Preliminary validation of the pica, ARFID and rumination disorder interview ARFID questionnaire (PARDI-AR-Q)

BACKGROUND

The Pica, ARFID, and Rumination Disorder Interview (PARDI) is a structured interview that can be used to determine diagnosis, presenting characteristics, and severity across three disorders, including avoidant/restrictive food intake disorder (ARFID). The purpose of this study was to evaluate the psychometric properties of a questionnaire focused specifically on ARFID (PARDI-AR-Q), which has the potential to provide related information with less participant burden.

METHODS

Adolescents and adults (n = 71, ages 14-40 years) with ARFID (n = 42) and healthy control participants (HC, n = 29) completed the PARDI-AR-Q and other measures. A subset of the ARFID group (n = 27) also completed the PARDI interview.

RESULTS

An exploratory factor analysis of proposed subscale items identified three factors corresponding to the ARFID phenotypes of avoidance based on the sensory characteristics of food, lack of interest in eating or food, and concern about aversive consequences of eating. Further analyses supported the internal consistency and convergent validity of the PARDI-AR-Q subscales, and subscale ratings on the questionnaire showed large and significant correlations (all p-values < 0.001; r's ranging from 0.48 to 0.77) with the corresponding subscales on the interview. The ARFID group scored significantly higher than HC on all subscales. Furthermore, 90% of the ARFID group scored positive on the PARDI-AR-Q diagnostic algorithm while 93% of the HC scored negative.

CONCLUSIONS

Though replication in larger and more diverse samples is needed, findings provide early support for the validity of the PARDI-AR-Q as a self-report measure for possible ARFID in clinical or research settings.

Healthy feeding habits: efficacy results from a cluster-randomized, controlled exploratory trial of a novel, habit-based intervention with parents

BACKGROUND

As dietary gatekeepers for young children, parents are often the proximal target of family-based dietary interventions. Habit theory offers a novel approach to modifying parental feeding, based on "context-dependent repetition" to promote automatic responding and to reduce decisional conflict.

OBJECTIVE

This exploratory trial evaluated an intervention promoting habit formation for 3 parental feeding behaviors: serving fruit/vegetables, serving healthy snacks, and serving nonsweetened drinks. The primary outcome was parental habit strength for each behavior. The secondary outcome was children's food intake.

DESIGN

Parents of children aged 2-6 y (n = 126) were recruited from 6 children's centers in London and cluster-randomized to intervention (n = 3) or no-treatment control (n = 3) conditions. Parents in the intervention group (n = 58) received training on habit formation for 3 feeding behaviors; control participants (n = 68) were asked only to complete the measures. At baseline and after treatment, parents completed validated measures of subjective "automaticity" for feeding behaviors and a brief child food-frequency measure. Parents in the intervention group were interviewed about the program. The change between groups, after clustering was controlled for, was analyzed.

RESULTS

For all parental feeding behaviors, automaticity increased more in the intervention group than in the control group (P < 0.01 for all). Significant intervention effects on children's intake of vegetables (P = 0.003), healthy snacks (P = 0.009), and water (P = 0.032) were observed. Changes in children's food intake correlated with changes in parental automaticity of feeding behaviors, and program acceptability was high.

CONCLUSIONS

A habit-based intervention successfully modified parental feeding behaviors, affected children's diets positively, and was well received by parents. Habit theory provides a promising new tool to support family-based obesity prevention. This trial was registered as ISRCTN09910187.

Eating for pleasure or profit: the effect of incentives on children's enjoyment of vegetables

Parents commonly use rewards to encourage children to eat healthfully, but this practice remains controversial because rewards are suspected of undermining children's intrinsic motivation. A cluster-randomized trial examined children's acceptance of a disliked vegetable over 12 daily taste exposures. These exposures were paired with a tangible reward, a social reward, or no reward, and the findings were compared with the results from a no-treatment control condition. Liking and intake of the vegetable were assessed in a free-choice consumption task at preintervention, postintervention, 1 month after intervention, and 3 months after intervention. Liking increased more in the three intervention conditions than in the control condition, and there were no significant differences between the intervention conditions. These effects were maintained at follow-up. Children in both reward conditions increased consumption, and these effects were maintained for 3 months; however, the effects of exposure with no reward became nonsignificant by 3 months. These results indicate that external rewards do not necessarily produce negative effects and may be useful in promoting healthful eating.

Genetic and environmental influences on children's food neophobia

BACKGROUND

Food neophobia in children has been associated with a low intake of fruit, vegetables, and protein foods. The design of effective interventions to improve children's diets would be facilitated by a better understanding of the determinants of neophobia.

OBJECTIVE

Our objective was to quantify the contribution of genetic and environmental differences to variation in child food neophobia.

DESIGN

Parents of twins aged 8-11 y (n = 5390 pairs) completed questionnaires about their children's eating habits, including a measure of food neophobia.

RESULTS

The results showed that neophobia is highly heritable. The heritability estimate from model fitting was 0.78 (95% CI: 0.76, 0.79). A further 22% of the variance was explained by nonshared environmental factors, with no influence of shared environmental factors.

CONCLUSIONS

Neophobia appears to be a heritable trait, but almost a quarter of the phenotypic variation is accounted for by nonshared environmental factors. An important aim for future research is the identification of influential aspects of the environment specific to individual children.

Age and gender differences in children's food preferences

The present study was conducted to examine the developmental patterning of food preferences in a large sample of British schoolchildren and to investigate possible gender differences. Using a cross-sectional survey design, the study was carried out in three primary and three secondary schools in West London, UK. A total of 1291 children aged from 4 to 16 years completed a 115-item food preference questionnaire in class time, supervised by class teachers and assistants. Children indicated whether they had ever tried each item and, if so, how much they liked it. We observed age-related increases in the number of foods tried (P<0·001), liked (P<0·005) and disliked (P<0·05). Controlling for the number of foods tried rendered the increase in dislikes non-significant and reversed the age effect on the number liked. Girls liked fruit (P<0·05) and vegetables (P<0·001) more than boys did; boys liked fatty and sugary foods (P<0·005), meat (P<0·001), processed meat products (P<0·001) and eggs (P<0·05) more than girls did. Some age differences were apparent in liking for categories of food, although the effects were not linear. Across ages and genders, children rated fatty and sugary foods most highly, although ratings for fruit were also high. Children's food preferences overall are not consistent with a healthy diet. Interventions should focus on increasing the familiarity, availability and accessibility of healthy foods and should be mindful of the need to target messages appropriately for boys who have less healthful food preferences than girls at all ages.

Occupational injury in a fishmonger with a macular rash, hepatosplenomegaly and pancytopenia

A 47-year-old fishmonger presented with a history of weight loss and lethargy. On investigation he was found to have myeloma. He presented again before follow up, with a 3-day history of fever and a maculopapular rash. He was admitted to the haematology ward and treated with broad-spectrum antibiotics. Blood cultures were found to be positive for Erysipelothrix rhusiopathiae. Penicillin treatment was given, and he made a good recovery. The importance of occupational illness in an already immunocompromised patient and of taking a proper social and occupational history from patients on admission is illustrated through this case.

Platelet size has diagnostic predictive value in patients with thrombocytopenia

We studied 473 unselected patients with thrombocytopenia. The mean platelet volume (MPV) was 8.1 fl in patients with marrow disease and 9.8 fl in patients without marrow disease (P < 0.001). A total of 5% of patients with an MPV >or=10.5 fl have marrow disease (odds ratio 0.05, 95% CI 0.02-0.13). Conversely over three quarters of patients with an MPV of <8.0 fl have marrow disease (odds ratio 8.1, 95% CI 5.0-13.0). Therefore the MPV can strongly guide the clinician as to the likely presence or absence of bone marrow disease in thrombocytopenic patients.

Primary central nervous system lymphoma: a single-centre experience of 55 unselected cases

AIMS

Current treatment for primary central nervous system lymphoma (PCNSL) involves high-dose methotrexate (HDMTX) with or without radiotherapy. Many published studies describing this approach include a highly selected group of patients. We report a single-centre experience of unselected cases of PCNSL.

MATERIALS AND METHODS

We retrospectively reviewed the case notes of 55 consecutive patients diagnosed with biopsy-proven PCNSL between 1995 and 2003 at Addenbrooke's Hospital Cambridge, UK. We describe the treatment and outcome, including survival, treatment-related toxicity and long-term functional disability.

RESULTS

At diagnosis, 45% of patients were considered unfit to receive treatment with HDMTX, owing to poor performance status or comorbidity. These patients had a median survival of 46 days and may not have been included in other published studies. The remaining patients were treated with a chemotherapy regimen, which included HDMTX. Patients who received at least one cycle of a chemotherapy containing HDMTX had a median survival of 31 months. Forty per cent did not complete planned chemotherapy owing to toxicity, disease progression or death. The median survival of patients treated with HDMTX aged 60 years compared with patients aged under 60 years was 26 months vs 41 months (P = 0.07), respectively. Younger patients treated with HDMTX, who achieved complete remission with chemotherapy, had a median survival of 56 months. We identified a high incidence of functional disability among survivors, resulting from a combination of the tumour itself, the neurosurgical procedure required for diagnosis and the late neurotoxicity of combined chemoradiotherapy.

CONCLUSION

The treatment of PCNSL is associated with significant early and late toxicity. Further attempts to improve treatment should address mechanisms to reduce this toxicity. In particular, the benefit of radiotherapy in patients who achieve complete remission with HDMTX will remain uncertain until it is addressed in a multicentre, randomised trial.

Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children

OBJECTIVE

To examine the contribution to fruit and vegetable eating in children of potential predictive variables within the domains of demographics, parental feeding practices and personality traits.

DESIGN

Cross-sectional survey.

SETTING

Questionnaires were distributed to parents through 22 London nursery schools.

SUBJECTS

Questionnaires were completed and returned by 564 parents or principal caregivers of 2-6-year-old children.

RESULTS

Significant predictors of children's fruit and vegetable intake emerged from all three domains examined. Demographic variables associated with child's vegetable consumption were mother's education and child's age and gender. Only ethnicity was significantly associated with fruit consumption. Parental consumption, breast-feeding and early introduction to fruit and vegetables were related to intake of both. Family meal times were associated with higher intake of vegetables, but not of fruit. Two characteristics of children themselves (food neophobia and enjoyment of food) were strongly related to the consumption of fruit and vegetables. Subsequent multivariate analyses revealed that parental intake and child food neophobia independently predicted intake of both foods. In the presence of these, fruit consumption was affected by breast-feeding and early introduction to fruit, whereas vegetable consumption was related only to child's gender and enjoyment of food.

CONCLUSIONS

These findings may be used to inform future interventions aimed at increasing children's consumption of fruit and vegetables. Parents should be made aware of the possible impact of their own behaviour on the eating habits of their children.

Increasing children's acceptance of vegetables; a randomized trial of parent-led exposure

Despite considerable epidemiological evidence of the health benefits of a diet high in fruit and vegetables, consumption in pre-school children remains well below recommended levels. This study evaluated the effectiveness of an exposure-based intervention, carried out by parents in the home, in increasing children's liking for a previously disliked vegetable. 156 parents of 2-6 year old children were randomly assigned to Exposure, Information or Control groups after a pre-intervention taste test at which a 'target' vegetable was selected. Parents in the Exposure group gave their child a taste of this vegetable daily for 14 days, parents in the Information group were given nutritional advice and a leaflet, and parents in the Control group received no further intervention. All participants took part in a post-intervention taste test. Greater increases in liking, ranking and consumption of the 'target' vegetable from pre- to post-intervention occurred in the Exposure group than in either of the other two groups. Only the Exposure group showed significant increases across all three outcomes. It can be concluded that a parent-led, exposure-based intervention involving daily tasting of a vegetable holds promise for improving children's acceptance of vegetables. These findings suggest a parental advice strategy which could be disseminated directly to parents or by health professionals.

Glioblastoma multiforme and ascending weakness

An 18-year-old man with a known glioblastoma multiforme, previously treated with de-bulking, chemotherapy, radiation and steroids, underwent a repeat craniotomy after presenting with several days of intractable vomiting and headache. Postoperatively, he developed progressive delirium, bilateral sixth and seventh nerve palsies, dysphagia and ascending weakness of the upper and lower limbs. Within five postoperative days, he was quadraparetic, areflexic and had marked extraocular muscle and facial weakness, dysphagia, dysphonia and respiratory muscle weakness. The patient was started empirically on intravenous immunoglobulin for suspected Guillain-Barré syndrome (GBS). The following day, lumbar puncture demonstrated elevated protein (1.96g/l; normal <0.45), and a reduced glucose (0.5 mmol/l) and elevated red (4125x106 per litre) and white cell (214x106 per litre) counts in the cerebrospinal fluid (the red cells were felt to be related to surgery). The cell differential included 69% neutrophils, 3% lymphocytes, 15% monocytes and 13% blast-like cells. Gram stains and cultures of the cerebrospinal fluid were negative.

Chinook winds and migraine headache

OBJECTIVE

To determine the effects of chinook weather conditions on probability of migraine headache onset.

BACKGROUND

Many migraineurs believe weather to be a trigger factor for their headaches; however, there is little supportive evidence in the literature. Migraineurs in the southern part of the Canadian province of Alberta frequently report that chinooks, warm westerly winds specific to the region, trigger their headaches.

METHOD

Weather data from Environment Canada were used to designate each calendar day during the study period as a chinook, prechinook, or nonchinook day. Headache data were collected from 75 patient diaries from the University of Calgary Headache Research Clinic. Individual and multiple logistic regression models were used to determine if the weather conditions affected the probability of migraine onset.

RESULTS

The probability of migraine onset was increased on both prechinook days (odds ratio 1.24; 95% CI 1.08 to 1.42) and on days with chinook winds (1.19; 1.02 to 1.39) compared with nonchinook days. Analysis of chinook wind velocities revealed that for chinook days, the relative risk of migraine onset was increased only on high-wind chinook days (velocity > 38 km/h) (odds ratio 1.41; 95% CI 1.06 to 1.88). A subset of individuals was sensitive to high-wind chinook days, and another subset was only sensitive to prechinook days. Only two patients were sensitive to both weather conditions, and the majority of patients was not sensitive to either. Neither weather condition had a protective effect. Increasing age was associated with high-wind chinook sensitivity (p = 0.009) but not prechinook sensitivity (p = 0.389).

CONCLUSIONS

Both prechinook and high-wind chinook days increase the probability of migraine onset in a subset of migraineurs. Because few subjects were found to be sensitive to both weather types, the mechanisms for these weather effects may be independent. This is supported by the presence of an age interaction for high-wind chinook days but not for prechinooks day.

Inhibitors of serine/threonine phosphatases increase membrane-bound choline acetyltransferase activity and enhance acetylcholine synthesis

The present investigation examines the effects of phosphatase inhibition on short-term regulation of cholinergic function, with particular emphasis on choline acetyltransferase, the enzyme which synthesizes acetylcholine. Rat hippocampal synaptosomes were treated with either okadaic acid (10 nM) or calyculin-A (50 nM) to inhibit protein phosphatases 1 and 2A for 20 min prior to subfractionation of nerve terminals and measurement of choline acetyltransferase activity, or quantification of high-affinity choline transport and acetylcholine synthesis. Inhibition of synaptosomal phosphatases did not alter total or salt-soluble choline acetyltransferase activity, but membrane-bound and water-soluble forms of the enzyme were selectively increased in okadaic acid-treated nerve terminals to 129 +/- 11% and 137 +/- 10% of control, respectively. High-affinity choline transport was reduced to 77 +/- 6% and 76 +/- 7% of control in calyculin-A- and okadaic acid-treated nerve terminals, respectively. Acetylcholine synthesis was reduced to 73 +/- 6% of control in calyculin-A-treated synaptosomes only; acetylcholine synthesis was at control levels in okadaic acid-treated cultures correlating with enhanced choline acetyltransferase activity in the water-soluble and nonionically membrane-bound fractions. These investigations indicate a role for phosphoprotein phosphatases in the regulation of acetylcholine synthesis in the cholinergic nerve terminal. The observed increases in choline acetyltransferase activity in two subcellular fractions appears to compensate for decreased choline precursor availability, allowing acetylcholine synthesis to be maintained at control levels. The uncoupling of choline transport and acetylcholine synthesis in this situation represents a unique functional role for a subfraction of choline acetyltransferase.

Factors influencing in vitro production of colony-stimulating factor by mononuclear leukocytes from humans

The purpose of this study was to identify factors that influence the production of colony-stimulating factor by leukocytes of humans. The use of nonadherent light-density bone marrow cells is semisolid agar cultures to assay the concentrations of colony-stimulating factor in the supernatant of monocyte and mononuclear leukocyte cultures made it possible to distinguish between colony-stimulating factor, which stimulates colony-forming cells directly, and monocyte-dependent stimulating activity, which acts indirectly, by increasing the monocyte production of colony-stimulating factor. Colony-stimulating factor was not detectable in the cytosol of monocytes; that detected in culture must, therefore, have been newly synthesized. Synthesis was enhanced independently by heat-inactivated human serum and by semipurified serum fractions enriched with monocyte-dependent stimulating activity. The kinetics of the production of colony-stimulating factor in the presence and absence of monocyte-dependent stimulating activity indicated that the latter facilitated monocyte production of the former. Factors released from neutrophils were shown to reduce the production of colony-stimulating factor and thr proliferation of colony-forming cells and thus may provide a feedback control mechanism limiting the proliferation of neutrophils.