of cellulosic feedstock. Our results indicated that there is an association between strain diversity, the environment and the geographic location, whilst, individual strains display phenotypes. The Cape West Coastal region was associated with inhibitor-resistant strains, whereas the Breede River valley was characterised by inhibitor-sensitive strains. Strains that displayed an increased fermentation capacity were associated with the Cape South Coast. Several strains with tolerant phenotypes i.e. the ability to grow and/or ferment under a range of environmental conditions, were identified, including a multi-tolerant strain, YI13, with growth tolerance against ethanol (15 % v/v), inhibitors (15 %) and increased temperature (45 °C). Two inhibitor tolerant (25 %) strains, HR4 and YI30, displayed improved fermentation capacity (0.22 and 0.35 g/L/h) during aerobic and anaerobic conditions, respectively. Artificial hybridisation generates genetic diversity that affects the phenotype of the organism and was applied to produce progeny strains. Several of these strains displayed inhibitor tolerance heterosis, whereas pH and salt tolerance decreased relative to the parental strains. In addition, unique phenotypes were generated, with strain HR4/YI30#6 displaying growth at 2 M NaCl and in 20 % ethanol. A single multi-tolerant strain, V3/YI30#6, with unique (2 M NaCl and 45 °C tolerance) and general (25 % inhibitor tolerance) traits was obtained. However, the fermentation capacity of this strain was decreased to a theoretical ethanol yield of 60 % compared to ~80 % for the parental strains. This indicates that although hybridisation produces heterosis and novel phenotypes, there is a limit to the degree of phenotypic diversity that can be obtained in a single strain. This may be due to the high energy demand (due to the increase in metabolic flux of certain biological processes) during the various stress responses, whilst maintaining cell viability. The molecular mechanisms for inhibitor and temperature tolerance of two natural strains were subsequently investigated. In addition to several biological processes, an upregulation of amino acid biosynthesis and ribosome biogenesis was observed in the temperature tolerant strain, YI13. This was possibly in response to irreversible protein damage inflicted by reactive oxygen species generated in response to an increase in temperature. The main contributor to inhibitor tolerance in strain YI30 was the activation of the oxidative stress response. This is probably due to the increased oxidoreductase activity required for the detoxification of the inhibitory compounds. Activation of the traditional heat shock response did not play a major role in combating temperature stress, however, an upregulation in this stress response was observed in reaction to inhibitor stress. This study indicates that the natural diversity of S. cerevisiae yields unique strains and that phenotype diversity can be enhanced through hybridisation. In addition, S. cerevisiae strains display similar mechanisms in response to environmental stress. However, the specific molecular mechanisms that allow robustness and the degree to which these stress responses are activated, are strain dependent. A single strain will not be able to display all the required characteristics for a particular process, therefore a compromise will have to be made where the characteristics of the host organism and the specific application are considered, including genetic engineering of yeast strains.AFRIKAANSE OPSOMMING: Natuurlike Saccharomyces cerevisiae stamme toon 'n verhoogde robuustheid wat verband hou met die omgewing wat dit beset. Die robuustheid word deur komplekse biologiese netwerke uitgedruk en bied die organisme die vermoë om sellewensvatbaarheid tydens ongewenste omgewingsomstandighede te handhaaf. In hierdie studie is die natuurlike diversiteit van S. cerevisiae-stamme uitgebuit om stamme met fenotipiese eienskappe te verkry wat voordelig vir die produksie van tweede generasie bio-etanol is. Kunsmatige hibridisering is gebruik om die genetiese en dus fenotipiese diversiteit te verhoog, waarna 'n transkriptomiese benadering gebruik is om die molekulêre meganismes te verklaar wat aanpassing by 'n verhoogde temperatuur en oorlewing in 'n omgewing wat inhiberende verbindings bevat, wat met die afbraak van sellulose-voer geassosieer is, toe laat. Ons resultate het aangedui dat daar 'n verband tussen stamdiversiteit, die omgewing, en die geografiese ligging bestaan, terwyl individuele stamme unieke fenotipes vertoon. Die Kaapse Weskusstreek gebied was geassosieer met stamme wat 'n inhibeerderweerstandbiedende fenotipe getoon het, terwyl die Breederiviervallei gekenmerk word deur inhibeerder-sensitiewe stamme. Stamme wat 'n verhoogde fermentasievermoë toon, is met die Kaapse Suidkusstreek geassosieer. Verskeie stamme met tolerante fenotipes dws, die vermoë om te groei en/of te fermenteer onder 'n verskeidenheid omgewingstoestande, is geïdentifiseer, insluitende 'n multi-tolerante stam, YI13, wat groeitoleransie teen etanol (15 % v/v), inhibitore (15 %) en temperatuur (45 °C) toon. Twee inhibitortolerante (25 %) stamme, HR4 en YI30, het verbeterde (0.22 en 0.35 g/L/) fermentasiekapasiteit gedurende onderskeidelik aërobiese en anaërobiese toestande getoon. Kunsmatige hibridisering genereer genetiese diversiteit wat die fenotipe van die organisme beïnvloed en was gebruik om nageslagstamme te genereer. Verskeie van hierdie stamme het inhibitortoleransie heterosis getoon, terwyl pH- en souttoleransie afgeneem het. Daarbenewens is unieke fenotipes gegenereer, met HR4/YI30#6 wat groei in 2 M NaCl en in 20 % etanol getoon het. ‘n Enkele multi-tolerante stam, V3/YI30#6, met unieke (2 M NaCl en 45 °C toleransie) en algemene (25 % inhibitortoleransie) eienskappe, is verkry. Die fermentasievermoë van hierdie stam het egter verlaag tot 'n teoretiese etanol opbrengs van 60 % in vergelyking met ~80 % vir die ouerstamme. Dit dui daarop dat alhoewel hibridisasie heterosis en nuwe fenotipes toelaat, daar 'n beperking op die mate van fenotipiese diversiteit is wat in 'n enkele stam verkry kan word. Dit kan wees as gevolg van die hoë energie behoefte (weens die toename in metaboliese fluks van sekere biologiese prosesse) tydens die verskillende stresreaksies terwyl sellewensvatbaarheid behoue moet bly. Die molekulêre meganismes vir inhibitor- en temperatuurtoleransie van twee natuurlike stamme is vervolgens ondersoek. Benewens verskeie biologiese prosesse, is 'n opregulering van aminosuurbiosintese en ribosoombiogenese in die temperatuurtolerante stam YI13 waargeneem. Dit was moontlik in reaksie op die onomkeerbare proteïenskade wat veroorsaak is deur reaktiewe suurstofspesies wat gegenereer is in reaksie op ‘n toename in temperatuur. Die belangrikste bydrae tot inhibitortoleransie in stam YI30 was die aktivering van die oksidatiewe stresreaksie. Dit is waarskynlik te wyte aan die verhoogde oksidoreduktase aktiwiteit wat benodig word vir die detoksifisering van die inhiberende verbindings. Aktivering van die tradisionele hitte-skokreaksie het nie 'n belangrike rol in die bestryding van temperatuurstres gespeel nie, maar 'n opregulering in hierdie stresreaksie om inhibitorstres te hanteer, is waargeneem. Hierdie studie dui daarop dat die natuurlike diversiteit van S. cerevisiae unieke stamme lewer en dat die fenotipese diversiteit deur hibridisasie verbeter kan word. Daarbenewens vertoon S. cerevisiae dieselfde meganismes om omgewings stres te hanteer. Die spesifieke molekulêre meganismes wat robuustheid toelaat, asook die mate waartoe hierdie stresreaksie geaktiveer word, is egter van die spesifieke stam afhanklik. Geen enkele stam sal aan al die vereiste eienskappe vir 'n bepaalde proses kan voldoen nie, dus moet 'n kompromie gevind word waar die eienskappe van beide die gasheerorganisme en die spesifieke toepassing oorweeg word, insluitende genetiese manipulasie van gisrasse.Doctora

A qualitative exploration of clinicians' strategies to communicate risks to patients in the complex reality of clinical practice

BACKGROUND:Risk communication, situated in the model of shared decision making (SDM), is an essential element in daily clinical practice. The scientific literature makes a number of generic recommendations. Yet the application of risk communication remains a challenge in patient-clinician encounters. How clinicians actually communicate risk during consultations is not well understood. We aimed to explore the risk communication strategies used by clinicians and extract narratives and visualizations of those strategies to help inform medical education. METHODS:In this qualitative descriptive study, we interviewed fifteen purposely sampled clinicians from several medical disciplines, who were familiar with the concept of SDM. Deductive and inductive content analysis was used during an iterative data collection and analyses process. RESULTS:Our study identified various strategies reported to be used by clinicians to address the complexities of risk communication such as dealing with uncertainty. These included verbal, numerical and visual risk communication and framing. Clinicians were familiar with recommended risk formats such as natural frequencies and population pictograms. However, it became clear that clinicians' expertise and communication goals also play an important role in the risk talk. Clinicians try to lay a foundation for balanced decision-making and to incorporate patient preferences while faced with several challenges such as the dilemma of raising awareness but triggering anxiety or fan fear in patients. Consequently, they also use communication goals such as influencing mindset and reassuring patients. Additionally, clinicians frequently have to account for the illusion of certainty in the risk talk. CONCLUSION:Risk communication is a multi-faceted construct that cannot be dealt with in isolation from the clinical context. For future research we recommend considering a more practical framework within the clinical setting and to take a goal-directed approach into account when investigating and teaching the topic. The patient perspective should also be addressed in further research