Assessing the prevalence of eating disorders in an Australian twin population

OBJECTIVE

This paper examines the prevalence of disordered eating in a female Australian twin population aged between 28 and 90 years in 1993.

METHOD

In two waves of data collection, the eating behaviour of 3869 female twins was first assessed in 1988-1989 by self-report questionnaire and then in 1992-1993 with a telephone interview, using the Semi-Structured Assessment for the Genetics of Alcoholism interview.

RESULTS

It was found that about 0.4% of the women have a lifetime prevalence of anorexia nervosa and 1.8% of the group have suffered from bulimia nervosa. The incidence of bulimia nervosa but not anorexia nervosa was markedly higher for those women under 45 (2.3% bulimia nervosa) than for those women 45 years or older. Furthermore, one in three women have at some stage in their life used some extreme method of weight control.

CONCLUSIONS

The levels of bulimia nervosa and anorexia nervosa found are commensurate with those found in smaller studies in Australia and other parts of the world. The finding of widespread use of extreme weight control methods is of concern as this behaviour is a well-recognised precursor to more serious eating disorders.

Pterygium in lepromatous leprosy

Pterygia from the eyes of three lepromatous leprosy patients were histopathologically studied. All of the specimens contained acid-fast bacilli (AFB) and exhibited features of chronic inflammation. In the etio-pathogenesis of the pterygium that occurs in leprosy patients, the chronic inflammation that is a feature of the disease, the involvement of the nerves within the pterygium, the increased exposure to sunlight, dust and wind (especially in patients having lagophthalmos), and the ostrasization by society that necessitates living predominantly outdoor lives, should be taken into account.

Geographical distribution of endomyocardial fibrosis in south Kerala

BACKGROUND

Endomyocardial fibrosis (EMF) is a chronic heart disease confined to a few geographically specific locations within 15 degrees of the equator. Several aetiological hypotheses exist, among them filarial infection, eosinophilia, and toxic effect of the monazite element cerium from the soil. This study attempts to find out whether the pattern of distribution of EMF in south Kerala in India is consistent with the geochemical hypothesis.

METHODS

From hospital records we identified all patients from south Kerala who had a confirmed diagnosis of EMF during the period 1978-1994. Our controls were patients from the southern districts diagnosed to have rheumatic heart disease (RHD) during the same period. We traced their residence address to the administrative subunit of taluk, and plotted the distribution of patients with EMF and RHD for each taluk in south Kerala. The taluks were then grouped into areas of high (> 4/100,000), medium (2.01-4/100,000), and low (< or = 2/100,000) density in each case.

RESULTS

We identified an area of high density of EMF comprising four taluks near the coastline situated within the districts of Alapuzha, Kollam, and Pathanamthitta. Two coastal taluks in Kollam and Alapuzha districts are known areas of deposits of monazite elements in the state. Geographical distribution is not related to prevalence of filariasis and eosinophilia.

CONCLUSION

Coexistence of high density of occurrence of EMF and deposits of monazite elements support the geochemical hypothesis.

Quantitative evaluation of histological features in "time-zero" liver allograft biopsies as predictors of rejection or graft failure: receiver-operating characteristic analysis application

Harvest injury in liver transplantation adversely affects both allograft function and subsequent acute rejection. The aim of this study was to use receiver-operating characteristic (ROC) analysis to determine the strength of histological features in time-zero liver allograft biopsies as predictors of subsequent acute rejection episodes or primary allograft failure. The study population consisted of 38 patients who underwent orthotopic liver transplantation between 1989 and 1992. Time-zero biopsies and all subsequent biopsies were retrospectively reviewed. The following time-zero histological features were graded: hepatocyte swelling, centrilobular necrosis, centrilobular hemorrhage, neutrophilic infiltrate, cholestasis, and number of apoptotic cells. Eleven transplants showed primary graft nonfunction; 15 experienced one or more episodes of moderate to severe acute rejection; 4 experienced only mild rejection episodes; and 8 showed no rejection over long follow-up periods. ROC analysis showed that the presence of hepatocyte swelling in the time-zero biopsy is a significant predictor of subsequent moderate to severe rejection. Apoptotic cells, centrilobular hemorrhage, hepatocyte swelling, and centrilobular necrosis were all significant predictors of primary graft failure. No histological feature was predictive of subsequent mild rejection. In conclusion, certain histological features serve as markers for adverse outcomes in the liver transplant population. Patients who show apoptotic cells, centrilobular hemorrhage and necrosis, or hepatocyte swelling in their time-zero biopsy should be monitored carefully for signs of graft failure and rejection.

The measurement of complexity in surgical pathology

The quantitation of effort both within and among surgical pathology laboratories is data which is being increasingly sought by physician managers, hospital administrators and managed care organizations. Simple measurement of case numbers fails to adequately represent the work of a laboratory. The complexity of the cases reviewed is likely to explain a significant portion of the variance in the time required to bring a case to final diagnosis. Measures which adequately reflect complexity in surgical pathology cases have not been developed. We have studied a variety of extractable report features and correlated these with the time required for case sign-out. Numbers of slides reviewed and total lines of factual data provided were strong correlates of the time required to complete case review, report construction and verification. Such data suggests that models can be constructed based on data that can be gleaned from case reports and records which will relate such data to actual work time.

Characterization and identification of an adrenal age-related nonpolar fluorescent substance

The adrenal cortexes of humans and rodents accumulate lipofuscin with age, but the chemical nature of the substance that produces lipofuscin fluorescence in the gland is not known. Analysis of rat adrenal nonpolar lipids revealed a fluorescence profile with increased intensity in the lipids extracted from older animals (23-24 months > 6 months > 6 weeks). The peak occurred at a wavelength of 470 +/- 5 nm(n = 26) when excited at 340 nm. After sucrose density gradient centrifugation, the fluorescent substance was primarily concentrated in subcellular lipid droplets rather than supernatant or particulate. Prolonged stimulation of rats with ACTH for 7 consecutive days caused 14-51% decreases in the fluorescence levels, with a tendency of return to control levels poststimulation regardless of age. In contrast, the nonpolar lipids of mouse adrenal tumor (Y1) cells, which contain no lipofuscin, did not display this fluorescence in the presence or absence of ACTH. The chromatographic characteristics of the substance in a silica gel-60 column resembled those of authentic retinyl palmitate and cholesteryl oleate. Analysis of the substance by HPLC demonstrated at least three prominent peaks, designated XI-3 in order. X1 and X2 were minor peaks; X3 was the major peak. Whereas none of the peaks comigrated with cholesteryl esters, X1 comigrated with authentic retinyl palmitate. Determination of the fatty acid component of the major fluorescent substance X3 by gas-liquid chromatography disclosed stearic acid. Retinyl stearate was, therefore, synthesized. The fluorescent profiles, HPLC retention time and mass spectrometric fragmentation of purified X3 substance were all identical to those of the synthetic compound. In contrast, the rat liver principally accumulated retinyl palmitate with age. Thus, we conclude that 1) the major nonpolar fluorescent substance accumulated in the rat adrenal with age is retinyl stearate, which may be a fluorophore of adrenal lipofuscin; 2) ACTH action may be related to this accumulation; and 3) the type of retinyl ester accumulated in aged animals is organ specific.

Apolipoprotein E is increased in aged rat kidney

There is growing evidence to indicate that apolipoprotein (apo) E may be associated with age-related disorders and altered longevity in humans. Using rats as a model, we measured apoE in plasma, brain, heart, kidney, liver and spleen in aged (24-25 mo) and younger rats (6-8 mo). The results disclosed that: (a) the plasma concentrations of immunoreactive apoE in aged rats were higher than those in young animals by 70% (P < 0.01); (b) there was no age-related difference of apoE in the brain, heart, liver or spleen; (c) in contrast, the concentrations of apoE in the kidney of aged rats were markedly higher than those of young animals by 490% (P < 0.01). Our data suggest that, in the rat, age-related change in the organ concentrations of apoE is heterogeneous, and the selective increase in the kidney may have physiologic importance which merits further study.

The effect of sexual experience on the attitudes of medical students to learning gynecological examinations

The influence of sexual experience and gender on the attitudes of medical students to the methods of teaching the gynecological examination was studied. Data were obtained by questionnaire from students who had completed their obstetric/gynecological and family medicine clinical terms. Two hundred and eighty-six students agreed to participate. Ninety of the male students (53%) and 63 (54%) of the female students had experienced sexual intercourse. Students, male and female, who were sexually experienced felt they were more able to conduct a gynecological examination with sensitivity, put the woman at ease and to explain to the women what was being done and why. Male students who had not experienced sexual intercourse felt less able to perform a speculum examination, to do a Papanicolaou smear or be able to detect an abnormality. There were no gender differences between the preferred methods of learning to conduct a gynecological examination but non-sexually experienced students ranked higher the examination of a woman under anesthesia. The suggestion of student volunteers was more acceptable to sexually experienced women and non-sexually experienced male students. Students varied in their response to being volunteers for students learning to conduct vaginal or rectal (if male) examinations. If only the same sex were present 31% of non-sexually experienced male students would possibly volunteer for rectal examination and 39% of sexually experienced female students for vaginal examination. Sexual experience influences students' choice of methods for learning to conduct a gynecological examination.

Structure of disordered eating in a twin community sample

OBJECTIVE

To describe the types of eating problems experienced by women in an Australian twin population.

METHOD

Questions assessing preoccupation with weight or shape, use of various methods of weight control, difficulties with weight control, disordered eating, or binging, were administered to a group of 3,869 female twins. Exploratory and confirmatory factor analyses were used to summarize and describe problematic eating behaviors.

RESULTS

For those women experiencing problems with eating, five groups could be identified. These were overweight women who were dissatisfied with their weight and shape, underweight women struggling with anorexic behaviors, women who were having problems with binging, women who were using more extreme methods of weight control such as vomiting, laxatives, and starvation, and overweight women who were using slimming and fluid tablets for weight control. Confirmatory factor analysis suggested that this factor model is an acceptable fit to the data and that the factor structure generalizes well across two groups viz, the first-born and second-born twins.

DISCUSSION

It was concluded that future studies aiming to develop a general description of eating problems in the community should specifically assess the purging behaviors used by women.

Eating and weight controlling behaviours of young ballet dancers

Ballet dancers (n = 60) in full-time ballet training and school students (n = 216) completed questionnaires relating to body weight and eating behaviour. Dancers were at lower body weight and had less body fat. Dancers considered they were more preoccupied with thoughts of eating and body weight, felt they had greater difficulty controlling their body weight, used and abused laxatives for weight control, and reported disordered eating more than school students. Two-thirds of dancers and students were currently using at least one method of weight control, dancers favouring not eating between meals, and students exercise. Both groups reported binge eating and using multiple methods to control this behaviour. The pressure for dancers to be at below average weight affects their eating and weight controlling behaviours and their life-style. Young women such as dancers, gymnasts and some athletes are required to be at low body weight. These women maintain high levels of exercise. Whether ballet dancers are self-selected as they are genetically slim, control their body weight with the higher levels of exercise or need to employ strategies to maintain their low body weight, has not been clarified. A significant proportion of ballet dancers have been reported to have symptoms of anorexia nervosa and to be described as 'weight preoccupied'. It has also been suggested that the incidence of disordered eating is greater in women who are under pressure to maintain low body weight. The aim of this study is to compare the eating and weight losing behaviour, attitudes and anthropomorphic characteristics of young women in full-time ballet training and those who are not.

Characteristics of eating disorders among young ballet dancers

The characteristics of anorexia nervosa and bulimia nervosa were studied in ballet dancers in full-time training and compared with other young women at school. Dancers had higher scores on the Eating Attitudes Test. Dancers were more likely to have an eating disorder when strict modified DSM-3-R criteria were applied. Currently 1 dancer (1.6%) and no student had anorexia nervosa, 1 dancer (1.6%) and 3 students (1.3%) had bulimia nervosa and 5 dancers (8.3%) and 9 students (4.2%) had an unclassified eating disorder. Another dancer had been treated for anorexia nervosa in the past. One dancer was treated for bulimia nervosa and 6 for weight loss. Dancers were more likely to have been told to increase their body weight. Dancers were not more likely to be afraid of losing control of their weight and becoming obese if they attempted weight gain, to ignore the advice to gain weight or resist gaining weight. Regular self-induced vomiting was reported by 4% of women. Dancers are at risk for the development of eating disorders. Ballet dancers are under pressure to maintain low body weight. The low body weight and menstrual disturbance found among young dancers during training are two of the characteristics of anorexia nervosa Ballet dancers use behaviours aimed at weight control and weight loss. In dancers and professional groups under intense pressure to diet, low body weight and amenorrhoea are not sufficient criteria to diagnose anorexia nervosa. These behaviours can result in binge eating and multiple behaviours aimed at preventing binge eating. Whether the characteristics of bulimia among dancers are sufficient for a diagnosis of bulimia nervosa to be made is unknown. The aim of this paper is to study the characteristics of the eating disorders anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified among young ballet dancers in full-time ballet training and to provide information about the risk of development of eating disorders among young women required to maintain below average body weight while continuing above average exercise.

The inter-relationship of premenstrual symptoms

The prospective symptom reports of women seeking treatment for premenstrual symptoms and control subjects was investigated. In order to compare symptom reports from premenstrual symptom sufferers and control subjects a method of combining and analysing prospectively collected menstrual cycle symptom data is required. A technique that uses the time of onset of menses and the time of ovulation (as measured by urinary luteinizing hormone excretion) to standardize each cycle into 14 time points was developed. Summary factors were then empirically derived from data collected prospectively from 30 premenstrual symptom sufferers and 19 control subjects. Twenty-two mood symptoms were summarized into a single factor and the 29 most frequently occurring physical symptoms were summarized into two factors. Factor scores were calculated on the basis of these factors and the effect of time during the menstrual cycle on these scores examined. Both physical symptom factor scores increased significantly in the luteal phase for both the premenstrual symptom sufferer group and the control group. The single mood factor score increased significantly in the luteal phase for the premenstrual sufferer group but not for the control group, suggesting that the only qualitative difference between the groups was the presence of cyclic mood symptoms in the premenstrual symptom sufferer group. The premenstrual symptom sufferer group recorded significantly higher scores on each of the three factors than the control group. The correlation between the scores on each of the factors over three cycles was high both in the follicular and luteal phase suggesting that these factor scores provide a reproducible measure of menstrual cycle symptomatology.

AF150(S): a new functionally selective M1 agonist improves cognitive performance in rats

This study was aimed at evaluating the ability of a new functionally selective partial M1 agonist, AF150(S), to reverse cognitive impairments in rats. A memory deficits-induced animal model was used that involved AF64A (3 nmol/2 microliters/side) bilaterally injected ICV. AF150(S) was administered PO. The pharmacodynamic profile of the compound was established and its general toxicity was evaluated. Animals were tested on three behavioral tasks: step-through passive avoidance, Morris water maze reference memory paradigm, and radial arm maze working memory paradigm. The sign-free dose of AF150(S) was > 40 mg/kg whereas the LD50 was > 500 mg/kg. In comparison, the effective dose in reversing performance impairments on the various tasks was much lower (0.5-5 mg/kg). The data suggest that AF150(S) possesses potential cognitive enhancement abilities, probably due to a specific increase of cholinergic function.

Australian women's perceptions of hormone replacement therapy over 10 years

The knowledge, beliefs and experience of 60 women with HRT was studied when the women were premenopausal, and 10 years later when they were postmenopausal. Thirty-eight women had taken HRT by 1993. In 1993 women no longer considered clinics and self help groups to be the most useful sources of information about the menopause. They were more likely to think that doctors' knowledge of HRT was not adequate and to favour the use of HRT. Their reservations about all postmenopausal women receiving HRT continued. The women's understanding of long-term use of HRT varied. The women continued to maintain a desire not to experience withdrawal bleeding with HRT. More than 60% of women considered that HRT helped hot flushes, non-specific emotional changes and vaginal dryness. Women in 1993 were more likely to consider that HRT would help the menopausal symptoms of osteoporosis, insomnia and loss of muscle tone while fewer considered anxiety and depression would be relieved by HRT. Only one third believed HRT would reduce the incidence of heart disease. Women were more likely to take or have taken HRT if they were working and had achieved a higher work status (professional), considered reading material as the most useful source of information about menopause, had experienced menopause symptoms as distressing, considered menopause made relationships with husband and children more difficult and supported the universal use of HRT for all women.

Vaginal and speculum examination in medical curricula

Medical students' perception of their own psychomotor skills and attitudes to different methods of teaching the gynaecological examination were studied. Students rated their physical skills poorly, only 7% feeling confident they could detect an abnormality and only 14% considering their ability to perform a Pap smear was good or very good. They rated their doctor/patient skills better, 55% considering they are good at conducting an examination with sensitivity and 67% at explaining to their patient what they were doing and why. Students' first preference for instruction was to examine patients in the Outpatient Clinic under the supervision of a doctor, a method experienced by most students on one occasion. The next preferred method was for students to work with 2 trained gynaecological assistants, acting as patient and instructor, with discussion of feelings and feedback (see Subjects and Methods). The option of student volunteers was a least favoured method but was cited as first preference by 5% of students. Over 25% of the female students considered volunteering for vaginal examination a 'possibility' if they were examined by a student of the same sex. Over 25% of males would 'possibly' volunteer for rectal examination only if the same sex was present. The comments by the students offer help in the future planning of teaching vaginal examination.

Gene expression in the intestine: the effect of dietary nucleotides

There is scientific concern regarding the role of dietary nucleotides in the maintenance and repair of the gastrointestinal tract. This concern is based on a growing body of research that demonstrates potential mechanisms for dietary nucleotides to affect intestinal development and turnover. It seems clear that intestinal gene transcription as well as the activity of transcription factors is at least sometimes directly related to nutrition. Implications of this work include the potential role of dietary nucleotides in infant nutrition and in intestinal repair. The techniques of molecular biology will now allow us to explore and explain how dietary factors such as nucleotides affect intestinal mucosal development, function, adaptation, and repair.

Attitudes to body weight, weight gain and eating behavior in pregnancy

The eating behavior and attitudes to body weight of 100 healthy women were studied 3 days after the birth of their first child. During pregnancy women 'watch their weight' and use a range of methods of weight control which include cigarette smoking and inducing vomiting. During pregnancy 41 women reported weight control problems and 20 women considered their weight and eating problems to be greater than at any previous time. Picking was the most common unwanted behavior. Binge eating was experienced by 44 women, nine of whom reported it to be a 'severe' problem. Although women were ambivalent about being weighed at each antenatal visit, 81 recommended weighing once each month. The women held differing opinions on the effects of breastfeeding on body weight and on the need for nutritional supplements during pregnancy. Women reporting 'disordered eating' were more likely to have antenatal complications and give birth to low birthweight babies. The results suggest good obstetric care should include a history of the woman's eating behavior and body weight.

Changes in Australian women's perception of the menopause and menopausal symptoms before and after the climacteric

The symptoms and perceptions of menopause of 60 Australian women were studied, by questionnaire, when they were premenopausal and 10 years later when they were postmenopausal. Menopausal symptoms expected and experienced by the women were compared, fewer women experiencing hot flushes, headache, depression and nervousness and more experiencing insomnia, increase in appetite, abdominal fullness, numbness and muscular problems. The symptoms women thought were due to hormonal changes at menopause were compared. In 1993 more women cited osteoporosis, insomnia, loss of libido, obesity and loss of muscle tone as due to hormone change while fewer cited depression. The premenstrual symptoms and their severity experienced by a woman when she was premenopausal significantly predicts the type and severity of the menopausal symptoms experienced by the woman. The expected menopausal symptoms and their severity cited by a woman also significantly predicts the type of severity of the menopausal symptoms experienced. More premenstrual symptoms predict the menopausal symptoms than those menopausal symptoms the women expected. The expectation menopause will be 'a relief' or 'a nuisance' significantly predicted the overall menopause experience described by the women. Their negative attitudes about doctors' understanding and information available about menopause remained unchanged but they forget menstrual cycle problems over the 10 years. The results suggest a possible physiological basis for premenstrual and menopausal symptoms. Assistance for women with their premenstrual and menstrual cycle symptoms may improve their quality of life at menopause.

Psychological and sexual changes after the cessation of breast-feeding

OBJECTIVE

To characterize the effect of breast-feeding cessation on the mood and sexuality of women after the birth of their first child.

METHODS

Women in good physical and psychological health, who had been breast-feeding for 6-23 months and had responded to a request for subjects in a parents' magazine, collected data daily for 2 months before and 2 months after weaning. They were asked to rate 14 measures of psychological, physical, and sexual variables at the same time each day on 3- or 5-point scales.

RESULTS

Nineteen women completed the study. Five of these subjects became pregnant before weaning and ceased breast-feeding when pregnancy was confirmed; their last menstrual period was 6 weeks before weaning. The non-pregnant women weaned their babies just before or during menstruation. After weaning, the nonpregnant women reported a significant decrease in fatigue, improvement in mood, and an increase in sexual activity, sexual feelings, and frequency of coitus. Significant changes in fatigue and mood occurred during the second week after weaning; in fatigue, sexual activity, and sexual intercourse during the third week; and in the frequency of sexual intercourse in the fourth week. THe results were not caused by the subjects' expectations about breast-feeding and sexuality or perineal comfort. The women who conceived did not show these changes; a gradual increase in fatigue and decline in sexuality was observed.

CONCLUSION

In women who are not pregnant, the cessation of breast-feeding is associated with an improvement in mood, fatigue, and sexuality.

Receiver operating characteristic analysis of glycogenated nuclei in liver biopsy specimens: quantitative evaluation of their relationship with diabetes and obesity

Glycogenated hepatocyte nuclei are a common finding in liver biopsy specimens from patients presenting with a variety of clinical disorders. Most commonly, glycogenated nuclei from part of a spectrum of pathological changes in the diabetic or obese patient. However, no previous investigation has assessed glycogenated hepatocyte nuclei in a quantitative manner. In this study we used receiver operating characteristic (ROC) analysis to assess quantitatively the strength of glycogenated nuclei as a marker for diabetes and/or obesity. The study population consisted of 102 liver biopsy specimens from the adult population: 20 from diabetic patients, 41 from obese patients, 10 from both obese and diabetic patients, and 31 from neither diabetic nor obese patients. The mean age was 48.5 years with a range of 18 to 80 years. We evaluated the extent of glycogenated nuclei by averaging the number present per high power field over a minimum of 10 high power fields, representing all zones of the liver. The extent of steatosis was graded on a numerical scale from 1 to 10. In ROC analysis perfect tests are associated with an area of 1.0 and completely random tests with an area of 0.5. Receiver operating characteristic analysis showed that glycogenated nuclei are a relatively good test for distinguishing diabetic from nondiabetic patients (area, 0.75), a poor test for distinguishing obese from nonobese patients (area, 0.60), and a fair test for either condition (area, 0.67). In addition, we observed that glycogenated nuclei were preferentially distributed in the periportal "zone 1" of the liver, showed no correlation with steatosis, and had no relation to patient age. For our patient study population the prevalence of diabetes mellitus was 12%. At a cutoff level of four glycogenated nuclei per 400 x high power field, the specificity and sensitivity of glycogenated nuclei as a test for diabetes are 0.98 and 0.30, respectively, with a positive predictive value of 66%.