Lung function, adherence and denial in asthma patients who exhibit a repressive coping style

Lung function, adherence and denial were explored in asthma patients who possess a repressive coping style (repressors). Repressors (low trait anxiety, high defensiveness) and non-repressors were identified by their trait anxiety and defensiveness scores. Participants completed measures of self-reported adherence, denial, morbidity and demographic data. A lung function measure (FEV(1)) was obtained for a subset of patients. Repressors, who comprised 33% of the sample, had significantly worse lung function but scored significantly higher on self-reported adherence, compared to non-repressors. Age was positively correlated with adherence. Although repressive coping was positively correlated with denial, denial was significantly correlated with defensiveness but not trait anxiety. The study provides evidence that repressors are an important group to identify in future studies of asthma.

Increasing food acceptance in the home setting: a randomized controlled trial of parent-administered taste exposure with incentives

BACKGROUND

The use of rewards to encourage children to eat healthily is controversial. However, researcher-led interventions have shown that incentives combined with taste exposure can increase both intake and liking. To date, this has not been tested in the home setting.

OBJECTIVES

The objectives were to test the hypothesis that parent-administered repeated taste exposures to an initially disliked vegetable combined with reward will increase children's liking and intake and to compare the effects of tangible and social rewards.

DESIGN

In this randomized controlled trial, families with children aged 3-4 y (n = 173) were randomly assigned to exposure + tangible reward (sticker), exposure + social reward (praise), or no-treatment control conditions after a pretest assessment in which a target vegetable was selected for each child. In the intervention groups, parents offered their children 12 daily tastes of the vegetable, giving either praise or a sticker for tasting. No specific advice was given to the control group. Assessments of intake and liking of the target vegetable were conducted by researchers immediately after the intervention period and 1 and 3 mo later.

RESULTS

Children who received exposure + tangible rewards increased their intake (P = 0.001) and liking (P = 0.001) of their target vegetable significantly more than did children in the control group. Differences were maintained at the 3-mo follow-up (intake: P = 0.005; liking: P = 0.001). Increases in intake and liking in the exposure + social reward group were not significantly different from the control group.

CONCLUSION

The findings of this home-based study support parental use of tangible rewards with repeated taste exposures to improve children's diets. This trial is registered as ISRCTN42922680.

Characteristics of family mealtimes affecting children's vegetable consumption and liking

Research has documented an association between family mealtimes and higher dietary quality in school-aged children and adolescents. However, there is little understanding of the specific characteristics of mealtimes that are beneficial and a lack of research with preschool-aged children. This cross-sectional study conducted in the United Kingdom in 2008 examined associations between mealtime characteristics and preschoolers' vegetable consumption and liking. Four hundred and thirty-four primary caregivers of children aged 2 to 5 years reported on children's vegetable intake and liking and completed a questionnaire on frequency of family meals, food preparation, and the social and environmental context of family mealtimes. Univariate and multiple linear regression analyses assessed mealtime variables and children's vegetable intake and liking. Multiple regression analysis revealed children's vegetable consumption was predicted by eating approximately the same food as their parents (β=.14; P ≤ 0.01), using ready-made sauces (β=-.12; P ≤ 0.05), and cooking from scratch (β=.11; P ≤ 0.05), accounting for 21% of the variance (with covariates). Children's liking for vegetables was predicted by eating approximately the same food as their parents (β=.15; P ≤ 0.01) and use of preprepared dishes (β=-.15; P ≤ 0.01), accounting for 8% of the variance (with covariates). Frequency of family mealtimes was unrelated to children's vegetable consumption or liking in this sample. This contrasts with findings in older children and adolescents, where frequency of family mealtimes is related to dietary quality and intake. In preschool-aged children, it seems emphasis should be placed on encouraging parents to provide home-cooked meals that mirror those eaten by the adults in the family to improve vegetable intake.

Child adiposity and maternal feeding practices: a longitudinal analysis

BACKGROUND

Parental control has been hypothesized to cause weight gain in children by weakening self-regulatory processes. However, most studies that link control with weight have been cross-sectional, and therefore causation is uncertain. It remains possible that parental control is a response to child overweight rather than a cause.

OBJECTIVE

We investigated the direction of the association between parental feeding practices and children's adiposity in a longitudinal study.

DESIGN

Three subscales of the Child Feeding Questionnaire (CFQ) that measure "pressure," "restriction," and "monitoring" were completed by 213 mothers of 7-9-y-old children as part of the Physical Exercise and Appetite in CHildren Study (PEACHES) and repeated by 113 mothers 3 y later. Baseline and follow-up anthropometric measurements [body mass index (BMI); fat mass index (FMI), and waist circumference (WC)] were made by researchers when the children were aged 7-9 y and 10-11 y.

RESULTS

Regression analyses showed no association between any of the CFQ scales at baseline and change in child adiposity. In contrast, higher child BMI at baseline predicted a smaller decrease in follow-up CFQ "monitoring" (P = 0.003) and a larger decrease in "pressure to eat" (P = 0.04) after baseline scores were controlled for. Similar results were observed for FMI and WC, although they did not reach significance for WC. There were no significant longitudinal associations between child adiposity and the CFQ "restriction" subscale.

CONCLUSION

The results were more consistent with a "child-responsive" model whereby a mother's choice of feeding practice is influenced by her child's weight status rather than her feeding practices influencing the child's weight gain.

Maternal perception of the causes and consequences of sibling differences in eating behaviour

Objective

To explore mothers’ perceptions of differences between their children in the eating behaviour domain.

Methods

Twelve semi-structured interviews were carried out with mothers who had at least two children aged between 6 and 15 years, to discuss feeding experiences, particularly around healthy eating. Interviews were recorded and transcribed verbatim and analysed using Framework Analysis.

Results

Mothers frequently identified differences in appetite and food preferences between their children, which they attributed largely to genetic factors. These sibling differences meant that although feeding goals might be common, the pathways to the goals varied depending on each child’s appetitive characteristics. The overall pattern was one of flexible responsiveness to each child. In contrast to perceptions of their own children’s eating behaviours, feeding difficulties in other families were usually attributed to lack of parental control.

Conclusion

The feeding relationship is complex and interactive, resulting in parents modulating their feeding strategies to match each child’s eating behaviour. Guidance to parents on healthy feeding needs to acknowledge the nuanced and interactive nature of feeding practices.

Natural Occurrence of Phytophthora infestans Causing Late Blight on Woody Nightshade (Solanum dulcamara) in New York

Woody nightshade (Solanum dulcamara) is a common hedgerow herbaceous perennial in the United States, one of only three native Solanum spp. S. dulcamara is a known host of Phytophthora infestans (3), but infection is rarely reported. There is a U.S. record from Maryland (2); in 1947, Peterson (4) stated that this species had never been found blighted in its natural habitat, although in 1960 it was listed as a host of P. infestans in New York (1). The A2 mating type has not been reported on this host. On 2 July, 2009, leaf lesions similar to those of P. infestans on potato were found on wild S. dulcamara at Riverhead, NY. The plant was growing in a home garden within 10 m of potato and tomato plants infected with P. infestans. When two infected leaves of S. dulcamara were incubated for 24 h under high humidity, a pathogen growth developed around the lesion margins that was characterized by hyaline mycelium bearing lemon-shaped sporangia that released motile zoospores after chilling in water, which is consistent with P. infestans. The caducous and limoniform to ovoid sporangia were 39 to 50 μm (average 45 μm) × 26 to 28 μm (average 27 μm) with a length/breadth ratio of 1.66. No oospores were observed. Three isolates were obtained from this plant during July 2009. Growth on rye agar was indistinguishable from that of local tomato isolates of P. infestans. Detached leaflets of S. dulcamara and S. tuberosum, inoculated with the woody nightshade isolates and kept in a humid chamber, became infected and developed profuse sporulation within 5 days. The pathogen isolated was confirmed as P. infestans by morphological, biochemical, and molecular characteristics. Inoculations of attached leaves of potted S. dulcamara plants resulted in necrotic lesions with many sporangia; sporulation also developed on inoculated, attached, and detached tomato leaves. P. infestans was reisolated and identity confirmed as before. The three isolates were A2 mating type, metalaxyl-resistant, mitochondrial haplotype Ia. All were glucose-6-phosphate isomerase 100/122 and peptidase 100/100, as confirmed with single-spore isolates. RG57 fingerprint analysis confirmed that isolates from woody nightshade, tomato, and potato obtained from the same and nearby sites were identical. Although P. infestans in the United States belongs to the new population, which may infect a wider host range than the old US-1 clonal lineage, S. dulcamara infections have only been found when late blight is already widespread in neighboring fields and there is no evidence to suggest that woody nightshade acts as an overwintering host in the United States. References: (1) Anonymous. Index of Plant Diseases in the United States. Page 456 in: Agric. Handb. No. 165, 1960 (2) C. Cox. Phytopathology 38:575, 1948. (3) D. C. Erwin and O. K. Ribeiro. Page 190 in: Phytophthora Diseases Worldwide. The American Phytopathological Society, St. Paul, MN, 1996. (4) L. C. Peterson. Am. Potato J. 24:188, 1947.

Associations between child weight and maternal feeding styles are mediated by maternal perceptions and concerns

Objective

To determine whether controlling parental feeding practices are associated with children’s adiposity and test the hypothesis that any associations are mediated by maternal perception of their child’s weight.

Method

Children aged 7-9 yrs (n=405) were weighed and measured at school as part of the Physical Exercise and Appetite in CHildren Study (PEACHES). Adiposity was indexed with BMI SD-scores. The Child Feeding Questionnaire (CFQ) was completed by 53% of mothers of participating children (n=213). Mothers reported whether they thought their child was overweight, normal weight or underweight, and rated their concern about future overweight on a 5-point scale.

Results

Higher child adiposity was associated with lower ‘pressure to eat’ and higher ‘restriction’ scores. Restriction increased linearly with maternal concern about overweight, and maternal concern about overweight fully mediated the association between child adiposity and restriction. Use of pressure increased as mothers perceived their child to be thinner, but perceived weight did not mediate the association between child weight status and maternal pressure to eat. Monitoring was not associated with child adiposity, maternal perception of weight or concern about overweight.

Conclusion

Restriction appears to be a consequence of mothers’ concern about their child becoming overweight rather than a cause of children’s weight gain. Pressure may be a more complex response that is influenced by the desire to encourage consumption of healthy foods as well as ensure adequate energy intake and appropriate weight gain.

Do social norms affect intended food choice?

OBJECTIVE

To evaluate the effect of social norms on intended fruit and vegetable intake.

METHODS

A two-stage design to i) compare the perceived importance of normative influences vs cost and health on dietary choices, and ii) test the prediction that providing information on social norms will increase intended fruit and vegetable consumption in an experimental study. Home-based interviews (N=1083; 46% men, 54% women) were carried out as part of the Office for National Statistics Omnibus Survey in November 2008.

RESULTS

The public's perception of the importance of social norms was lower (M=2.1) than the perceived importance of cost (M=2.7) or health (M=3.4) (all p's<0.001) on a scale from 1 (not at all important) to 4 (very important). In contrast, results from the experimental study showed that intentions to eat fruit and vegetables were positively influenced by normative information (p=0.011) in men but not by health or cost information; none of the interventions affected women's intentions.

CONCLUSIONS

People have little awareness of the influence of social norms but normative information can have a demonstrable impact on dietary intentions. Health promotion might profit from emphasising how many people are attempting to adopt healthy lifestyles rather than how many have poor diets.

Mothers' views on portion sizes for children

BACKGROUND

Childhood obesity has increased steadily over recent years and has coincided with a general trend towards larger portions of foods consumed both inside and outside the home. A causal link between portion size and weight gain has not been established, although there is evidence of an association between larger portions and greater energy intake. The present study aimed to investigate parent's attitudes, knowledge, practices, and concerns about appropriate portions for children.

METHODS

Four focus groups with a total of 14 volunteer mothers of 8-11-year-old children taking part in a larger school-based study. Mothers were asked their views about portion sizes for their children and were asked to demonstrate typical servings that they would offer their children, by weighing five common foods provided. Conversations were tape-recorded and transcribed for thematic analysis.

RESULTS

Participants were unconcerned about portion sizes and would not welcome official guidance, particularly if it involved weighing foods. Mothers fed their children the amount that they believed they would eat and felt that this varied across children and across occasions. The weighing task revealed a wide variation in portion sizes served to children, with portions of the more energy-dense foods being smaller on average than those of less energy-dense foods.

CONCLUSIONS

There was little understanding of age-appropriate serving sizes amongst mothers in this study. Education campaigns should be mindful of the need to make portion information clear and simple because parents may not be prepared to weigh the food that they serve to their children.

The management of patent ductus arteriosus in Australia and New Zealand

AIM

This study aimed to establish current management practice for patent ductus arteriosus (PDA) among individual consultant neonatologists in Australia and New Zealand, to examine the influences that drives practice and highlight the importance of future randomised controlled trials in the region.

METHODS

Eligible subjects were identified from the Directory of Neonatal Intensive Care Units in Australia and New Zealand, 2007. A questionnaire was sent online to each consultant and was followed up with a letter and telephone call. Seven questions addressed management approach, the drug used and the treatment regimen, threshold for referral for surgical ligation and the literature influencing practice. Data were collected from 22 August 2007 to 22 November 2007.

RESULTS

The overall response rate was 95%. For infants < or =28 weeks or < or =1000 g, all consultants treat PDA by one of four distinct management approaches. Expectant management was favoured by 35%, echocardiographic targeted prophylaxis 32%, presymptomatic treatment 16% and prophylaxis by 17%. There were marked regional variations in practice. Within individual units, more than one approach is used in 14 out of 24 units. Long courses of indomethacin are used to treat PDA by 86%. For 22% of consultants, management is not influenced by published literature.

CONCLUSIONS

Differences of opinion in the literature are reflected by the heterogeneity in clinical practice across regions and within units. Crucial questions undergoing evaluation are whether data extrapolated from a previous area are relevant to PDA in modern neonatology and whether targeting treatment early can translate to improved clinical outcome.

Soft drinks and 'desire to drink' in preschoolers

Interest in soft drink consumption has increased following a dramatic rise in intake over recent years. Research to date has focused primarily on general trends in consumption or on understanding the mechanism by which soft drink consumption may be linked to weight gain. It is clear however that there is considerable individual variability in the extent to which soft drinks are consumed and factors potentially influencing intake have received little attention. This study examines how the Child Eating Behaviour Questionnaire (CEBQ) construct 'Desire to Drink' (DD) relates to drink consumption, preferences and BMI-SDS.Three hundred and forty six same-sex twin children (mean age 11.2 years; s.d. 0.54; 56% female; 53% dizygotic) were weighed, measured and reported their liking for milk, water, fruit juice, fruit squash and sweetened soft drinks. Mothers reported on their child's drink consumption and completed the CEBQ.Scores on the CEBQ DD subscale were not significantly related to child BMI-SDS in this sample. Children scoring higher on DD had higher preferences for sugar-sweetened soft drinks (p = 0.016), fruit squash (p = 0.042) and milk (p = 0.020) than children scoring lower on the scale. DD was also positively related to more frequent consumption of sugar-sweetened soft drinks (p = 0.017) and low calorie soft drinks (p = 0.003). No relationship was observed between DD scores and liking for or intake of water or 100% fruit juice.These findings suggest that the construct desire to drink in children is related to a liking for consuming sweetened drinks, and does not appear to simply denote greater thirst or hunger. This may have important implications for the ongoing development of dietary patterns and weight status in the longer term through an increased preference for sweet things in the mouth and a failure to compensate for calories provided by drinks.

Changing perceptions of weight in Great Britain: comparison of two population surveys

OBJECTIVES

To examine changes in public perceptions of overweight in Great Britain over an eight year period.

DESIGN

Comparison of data on self perceived weight from population surveys in 1999 and 2007.

SETTING

Household surveys of two representative samples in Great Britain.

PARTICIPANTS

853 men and 944 women in 1999, and 847 men and 989 women in 2007.

MAIN OUTCOME MEASURES

Participants were asked to report their weight and height and classify their body size on a scale from "very underweight" to "obese."

RESULTS

Self reported weights increased dramatically over time, but the weight at which people perceived themselves to be overweight also rose significantly. In 1999, 81% of overweight participants correctly identified themselves as overweight compared with 75% in 2007, demonstrating a decrease in sensitivity in the self diagnosis of overweight.

CONCLUSIONS

Despite media and health campaigns aiming to raise awareness of healthy weight, increasing numbers of overweight people fail to recognise that their weight is a cause for concern. This makes it less likely that they will see calls for weight control as personally relevant.

The importance of exposure for healthy eating in childhood: a review

Children's food preferences are strongly associated with their consumption patterns. Identifying the factors that influence preferences is therefore crucial to the development of effective interventions to improve children's diets. Perhaps the most important determinant of a child's liking for a particular food is the extent to which it is familiar. Put simply, children like what they know and they eat what they like. From the very earliest age, children's experiences with food influence both preferences and intake, and research suggests that the earlier and broader that experience, the healthier the child's diet. Laboratory studies of children's food acceptance have indicated that repeated opportunities to taste unfamiliar foods results in increased liking and consumption. In order to investigate whether these results can be replicated in real-world situations, a series of naturalistic studies testing the efficacy of exposure-based interventions have been carried out. In a school-based study large increases in liking and intake of raw red pepper were seen in 5- to 7-year olds and two further studies, in which mothers used exposure techniques to increase children's acceptance of vegetables, achieved similar results. If future large-scale interventions prove to be successful, training could be offered to health professionals or directly to parents themselves.

Humanized anti-CEACAM6 PEGylated scFv: A promising novel therapy for pancreatic cancer

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Background: Novel Therapies for pancreatic cancer (PC) based on biological insight are urgently needed. CEACAM6, a member of the carcinoembryonic antigen (CEA) family, is a cell surface oncogene on PC cells. It is a glycoprotein composed of 3 Ig-like domains (Mr ∼35.2kD) and is linked to the plasma membrane via a glycophospholipid linked anchor. It is over-expressed on ≥95% PC patients’ found irrespective of stage of disease and represents a target for antibody therapy. Methods: Murine anti-CEACAM6 monoclonal antibody (Mab) 13–1 was humanized by a structure-based approach and single chain variable fragments (scFv) designed consisting of a Gly/Ser-linker which includes a cysteine residue for PEGylation. Murine scFv and 4 humanized scFv fragments (Version.1, 2, 7, 8) were bacterially expressed, purified, PEGylated and evaluated for activity alone or in combination with gemcitabine in human PC cell lines and mouse xenograft tumors. Cell viability, apoptosis and in-cell Westerns were done for efficacy and binding. Mouse xenograft tumors were treated with scFv or PEGylated scFv or combination with gemcitabine. Tumors (treated Vs untreated) were analyzed by immunohistochemistry for Ki-67, CD31, CEACAM6 and Caspase 3 Results: Mab 13–1, murine and 4 humanized scFvs’ were cytotoxic to CEACAM6 expressing PC cells (BxPC-3, HPAF-2) and not to PC cells that lack CEACAM6 (CaPan-2) with increased PARP-cleavage that was dose dependent (IC50=10μg/mL). Western blotting of culture media and serum from xenograft mice showed that CEACAM6 is not shed. In-cell Western confirmed humanized V.7 to be the best binder (KD=1–10μg/mL) confirming protein-protein interaction studies performed in silico with homology models of murine and humanized scFvs’ and CEACAM6. The murine scFv alone or the humanized scFV (V.8) in combination with gemcitabine delayed tumor growth by >50%. This tumor reduction correlated well with the immunohistochemical markers of response. Conclusions: We have demonstrated that CEACAM6 is a clinically relevant target in PC and that a PEGylated humanized scFv is a novel effective therapy alone and/or in combination with gemcitabine. Humanized scFv V.7 is undergoing mouse xenograft evaluation and expect will be the most effective agent to take forward into clinical development.

No significant financial relationships to disclose.