Pica: The Mysterious Eating Disorder

Background. ‘Pica’ is the Latin word for magpie, a bird that ingests inedible substances. The DSM-V defines pica as a disorder of persistent eating of nonnutritive, nonfood substances over a period of at least one month. Although pica is a disorder that affects a widespread population, it is seen as a social anomaly which prevents patients from admitting their behavior. As the behavior continues unnoticed and untreated, patients will experience the adverse effects of ingesting foreign materials. Thus, healthcare providers and family members should educate themselves on pica’s etiologies and manifestations to prevent complications and avoid unnecessary hospitalizations. Methods. The data was obtained using the Google search engine. Search terms used were: (a) history of pica, (b) diagnosing pica, and (c) treating pica for the years 1990-2018. The DSM-V was referenced for the medical definition of pica. Results. The few studies done on pica have drawn inconclusive data. While the percentage of the population that suffers from pica is unknown, common risk factors are: (a) nutritional deficiencies such as iron-deficiency anemia, (b) low socioeconomic status due to the inaccessibility of nutritious foods, (c) nondiscriminating oral behaviors in those with intellectual disabilities, and (d) an underlying biochemical behavior. No specific laboratory tests are indicated to evaluate pica. Providers have found success in diagnosing pica through: (a) dietary history, (b) interviewing family members, and (c) a high index of suspicion. Without verbal admittance, the only way to evaluate pica is to test for nutrient deficiencies and identify ingested materials using: (a) abdominal radiography, (b) barium enema, and (c) upper GI endoscopy. Although this disorder is seen most frequently in children and the developmentally disabled, it is also observed in pregnant women who ingest starch to quell morning sickness. Pica patients have been reported to ingest a variety of substances including, but not limited to: (a) clay, (b) dirt, (c) stones, (d) cigarette butts, and, (e) lead paint and soil. Lead poisoning affects the central nervous system and leads to irreversible neurological damage; it is also associated with decreased renal function and hypertension. Conclusions and Recommendations. Serious complications of pica include obstruction or perforation of the gastrointestinal tract, and lead poisoning. Early detection of lead toxicity is vital to prevent systemic complications. There is no definitive management for pica but current therapies include (a) nutrient replacement, (b) behavioral therapy, and (c) dopaminergic function enhancing medications such as olanzapine. Since very little is known about pica, it would be beneficial to perform longitudinal studies to observe and educate the general public on the long-term effects of pica so they understand that this behavior is more than a habit but one with serious consequences. Pica is a condition that requires a multidisciplinary approach utilizing physicians, psychologists, and social workers and it is recommended that healthcare providers treating high-risk patients ask appropriate primary and exploratory questions during physical exams. While many may be discouraged at the lack of data on pica, it should be seen as an opportunity to promote its clinical importance through awareness and education

Relationship between social support, quality of life, and Th2 cytokines in a biobehavioral cancer survivorship trial.

ObjectiveBenefits of social support (SS) during cancer survivorship are complex. This study examines change in SS over time in cervical cancer (CXCA) survivors who have completed definitive treatment and how changing SS impacts quality of life (QOL) and T-helper type 2 (Th2) cytokines.MethodsWe conducted a randomized trial in 204 CXCA survivors to test if psychosocial telephone counseling (PTC) could improve QOL compared to usual care (UC). Although PTC did not target SS, data were collected at baseline, 4 and 9 months post-enrollment using the Medical Outcomes Survey Social Support scale. Biospecimens were collected to investigate associations with patient-reported outcomes. Data were analyzed using multivariate linear models and stepwise regression.ResultsParticipants' mean age was 43. PTC participants experienced increasing SS compared to UC at 4 months (PTC-UC = 5.1; p = 0.055) and 9 months (PTC-UC = 6.0; p = 0.046). Higher baseline SS and increasing SS were independently associated with improved QOL at 4 and 9 months after adjusting for patient characteristics (p < 0.05). Differences between study arms were not statistically significant. Improvements in QOL at 4 months were observed with increases in emotional/informational and tangible SS. Increasing SS predicted significant longitudinal decreases in IL-4 and IL-13 at 4 months that were larger in the PTC arm (interactions p = 0.041 and p = 0.057, respectively).ConclusionImproved SS was significantly associated with improved QOL independent of patient characteristics and study arm. Decreasing Th2 cytokines with increasing SS and QOL are consistent with a biobehavioral paradigm in which modulation of the chronic stress response is associated with shifts in immune stance

Validation of PROMIS emotional distress short form scales for cervical cancer.

ObjectivesCervical cancer patients are at high risk for emotional distress. In this study we evaluate the PROMIS emotional distress-Depression and -Anxiety Short Forms for assessing depression and anxiety in a cervical cancer population.MethodsA 15-item questionnaire was used in a cervical cancer biobehavioral randomized clinical trial, testing psychosocial telephone counseling (PTC) against usual care (UC). It was administered to 204 patients prior to randomization, four months post-enrollment, and nine months post-enrollment, together with legacy measures of depression. The short forms were evaluated in patients participating in this study over three time points for internal consistency, convergent validity, and responsiveness to change over time.ResultsOverall, 45% and 47% of patients scored in the moderate to severe range for anxiety and depression, respectively. Internal consistency coefficients were ≥ 0.95 at baseline, 4 months, and 9 months for depression and anxiety. The average inter-item correlation was 0.65 and 0.73 at baseline assessment for depression and anxiety, respectively. The depression short form T-score was correlated with legacy distress scales ranging from 0.44-0.76, and the anxiety short form ranging from 0.45-0.78. The depression short form demonstrated sensitivity to change as patients randomized to the counseling intervention reported greater improvement over time in depression (p = 0.014), and a nonsignificant improvement in anxiety, compared to the patients receiving usual care.ConclusionsThe PROMIS depression and anxiety short forms reliably and validly assess cervical cancer-specific emotional distress, capture salient features of distress in this population, and perform as well or better than legacy measures

Path integrals for dimerized quantum spin systems

Dimerized quantum spin systems may appear under several circumstances, e.g\ by a modulation of the antiferromagnetic exchange coupling in space, or in frustrated quantum antiferromagnets. In general, such systems display a quantum phase transition to a N\'eel state as a function of a suitable coupling constant. We present here two path-integral formulations appropriate for spin $S=1/2$ dimerized systems. The first one deals with a description of the dimers degrees of freedom in an SO(4) manifold, while the second one provides a path-integral for the bond-operators introduced by Sachdev and Bhatt. The path-integral quantization is performed using the Faddeev-Jackiw symplectic formalism for constrained systems, such that the measures and constraints that result from the algebra of the operators is provided in both cases. As an example we consider a spin-Peierls chain, and show how to arrive at the corresponding field-theory, starting with both a SO(4) formulation and bond-operators.Comment: 20 pages, no figure

Severe Acute Respiratory Syndrome (SARS) in Singapore: Clinical Features of Index Patient and Initial Contacts

Severe acute respiratory syndrome (SARS) is an emerging viral infectious disease. One of the largest outbreaks of SARS to date began in Singapore in March 2003. We describe the clinical, laboratory, and radiologic features of the index patient and the patient’s initial contacts affected with probable SARS

What have studies of non-industrialized countries told us about the cause of allergic disease?

The increase in allergic diseases that was observed in countries that had experienced rapid economic growth since the mid-20th century initiated a search for environmental exposures that may explain these phenomena that continues to the present day. Societies that are in the earlier stages of the process of industrialization provide an opportunity to compare the initial stages of economic development and the lifestyle changes that may accompany this, with other communities whose way of life may not have changed appreciably for centuries. These studies have consistently demonstrated higher levels of allergic disease in the relatively affluent populations compared with those who maintain a more traditional lifestyle. Environmental changes that have emerged from these studies that may modify the risk of allergic disease include microbial exposures including parasite infection, pollution, diet and obesity. In addition, food and drug allergies represent a neglected area of research in these countries that may be causing a relatively high burden of disease

Reading Across Cultures: Global Narratives, Hotels and Railway Stations

This is the final version of the article. Available from Springer Verlag via the DOI in this record.This article takes its cue from the English critic, novelist and painter John Berger. He argues that what we know determines what we see. Hotels and railway stations, though they differ in size, design and appearance, are places of temporary national and international congress that are recognized by everyone. They become visible or even iconic once their history or their role is turned into at least part of a wider narrative—in literature, film or in other arts. This provides a representative focus by which we may read a city’s or a nation’s past. In exemplifying such connections I focus first on the long-term history of Friedrichstraße station and some of the surrounding hotels in the context of the history of Berlin, situating them within the national and, by implication, also the international context. Secondly, I will consider the outbreak of the First World War in 1914 as an event in which the role of railway stations generated both personal and collective memories across cultures and over several decades