The Relationship Among the Contributing Factors to Anorexia Nervosa

Anorexia nervosa is now being viewed as a multidimensional disorder in terms of predisposing factors such as genetics, biology, and environment. Results from twin studies suggest that part of a susceptibility to AN may lie in genetic factors (Holland et al., 1984, 1988; Treasure and Holland, 1991). However, the nature of a genetic contribution, if any, remains unclear. Neurochemical alterations have been found to be associated with AN, but it is difficult to assess what role these neurochemical changes play in the etiology of the disorder since they may precipitate, accompany, or follow weight loss (Fava et al., 1989). Abnormal family interactions (Humphrey et al., 1986; Kog and Vandereycken, 1989) and cultural practices of diet and exercise (Epling and Pierce, 1988) have also been implicated as contributing factors to AN. The cultural and familial models are deficient, however, in that they do not account for individual susceptibility (Treasure and Campbell, 1994). Further, issues of nature versus nurture have not been fully examined in family models. The lack of understanding in the exact nature and role of the contribution of these factors to the development of AN, and the further complex relationship among these factors present a problem for researchers in understanding the aetiology of the disorder

Using a cell phone-based glucose monitoring system for adolescent diabetes management

INTRODUCTION: Mobile technology may be useful in addressing several issues in adolescent diabetes management. PURPOSE: To assess the feasibility and acceptability of a cell phone glucose monitoring system for adolescents with type 1 diabetes and their parents. METHODS: The authors recruited patients with type 1 diabetes who had been diagnosed for at least 1 year. Each adolescent used the system for 6 months, filling out surveys every 3 months to measure their usability and satisfaction with the cell phone glucose monitoring system, as well as how use of the system might affect quality of family functioning and diabetes management. RESULTS: Adolescents reported positive feelings about the technology and the service, even though a concerning number of them had significant technical issues that affected continued use of the device. Nearly all thought that the clinic involvement in monitoring testing behavior was quite acceptable. The use of the Glucophone™ did not, however, significantly change the quality of life of the adolescents, their level of conflict with their parents, their reported self-management of diabetes, or their average glycemic control within the short time frame of the study. CONCLUSIONS: As a feasibility study of the technology, this work was successful in demonstrating that cell phone glucose monitoring technology can be used in an adolescent population to track and assist in self-monitoring behavior. The authors speculate that explicitly attempting to change behavior, perhaps with the use of behavioral contracts, would enhance the technology's ability to improve outcomes

Individual growth and foraging responses of age-0 largemouth bass to mixed prey assemblages during winter

We conducted an outdoor pool experiment at a mid-temperate latitude (Ohio, 40°N) to determine how commonly occurring prey assemblages affect individual foraging and growth of individually marked, age-0 largemouth bass during winter. The treatments were low prey, bluegill prey only, macroinvertebrates only, and bluegill plus macroinvertebrates. Across all treatments, growth in mass (g) was unrelated to body size. Conversely, small individuals lost more energy (kJ) than large counterparts in all but the macroinvertebrate-only treatment. With low prey, overall growth of largemouth bass was negative, with losses varying among individuals by 30% and 60% for mass and energy content, respectively. Counterparts in bluegill-only pools also consistently lost mass and energy, with less variability (15% mass; 30% energy). In the macroinvertebrate-only treatment, 31% of individuals gained mass, reflecting the greatest range in mass (100%) and energy (60%) change. With macroinvertebrates plus bluegill, overall growth was generally negative, with intermediate variance among individuals. Variation in growth among individuals typically increased with the frequency that prey occurred in diets during sampling. Apparently, some individuals were inactive, foraged infrequently, and consistently lost intermediate quantities of mass and energy. Others were active and foraged with variable success. Because activity and growth vary among individuals as a function of prey composition during winter, prey assemblages during this season will affect patterns of first-year survival and cohort strength.Funding for this project was provided by National Science Foundation grant DEB 9407859 to R.A.S. and Federal Aid in Sport Fish Restoration Project F-69-P, administered jointly by the U.S. Fish and Wildlife Service and Ohio Division of Wildlife

Perfil clínico periodontal de homens usuários de esteróides anabolizantes androgênicos

Orientador: Prof. Dr. João Paulo SteffensCoorientadora: Profª. Dra. Geisla Mary Silva SoaresDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Odontologia. Defesa : Curitiba, 24/07/2018Inclui referênciasResumo: A testosterona é o principal hormônio sexual masculino e promove, entre suas várias funções, o crescimento muscular. Desta forma, derivados sintéticos deste hormônio (Esteroides Anabolizantes Androgênicos - EAAs) são amplamente usados por atletas e fisiculturistas. Entretanto, o uso inadequado dos EAAs pode gerar efeitos colaterais, entre eles toxicidade hepática, acne, alterações comportamentais e podem alterar os tecidos periodontais. O objetivo deste estudo foi avaliar a condição periodontal de homens usuários de EAAs. Foram recrutados 15 homens, com idades igual ou superior a 18 anos, em academias de Curitiba, PR, Brasil, que reportassem uso de EAAs no momento da entrevista (grupo "caso"). O grupo controle foi composto por outros 15 homens, pareados por idade e hábito (frequentadores de academia) e que nunca fizeram uso de EAAs. Todos os pacientes foram avaliados clinicamente quanto a Índice de Placa (IP), Sangramento Marginal (SM), Profundidade de Sondagem (PS), Nível Clínico de Inserção (NIC) e Sangramento à Sondagem (SS). Considerou-se "periodontite" a presen.a de pelo menos dois sítios com PS maior que 3mm, com perda de inserção e SS no mesmo sítio. A idade dos pacientes variou entre 23 a 40 anos (grupo caso: 30,07±4,4 anos; grupo controle:28,1±4,6 anos), sendo a maioria de etnia branca (grupo caso: 92,5%; grupo controle: 100%) e com conclusão do ensino médio (grupo caso: 60%; grupo controle: 73,3%). O grupo caso apresentou significativamente mais sítios com doen.a periodontal, com PS?4mm e PS?4mm com SS e mais sítios com SS (p0,05). O uso de EAAs pode afetar a saúde periodontal, principalmente quanto aos parâmetros inflamatórios como PS e SM. Palavras-chave: Testosterona, anabolizante, periodonto, inflamação.Abstract: Testosterone is the main male sex hormone and promotes muscle growth among its many functions. In this way, synthetic derivatives of this hormone (Androgenetic Anabolic Steroids - AAS) are widely used by athletes and bodybuilders. However, inadequate use of AAS can generate side effects, including liver toxicity, acne, behavioral changes and may alter periodontal tissues. The objective of this study was to evaluate the periodontal status of the men using AAS. Fifteen men, aged 18 years and over, were recruited from gyms in Curitiba, PR, Brazil, who reported use of AAS at the time of the interview (case group). The control group consisted of 15 other men, matched by age and habit (gymgoers) who had never used AAS. All patients were clinically evaluated for the Plaque Index (PI), Marginal Bleeding (MB), Probing Pocket Depth (PD), Clinical Attachment Loss (CAL) and Bleeding on Probing (BoP). The presence of at least two sites with PD greater than 3mm, with attachment loss and BoP at the same site, was considered "periodontitis". The patients' ages ranged from 23 to 40 years (case group: 30.07 ± 4.4 years, control group: 28.1 ± 4.6 years), most of them white (case group: 92.5%, control group: 100%) and with high school education (case group: 60%, control group: 73.3%). The case group presented significantly more sites with periodontal disease, PD ?4 mm with our without BoP (p 0.05). The use of AAS can affect periodontal health, especially in relation to inflammatory paraments such as PD and MB. Key words: Testosterone, anabolic agents, periodontium, inflammation

Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation.

BackgroundThe first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1.MethodsMARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site's local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient.DiscussionA mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation

Increased parental care cost for nest-guarding fish in a lake with hyperabundant nest predators

Although parental care increases offspring survival, providing care is costly, reducing parental growth and survival and, thereby, compromising future reproductive success. To determine if an exotic benthic predator might be affecting parental care by nest-guarding smallmouth bass (Micropterus dolomieu), we compared nest-guarding behavior and energy expenditures in two systems, one with a hyperabundant recently introduced predator, the round goby (Neogobious melanostomus). In Lake Erie, USA, smallmouth bass vigorously defended their nests from benthic round gobies. In Lake Opeongo, Canada, smallmouth bass were exposed to fewer and predominantly open-water predators and were less active in their nest defense. From scuba and video observations, we documented that nest-guarding smallmouth bass chased predators (99% of which were round gobies) nine times more frequently in Lake Erie than in Lake Opeongo. This heightened activity resulted in a significant decline in weight and energetic content of guarding males in Lake Erie but no change in Lake Opeongo males. Bioenergetic simulations revealed that parental care increased smallmouth bass standard metabolic rate by 210% in Lake Erie but only by 28% in Lake Opeongo. As energy reserves declined and offspring became increasingly independent, males in both lakes consumed more prey and spent more time foraging away from their nests; however, nest-guarding smallmouth bass consumed few prey and, in Lake Erie, rarely consumed round gobies. Therefore, increased parental care costs owing to the presence of round gobies could affect future growth, reproduction, and survival if smallmouth bass approach critically low energy reserves.Funding for this project was provided by Federal Aid in Sport Fish Restoration Project F-69-P, administered jointly by United States Fish and Wildlife Service and Ohio Department of Natural Resources, Division of Wildlife, a Sigma Xi Grant-in-Aid awarded to G.B.S., and the Department of Evolution, Ecology, and Organismal Biology at The Ohio State University

"Der Ernst des Lebens ... Frühpädagogik und Frühförderstellen im Spannungsfeld (miss-)gelingender Transitionen"

Der Übergang eines Kindes von der Kindertageseinrichtung in die Schule stellt in der Reihe der Transitionen eine besondere Herausforderung für alle Beteiligten dar, denn das System der Kindertageseinrichtung ist mit dem der Schule nur bedingt kompatibel. Aktuell ist von einer verhältnismäßig großen Anzahl von Kindern auszugehen, die zwar Auffälligkeiten aufweisen, jedoch ohne Anspruch auf Hilfen im Rahmen der Eingliederungshilfe bleiben. Im Zusammenhang mit einem Modellprojekt zur Übergangsbegleitung in Bayern werden Desiderate und Hürden identifiziert, insbesondere für den Kontext der Pädagogik bei Verhaltensstörungen. (DIPF/Orig.

The intersection of racial-ethnic socialization and adolescence: A closer examination at stage-salient issues

The literature on parental racial–ethnic socialization (RES) has established the multiple protective effects of RES on developmental outcomes. Although the majority of this literature examines RES processes in adolescence, with the exception of identity processes this literature has not specifically tackled how these messages intersect with specific adolescent developmental processes. We review the literature on RES processes in non-White adolescents with a focus on the parent–adolescent relationship, risk-taking behaviors, romantic relationships, and different contexts (i.e., extracurricular, work, and social media settings). We propose that developmental science needs to account for how parental RES may not only change in adolescence, but in particular responds to the perceived risks associated with this developmental period and interacts with normative developmental tasks and milestones

Assessment of pharmacotherapeutic safety of medical prescriptions for elderly residents in a long-term care facility

The present study aimed to estimate the prevalence of elderly using potentially inappropriate medications (PIM) and with occurrence of potentially hazardous drug interactions (PHDI); to identify the risk factors for the prescription of PIM and to evaluate the impact of pharmaceutical intervention (PI) for the prescription of safer therapeutic alternatives. Therefore, a cross-sectional study was performed in a long-term care facility in São Paulo State, between December/2010 and January/2011. The medical records of the patients >60 years old who took any drugs were consulted to assess the pharmacotherapeutic safety of the medical prescriptions, in order to identify PIM and PHDI, according to the Beers (2003) and World Health Organization criteria, respectively. PI consisted of a guidance letter to the physician responsible for the institution, with the suggestions of safer equivalent therapeutics. Approximately 88% of the elderly took at least one drug, and for 30% of them the PIM had been prescribed. Most of the PIM identified (53.4%) act on the central nervous system. Among the 13 different DI detected, 6 are considered PHDI. Polypharmacy was detected as a risk factor for PIM prescription. After the PI there was no change in medical prescriptions of patients who had been prescribed PIM or PHDI. The data suggests that PI performed by letter, as the only interventional, method was ineffective. To contribute it a wide dissemination of PIM and PHDI among prescriber professionals is necessary for the selection of safer treatment for elderly. Additionally, a pharmacist should be part of the health care team in order to help promote rational use of medicines.O presente estudo teve como objetivos estimar a prevalência de idosos em uso de medicamentos potencialmente impróprios (MPI) e com ocorrência de interações medicamentosas potencialmente perigosas (IMPP); identificar os fatores de risco para a prescrição de MPI e avaliar o impacto de intervenção farmacêutica (IF) para a prescrição de alternativas terapêuticas mais seguras. Para tanto, realizou-se estudo transversal em instituição de longa permanência do interior de São Paulo, de dezembro/2010 a janeiro/ 2011. Os prontuários médicos dos pacientes >60 anos e que utilizavam pelo menos um medicamento foram consultados para avaliar a segurança farmacoterapêutica das prescrições médicas, identificando-se os MPI e as IMPP, segundo critérios de Beers (2003) e o critério da Organização Mundial da Saúde, respectivamente. A IF constou de carta de orientação ao médico da instituição, com sugestão de equivalentes terapêuticos mais seguros. Aproximadamente 88% dos idosos haviam utilizado pelo menos um medicamento e, para 30% deles, havia pelo menos um MPI prescrito. A maioria dos MPI identificados (53,4%) age no sistema nervoso central. Entre as 13 interações medicamentosas detectadas, 6 são consideradas IMPP. A polimedicação foi detectada como fator de risco para a prescrição de MPI. Após a IF, não houve alterações nas prescrições médicas dos pacientes que apresentavam MPI e IMPP prescritos. Os dados sugerem que IF realizadas por cartas, como único método interventivo, não são efetivas. Para contribuir com a seleção de farmacoterapia mais segura para idosos é necessária ampla divulgação dos MPI e IMPP entre os profissionais prescritores. Além disso, o farmacêutico deve fazer parte das equipes de saúde para auxiliar na promoção do uso racional de medicamentos.State University of São Paulo Júlio de Mesquita Filho School of Pharmaceutical SciencesFederal University of São Paulo School of MedicineUNIFESP, EPMSciEL