A two-phase population study: relationships between overweight, body composition and risk of eating disorders

BACKGROUND

Overweight and eating disorder (ED) are major public health problems in adolescents.

AIMS

To assess the association of overweight, body composition and anthropometric characteristics with the probability being at risk of ED.

METHODS

A two-phase study was used. 329 girls and 96 boys (aged 12-18 years) from an initial sample of 2967 adolescents were studied. The BMI, percentage of fat mass estimated by bioimpedance (FM(BIA)), waist circumference, waist-to-height ratio, and waist-to-hip ratio (WHipr) were calculated. The Eating Attitudes Test, Youth's Inventory-4 and a questionnaire to evaluate social influences were administered.

RESULTS

A total of 34.7% of girls and 53.6% of boys at risk of ED were overweight (including obesity). For girls, overweight frequency was significantly higher in risk ED group than in control group. Increases of one point in the BMI or FM(BIA) increased the probability of being at risk of ED by 12% (3.0-19.0) and 4% (0.0-8.0), respectively. An increase in WHipr was negatively associated with ED risk. Smoking and symptoms of dysthymia and the genralized anxiety disorder also increase the probability of being at risk of ED in adolescent girls. In adolescent boys, these relations were not observed.

CONCLUSIONS

The higher BMI and the percentage of FM(BIA) are associated with greater risk of ED in adolescent girls, when psychological factors are present. Increases in the WHipr, characteristic of childhood body is negatively associated with that risk.

Influence of parent's eating attitudes on eating disorders in school adolescents

OBJECTIVE

To investigate the relationship between parents' cognitive and behavioural dimensions and the risk of eating disorders (ED) in non-clinical adolescents.

METHODS

From an initial sample of 1,336 boys and girls with a mean age of 11.37, a total of 258 subjects were selected either as being at risk of ED or as controls. These subjects and their parents comprised the sample at T1 and were followed-up 2 years later (T2). We examined disordered eating attitudes, body dissatisfaction (BD), body mass index (BMI) and ED diagnoses in the adolescents at two points in time. We also used the Eating Disorder Inventory-2 to examine the disordered eating attitudes of their parents at T1.

RESULTS

The mother's BD, drive for thinness (DT), ineffectiveness and interoceptive awareness, and the father's DT and perfectionism were related to long-term ED. Logistic regression showed that predictors of ED were being female, mother's DT and social insecurity, and adolescent's BD. The BMI was not a predictor in this model. Father's perfectionism was a risk factor of ED.

CONCLUSION

Specific cognitive and behavioural dimensions of ED in both parents can influence the development of an ED in early adolescents. This should be taken into account in the prevention and family oriented treatment of ED.

Prevalence and determinants of high-risk human papillomavirus (HPV) infection and cervical cytological abnormalities in imprisoned women

The aim of the study was to estimate the prevalence and risk factors associated with infection by high-risk human papillomavirus (HR-HPV) in cervix and squamous intra-epithelial lesions (SIL) in imprisoned women. This was done by a cross-sectional study of imprisoned women attending the gynaecological clinic in Foncalent prison in Alicante, Spain. The study period was from May 2003 to December 2005. HR-HPV infection was determined through Digene HPV Test, Hybrid Capture II (HC-II). HPV typing was determined by multiplex nested PCR assay combining degenerate E6/E7 consensus primers. Multiple logistic regression modelling was used for the analysis of associations between variables where some were considered possible confounders after checking for interactions. A total of 219 women were studied. HR-HPV prevalence was 27.4% and prevalence of SIL was 13.3%. HIV prevalence was 18%, higher in Spaniards than in migrant women (24.6% vs. 14.3%, P<0.05). In multivariate analyses, risk factors for HPV infection were younger age (P for trend=0.001) and tobacco use (OR 2.62, 95% CI 1.01-6.73). HPV infection (OR 4.8, 95% CI 1.7-13.8) and HIV infection were associated with SIL (OR 4.8, 95% CI 1.6-14.1). The commonest HPV types were HPV16 (29.4%), HPV18 (17.6%), HPV39 (17.6%) and HPV68 (17.6%). The prevalence of both HR-HPV infection and SIL in imprisoned women found in this study is high. Determinants for each of the outcomes studied were different. HPV infection is the most important determinant for SIL. A strong effect of HIV co-infection on the prevalence of SIL has been detected. Our findings reinforce the need to support gynaecological clinics in the prison setting.

Non-clinical adolescent girls at risk of eating disorder: under-reporters or restrained eaters?

BACKGROUND

To evaluate the plausibility of self-reported energy intake, Goldberg et al proposed a technique to identify the miss-reporters.

SUBJECTS

After screening 2,967 adolescents by EAT-40 test, 132 at risk of ED and 151 as a control group were studied.

AIM

To determine whether subjects at risk of eating disorders that are identified as under reporters can be considered as UR or in turn as restrained eaters.

METHODS

We determined dietary energy intake, body mass index, body satisfaction, physical activity, psychopathology, dietary restraint factor, weight loss and diagnoses of eating disorders. We applied Goldberg's equations to identify under reporters.

RESULTS

40.9% of girls at risk of eating disorders were identified as under reporters and only 7.3% were in the control group. A total of 64.4% of the Eating Disorders Not Otherwise Specified were under reporters. The body mass index of under reporters was significantly higher than in the other of subjects regardless of whether they were at risk of eating disorders. Girls at risk of eating disorders and under reporter had significantly lower body satisfaction than other groups. Multiple logistic regressions in all subjects showed that the risk of being UR was associated with an increase in the body mass index, increase in dietary restraint scores and weight loss; whereas, that only the body mass index was associated with the control group.

CONCLUSION

The prevalence of under reporter increases with the severity of the eating disorders several adolescent girls at risk of eating disorder and identified by Goldberg cut-off technique as under reporter may to be restricting their intake and therefore they would not be under reporter.

Epidemiology of eating disorders: a two year follow up in an early adolescent school population

OBJECTIVE

The aims of this study were to determine the prevalence of eating disorders (ED) in a representative school population of early adolescents of both sexes and to evaluate persistence and incidence after two years.

METHOD

An initial sample of 1336 (mean age = 11.37) was assessed in a two-phase design. The Children Eating Attitudes Test was used to select 258 participants (T1) from the initial sample who were followed-up two years later (T2; n = 200). Diagnoses of ED were obtained using the Diagnostic Interview for Children and Adolescents- Children and Parent Version (DICA-C and DICA-P) at T1, and Adolescent Version (DICA-A) at T2. At T2, participants were also assessed with the Eating Attitudes Test, the Bulimic Investigatory Test, and the Eating Disorders Inventory. The Body mass index (BMI) was obtained for all participants.

RESULTS

The estimated prevalence of any ED according to DICA-C (T1) and DICA-A was 3.44% and 3.81%, respectively. The most frequent diagnoses were syndromes that were not full-blown. Biannual incidence of any ED was 2.02%. Amongst those with an ED, 52.17% persisted. Females showed a higher incidence and persistence of any ED than males. Participants who had the highest BMI were those who had a persistent diagnosis of ED.

CONCLUSION

ED that began at early ages in less severe forms and in females often persisted with increasing severity.

Oncogenic human papillomavirus (HPV) type distribution and HPV type 16 E6 variants in two Spanish population groups with different levels of HPV infection risk

The aim of this study is to determine oncogenic human papillomavirus (HPV) types and HPV type 16 (HPV16) variant distribution in two Spanish population groups, commercial sex workers and imprisoned women (CSW/IPW) and the general population. A multicenter cross-sectional study of 1,889 women from five clinical settings in two Spanish cities was conducted from May to November 2004. Oncogenic HPV infection was tested by an Hybrid Capture II (HC2) test, and positive samples were genotyped by direct sequencing using three different primer sets in L1 (MY09/11 and GP5+/GP6+) and E6/E7. HPV16 variants were identified by sequencing the E6, E2, and L1 regions. Four hundred twenty-five samples were positive for the HC2 test, 31.5% from CSW/IPW and 10.7% from the general population. HPV16 was the most frequent type. Distinct profiles of oncogenic HPV type prevalence were observed across the two populations. In order of decreasing frequency, HPV types 16, 31, 58, 66, 56, and 18 were most frequent in CSW/IPW women, and types 16, 31, 52, 68, 51, and 53 were most frequent in the general population. We analyzed HPV16 intratype variants, and a large majority (78.7%) belonged to the European lineage. AA variants were detected in 16.0% of cases. African variants belonging to classes Af1 (4.0%) and Af2 (1.3%) were detected. Different HPV types and HPV16 intratype variants are involved in oncogenic HPV infections in our population. These results suggest that HPV type distribution differs in CSW/IPW women and in the general population, although further analysis is necessary.

Higher prevalence of human papillomavirus infection in migrant women from Latin America in Spain

OBJECTIVES

To estimate prevalence and determinants of high risk (HR) human papillomavirus (HPV) by country of origin in women attending a family planning centre (FPC) in Alicante, Spain.

METHODS

Cross sectional study of all women attending a FPC from May 2003 to January 2004. An ad hoc questionnaire was designed and data were collected prospectively. HR HPV infection was determined through the Digene HPV test, Hybrid Capture II, and positive samples for PCR were directly sequenced. Data were analysed through multiple logistic regression.

RESULTS

HR HPV prevalence in 1011 women was 10% (95% CI: 8.2 to 12). Compared to Spaniards (prevalence 8.2%) HR HPV prevalence in Colombians was 27.5% (OR: 4.24 95% CI: 2.03 to 8.86), 23.1% in Ecuadoreans (OR: 3.35 95% CI: 1.30 to 8.63), and 22.73% in women from other Latin American countries (OR: 3.29 95% CI: 1.17 to 9.19). Women with more than three lifetime sexual partners had an increased risk of HR HPV infection (OR 3.21 95% CI: 2.02 to 5.10). The higher risk of HR HPV infection was maintained in Latin American women in multivariate analyses that adjusted for age, number of lifetime sexual partners, and reason for consultation. The commonest HPV types in women with normal cervical smears were HPV-18 (20%), HPV-16 (14%) and HPV-33 (11%).

CONCLUSIONS

Prevalence of HR HPV is more than three times higher in Latin Americans than in Spaniards. Latin American women's HPV prevalence resembles more that of their countries of origin. It is essential that health service providers identify these women as a priority group in current cervical screening programmes.

Feeding problems in nursery children: prevalence and psychosocial factors

AIM

In this study we analyze the prevalence of feeding problems in a sample of nursery children and examine the environmental and psychopathological factors related to such problems.

METHODS

We used the Early Childhood Inventory-Parents Checklist to assess 851 Spanish children aged between 3 and 6 years from both urban and rural samples. This screens emotional and behavioural problems and is based on the Diagnostic and Statistical Manual of Mental Disorders-IV. We collected sociodemographic data and information about life events and the psychopathology of the children's parents (General Health Questionnaire-28).

RESULTS

Our results showed that the prevalence of feeding problems was 4.8% and that there were no differences between gender. Sample subtype, socioeconomic level and family characteristics were not linked to feeding problems. Children with feeding problems had significantly more symptoms of psychological problems and somatic complaints and had experienced more life events in the previous 12 months. The psychopathology of the mother, especially in terms of anxiety problems, increased the risk of feeding problems in children.

CONCLUSION

When there are complaints of feeding problems in preschools, the psychological problems of children and their mothers should be taken into consideration during paediatric consultation, irrespective of gender or socioeconomic status.

The Beck Depression Inventory: Psychometric Characteristics and Usefulness in Nonclinical Adolescents

Summary: Epidemiological utility and characteristics of the Beck Depression Inventory (BDI) were examined in a sample of 304 nonclinical adolescents. Psychopathological diagnoses according ICD-10 criteria were assessed by the Schedules for Clinical Assessment in Neuropsychiatry. The female BDI scores were significantly higher than the male scores. The depressed adolescent scores were significantly higher than for nondepressed adolescents. Different scores as discriminators of depression subtypes were reported. The BDI pessimism item was the most important predictor of the total BDI score. Gender differences were found in depressive symptomatology. According to the rates of sensitivity and specificity, the best cutoff scores found were 16 and 10 for major depression and dysthymia, respectively. In conclusion, the BDI proved to be a reliable and valid instrument that could be used as a depression screening in nonclinical adolescents.

Prevalence of DSM-III-R and ICD-10 psychiatric disorders in a Spanish population of 18-year-olds

The aim of this study was to estimate the current prevalence of DSM-III-R and ICD-10 psychiatric disorders in Spanish 18-year-old members of the general population. Subjects were assessed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Nearly 30% of the study subjects reported at least one current disorder according to ICD-10 criteria, and almost 21% reported at least one current disorder according to DSM-III-R criteria. Women had a significantly higher probability of suffering from any psychiatric disorder than men. The most common disorders were insomnia, dysthymia, major depression and simple phobia. Nearly 40% of the diagnosed subjects had one or more comorbid disorders. Comorbidity was found to be higher among female subjects. Consistent with previous risk factor research, it was found that women had higher rates of mood, anxiety and sleep disorders than men. Good communication between parents and their offspring was found to be a protecting factor for all disorders.

Stressful events and salivary cortisol

No relationship of stressful events with salivary cortisol was found for 29 stressed women. An increased cortisol tendency in women suggests different responses by sex.

Smoking and trait anxiety

Smoking behavior was not associated with trait anxiety scores for a sample of 290 Spanish youth of 18 years.

A longitudinal study of depression in an urban Spanish pubertal population

Depression characteristics were investigated in 507 adolescents using a two-stage longitudinal study design. The three-year longitudinal study started when the girls and boys were 11 and 12 years, respectively. In the initial (screening) phase the Children's Depression Inventory (CDI) was used to select subjects for phase-II of the study in which the Children's Depression Rating Scale-Revised (CDRS-R) interview was used. The caseness definition of Major Depression (MD) and Dysthymia (D) was based on the DSM-III-R criteria. Pubertal development was assessed by Tanner's staging. Estimated prevalence of Major Depression in the female sample for each increasing year of age was 2.2%, 2.7% and 4.1%. In the male sample the prevalence for the three years was 0.9%, 0.3% and 0.6%. There was no relation to age. The estimated mean prevalence of Dysthymia was 1.4% in girls and 0.8% in boys. No association between pubertal development and depression was found. Longitudinal data support the notion of chronic depression in early adolescence.

Host Range of a Population of Pratylenchus vulnus in Commercial Fruit, Nut, Citrus, and Grape Rootstocks in Spain

In a host-range study carried out under greenhouse conditions, a total of 37 commercial fruit tree, grape, and citrus rootstocks were tested for their reaction to a population of the lesion nematode, Pratylenchus vulnus, in Spain. Twenty-five rootstocks had a Pf/Pi > 1.5. These included almond (Desmayo Rojo, 1143), apple (EM-9, EM-106), avocado (Hass), cherry (Santa Lucia 64, Camil, M x M 14, Masto de Montafiana), grape (41-B, Fercal, Ritcher 110), hazelnut (Pauetet), loquat (Nadal), peach (Montclar, GF-305), pear (OHF-333), pistachio (P. atlantica, P. vera, P. terebinthus), plum (San Julian 655-2, Montizo, Pixy, Myrobalan 605), and walnut (Serf). The peach rootstock Nemaguard and the grape 161-49 had Pf/Pi between 1.0 and 1.5 (slightly higher than inoculation level). All the tested citrus (Alemow, rough lemon, Carrizo citrange, sour orange, Troyer citrange, Citrumelo), plus three grape (SO4, Vitis rupestris, 1103-P), and the olive rootstock Arbequina had a Pf/Pi < 1.0.

Scores on the State-Trait Anxiety Inventory for children in a longitudinal study of pubertal Spanish youth

Changes in scores on the State-Trait Anxiety Inventory for Children for a sample of 534 pubertal adolescents were longitudinally studied over a period of 4 years. Biological development and other variables were investigated. For the 310 boys, A-trait scores decreased significantly with age. The 224 girls showed significantly higher scores than boys in all years of the study. No significant relationship was found between anxiety and pubertal maturity. The year-to-year persistence in symptomatology of anxiety ranged between 55.6% and 66.1% for girls and between 48.5% and 53.1% for boys. Girls showed bi- and tri-annual persistence between 31% and 50%, and boys between 13% and 27%. Neuroticism scores formed the best predictor of A-trait scores. Symptomatology of anxiety is not transient during early adolescence, so personality may provide a risk indicator in the development of anxiety.

[Abdominal trauma at a third-level pediatric hospital: study of 150 patients]

All paediatric patients with abdominal trauma admitted in our hospital from 1975 to 1989 were retrospectively studied. We present 150 children with ages ranging from 1 to 14 years, mean age 6 +/- 2.6 years. Sixty-five percent of them were male. Trauma was classified as severe (37%) and mild (63%) and relationated with associated extra-abdominal injuries. The 42% of patients could be attended in other less specialized centres. Since 1982, severe abdominal trauma patient with parenchymal lesions of liver, kidney and spleen were treated according to a non-surgical protocol without secondary complications.