[Epidemiology of eating disorders].
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Adolescent↗
Biomedical subjects
J Toro
Publications and source records attributed to J Toro.
Quality of rearing practices as predictor of short-term outcome in adolescent anorexia nervosa.
BACKGROUND: Studies of family relationships in anorexia nervosa have produced conflicting results. Some authors claim that family factors are related to short-term outcomes. METHODS: Perceived rearing practices, as measured by the EMBU (Egna Minnen Betraffande Uppfostran: 'My memories of Upbringing') were examined in a sample (N = 158) of adolescents with anorexia nervosa and compared with the perceptions of adolescents (N = 159) from the general population. A further comparison was made between the groups of patients with good and bad short-term outcomes. Logistic regression analysis was performed to evaluate the predictive value of different variables on short-term outcome. RESULTS: Overall, small differences were observed in the perceptions of rearing practices as expressed by the controls and the anorexic patients. Patients with bad short-term outcome perceived more rejection and control-overprotection from both parents than those with good outcome. In the logistic regression analysis only Rejection from father and the EAT (Eating Attitudes Test) total score gave independent prediction of treatment response. CONCLUSIONS: Taken as a whole, these results do not support the idea of altered rearing practices in anorexic patients, at least in young patients with a short evolution of the disease. Perceived rearing practices, especially 'rejection', appear to have an appreciable effect on the short-term outcome.
Adolescent↗
Predictors of bone mineral density reduction in adolescents with anorexia nervosa.
OBJECTIVES: To determine which variables are associated with a significant reduction in bone mineral density (BMD) in adolescent anorexia nervosa and to establish guidelines for indication of bone densitometry. METHOD: One hundred seventy patients (treated from 1997 until 1999), aged 10 to 17 years, with a DSM-IV diagnosis of anorexia nervosa were evaluated by dual-energy-x-ray absorptiometry in the lumbar spine (L2-L4) and the femoral neck. The results were compared with the normative data for BMD values by age and sex in Spanish adolescents. RESULTS: 44.1% of patients had osteopenia at the lumbar spine and 24.7% at the femoral neck. The following variables were related to osteopenia: more than 12 months since onset of the disorder (p < .001), more than 6 months of amenorrhea (p < .001), body mass index <15 (p < .001), calcium intake <600 mg/day (p < .01), and <3 hours/week of physical activity (p < .001). In a stepwise logistic regression analysis to predict reduced spinal BMD, 3 variables-months elapsed since the onset of weight loss, calcium intake, and body mass index--correctly classified 78.8% of patients. CONCLUSIONS: Adolescent anorexia nervosa patients with the characteristics outlined above are at high risk of reduced BMD, and densitometry is recommended to determine the degree of osteopenia.
Absorptiometry, Photon↗
Dermatologic manifestations of Hermansky-Pudlak syndrome in patients with and without a 16-base pair duplication in the HPS1 gene.
BACKGROUND: Hermansky-Pudlak syndrome (HPS) consists of oculocutaneous albinism, a platelet storage pool deficiency, and lysosomal accumulation of ceroid lipofuscin. Patients with HPS from northwest Puerto Rico are homozygous for a 16-base pair (bp) duplication in exon 15 of HPS1, a gene on chromosome 10q23 known to cause the disorder. OBJECTIVE: To determine the dermatologic findings of patients with HPS. DESIGN: Survey of inpatients with HPS by physical examination. SETTING: National Institutes of Health Clinical Center, Bethesda, Md (a tertiary referral hospital). PATIENTS: Sixty-five patients aged 3 to 54 years were diagnosed on the basis of the absence of platelet dense bodies in individuals with albinism and a bleeding diathesis. The presence of a 16-bp duplication in HPS1 was determined by polymerase chain reaction amplification; 40 patients were homozygous for the duplication and 25 lacked the duplication. All patients with the duplication were from northwest Puerto Rico; all patients without the duplication were non-Puerto Rican except 4 from central Puerto Rico. RESULTS: Both patients homozygous for the 16-bp duplication and patients without the duplication displayed skin color ranging from white to light brown. Patients with the duplication, as well as those lacking the duplication, had hair color ranging from white to brown and eye color ranging from blue to brown. New findings in both groups of patients with HPS were melanocytic nevi with dysplastic features, acanthosis nigricans-like lesions in the axilla and neck, and trichomegaly. Eighty percent of patients with the duplication exhibited features of solar damage, including multiple freckles, stellate lentigines, actinic keratoses, and, occasionally, basal cell or squamous cell carcinomas. Only 8% of patients lacking the 16-bp duplication displayed these findings. As a group, the patients with the duplication lived closer to the equator than those without the duplication. CONCLUSION: Patients with HPS exhibit wide variation in pigmentation and dermatologic findings.
Adolescent↗
The Body Attitude Test: validation of the Spanish version.
A Spanish version of the Body Attitude Test (BAT) is presented. It was validated with 165 eating disorder patients (79 anorexia nervosa, 86 bulimia nervosa) and 220 schoolgirls from the general population. Factor analysis allowed the extraction of four factors, as in the original questionnaire, but with different item loadings on each. Taken together, these four factors accounted for 67.1% of the variance. The alpha reliability coefficient was 0.92 in both groups. The test-retest reliability with a one-week interval was 0.91 in a subgroup of 34 eating disorder patients and in a subgroup of 43 girls from the general population. The difference between the mean scores of the girls from the general population and the anorexics on one hand and the bulimics on the other was highly significant (p < 0.0001). On the basis of the discriminant validity study, the use of a cut-off point of 41--which gives a sensitivity of 75.1% and a specificity of 72.7%--is recommended.
Adolescent↗
Parenting style in relation to pathogenic and protective factors of Type A behaviour pattern.
BACKGROUND: Studies of type A behaviour pattern suggest that it can be promoted as a whole by certain parental rearing styles. However, the association of the different components of the type A behaviour with specific rearing practices has not been clarified. METHOD: The relationship between parents' rearing style and the different type A behaviour components of their children was analysed in a sample of 312 university students. Parental rearing style was assessed with the EMBU, a Swedish measure originally designed to assess one's recollections concerning one's parents rearing behaviour. Type A pattern was measured by the JAS, a self-administered questionnaire that gives the global type A score and three of its components. RESULTS: Hard Driving was related to Rejection and Favouring Subject in males. Speed-Impatience was related to Rejection and Control in both sexes, and Job Involvement was related to Control and Favouring Subject in females. In a discriminant factor analysis in males, Rejection, Control and Favouring Subject on the part of fathers classified correctly 80% of the subjects identified as having high or low Speed-Impatience and the variables of Rejection and Favouring Subject (also by fathers) classified correctly 69.23% of the subjects identified as high or low Hard Driving. In females, Control and Favouring Subject on the part of mothers and low Rejection by fathers classified correctly 70.37% of the subjects with high or low Job Involvement. CONCLUSION: These results suggest that different rearing characteristics are related to the various components of the type A behaviour pattern.
Adult↗
Anorexia nervosa in a Spanish adolescent sample: an 8-year longitudinal study.
OBJECTIVE: The aim of this study was to determine the intermediate-term outcome of a sample of Spanish children and adolescents with anorexia nervosa (AN). METHOD: A total of 48 female patients were evaluated at a mean follow-up time of 8 years by means of the Psychiatric Status Rating Scale, the Morgan and Russell Outcome Scale, a structured DSM-III interview and several self-report questionnaires. Their scores were compared with a sex- and age-matched control group. RESULTS: Three patients (6%) still had AN, two (4%) had partial syndromes of anorexia, 11 patients (23%) had recovered but still showed concern about food/body weight and 32 patients (67%) had recovered completely. The crude mortality rate was 2%. CONCLUSION: The majority of this sample of children and adolescents with anorexia nervosa sample recovered. Perfectionism and interpersonal distrust were significantly more common in the anorexic patients than in the controls. Depression and phobias, including social phobia, were the most common comorbid psychiatric diagnoses at follow-up.
Adolescent↗
Subjective body-image dimensions in normal and anorexic adolescents.
The subjective body dimensions of adolescent anorexic patients and adolescents from the general population were studied by means of a new technique that combines certain characteristics of the 'body-site estimation' and the 'whole-image adjustment' procedures. The technique used (Subjective Body Dimensions Apparatus-SBDA) reveals the individual's idea of the size of the different parts of his/her body, and produces a life-size global silhouette. Eighty-five female anorexic patients (ages 12 to 18) were compared with 427 adolescents from the general population. The technique showed acceptable test-retest stability. The comparison group overestimated their thorax, waist and hips, and anorexic patients overestimated all parts of their body but their thorax, waist and hips especially. For all parts of the body, the anorexic group showed greater overestimation (p < .0001) than the comparison group.
Adolescent↗
[The relationship of Campylobacter jejuni subsp. jejuni enterotoxigenicity and the increase of cAMP and electrolyte changes in the rat intestine].
BACKGROUND: Small intestine alterations produced by the enterotoxigenic capacity of Campylobacter jejuni subsp. jejuni are similar to the hydric, electrolytic and pathological changes caused by choleraic and thermolabile Escherichia coli toxins. AIM: To study the enterotoxigenic capacity of 4 strains of Campylobacter jejuni subsp. jejuni using the intestinal loop model. MATERIAL AND METHODS: Rat intestinal loops were inoculated with culture filtrates of the four strains. Enterotoxigenicity was assessed by fluid accumulation, the increase in Na+ and Cl- in the loop fluid, and cAMP increase in loop tissues. An enterotoxigenic Escherichia coil strain and sterile Brucella both were used as positive and negative controls, respectively. RESULTS: The filtrates of two strains produced fluid accumulation in the loops, significantly increased Na+ and Cl- secretion to the intestinal lumen and increased tissue cAMP levels. CONCLUSIONS: Some strains of Campylobacter jejuni subsp. jejuni are able to show enterotoxigenicity in vivo, increasing cAMP levels in the intestinal cells and altering electrolyte exchange mechanisms.
Animals↗
Assessing rearing behaviour from the perspectives of the parents: a new form of the EMBU.
The EMBU (Egna Minnen Beträffande Uppfostran) is a self-reporting questionnaire developed to assess memories of adults about their parents' rearing practices. In the present study, an exploratory factor analysis was carried out on items of the EMBU-P, a new version of the EMBU especially designed to obtain ratings from parents about their own rearing behaviour with their children. The factor analysis yielded a structure similar to that obtained with the original EMBU (Rejection, Emotional Warmth, Control Attempts and Favouring Subject), but composed of fewer items. The internal consistency was adequate for the three major scales. Some significant correlations emerged between the EMBU-P scales. The Rejection scale correlated negatively with the Emotional Warmth scale and positively with the Control Attempts scale. The latter also correlated positively with Emotional Warmth. There were no significant correlations between the scales and the age of the parents. The sex of the parents was significantly associated with the EMBU-P scores.
Adult↗
[Wernicke's encephalopathy and dialysis: report of two cases].
Wernicke encephalopathy is considered a complication of dialytic therapy, but there are few reports of this complication. We report a 57 years old man and a 45 years old woman, with grade IV renal failure, who after acute peritoneodialysis and chronic hemodialysis respectively, had a confusional syndrome that responded to the administration of thiamine. CT scans in both patients discarded abnormal blood collections or new cerebrovascular episodes. The man bad two previous cerebrovascular episodes, a severe anemia that was corrected, angina and an episode of arrhythmia during the dialytic procedure previous to the confusional episode. The woman had an acute uremic syndrome and a concomitant urinary tract infection during the confusional episode. Wernicke encephalopathy must be suspected in patients in dialysis with confusional episodes.
Female↗
[Clinical, psychological and biological variables in a group of 108 adolescent patients with anorexia nervosa].
BACKGROUND: To assess the clinical and psychological characteristics, hormonal changes derived from malnutrition and the prognostic factors in an adolescent group of patients with anorexia nervosa. PATIENTS AND METHODS: In this retrospective study specific case-history medical record for this disorder was used first with the parents and later with the patients. Depression questionnaires (BDI or CDI) and eating disorders questionnaires (EAT and CIMEC) were also administered, and hormonal tests were carried out. RESULTS: 98 out of 108 patients (90.7%) were females. Mean age was 15 years, 23 patients (21.1%) showed major depressive disorders or obsessive-compulsive disorders besides anorexia nervosa. The duration of the disorder was 12.0 +/- 9.0 months. The age at onset of the disorder was 15.1 +/- 1.5 (10-17 years), and the percentage of weight loss ranged between 15.53%. In relation to the hormonal findings the low levels of T3, insulin, somatomedin, prolactin, LH and 17 B estradiol were shown up. There were no differences between inpatients and outpatients in relation to the age of onset of the disorder onset, duration of the disorder, percentage of weight loss, psychological variables or applied hormonal findings. There were differences in relation to the used psychometric tests, which differentiated between patients with a good and bad outcome. CONCLUSIONS: Major depressive disorders and obsessive-compulsive disorders are the most frequent comorbid psychiatric disorders in the anorexia nervosa. The age at onset of the disorder, duration of the disorder, percentage of weight loss and hormonal changes do not seem to influence in outcome, whereas initial affective and eating symptomatology tend to predict disorder outcome.
Adolescent↗
Large scale, postlicensure, selective vaccination of Chilean infants with PRP-T conjugate vaccine: practicality and effectiveness in preventing invasive Haemophilus influenzae type b infections.
BACKGROUND: Haemophilus influenzae type b (Hib) conjugate vaccines have demonstrated an impressive impact in diminishing Hib disease in industrialized countries. However, their high cost prompts nonindustrialized countries to corroborate their effectiveness under local conditions before considering their programmatic implementation. Such a postlicensure evaluation of vaccine effectiveness was undertaken in Chile. METHODS: After its licensure in Chile polyribosylribitol phosphate-tetanus toxoid protein conjugate vaccine (PRP-T), combined with diphtheria-tetanus-pertussis vaccine, was introduced into the Expanded Program on Immunization schedules in 36 health centers throughout metropolitan Santiago for 12 months, whereas 35 similar health centers administered only diphtheria-tetanus toxoid-pertussis vaccine. Bacteriologic surveillance data for invasive Hib cases collected over the ensuing 30 months were analyzed. RESULTS: In an intent-to-vaccinate (effectiveness) analysis, PRP-T provided 90.2% protection (95% confidence interval, 74.5 to 100%) against invasive Hib disease (40 vs. 4 cases, P < 0.001). Vaccine effectiveness was 91.3% against meningitis (22 vs. 2 cases) and 80% against pneumonia and empyema (10 vs. 2 cases, P = 0.039). Vaccine efficacy among infants who received all three doses of PRP-T was 91.7% (95% confidence interval, 64.8 to 100%). CONCLUSIONS: Programmatic use of Hib conjugate vaccine administered in combination with diphtheria-tetanus-pertussis vaccine constitutes a highly effective and practical intervention in Chile, a newly industrializing country.
Bacterial Capsules↗
[Nocardiosis in a renal transplant recipient].
We report a unilateral pulmonary nocardiosis in a 51 years old male that received a renal allograft. The clinical picture appeared 68 days after transplantation and the culture of a bronchoalveolar lavage showed the presence of Nocardia asteroides. Cyclos-porine and azathioprine were discontinued and trimethoprim-sulphamethoxazole was started with a good clinical response. Afterwards, azathioprine was restarted and the patient is asymptomatic at the present moment.
Azathioprine↗
A clinical and phenomenological study of 185 Spanish adolescents with anorexia nervosa.
The objectives of the present study were the following to determine the socio-familial, academic and interpersonal characteristics specific to anorexia nervosa (AN); to study comorbidity in patients with anorexia and morbidity in their parents; and to ascertain whether patients with anorexia nervosa in Spain are similar to those in other countries. The research team revised the clinical records of 185 Spanish adolescents with AN (aged 11-18 years). The results were compared with those obtained from a group of 185 psychiatric patients without AN matched by sex, age, time of consultation and centre. No significant differences were found with regard to broken home, birth order or parent-patient conflict. The parents of patients with anorexia have a higher standard of education and develop more affective disorders. When compared with other patients, the individuals with anorexia nervosa perform much better academically but are more socially withdrawn. Males with anorexia nervosa perform worse academically than females and have more anxiety diagnoses. Patients with anorexia have a high comorbidity for affective and obsessive-compulsive disorders. Sufferers from anorexia nervosa in Spain are clinically analogous to patients with anorexia in other countries. The two characteristics specific to these patients are a high standard of academic performance and an intense degree of social withdrawal, although there are certain factors common to other pathologies relating to adolescence.
Adolescent↗
Assessment of sociocultural influences on the aesthetic body shape model in anorexia nervosa.
The prevailing aesthetic body shape model in our culture-that of slenderness-plays a leading role in eating disorders. A questionnaire (CIMEC) was prepared in an attempt to measure the influence of the agents and situations that transmit this model. The CIMEC questionnaire was applied to 59 anorectics and 59 normal girls matched by age and social class. Highly significant differences were found between the scores obtained from both groups, showing the patients to have a much greater involvement with the sociocultural agents encouraging weight loss. Factorial analysis of the discriminating items gave rise to 5 factors, each of which also significantly differentiated between anorectics and the normal group. The questionnaire, in two versions, showed satisfactory internal consistency and appropriate sensitivity and specificity and would serve as a sound instrument for screening. It calls into question the causal relationship between anorexia nervosa and sociocultural influences.
Adolescent↗
Exploring the feasibility of assessing perceived parental rearing styles in Spanish children with the EMBU.
Most of the available data on the dimensional structure underlying the EMBU--an originally Swedish measure designed to assess one's recollections concerning one's parents' rearing behaviour--has been obtained with adults or adolescents. In the present study, using exploratory factor analysis, an attempt was made to determine the EMBU factorial structure in a Spanish sample of children aged 7-12 years (N = 205). Four factors explaining only 24% and 25% of the total variance in the ratings of the fathers and those of the mothers, respectively, and being invariant across parental sex, were interpreted: Emotional Warmth, Rejection, Control Attempts, and Favouring Subject. Results with respect to the internal consistency reliability of the corresponding scales were satisfactory, as were homogeneity figures pertaining to each set of theoretically-related items. Higher-order analyses of the first-order dimensions (mothers and fathers jointly) revealed three factors explaining 85% of the total variance. Control Attempts, Care (Rejection vs. Emotional Warmth), and Favouring Subject. The factorially-derived (first-order) scales were uncorrelated with sex of the recipient. All scales (except Rejection) correlated sizeably, negatively, with age (medium effect size) pointing, as outlined, to the need to take into account the relevant normative, design and research implications in further investigation. Some similarities and differences with findings yielded previously with adults and adolescents are briefly pinpointed.
Attitude↗
Obsessive-compulsive disorder in childhood and adolescence: a clinical study.
The clinical records of 72 children and adolescents aged 5-18 with a diagnosis of OCD were examined. Mean age of onset was 11 years. Repeating, cleaning and checking were the most common compulsions. Twenty percent of subjects showed obsessions unrelated to compulsions. In 53% of cases stress situations preceded the disorder. Seventy-seven percent of subjects suffered some other psychiatric disorder, lifetime or current, particularly anxiety and affective disorders. The majority (57%) had some first-degree relative with a psychiatric diagnosis. Family conflicts, social withdrawal and poor school performance were also common features.
Adolescent↗