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Association of Attention-Deficit/Hyperactivity Disorder Diagnosis With Adolescent Quality of Life.
Kazda, L, McGeechan, K, Bell, K, Thomas, R, Barratt, A
JAMA network open. 2022;5(10):e2236364
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Attention-deficit/hyperactivity disorder (ADHD) is “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning…and negatively impacts…social and academic activities”. This negative effect can extend beyond activities directly impacted by hyperactive or inattentive (H/I) behaviours, thus affecting overall quality of life (QOL). The aim of this study was to investigate whether an ADHD diagnosis in childhood or early adolescence is associated with improved QOL in adolescents compared with well-matched individuals without diagnosis. This study is a cohort study which followed an emulated target trial design using prospective, observational data from the Longitudinal Study of Australian Children. Results show that children diagnosed with ADHD reported similar or poorer QOL at age 14 to 15 years compared with children who had grown up experiencing the same levels of H/I behaviours but had not been given an ADHD diagnosis. Furthermore, an ADHD diagnosis did have some negative associations, including an increase in risk of self-harm. Authors conclude that their findings raise important questions about the long-term effectiveness and safety of diagnosing children and adolescents with ADHD, especially for those with low-risk or borderline H/I behaviours.
Abstract
IMPORTANCE Appropriate diagnosis of attention-deficit/hyperactivity disorder (ADHD) can improve some short-term outcomes in children and adolescents, but little is known about the association of a diagnosis with their quality of life (QOL). OBJECTIVE To compare QOL in adolescents with and without an ADHD diagnosis. DESIGN, SETTING, AND PARTICIPANTS This cohort study followed an emulated target trial design using prospective, observational data from the Longitudinal Study of Australian Children, a representative, population-based prospective cohort study with biennial data collection from 2006 to 2018 with 8 years of follow-up (ages 6-7 to 14-15 years). Propensity score matching was used to ensure children with and without ADHD diagnosis were well matched on a wide range of variables, including hyperactive/inattentive (H/I) behaviors. Eligible children were born in 1999 to 2000 or 2003 to 2004 and did not have a previous ADHD diagnosis. All incident ADHD cases were matched with controls. Data were analyzed from July 2021 to January 2022. EXPOSURES Incident parent-reported ADHD diagnosis at age 6 to 7, 8 to 9, 10 to 11, 12 to 13, or 14 to 15. MAIN OUTCOMES AND MEASURES Quality of life at age 14 to 15 was measured with Child Health Utility 9D (CHU9D) and 8 other prespecified, self-reported measures mapped to the World Health Organization's QOL domains. Pooled regression models were fitted for each outcome, with 95% CIs and P values calculated using bootstrapping to account for matching and repeat observations. RESULTS Of 8643 eligible children, a total of 393 adolescents had an ADHD diagnosis (284 [72.2%] boys; mean [SD] age, 10.03 [0.30] years; mean [SD] H/I Strengths and Difficulties Questionnaire score, 5.05 [2.29]) and were age-, sex-, and H/I score-matched with 393 adolescents without ADHD diagnosis at time zero. Compared with adolescents without diagnosis, those with an ADHD diagnosis reported similar QOL on CHU9D (mean difference, -0.03; 95% CI, -0.07 to 0.01; P = .10), general health (mean difference, 0.11; 95% CI, -0.04 to 0.27; P = .15), happiness (mean difference, -0.18; 95% CI, -0.37 to 0.00; P = .05), and peer trust (mean difference, 0.65; 95% CI, 0.00 to 1.30; P = .05). Diagnosed adolescents had worse psychological sense of school membership (mean difference, -2.58; 95% CI, -1.13 to -4.06; P < .001), academic self-concept (mean difference, -0.14; 95% CI, -0.02 to -0.26; P = .02), and self-efficacy (mean difference, -0.20; 95% CI, -0.05 to -0.33; P = .007); displayed more negative social behaviors (mean difference, 1.56; 95% CI, 0.55 to 2.66; P = .002); and were more likely to harm themselves (odds ratio, 2.53; 95% CI, 1.49 to 4.37; P < .001) than adolescents without diagnosis. CONCLUSIONS AND RELEVANCE In this cohort study, ADHD diagnosis was not associated with any self-reported improvements in adolescents' QOL compared with adolescents with similar levels of H/I behaviors but no ADHD diagnosis. ADHD diagnosis was associated with worse scores in some outcomes, including significantly increased risk of self-harm. A large, randomized clinical trial with long-term follow-up is needed.
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Organic food consumption and gluten-free diet, is there a link? Results in French adults without coeliac disease.
Perrin, L, Allès, B, Julia, C, Hercberg, S, Touvier, M, Lairon, D, Baudry, J, Kesse-Guyot, E
The British journal of nutrition. 2021;125(9):1067-1078
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The gluten-free diet (GFD) is a medical response for people with coeliac disease, a systemic autoimmune disorder for which GFD is the only available effective treatment. The aim of this study was to compare the consumption of organic products (as a whole and by food group) in individuals (partially or totally) avoiding gluten or not, and their places of food purchases of organic food. Results indicate a positive association between gluten avoidance and contribution of organic food to the diet. A gradient was also observed with total avoiders consuming more of organic food than partial avoiders. This contribution was higher for all types of products, except milk and dairy products. Furthermore, the results appear consistent with the motives reported by individuals avoiding gluten. Authors conclude that their findings underline a strong positive correlation between gluten avoidance and organic food consumption.
Abstract
The rising popular belief that gluten is unhealthy has led to growth in gluten avoidance in people without coeliac disease. Little information is available on their dietary profiles and their dietary behaviours. Our aim was to compare the consumption of organic foods between gluten avoiders and non-avoiders, and their places of food purchase. We described their sociodemographic and dietary profiles. The study population included participants of the NutriNet-Santé cohort who completed both a food exclusion questionnaire and an organic semi-quantitative FFQ (n 23 468). Food intake and organic food consumption ratios were compared using multivariable adjusted ANCOVA models. Associations between gluten avoidance and organic food consumption as well as places of food purchase were investigated with multivariable logistic regression. Participants avoiding gluten were more likely to be women and had a healthier dietary profile. Organic food consumption was higher among gluten avoiders (48·50 % of total diet for total avoiders, 17·38 % for non-avoiders). After adjustments for confounders, organic food consumption and purchase in organic stores were positively associated with gluten avoidance: adjusted OR (aOR)Q5 v.Q1 organic food = 4·95; 95 % CI 3·70, 6·63 and aORorganic stores v.supermarkets = 1·82; 95 % CI 1·42, 2·33 for total avoiders. Our study highlights that individuals avoiding gluten are high organic consumers and frequently purchase their foods in organic stores which propose an extended offer of gluten-free food. Further research is needed to determine the underlying common motivations and the temporality of the dietary behaviours of healthy people avoiding gluten.
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Changes in Weight and Nutritional Habits in Adults with Obesity during the "Lockdown" Period Caused by the COVID-19 Virus Emergency.
Pellegrini, M, Ponzo, V, Rosato, R, Scumaci, E, Goitre, I, Benso, A, Belcastro, S, Crespi, C, De Michieli, F, Ghigo, E, et al
Nutrients. 2020;12(7)
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The pandemic of the coronavirus SARS-CoV-2 (COVID-19) has caused significant disruption in everyday lifestyle. The aim if this study was to evaluate the changes in weight and dietary habits in a sample of individuals with obesity attending the Obesity Unit after 1 month of enforced lockdown. This is an observational retrospective study were patients followed a 12-month multidisciplinary weight loss program. Results showed that patients with obesity attending an Obesity Unit in Northern Italy showed a ≈1.5 kg self-reported weight gain after the first month of lockdown. Lower education level, self-reported anxiety/depression, and not paying attention to the healthiness of food choices were significantly associated with weight and body mass index increase. Authors conclude that the adverse mental burden linked to the COVID-19 pandemic might be associated with their increased weight.
Abstract
Our aim is evaluating the changes in weight and dietary habits in a sample of outpatients with obesity after 1 month of enforced lockdown during the COVID-19 pandemic in Northern Italy. In this observational retrospective study, the patients of our Obesity Unit were invited to answer to a 12-question multiple-choice questionnaire relative to weight changes, working activity, exercise, dietary habits, and conditions potentially impacting on nutritional choices. A multivariate regression analysis was performed to evaluate the associations among weight/BMI changes and the analyzed variables. A total of 150 subjects (91.5%) completed the questionnaire. Mean self-reported weight gain was ≈1.5 kg (p < 0.001). Lower exercise, self-reported boredom/solitude, anxiety/depression, enhanced eating, consumption of snacks, unhealthy foods, cereals, and sweets were correlated with a significantly higher weight gain. Multiple regression analyses showed that increased education (inversely, β = -1.15; 95%CI -2.13, -0.17, p = 0.022), self-reported anxiety/depression (β = 1.61; 0.53, 2.69, p = 0.004), and not consuming healthy foods (β = 1.48; 0.19, 2.77, p = 0.026) were significantly associated with increased weight gain. The estimated direct effect of self-reported anxiety/depression on weight was 2.07 kg (1.07, 3.07, p < 0.001). Individuals with obesity significantly gained weight 1 month after the beginning of the quarantine. The adverse mental burden linked to the COVID-19 pandemic was greatly associated with increased weight gain.
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Investigating effective treatment factors in brief cognitive behavioral therapy for panic disorder.
Lim, JA, Lee, YI, Jang, JH, Choi, SH
Medicine. 2018;97(38):e12422
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Both standard and short-term cognitive behaviour therapy (CBT) have been shown to be effective in the treatment of panic disorder (PD). The aim of this study was to investigate the effectiveness of a mindfulness-based brief CBT, in particular, with respect to physiological symptoms, like palpitations and accelerated heart rate, and factors that may help predict treatment outcome. Treatment consisted of psychoeducation about the condition and teaching meditation/relaxation techniques. CBT was delivered once a week over a four week period (a total of four sessions). Several self-assessed scales were used to determine outcome and efficacy. The four week intervention showed statistically significant improvements on almost all scores. The results suggest that fear of cardiovascular (CV) symptoms may be an important predictor of the clinical course of PD. The authors concluded that managing fear of CV symptoms can help improve effectiveness of brief CBT and that short-term CBT may be particularly effective for patients who suffered from CV symptoms. The study was limited by the fact that there was no control group and that participants had relatively mild PD symptoms and may therefore not have been representative of the PD patient population as a whole.
Abstract
Numerous studies have provided evidence for the effectiveness of cognitive behavioral therapy (CBT) on panic disorders (PDs). There has also been growing attention on brief CBT with regard to delivering intensive treatment efficiently. This study investigated the essential parts of mindfulness-based brief CBT to optimize treatment benefits.A total of 37 patients were retrospectively enrolled in this study. They were recruited from the anxiety/panic/fear clinic of Seoul National University Hospital. The patients participated in group CBT once a week for a total of 4 sessions over a 4-week period, when they were assessed using the Panic Disorder Severity Scale (PDSS), Anxiety Sensitivity Index-Revised (ASI-R), Albany Panic and Phobia Questionnaire (APPQ), State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and after brief CBT. Twenty-nine patients completed the 1-month follow-up.There were significant reductions in PDSS (P < .001), ASI-R-fear of respiratory symptoms (P = .006), ASI-R-fear of publicly observable anxiety reaction (P = .002), ASI-R-fear of cardiovascular symptoms (P < .001), ASI-R-fear of cognitive dyscontrol (P = .001), ASI-R-Total (P < .001), APPQ-Agoraphobia (P = .003), APPQ-Total (P = .028), STAI-State anxiety (P < .001), STAI-Trait anxiety (P = .002), BAI (P = .003), and BDI (P < .001) scores. We also found significant associations between ASI-R-fear of cardiovascular symptoms, ASI-R-Total, and changes in PDSS scores. A stepwise multiple linear regression analysis indicated that anxiety sensitivity for fear of cardiovascular symptoms predicted an improvement in panic severity (β = 0.513, P = .004).Our findings suggested that behavioral aspects, especially physiological symptom control, needed to be considered in brief, intensive CBT for PD. The results also suggested that a mindfulness-based brief CBT approach might be particularly helpful for patients with PD who have severe cardiovascular symptoms.
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Binge-eating disorder and the outcome of bariatric surgery in a prospective, observational study: Two-year results.
Chao, AM, Wadden, TA, Faulconbridge, LF, Sarwer, DB, Webb, VL, Shaw, JA, Thomas, JG, Hopkins, CM, Bakizada, ZM, Alamuddin, N, et al
Obesity (Silver Spring, Md.). 2016;24(11):2327-2333
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Binge eating disorder is characterised by the consumption of an objectively large amount of food in a discrete period of time (i.e. 2hrs) with an accompanying loss of control over eating. This study is a follow-up study that examined weight loss over an average of 24 months post bariatric surgery (as most studies are based on a shorter duration i.e. less than 12 months) in 59 patients. Another aim of the study was whether bariatric surgery had any effects on the remission or precipitation of binge eating. Results indicate that patients with a preoperative diagnosis of binge-eating disorder lost significantly less weight 2 years after surgery than those individuals who were free from binge-eating prior surgery. However, those with a diagnosis of binge-eating disorder who received lifestyle modifications lost significantly less than those who had bariatric surgery. Authors conclude that bariatric-surgery may be a useful long-term weight loss strategy for patients with eating disorders. However, they also recommend that these patients may benefit from additional counselling and behavioural support, such as cognitive behaviour therapy.
Abstract
OBJECTIVE A previous study reported that preoperative binge-eating disorder (BED) did not attenuate weight loss at 12 months after bariatric surgery. This report extends the authors' prior study by examining weight loss at 24 months. METHODS A modified intention-to-treat population was used to compare 24-month changes in weight among 59 participants treated with bariatric surgery, determined preoperatively to be free of a current eating disorder, with changes in 33 surgically treated participants with BED. Changes were also compared with 49 individuals with obesity and BED who sought lifestyle modification for weight loss. Analyses included all available data points and were adjusted for covariates. RESULTS At month 24, surgically treated patients with BED preoperatively lost 18.6% of initial weight, compared with 23.9% for those without BED (P = 0.049). (Mean losses at month 12 had been 21.5% and 24.2%, respectively; P = 0.23.) Participants with BED who received lifestyle modification lost 5.6% at 24 months, significantly less than both groups of surgically treated patients (P < 0.001). CONCLUSIONS These results suggest that preoperative BED attenuates long-term weight loss after bariatric surgery. We recommend that patients with this condition, as well as other eating disturbances, receive adjunctive behavioral support, the timing of which remains to be determined.