Substance use disorders in hospice palliative care: A narrative review of challenges and a case for physician intervention

OBJECTIVES

Substance use disorders (SUDs) are frequently encountered in hospice palliative care (HPC) and pose substantial quality-of-life issues for patients. However, most HPC physicians do not directly treat their patients' SUDs due to several institutional and personal barriers. This review will expand upon arguments for the integration of SUD treatment into HPC, will elucidate challenges for HPC providers, and will provide recommendations that address these challenges.

METHODS

A thorough review of the literature was conducted. Arguments for the treatment of SUDs and recommendations for physicians have been synthesized and expanded upon.

RESULTS

Treating SUD in HPC has the potential to improve adherence to care, access to social support, and outcomes for pain, mental health, and physical health. Barriers to SUD treatment in HPC include difficulties with accurate assessment, insufficient training, attitudes and stigma, and compromised pain management regimens. Recommendations for physicians and training environments to address these challenges include developing familiarity with standardized SUD assessment tools and pain management practice guidelines, creating and disseminating visual campaigns to combat stigma, including SUD assessment and intervention as fellowship competencies, and obtaining additional training in psychosocial interventions.

SIGNIFICANCE OF RESULTS

By following these recommendations, HPC physicians can improve their competence and confidence in working with individuals with SUDs, which will help meet the pressing needs of this population.

Nutritional considerations for gender-diverse people: a qualitative mini review

Dietitians working with gender-diverse people may require different skills and knowledge than those caring for cisgender men and women, as indicated by a growing body of literature that highlights gender-diverse people's unique experiences with and relationships to nutrition and eating behaviors. To provide insight into how dietitians can best serve this population, this mini review identifies and summarizes qualitative studies that investigate gender-diverse people's lived experiences and perspectives regarding nutrition, eating disorders, and access to eating-related healthcare services. Fourteen studies examining nutrition or eating behaviors among gender-diverse samples were selected through a systematic search and screening process: 11 focused on disordered eating or eating disorders and the remaining three focused on nutritional needs, nutritional knowledge, and food insecurity. Extracted themes included: using dietary restriction to suppress secondary sex characteristics or conform to societal norms; the impact of gender-affirming care on disordered eating; negative experiences with, and beliefs about, nutrition and eating disorders healthcare services; and suggestions for clinicians. Recommendations discuss the need for increased trans literacy among clinicians, the creation of safe spaces for gender-diverse people with eating disorders, and the importance of dual competencies in eating disorders treatment and gender-affirming care.

Integrated treatment for comorbid eating disorders and substance use disorders: a scoping review protocol

OBJECTIVE

This review will identify and summarize the literature on the integrated treatment of comorbid eating disorders and substance use disorders, focusing on clinical practice guidelines and treatment studies.

INTRODUCTION

Eating disorders and substance use disorders are the deadliest psychiatric conditions, frequently co-occur, and are linked to greater symptom severity and poorer treatment outcomes. Despite repeated calls for their integrated treatment, such an approach has rarely been empirically evaluated. To advance the development of integrated treatments for comorbid eating disorders and substance use disorders, a critical first step is to describe existing treatment guidelines and summarize research evidence for this approach.

INCLUSION CRITERIA

This review will consider all peer-reviewed and gray literature describing the integrated treatment of comorbid eating disorders and substance use disorders, focusing on i) clinical practice guidelines; and ii) treatment studies. We will not place limitations on populations, types of eating disorders, types of substance use disorders, or other contextual factors.

METHODS

Databases to be searched will include MEDLINE (Ovid), Embase, CINAHL (EBSCOhost), PsycINFO (EBSCOhost), Scopus, and clinical practice guidelines databases identified by CADTH Grey Matters. No date or language limits will be applied to the search. At the screening stage, we will only consider literature in English or French. Two independent reviewers will screen studies at the title/abstract and full-text levels, and extract relevant studies. Disagreements will be resolved through discussion. Findings will be presented in tabular format and a narrative summary.

REVIEW REGISTRATION

Open Science Framework https://osf.io/za35j/.

Normative body image development: A longitudinal meta-analysis of mean-level change

This meta-analysis synthesized longitudinal data on mean-level change in body image, focusing on the constructs of body satisfaction and dissatisfaction, body esteem, perceived attractiveness, valuation, self-objectification, and body shame. We searched five databases and accessed unpublished data to identify studies that assessed body image at two or more time points over six months or longer. Analyses were based on data from 142 samples representing a total of 128,254 participants. The age associated with the midpoint of measurement intervals ranged from 6 to 54 years. Multilevel metaregression models examined standardized yearly mean change, and the potential moderators of body image construct, gender, birth cohort, attrition rate, age, and time lag. Boys and men showed fluctuations in overall body image with net-improvements between ages 10 and 24. Girls and women showed worsening body image between ages 10 and 16, but improvements between ages 16 and 24. Change was greatest between ages 10 and 14, and stabilized around age 24. We found no effect of construct, birth cohort, or attrition rate. Results suggest a need to revise understandings of normative body image development: sensitive periods may occur somewhat earlier than previously believed, and body image may show mean-level improvements during certain age ranges.

Effect of a CI Programming Fitting Tool with Artificial Intelligence in Experienced Cochlear Implant Patients

OBJECTIVE

Cochlear implants (CIs) are the treatment of choice for patients with severe to profound hearing loss. The hearing results, however, considerably vary across patients. This may partly be due to variability in the CI fitting. We investigated the effect of FOX, a software tool to program CIs using artificial intelligence (AI), on hearing outcomes.

METHODS

Forty-seven experienced CI patients who came to our tertiary CI center for their annual follow-up between 2017 and 2020 were recruited for this study. They received a new CI map created by the AI software tool. CI parameters and auditory outcomes obtained with this new map were compared with those of the initial manual map after 15 days of take-home experience. Within-patient differences were assessed. At the end of the study, the patients were offered a choice to continue using the AI map or to revert to their old manual map.

RESULTS

Several auditory outcomes improved with the AI map, namely, pure tone audiometric threshold at 6,000 Hz (median improvement 10 dB, range = -20 to 50 dB, Z = -2.608, p = 0.008), phonemic discrimination scores (median improvement 10%, range = 0% to 30%, Z = -4.061, p = 0.001), and soft-intensity (median improvement of 10%, range = -20% to 90%, Z = -4.412, p < 0.001) to normal-intensity (median improvement of 10%, range = -30% to 60%, Z = -3.35, p < 0.001) speech audiometric scores.

CONCLUSION

The AI-assisted CI mapping model as a potential assistive tool may improve audiological outcomes for experienced CI patients, including high-frequency pure tone audiometry and audiometric speech scores at low and normal presentation levels.Clinical trial registration: NCT03700268.

Adult Female Sleep During Hypoxic Bed Rest

Purpose

Hypobaric hypoxic habitats are currently being touted as a potential solution to minimise decompression procedures in preparation for extra vehicular activities during future space missions. Since astronauts will live in hypoxic environments for the duration of such missions, the present study sought to elucidate the separate and combined effects of inactivity [simulated with the experimental bed rest (BR) model] and hypoxia on sleep characteristics in women.

Methods

Twelve women (Age = 27 ± 3 year) took part in three 10-day interventions, in a repeated measures cross-over counterbalanced design: (1) normobaric normoxic BR (NBR), (2) normobaric hypoxic BR (HBR; simulated altitude of 4,000 m), and (3) normobaric hypoxic ambulatory (HAMB; 4,000 m) confinement, during which sleep was assessed on night 1 and night 10 with polysomnography. In addition, one baseline sleep assessment was performed. This baseline assessment, although lacking a confinement aspect, was included statistically as a fourth comparison (i.e., pseudo normobaric normoxic ambulatory; pNAMB) in the present study.

Results

Hypoxia decreased sleep efficiency (p = 0.019), increased N1% sleep (p = 0.030), decreased N3 sleep duration (p = 0.003), and increased apnea hypopnea index (p < 0.001). BR impaired sleep maintenance, efficiency, and architecture [e.g., N2% sleep increased (p = 0.033)]. Specifically, for N3% sleep, the effects of partial pressure of oxygen and activity interacted. Hypoxia decreased N3% sleep both when active (pNAMB vs HAMB; p < 0.001) and inactive (NBR vs HBR; p = 0.021), however, this decrease was attenuated in the inactive state (–3.8%) compared to the active state (–10.2%).

Conclusion

A 10-day exposure to hypoxia and BR negatively impacted sleep on multiple levels as in macrostructure, microstructure and respiratory functioning. Interestingly, hypoxia appeared to have less adverse effects on sleep macrostructure while the participants were inactive (bed ridden) compared to when ambulatory. Data were missing to some extent (i.e., 20.8%). Therefore, multiple imputation was used, and our results should be considered as exploratory.

Lessons From Special Forces Operators for Elite Team Sports Training: How to Make the Whole Greater Than the Sum of the Parts

This methodology paper describes the design of a holistic and multidisciplinary human performance program within the Belgian Special Forces Group, the Tier 1 Special Operations unit of the Belgian Defense. Performance management approaches in the military draw heavily on sports science. The key component of the program design described here is its integrative nature, which team sports training might benefit from. The basic rationale behind the program was to bridge several gaps: the gap between physical and mental training; the gap between the curative or preventive medical approach and the performance enhancement approach; and the gap between individual and team training. To achieve this goal, the methodology of Intervention Mapping was applied, and a multidisciplinary team of training and care professionals was constituted with operational stakeholders. This was the first step in the program design. The second step took a year, and consisted of formal and informal consultations, participant observations and task analyses. These two first stages and their conclusions are described in the Method section. The Results section covers the next two stages (three and four) of the process, which aimed at defining the content of the program; and to test a pilot project implementation. The third stage encompassed the choice of the most relevant assessment and intervention tools for the target population, within each area of expertise. This is described extensively, to allow for replication. The fourth and last stage was to "test drive" the real-life integration and implementation of the whole program at the scale of a single team (8 individuals). For obvious confidentiality reasons, the content data will not be reported extensively here. Implications for wider-scale implementation and tie-back to sports team training are presented.

The Cognitive-Vestibular Compensation Hypothesis: How Cognitive Impairments Might Be the Cost of Coping With Compensation

Previous research in vestibular cognition has clearly demonstrated a link between the vestibular system and several cognitive and emotional functions. However, the most coherent results supporting this link come from rodent models and healthy human participants artificial stimulation models. Human research with vestibular-damaged patients shows much more variability in the observed results, mostly because of the heterogeneity of vestibular loss (VL), and the interindividual differences in the natural vestibular compensation process. The link between the physiological consequences of VL (such as postural difficulties), and specific cognitive or emotional dysfunction is not clear yet. We suggest that a neuropsychological model, based on Kahneman's Capacity Model of Attention, could contribute to the understanding of the vestibular compensation process, and partially explain the variability of results observed in vestibular-damaged patients. Several findings in the literature support the idea of a limited quantity of cognitive resources that can be allocated to cognitive tasks during the compensation stages. This basic mechanism of attentional limitations may lead to different compensation profiles in patients, with or without cognitive dysfunction, depending on the compensation stage. We suggest several objective and subjective measures to evaluate this cognitive-vestibular compensation hypothesis.

A State-of-the-Art Review on the Use of Modafinil as A Performance-enhancing Drug in the Context of Military Operationality

INTRODUCTION

Modafinil is an eugeroic drug that has been examined to maintain or recover wakefulness, alertness, and cognitive performance when sleep deprived. In a nonmilitary context, the use of modafinil as a nootropic or smart drug, i.e., to improve cognitive performance without being sleep deprived, increases. Although cognitive performance is receiving more explicit attention in a military context, research into the impact of modafinil as a smart drug in function of operationality is lacking. Therefore, the current review aimed at presenting a current state-of-the-art and research agenda on modafinil as a smart drug. Beside the question whether modafinil has an effect or not on cognitive performance, we examined four research questions based on the knowledge on modafinil in sleep-deprived subjects: (1) Is there a difference between the effect of modafinil as a smart drug when administered in repeated doses versus one single dose?; (2) Is the effect of modafinil as a smart drug dose-dependent?; (3) Are there individual-related and/or task-related impact factors?; and (4) What are the reported mental and/or somatic side effects of modafinil as a smart drug?

METHOD

We conducted a systematic search of the literature in the databases PubMed, Web of Science, and Scopus, using the search terms "Modafinil" and "Cognitive enhance*" in combination with specific terms related to the research questions. The inclusion criteria were studies on healthy human subjects with quantifiable cognitive outcome based on cognitive tasks.

RESULTS

We found no literature on the impact of a repeated intake of modafinil as a smart drug, although, in users, intake occurs on a regular basis. Moreover, although modafinil was initially said to comprise no risk for abuse, there are now indications that modafinil works on the same neurobiological mechanisms as other addictive stimulants. There is also no thorough research into a potential risk for overconfidence, whereas this risk was identified in sleep-deprived subjects. Furthermore, eventual enhancing effects were beneficial only in persons with an initial lower performance level and/or performing more difficult tasks and modafinil has an adverse effect when used under time pressure and may negatively impact physical performance. Finally, time-on-task may interact with the dose taken.

DISCUSSION

The use of modafinil as a smart drug should be examined in function of different military profiles considering their individual performance level and the task characteristics in terms of cognitive demands, physical demands, and sleep availability. It is not yet clear to what extent an improvement in one component (e.g., cognitive performance) may negatively affect another component (e.g., physical performance). Moreover, potential risks for abuse and overconfidence in both regular and occasional intake should be thoroughly investigated to depict the trade-off between user benefits and unwanted side effects. We identified that there is a current risk to the field, as this trade-off has been deemed acceptable for sleep-deprived subjects (considering the risk of sleep deprivation to performance) but this reasoning cannot and should not be readily transposed to non-sleep-deprived individuals. We thus conclude against the use of modafinil as a cognitive enhancer in military contexts that do not involve sleep deprivation.

In situ continuous monitoring of dissolved gases (N2, O2, CO2, H2) prior to H2 injection in an aquifer (Catenoy, France) by on-site Raman and infrared spectroscopies: instrumental assessment and geochemical baseline establishment

The establishment of a baseline of gases from an aquifer appears to be an essential prerequisite for monitoring and securing underground storage operations such as the storage of carbon dioxide (carbon capture and storage: CCS), methane or hydrogen. This study describes an innovative metrological technique dedicated to the in situ and continuous quantification of dissolved gases (CO₂, O₂, N₂, CH₄ and H₂) in a shallow aquifer, on the site of Catenoy (Paris Basin) with a water table at a depth of 13 m. Monitoring was carried out from May 7, 2019 to November 19, 2019, before the simulation of H₂ injection. Gases as vapors were collected from the aquifer through a nine-meter long, half-permeable polymer membrane positioned below a packer in a 25-meter deep well. Collected gases were analyzed simultaneously at the surface by fiber Raman (CO₂, O₂, N₂, CH₄ and H₂) and infrared sensors (CO₂). Gas concentrations were determined from Raman and infrared data, and then converted into dissolved concentrations using Henry's law. The dissolved gas concentrations were about constant over the 6 months period with average values of 31-40 mg L^-1 (CO₂), 8 mg L^-1 (O₂), 17 mg L^-1 (N₂), and 0 mg L^-1 (H₂, CH₄) indicating a very low variability in the aquifer. This is believed to allow for rapid detection of any possible abnormal concentration variation, in particular linked to an accidental arrival of gases such as hydrogen. Such an online gas measurement system can be deployed as is on any site type of underground storage without any need for adaptation.

Neuropsychological profiles of children with vestibular loss

BACKGROUND

The impact of vestibular loss (VL) on cognition has been previously studied in experimental animal, human and adult patient studies showing links between VL, and cognitive impairments in space orientation, working memory, mental rotation and selective attention. However, few studies have been conducted on children with VL.

OBJECTIVE

We investigated for the first time, the impact of a VL on children's cognition.

METHODS

13 children with VL (10 years, 5 months) and 60 average-age matched controls performed a neuropsychological assessment consisting of visuospatial working memory, selective visual attention, mental rotation and space orientation tasks.

RESULTS

Children with VL recalled smaller sequences for both forward and backward memory subtasks (mean±SD = 6.3±1.9 and 5.3±2.6) than controls (8.2±2.3 and 7.3±2.0), have less accurate mental rotation scores (25.4±6 versus 30.8±5.1) and greater additional distance travelled in the maze task (96.4±66.6 versus 60.4±66.3); all corrected p-values <0.05. Selective visual attention measures do not show significant differences.

CONCLUSIONS

Children with VL show similar cognitive difficulties that adults with VL, in tasks involving dynamic cognitive processes (higher attentional load) that in tasks requiring static cognitive processes such as visual attention task.

Prevalence of social, cognitive, and emotional impairment among individuals with food addiction

PURPOSE

The clinical utility of the construct of food addiction has been heavily debated. Though food addiction has been associated with psychosocial impairment in clinical samples, it is critical to examine these associations in non-clinical samples, to obtain unbiased evidence regarding this phenomenon's clinical significance. It is also unknown which types of impairment are most common in food addiction. This observational study explored the association of self-reported food addiction with impairment in the domains of social, cognitive, and emotional functioning.

METHODS

Participants (356 university students and 544 adults recruited through Mechanical Turk) completed the Yale Food Addiction Scale 2.0 and Clinical Impairment Assessment 3.0 questionnaire, as well as measures of emotional eating, reward-driven eating, binge eating, and general disordered eating.

RESULTS

Food addiction scores showed large correlations with emotional (r = 0.55, 0.57), social (r = 0.56, 0.59), and cognitive impairment (r = 0.58, 0.53) in the student and Mechanical Turk samples, respectively. The most common difficulties endorsed were emotional (e.g., feeling ashamed or critical of oneself, upset, or worried due to one's eating habits), followed by social and cognitive.

CONCLUSION

Food addiction was strongly associated with psychosocial impairment in two non-clinical samples, suggesting this phenomenon merits further investigation. We found substantial associations of food addiction with emotional as well as social and cognitive impairment.

Body image disturbance partially explains eating-related psychosocial impairment in food addiction

BACKGROUND

This study aimed to explore the association of food addiction (FA) with eating-related psychosocial impairment and examine the extent to which this association was explained directly by FA symptoms themselves, versus through body image disturbance.

MATERIALS AND METHODS

Participants (356 university students and 544 crowdsourced adults) completed self-report measures of FA (Yale Food Addiction Scale; YFAS 2.0), psychosocial impairment (Clinical Impairment Assessment; CIA 3.0), and body image disturbance (Eating Disorders Examination Questionnaire; EDE-Q 6.0), and reported their body mass index (BMI) and gender.

RESULTS

Endorsement of distress and/or impairment on the YFAS corresponded to ratings on the CIA. Structural equation models indicated the relationship between FA and eating-related psychosocial impairment was partially mediated by body image disturbance. The indirect effect of body image disturbance explained more variance in eating-related psychosocial impairment than did YFAS scores themselves. Neither BMI nor gender significantly moderated any direct or indirect pathways from food addiction to psychosocial impairment.

CONCLUSIONS

Food addiction is associated with clinical impairment in men and women across the weight spectrum. A large portion of psychosocial impairment associated with food addiction may be explained by body image disturbance. Due to its role in explaining psychosocial impairment, body image disturbance warrants increased attention in FA research.

Prioritization of patients access to outpatient augmentative and alternative communication services in Quebec: a decision tool

Purpose: A large number of people living with a chronic disability wait a long time to access publicly funded rehabilitation services such as Augmentative and Alternative Communication (AAC) services, and there is no standardized tool to prioritize these patients. We aimed to develop a prioritization tool to improve the organization and access to the care for this population.Methods: In this sequential mixed methods study, we began with a qualitative phase in which we conducted semi-structured interviews with 14 stakeholders including patients, their caregivers, and AAC service providers in Quebec City, Canada to gather their ideas about prioritization criteria. Then, during a half-day consensus group meeting with stakeholders, using a consensus-seeking technique (i.e. Technique for Research of Information by Animation of a Group of Experts), we reached consensus on the most important prioritization criteria. These criteria informed the quantitative phase in which used an electronic questionnaire to collect stakeholders' views regarding the relative weights for each of the selected criteria. We analyzed these data using a hybrid quantitative method called group based fuzzy analytical hierarchy process, to obtain the importance weights of the selected eight criteria.Results: Analyses of the interviews revealed 48 criteria. Collectively, the stakeholders reached consensus on eight criteria, and through the electronic questionnaire they defined the selected criteria's importance weights. The selected eight prioritization criteria and their importance weights are: person's safety (weight: 0.274), risks development potential (weight: 0.144), psychological well-being (weight: 0.140), physical well-being (weight: 0.124), life prognosis (weight: 0.106), possible impact on social environment (weight: 0.085), interpersonal relationships (weight: 0.073), and responsibilities and social role (weight: 0.054).Conclusion: In this study, we co-developed a prioritization decision tool with the key stakeholders for prioritization of patients who are referred to AAC services in rehabilitation settings.IMPLICATIONS FOR REHABILIATIONStudies in Canada have shown that people in Canada with a need for rehabilitation services are not receiving publicly available services in a timely manner.There is no standardized tool for the prioritization of AAC patients.In this mixed methods study, we co-developed a prioritization tool with key stakeholders for prioritization of patients who are referred to AAC services in a rehabilitation center in Quebec, Canada.

Smartphone-Delivered Peer Physical Activity Counseling Program for Individuals With Spinal Cord Injury: Protocol for Development and Pilot Evaluation

Background

Leisure-time physical activity (LTPA) is a critical component of a healthy lifestyle for individuals with spinal cord injury (SCI). However, most individuals are not sufficiently active to accrue health benefits. The Active Living Lifestyles program for individuals with SCI who use manual wheelchairs (ALLWheel) targets important psychological factors that are associated with LTPA uptake and adherence while overcoming some barriers associated with participation restrictions.

Objective

The goal of the paper is to describe the protocol for the development and evaluation of the ALLWheel program for individuals with SCI who use manual wheelchairs.

Methods

The first three stages of the Medical Research Council framework for developing and evaluating complex interventions (ie, preclinical, modeling, exploratory) are described. The preclinical phase will consist of scoping and systematic reviews and review of theory. The intervention will be modeled by expert opinions and consensus through focus groups and Delphi surveys with individuals with SCI, clinicians, and community partners. Finally, the feasibility and potential influence of the ALLWheel program on LTPA and psychological outcomes will be evaluated.

Results

This project is funded by the Craig H Neilsen Foundation, the Fonds de Recherche du Québec–Santé, and the Canadian Disability Participation Project and is currently underway.

Conclusions

Using peer trainers and mobile phone technology may help to cultivate autonomy-supportive environments that also enhance self-efficacy. Following a framework for developing and evaluating a novel intervention that includes input from stakeholders at all stages will ensure the final product (ie, a replicable intervention) is desirable to knowledge users and ready for evaluation in a randomized controlled trial. If effective, the ALLWheel program has the potential to reach a large number of individuals with SCI to promote LTPA uptake and adherence.

International Registered Report Identifier (IRRID)

DERR1-10.2196/10798

Evaluating an abbreviated three-factor version of the Eating Disorder Examination Questionnaire in three samples

A brief, three-factor structure for the Eating Disorder Examination-Questionnaire (EDE-Q) has been identified that has stronger psychometric properties than the original four-factor EDE-Q structure. However, there is a need for independent replication of the brief version in different samples, and examination of how comparable the brief version is in women and men of diverse ages. This study compared factor structure fit and other psychometric properties between the original and brief versions in three independent samples of adults to evaluate the reliability and validity of this brief version. It also examined measurement invariance across gender in a middle-aged community sample. Participants included university women (N = 659), university women and men (N = 358), and crowdsourced community women and men (N = 544). Across samples, compared to the original version the brief version demonstrated greater internal consistency, somewhat less item overlap, and superior model fit in confirmatory factor analyses, although some fit indices fell below recommended cut-offs. Separate confirmatory factor analyses of the brief version in community women and men suggested the brief version may better fit community men than women, and measurement invariance across gender for the brief version was not supported for the community sample. This independent replication supports the factorial validity of the brief version in three samples of students and crowdsourced community adults, and highlights the importance of further examination of the psychometric properties of this brief three-factor version across gender and age categories, among others sample characteristics.

Folic acid supplementation during the preconception period: A systematic review and meta-analysis

Guidelines recommend that women take folic acid supplements in the preconception period to prevent neural tube defects (NTDs) in their offspring. Estimates of adherence to this recommendation across different countries worldwide have not been synthesized. Medline, CINAHL, and EMBASE were systematically searched to identify studies reporting the prevalence of preconception folic acid supplementation. Pooled prevalence estimates for each country (where data were available) were calculated; and differences based on demographic, methodological, and study quality characteristics were examined. Of 3372 titles and abstracts screened, 722 full-texts were reviewed and 105 articles that reported 106 estimates of preconception folic acid supplementation in 34 countries were included. Pooled prevalence estimates were 32-51% in North America, 9-78% in Europe, 21-46% in Asia, 4-34% in the Middle East, 32-39% in Australia/New Zealand, and 0% in Africa. No South American studies were identified. Higher supplementation prevalence was observed in studies that had more highly educated samples, were conducted in fertility clinics, and assessed folic acid use via self-report. Of note, only 32% and 28% of studies reported timing of folic acid use and adherence to folic acid, respectively. Preconception folic acid supplementation is highly variable worldwide and many women may not achieve sufficient folate levels to prevent NTDs. To better understand non-adherence, recommendations for future research include: more explicit reporting of methodology, more detailed assessment of folic acid use, assessment of variables potentially relevant to folic acid use, and surveillance of folic acid use in a greater diversity of countries, especially in the developing world.

The need to consume: Hoarding as a shared psychological feature of compulsive buying and binge eating

INTRODUCTION

Compulsive buying and binge eating are two frequently co-occurring psychiatric conditions. Hoarding, which is the psychological need to excessively gather and store items, is frequently associated with both compulsive buying severity and binge eating severity. In the present study, we explored whether different dimensions of hoarding are a shared feature of compulsive buying and binge eating.

METHOD

Participants consisted of 434 people seeking treatment for compulsive buying disorder. Registered psychiatrists confirmed the diagnosis of compulsive buying through semi-structured clinical interviews. Participants also completed measures to assess compulsive buying severity, binge eating severity, and dimensions of hoarding (acquisition, difficulty discarding, and clutter). Two-hundred and seven participants completed all three measures.

RESULTS

Significant correlations were found between compulsive buying severity and the acquisition dimension of hoarding. Binge eating severity was significantly correlated with all three dimensions of hoarding. Hierarchical regression analysis found that compulsive buying severity was a significant predictor of binge eating severity. However, compulsive buying severity no longer predicted binge eating severity when the dimensions of hoarding were included simultaneously in the model. Clutter was the only subscale of hoarding to predict binge eating severity in step two of the regression analysis.

CONCLUSION

Our results suggest that the psychological need to excessively gather and store items may constitute a shared process that is important in understanding behaviors characterized by excessive consumption such as compulsive buying and binge eating.

Moving beyond the "eating addiction" versus "food addiction" debate: Comment on Schulte et al. (2017)

In a recent commentary, Schulte et al. (2017) argued that addictive-like eating should be conceptualized as a substance use disorder rather than a behavioural addiction, and noted that many parallels that Hebebrand et al. (2014) drew between addictive-like eating and behavioural addictions apply likewise to substance use disorders. However, we argue that many of the arguments advanced by Schulte et al. (2017) in support of a substance-based food addiction model, including the important role played by ingested substances, are nonspecific. That is, these arguments apply equally well to behavioural addictions and other mental disorders, notably eating disorders, which raises the question of whether the phenomenon of addictive-like eating is encompassed by existing eating disorder diagnoses. Similarities between addictive-like eating and substance use, no matter how compelling, do not ensure the validity or clinical utility of a substance-based food addiction model and should not drive the conceptualization of addictive-like eating. The present commentary discusses problems with Schulte et al.'s (2017) arguments for substance-based food addiction, and draws attention to alternative conceptualizations of addictive-like eating which risk being overlooked when this conversation is framed as a dichotomous debate between the food and eating addiction models.

Weight Bias: A Systematic Review of Characteristics and Psychometric Properties of Self-Report Questionnaires

BACKGROUND

People living with overweight and obesity often experience weight-based stigmatization. Investigations of the prevalence and correlates of weight bias and evaluation of weight bias reduction interventions depend upon psychometrically-sound measurement. Our paper is the first to comprehensively evaluate the psychometric properties, use of people-first language within items, and suitability for use with various populations of available self-report measures of weight bias.

METHODS

We searched five electronic databases to identify English-language self-report questionnaires of weight bias. We rated each questionnaire's psychometric properties based on initial validation reports and subsequent use, and examined item language.

RESULTS

Our systematic review identified 40 original self-report questionnaires. Most questionnaires were brief, demonstrated adequate internal consistency, and tapped key cognitive and affective dimensions of weight bias such as stereotypes and blaming. Current psychometric evidence is incomplete for many questionnaires, particularly with regard to the properties of test-retest reliability, sensitivity to change as well as discriminant and structural validity. Most questionnaires were developed prior to debate surrounding terminology preferences, and do not employ people-first language in the items administered to participants.

CONCLUSIONS

We provide information and recommendations for clinicians and researchers in selecting psychometrically sound measures of weight bias for various purposes and populations, and discuss future directions to improve measurement of this construct.

Fuel poverty as a major determinant of perceived health: the case of France

OBJECTIVES

The number of households in fuel poverty is growing. Individuals increasingly struggle to heat their homes, and therefore, a growing number of individuals are exposed to low temperatures, which can affect their health. This study sought to determine the link between a subjective measure of fuel poverty (self-reported feeling cold) and self-reported health. The impact of other particular individual and environmental features on self-reported health were also analysed.

STUDY DESIGN

Econometric analysis.

METHODS

The study method uses self-reported perception of thermal discomfort (self-reported feeling cold) as a proxy for fuel poverty. The French database of the Healthcare and Insurance survey carried by the Institute for Research and Information on Health Economics (IRDES) was used to estimate a dichotomous probit model.

RESULTS

The estimation allows us to infer a negative impact of fuel poverty on self-reported health. Thus, a person in fuel poverty is 2.36 percentage points more likely to report poor or fair health status than a person who is not in fuel poverty.

CONCLUSION

It may be appropriate to reduce the impacts of fuel poverty to provide support for the most vulnerable categories of individuals with respect to the health impacts of fuel poverty and cold homes, e.g., chronic patients who experience difficulty heating their homes.

Randomized controlled study of the effect of a butter naturally enriched in trans fatty acids on blood lipids in healthy women

BACKGROUND

Whereas the negative effect of consuming trans fatty acids found in partially hydrogenated vegetable oils on cardiovascular disease (CVD) risk is well established, the effect of trans fatty acids from ruminant sources (rTFAs) on CVD risk factors has not yet been established, particularly among women.

OBJECTIVE

We investigated the effects of a butter naturally enriched in rTFAs, of which vaccenic acid is the predominant isomer, on plasma lipid concentrations among healthy women.

DESIGN

In a double-blind, randomized, crossover controlled study, 61 healthy women aged 19-70 y were fed 2 isoenergetic diets lasting 4 wk each. The 2 diets were defined as moderately high in rTFAs (3.7 g/d, 1.5% of daily energy) and control (0.9 g/d, 0.3% of daily energy).

RESULTS

No significant effect of the rTFA diet was found on total plasma cholesterol, LDL cholesterol, apolipoprotein B, apolipoprotein A-I, and triglyceride concentrations compared with the control diet. There was a small yet statistically significant reduction in plasma HDL-cholesterol concentrations with the rTFA diet (-2.8%; P = 0.004), which was significant (P for the BMI × treatment interaction = 0.006) among women with a BMI (in kg/m(2)) ≥25 (-5.2%; P = 0.004; n = 18) but not among women with a BMI <25 (-1.2%; P = 0.13; n = 43).

CONCLUSIONS

These results suggest that an increase in dietary rTFAs equivalent to ∼1% of daily energy has no significant effect on LDL but may be associated with a reduction in plasma HDL-cholesterol concentrations, particularly in overweight women. This trial is registered at clinicaltrials.gov as NCT00930137.

Computer-assisted re-design of spectrin SH3 residue clusters

We have developed a protein design computer program, called Perla, which performs searches in sequence space to uncover optimal amino acid sequences for desired protein three-dimensional structures. Optimal sequences are localised at the minima of a sequence-structure energy landscape defined using a complex scoring function (an all-atom molecular mechanics force field plus statistical terms including entropy and solvation) measured with respect to a reference state simulating a denatured protein. Sequence choices eventually optimise side chain packing, secondary structure propensities, and hydrogen bonding and electrostatics interactions. Perla was used to re-design clusters of residues of the SH3 domain of alpha-spectrin. Several mutant proteins were produced and characterised. Some of our designed proteins have significantly higher stabilities (stability enhancements about 0.25, 0.70 and 1.0 kcal mol(-1)) than the wild-type protein. These successful protein re-designs, and similar examples found in the literature, establish the quality of the structure-based computational approach to protein design.

Computer-aided design of beta-sheet peptides

The design of beta-sheet proteins is still a challenge in the field of de novo protein design. Here, we have tested the validity of automatic design methods to create and/or improve beta-sheet peptides and proteins. We chose Betanova, a three-stranded beta-sheet peptide, as target system, and, as an automatic design tool, a protein design algorithm called PERLA (protein engineering rotamer library algorithm). PERLA was used to define both stabilising and destabilising single- and multiple-residue mutations of Betanova. Conformational analysis by NMR spectroscopy and far-UV circular dichroism (CD) allowed us to evaluate population differences among the set of designed peptides. Some of the new mutants are approximately 1 kcal/mol more stable than the wild-type peptide. Comparison of the scale of predicted and observed stabilities demonstrates that they are in good agreement for most peptides studied. Our results show that automatic design algorithms can be successfully applied to the design of beta-sheet peptides.

Multifunctionalized alpha,beta-cyclopentenones from C-2 and C-4-ulopyranosyl compounds: a stereospecific rearrangement initiated by base

Base treatment of O-benzyl protected C-2- or C-4-ulopyranosyl compounds (4 alpha, 4 beta, and 11) by either 10% Et(3)N or 1% K(2)CO(3) in MeOH initiated a beta elimination to afford alpha,beta-unsaturated C-ulopyranosyl compounds (5 alpha, 5 beta, and 12), which further rearranged in a stereocontrolled manner to multifuctionalized alpha,beta-cyclopentenones (6 and 14) in 70-80% yield. Both C-alpha- and C-beta-2-ulosides (5 alpha and 5 beta) produced the same cyclopentenone 6, indicating that a 1,2-enolate is formed prior to the cleavage of the C-5--O bond. Because 6 is racemic, it was probably formed by the intramolecular cycloaldolization of two equally populated enantiomeric intermediates. When treated with 90% Et(3)N in MeOH, 5 alpha yielded almost exclusively 15 (isomer of 6), which was formed by a migration of the double bond in 5 alpha during the previously described rearrangement. Thus either 6 or 15 was the major product, depending on the base used.

Computational estimation of specific side chain interaction energies in alpha helices

We have used a structure energy-based computer program developed for protein design, Perla, to provide theoretical estimates of all specific side chain-side chain interaction energies occurring in alpha helices. The computed side chain-side chain interaction energies were used as substitutes for the corresponding values used by the helix/coil transition algorithm, AGADIR. Predictions of peptide helical contents were nearly as successful as those obtained with the originally calibrated set of parameters; a correlation to experimentally observed alpha-helical populations of 0.91 proved that our theoretical estimates are reasonably correct for amino acid pairs that are frequent in our database of peptides. Furthermore, we have determined experimentally the previously uncharacterized interaction energies for Lys-Ile, Thr-Ile, and Phe-Ile amino acid pairs at i,i + 4 positions. The experimental values compare favorably with the computed theoretical estimates. Importantly, the computed values for Thr-Ile and Phe-Ile interactions are better than the energies based on chemical similarity, whereas for Lys-Ile they are similar. Thus, computational techniques can be used to provide precise energies for amino acid pairwise interactions, a fact that supports the development of structure energy-based computational tools for structure predictions and sequence design.

Towards understanding a molecular switch mechanism: thermodynamic and crystallographic studies of the signal transduction protein CheY

The signal transduction protein CheY displays an alpha/beta-parallel polypeptide folding, including a highly unstable helix alpha4 and a strongly charged active site. Helix alpha4 has been shown to adopt various positions and conformations in different crystal structures, suggesting that it is a mobile segment. Furthermore, the instability of this helix is believed to have functional significance because it is involved in protein-protein contacts with the transmitter protein kinase CheA, the target protein FliM and the phosphatase CheZ. The active site of CheY comprises a cluster of three aspartic acid residues and a lysine residue, all of which participate in the binding of the Mg(2+) needed for the protein activation. Two steps were followed to study the activation mechanism of CheY upon phosphorylation: first, we independently substituted the three aspartic acid residues in the active site with alanine; second, several mutations were designed in helix alpha 4, both to increase its level of stability and to improve its packing against the protein core. The structural and thermodynamic analysis of these mutant proteins provides further evidence of the connection between the active-site area and helix alpha 4, and helps to understand how small movements at the active site are transmitted and amplified to the protein surface.

The design of linear peptides that fold as monomeric beta-sheet structures

Current knowledge about the determinants of beta-sheet formation has been notably improved by the structural and kinetic analysis of model peptides, by mutagenesis experiments in proteins and by the statistical analysis of the protein structure database (Protein Data Bank; PDB). In the past year, several peptides comprising natural and non-natural amino acids have been designed to fold as monomeric three-stranded beta-sheets. In all these cases, the design strategy has involved both the statistical analysis of the protein structure database and empirical information obtained in model beta-hairpin systems and in proteins. Only in one case was rotamer analysis performed to check for the compatibility of the sidechain packing. It is foreseeable that, in future designs, algorithms exploring the sequence and conformational space will be employed. For the design of small proteins (less than 30 amino acids), questions remain about the demonstration of two-state behavior, the formation of a well-defined network of mainchain hydrogen bonds and the quantification of the structured populations.

[Comparative study of the ideas about causes, disease mechanisms and therapies of the plague on the basis of the plague treatises of the Medical Faculty of Paris (1348-1349), of Joannes de Vesalia (after 1454) and of Thomas Montanus (1669)]

The comparison between the consilium of the Faculty of Paris (14th century), and the treatises by Joannes de Vesalia (15th century) and by Thomas Montanus (17th century) shows that the concepts with regard to the causes and the mechanisms of and the proposed preventive and curative measures against the plague did in essence not change for over three centuries. In fact this is not very surprising, since the development of modern physiology and physiopathology only started gradually in the second half of the 19th century. Furthermore, the plague bacillus has only been identified in 1894. However, the preventive and curative measures against plague that are proposed in the three treatises, do not result from an uncontrolled imagination. Most of these measures have a rational basis and are the result of--although erroneous--concepts with regard to the causes and mechanisms of the disease.

Elucidating the folding problem of alpha-helices: local motifs, long-range electrostatics, ionic-strength dependence and prediction of NMR parameters

The information about the conformational behavior of monomeric helical peptides in solution, as well as the alpha-helix stability in proteins, has been previously utilized to derive a database with the energy contributions for various interactions taking place in an alpha-helix: intrinsic helical propensities, side-chain-side-chain interactions, main-chain-main-chain hydrogen bonds, and capping effects. This database was implemented in an algorithm based on the helix/coil transition theory (AGADIR). Here, we have modified this algorithm to include previously described local motifs: hydrophobic staple, Schellman motif and Pro-capping motif, new variants of these, and newly described side-chain-side-chain interactions. Based on recent experimental data we have introduced a position dependence of the helical propensities for some of the 20 amino acid residues. A new electrostatic model that takes into consideration all electrostatic interactions up to 12 residues in distance in the helix and random-coil conformations, as well as the effect of ionic strength, has been implemented. We have synthesized and analyzed several peptides, and used data from peptides already analysed by other groups, to test the validity of our electrostatic model. The modified algorithm predicts, with an overall standard deviation value of 6.6 (maximum helix is 100%), the helical, content of 778 peptides of which 223 correspond to wild-type and modified protein fragments. To improve the prediction potential of the algorithm and to have a direct comparison with nuclear magnetic resonance data, the algorithm now predicts the conformational shift of the CalphaH protons, 13Calpha and 3JalphaN values. We have found that for those peptides correctly predicted from the point of view of circular dichroism, the prediction of the NMR parameters is very good.

Reading protein sequences backwards

BACKGROUND

Reading a protein sequence backwards provides a new polypeptide that does not align with its parent sequence. The foldability of this new sequence is questionable. On one hand, structure prediction at low resolution using lattice simulations for such a protein provided a model close to the native parent fold or to a topological mirror image of it. On the other hand, there is no experimental evidence yet to tell whether such a retro protein folds (and to which structure) or not.

RESULTS

In this work, we have analysed the possibility of a retro protein folding in two different ways. First, we modelled the retro sequence of the alpha-spectrin SH3 domain through distance geometry and molecular dynamics. This contradicted the plausibility of a mirror image of the native domain, whereas basic considerations opposed the likelihood of the native fold. Second, we obtained experimental evidence that the retro sequences of the SH3 domain, as well as the B domain of Staphylococcal protein A and the B1 domain of Streptococcal protein G, are unfolded proteins, even though some propensities for the formation of secondary structures might remain.

CONCLUSIONS

Retro proteins are no more similar to their parent sequences than any random sequence despite their common hydrophobic/hydrophilic pattern, global amino acid composition and possible tertiary contacts. Although simple folding models contribute to our global understanding of protein folding, they cannot yet be used to predict the structure of new proteins.

Amide hydrogen exchange and internal dynamics in the chemotactic protein CheY from Escherichia coli

The backbone internal dynamics of the wild-type 129 amino acid alpha/beta parallel protein CheY and its double mutant F14N/P110G are analysed here by the hydrogen-exchange method. The F14N mutation is known to stabilise the protein and to accelerate refolding while P110G is destabilising and accelerates unfolding. We first assigned and characterised the double mutant by nuclear magnetic resonance (NMR), to try and discover any possible conformational change induced by the two mutations. The main difference between the two proteins is a favourable N-capping interaction of the newly introduced Asn14 side-chain at the beginning of the first alpha-helix (alpha-helix A). Second, we have measured the exchange rates in the wild-type and mutant CheY. In the first case the observed protection factors are slightly dispersed around an average value. According to their distribution in the structure, protein stability is highest on one face of the central beta-sheet, in the surroundings of the main hydrophobic core formed by side-chains of residues in beta-strands I, II and III and helices A and E. The mutations in the double mutant protein affect two distinct subdomains differently (from beta-strand I to III and from alpha-helix C to the end). In the second subdomain the number of protected protons is reduced with respect to those in the wild-type. This differential behaviour can be explained by a selective decrease in stability of the second folding subdomain produced by the P110G mutation and the opposite effect in the first subdomain, produced by the F14N mutation. alpha-Helix A, which is involved together with beta-strands I and III in the folding nucleus of CheY, shows the largest protection factors in both proteins.

Influence of converting enzyme inhibition on isoflurane-induced hypotension for cerebral aneurysm surgery

Twenty-five patients (aged 18 to 72 years), who recovered after the first bleed from a cerebral aneurysm, were operated on under neuroleptanaesthesia. Isoflurane was added to induce hypotension. It was found that the required hypotension (51 (SEM 1) mmHg) could be obtained and maintained at much lower isoflurane concentrations (less than 1%) after blockade of the angiotensin converting enzyme activity by enalaprilat (2.5 mg i.v.) than without such inhibition. During the hypotension which lasted 78 (SEM 10) min, only minor adjustments of the isoflurane concentration (0.70 (0.04%) were needed. The desired level of hypotension was obtained with preservation of the cardiac output and without tachycardia. No resistance to the blood pressure lowering effect of isoflurane was observed. On recovery from anaesthesia, a small increase of blood pressure above control values was seen in 16 patients and was easily reversed by small doses of clonidine (mean total dose: 220 (61) micrograms). The operative conditions were excellent and the postoperative recovery was uneventful and complete in 23 patients.

Alpha 2-adrenoceptor-mediated inhibition of prolactin release in suckling- or fenfluramine-induced hyperprolactinemia

It has recently been shown that the specific and selective alpha 2-antagonist idazoxan (IDZ) displays prolactin-lowering activity on hyperprolactinemia induced in the rat either by suckling or serotonergic drugs. In an attempt better to understand the role of alpha 2-adrenoceptors under the above conditions, experiments were carried out to compare the effects of IDZ with that of the classic alpha 2-antagonist yohimbine (YOH), and also of the alpha 2-agonists clonidine (CLO) and B-HT 920, on prolactin (PRL) release during lactation and in hyperprolactinemia induced in male rats by the serotonergic drug fenfluramine (FEN). In lactating rats, both alpha 2-agonists decreased PRL release; this effect was enhanced by prior separation of the animals from their pups for several hours. A decrease of plasma PRL levels was also induced by IDZ but not by YOH, which tended further to increase hyperprolactinemia. In male rats treated with FEN, IDZ and CLO, a significant decrease of plasma PRL was produced, but YOH further enhanced PRL secretion. It is concluded that the alpha 2-agonists tested and also the alpha 2-antagonist IDZ display a unique inhibitory activity on PRL release during suckling or serotonergic-induced hyperprolactinemia.

Idazoxan inhibits hyperprolactinaemia in ovariectomized estrogen-treated rats

The alpha 2-antagonist idazoxan (IDZ) has previously been shown to inhibit hyperprolactinaemia triggered by various stimuli such as lactation, stress, serotonergic agents and morphine (Preziosi, Martire, Navarra, Pistritto and Vacca 1989; Krulich, Jurcovicova and Le 1989). In this study, we investigated the PRL-lowering activity of IDZ in ovariectomized estrogen-treated (OET) rats; since a PRL surge usually occurs in normal cycling rats on the day of proestrus, the effect of IDZ on pulsatile PRL release in intact female rats was also studied. IDZ significantly lowered plasma PRL levels in OET rats; no elevated PRL values were observed in normal cycling rats, indicating that IDZ might inhibit PRL surges in these animals. It is concluded that IDZ is an effective PRL-lowering agent in a number of physiological and pharmacological hyperprolactinaemic models.

Regulation of the pituitary 5 alpha-reductase activity by gonadotropin releasing hormone and testosterone in the adult male rat

Intact or castrated adult male rats were treated for nine days with GnRH (10 micrograms/day), the synthetic GnRH goserelin (100 micrograms/day) or the GnRH-antagonist Org 30276 (250 or 500 micrograms/day). In some series, 1 mg testosterone propionate was administered alone, or in combination with goserelin or Org 30276. The in vitro metabolism of [1 alpha,2 alpha-3H]testosterone by pituitary and hypothalamic homogenates was investigated in combination with the estimation of plasma concentrations of testosterone and gonadotropins. No qualitative or quantitative differences were observed in hypothalamic testosterone metabolism or in the pituitary 17 beta-hydroxysteroid dehydrogenase activity. Testosterone administration to intact male rats decreased the pituitary 5 alpha-reductase activity and LH, while administered to castrated rats, it was able to suppress totally the castration-induced increase of the 5 alpha-reductase activity and of the gonadotropin secretion. The drastic decrease of the plasma levels of testosterone, observed after a prolonged treatment with GnRH, goserelin or Org 30276 was not accompanied by an increased pituitary 5 alpha-reductase activity. Injected to castrated rats, it was observed that the castration-induced increase of the pituitary 5 alpha-reductase was further stimulated by GnRH, totally suppressed by goserelin and partially suppressed by Org 30276. Concomitant administration of goserelin or Org 30276 and testosterone propionate to castrated rats resulted in a further decrease of the pituitary 5 alpha-reductase activity, compared to the castrated, GnRH-analogue treated rats. These data indicate that the pituitary 5 alpha-reductase enzyme system is controlled by both direct steroidal and indirect GnRH-mediated mechanisms.

Effect of tamoxifen on the activity of enzymes of testicular steroidogenesis

Testicular homogenates of tamoxifen-treated rats were incubated with labeled steroid precursors (progesterone, 17 alpha-hydroxyprogesterone, dehydroepiandrosterone, androstenedione or testosterone) in order to study the effect of tamoxifen on testicular steroidogenesis. The results indicate that a 9 day treatment with a daily dose of 1 mg tamoxifen produces a reduction of the synthesis of testosterone. Inhibition of the 17 alpha-hydroxylase and C17,20-desmolase enzyme systems was observed together with an increased 20 alpha-hydroxysteroid dehydrogenase activity.