Are there differences in the attitudinal body image between adolescent anorexia nervosa and bulimia nervosa?

OBJECTIVE

Body image dissatisfaction is as well a risk factor for eating disorders (ED) and a central feature of ED. The exact nature of body image in adolescent ED is still debated. This study examined attitudinal body image in adolescent anorexia nervosa (AN) and bulimia nervosa (BN), and the association of age, maturational timing, duration of eating disorder, actual weight and general psychological distress with the attitudinal body image in ED.

METHODS

The study group consisted of an outpatient clinical sample of adolescents attending for assessment because of eating disorders. The attitudinal body image of 57 adolescents (girls) aged 14-21 years was studied at the beginning of the treatment. The attitudes to body shape, body size, appearance, tone and femininity were studied by a Likert format scale and by the body dissatisfaction (BD) and drive for thinness scales (DT) from EDI-2 inventory.

RESULTS

Bulimics reported more body image dissatisfaction than anorectics. In multivariate analyses BN and higher general psychological distress had strong associations with body image dissatisfaction. Longer duration of ED and earlier menarche were also associated with negative body image.

DISCUSSION

Attitudinal body image differs between adolescent AN and BN. The psychological distress has a great impact on body image in ED, which should be taken into account in assessment and in treatment interventions.

Insulin resistance, LDL particle size, and LDL susceptibility to oxidation in pediatric kidney and liver recipients

BACKGROUND

Dyslipidemia is common after solid organ transplantation. We have described hypertriglyceridemia in about 50% of our pediatric kidney, and in about 30% of our liver recipients. The aim of the present study was to find out whether this post-transplantation hypertriglyceridemia after pediatric solid organ transplantation is associated with insulin resistance and the occurrence of small, dense low-density lipoprotein (LDL).

METHODS

Fifty kidney and 25 liver recipients (aged 4 to 18 years) on triple immunosuppression, and 181 control children participated in the study for an average of 5.3 and 6.4 years after kidney and liver transplantation (range 1 to 11 years), respectively. Homeostasis model assessments for insulin resistance (HOMA) were calculated and fasting lipoprotein lipid profile, apolipoprotein A-I and B concentrations, LDL particle diameter, and indices of LDL susceptibility to copper-induced oxidation determined.

RESULTS

Kidney patients had significantly higher serum total, high-density, and low-density lipoprotein cholesterol, triglyceride, apolipoprotein A-I and B concentrations than liver patients or control subjects (P < 0.003 for all). HOMA indices higher than the 95th percentile of Canadian normal children were seen in 50.0% of kidney (of liver 41.2%) recipients younger than 11 years, and in 27.3% of older recipients (of liver 37.5%). Smaller sized LDL or LDL of increased oxidizability was not more frequent in patients than in control children.

CONCLUSION

Pediatric kidney recipients had significantly higher lipid and insulin concentrations than healthy control children. Combined hyperlipidemia and features of the dysmetabolic syndrome were common in children after kidney and liver transplantation. However, no small, dense LDL, or LDL prone to oxidation was seen in either group.

Prostacyclin, thromboxane A and the effect of low-dose ASA in pregnancies at high risk for hypertensive disorders

BACKGROUND

The aim of this study was to investigate the prostanoid production in pregnancies at high risk for hypertensive disorders, and the effect of low-dose acetylsalicylic acid (ASA) on prostanoids.

MATERIAL AND METHODS

Ninety women with a bilateral notching in uterine arteries screened by Doppler ultrasound at 12-14 gestational weeks were randomized to the ASA (0.5 mg/kg/day) or placebo group. Forty-three women in both groups were followed up throughout the pregnancy. Urine samples were taken at baseline, and at 24-26 and 32-34 weeks of gestation to determine the urinary 11-dehydrothromboxane B(2) (u-11-dehydro-TxB(2)) and 2,3-dinor-6-keto-prostaglandin F(1alpha) (u-2,3-dinor-6-keto-PGF(1alpha)), the metabolites of thromboxane A(2) and prostacyclin, respectively.

RESULTS

In the pregnancies with pregnancy-induced hypertension (PIH) before 37 gestational weeks, the 2,3-dinor-6-keto-PGF(1alpha)/11-dehydro-TxB(2) ratio did not increase as much as in other pregnancies (P = 0.028). In the placebo group pregnancies with preeclampsia had significantly lower 2,3-dinor-6-keto-PGF(1alpha) (P = 0.019) at 12-14 weeks of gestation compared to other pregnancies. In the placebo group the 2,3-dinor-6-keto-PGF(1alpha)/11-dehydroTxB(2) ratio remained unchanged throughout the pregnancy, with no significant difference between pregnancies with a normal or an adverse outcome. In the ASA group the 2,3-dinor-6-keto-PGF(1alpha)/11-dehydro-TxB(2) ratio increased (P < 0.001, early vs. midpregnancy). Again, the changes were similar in pregnancies with a normal or an adverse outcome.

CONCLUSION

The balance of prostacyclin and thromboxane A(2) shifted in an unfavorable direction in pregnancies complicated by PIH. ASA had a favorable effect on the prostanoids.

Polymorphisms in neprilysin gene affect the risk of Alzheimer's disease in Finnish patients

OBJECTIVES

Neprilysin (NEP) is an amyloid beta-peptide (Abeta) degrading enzyme expressed in the brain, and accumulation of Abeta is the neuropathological hallmark in Alzheimer's disease (AD). In this study we investigated whether polymorphisms in the NEP gene have an effect on the risk for AD.

METHODS

The frequencies of seven single nucleotide polymorphisms (SNPs) and apolipoprotein E (APOE) were assessed in 390 AD patients and 468 cognitively healthy controls. Genotypes of the study groups were compared using binary logistic regression analysis. Haplotype frequencies of the SNPs were estimated from genotype data.

RESULTS

Two SNPs, rs989692 and rs3736187, had significantly different allelic and genotypic frequencies (uncorrected p = 0.01) between the AD and the control subjects and haplotype analysis showed significant association between AD and NEP polymorphisms.

CONCLUSION

Taken together, these findings suggest that polymorphisms in the NEP gene increase risk for AD and support a potential role for NEP in AD.

Violent victimization in schizophrenia

BACKGROUND

We investigated the 3-year prevalence, and the sociodemographic and clinical correlates of violent victimization in a large and unselected nationwide sample of deinstitutionalized patients with schizophrenia.

METHODS

The sample comprised 670 schizophrenic patients aged 15-64 years, who had been discharged from psychiatric hospitals in Finland in 1994. Comprehensive data were collected from psychiatric case records on the patients' sociodemographic factors and psychiatric history, as well as the patients' overall level of functioning. The patients were interviewed 3 years after discharge by each district's psychiatric professionals using a structured interview schedule specifically designed for the purposes of the present study project.

RESULTS

The prevalence of self-reported violent victimization during the 3-year follow-up was 5.6%. In the multivariate analysis, a poor financial situation, alcohol abuse and being a perpetrator of a violent or some other crime were associated with violent victimization.

CONCLUSIONS

The prevalence of violent victimization among schizophrenic patients in Finland was markedly lower than that reported on patients in the United States or Great Britain, but correlates were similar. Patients with a poor financial situation and a history of alcohol misuse, as well as of violent behaviour, seem to have an increased risk for violent victimization, and constitute a vulnerable subgroup in this respect. This subgroup of deinstitutionalized patients with schizophrenia may need additional care and protection from the danger posed to them from other members of the society.

Urinary excretion of interleukin-6 correlates with proteinuria in acute Puumala hantavirus-induced nephritis

BACKGROUND

Nephropathia epidemica (NE) is a mild type of hemorrhagic fever with renal syndrome caused by Puumala Hantavirus. Cytokines are thought to have an important role in the pathogenesis of NE. The aim of this study is to evaluate whether cytokines contribute to renal involvement in NE.

METHODS

Overnight urinary excretion of interleukin-1beta (IL-1beta), IL-1 receptor antagonist (IL-1Ra), IL-6, tumor necrosis factor-alpha (TNF-alpha), albumin, immunoglobulin G (IgG), and alpha1-microglobulin and quantitative 24-hour urinary protein excretion were measured for 3 consecutive days from 70 hospitalized patients with acute NE (49 men, 21 women; age, 15 to 70 years; median age, 39 years). Plasma levels of the respective cytokines also were measured. Urinary collections were repeated after 1 year. The control group for blood samples included 400 healthy blood donors.

RESULTS

Maximum median urinary IL-6 excretion in the acute phase of NE was increased compared with values detected after 1 year (49.5 versus 0.7 pg/min; P < 0.001). Correspondingly, maximum median plasma IL-6 concentration in patients was increased compared with controls (14.6 versus 1.2 pg/mL; P < 0.001). Urinary IL-6 excretion correlated with urinary albumin, IgG, and protein excretion (r = 0.79; P < 0.001; r = 0.76; P < 0.001; and r = 0.65; P < 0.001, respectively), but not plasma IL-6 levels (r = 0.18; P = 0.148).

CONCLUSION

Plasma IL-6 concentrations and urinary IL-6 excretion were markedly increased in patients with acute NE, but there was no correlation between plasma and urinary IL-6 levels. The high urinary IL-6 levels might reflect local production of this proinflammatory cytokine in the kidneys during acute infection.

Possible association of nicastrin polymorphisms and Alzheimer disease in the Finnish population

The authors previously reported that genetic variation in the gene coding for nicastrin (NCSTN) modified risk for familial early-onset Alzheimer disease (AD) in a Dutch population-based sample. Risk was highest in patients without an APOE epsilon4 allele. Here, they evaluated if NCSTN polymorphisms increased risk of AD in the eastern Finnish population. A significant difference in one haplotype was observed in AD patients without the APOE epsilon4 allele.

Smoking-dependent association between paraoxonase 1 M/L55 genotype and coronary atherosclerosis in males: an autopsy study

High-density lipoprotein-associated paraoxonase 1 (PON1) enzyme can retard the oxidation of lipids. The methionine for leucine substitution at position 55 (M/L55) of the PON1 protein is associated with lower (MM genotype) or higher (ML or LL genotype) expression of the gene affecting serum level of PON1. We studied the association of the PON1 M/L55 genotype with the extent of atherosclerosis in an autopsy series of Finnish males. Areas of the coronary arteries and the aorta covered with fatty streaks and fibrotic and complicated lesions were measured from a total of 700 cases. Carriers of the MM genotype (14.4% of subjects) had larger percentual areas of fatty streaks in their left anterior descending coronary artery (P=0.014) and right coronary artery (P=0.004), as well as in thoracic (P<0.001) and abdominal aorta (P=0.010) compared to carriers of the LL or ML genotype. A PON1 genotype-by-smoking interaction was observed on the area of fatty streaks in left anterior descending coronary artery (P=0.011) and right coronary artery (P=0.005); the association between fatty streaks and MM genotype was evident only among non-smokers, whereas in smokers this association was abolished. The areas of more advanced atherosclerotic lesions did not vary significantly between the genotype groups. These data suggest that the genetic variation of PON1 affects the formation of early atherosclerotic lesions and that the effect is modified by smoking.

Serum lipids in children 3 to 5 years after kidney, liver, and heart transplantation

Although dyslipidemia is common after solid organ transplantation (Tx), there are few long-term studies in children. We investigated the prevalence of dyslipidemia up to 5 years after Tx in 125 children on triple immunosuppression with one of three different well-functioning grafts, kidney, liver, and heart, and 181 controls. Total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) concentrations were measured annually. Low-density lipoprotein cholesterol concentrations were also calculated. The risk factors for dyslipidemia were determined at 3 years. There was a high prevalence of hypertriglyceridaemia in all three groups, 50% in the kidney transplantation (KTx) and heart transplantation (HTx) groups and 30% in the liver transplantation (LTx) group. In addition, 50% of KTx patients had high TC. In the Tx groups taken together, the following independent associations were observed: KTx and high pre-Tx TC were associated with high TC, high trough concentration of blood cyclosporine with low HDL-C, and older age at Tx accounted for higher TG. Dyslipidemia, especially hypertriglyceridaemia, was common 3-5 years after Tx. The aetiology is multifactorial and depends on the transplanted organ.

Fathers' and mothers' perceptions of their child and maternal depressive symptoms

Fathers' reports concerning their children have seldom been considered in the previous studies on maternal depression and child development. The literature on parental reports in general suggests that discrepancies in mothers' and fathers' perceptions are associated with the psychological state of the parent and the gender of the child. As part of a prospective follow-up study, fathers' and mothers' perceptions of children's social competence and behavioural/emotional problems were assessed by the Child Behavior Checklists (CBCLs) when the firstborn children were 8-9 years old. The depressive symptoms of the mothers were screened by the Edinburgh Postnatal Depression Scale (EPDS) at the same time point. The level of children's social competence and behavioural/emotional problems reported by the fathers were analysed by background factors. The reports of both parents were explored by the gender of the child and by the presence of maternal depressive symptoms. The concordance of parental reports concerning child's social competence was high, but fathers usually reported lower problem levels than mothers, particularly for boys' problems. The presence of maternal depressive symptoms was associated with child's high problem levels from both fathers' and mothers' perspective. Parental ratings of children's externalizing problems in particular were associated with high maternal depressive symptom level.

Puberty, sexual development and eating disorders in adolescent outpatients

This study examined puberty and psychosexual state in a clinical sample of adolescents attending for assessment because of eating disorders (ED). A total of 57 adolescents (girls) aged 14-21 years (mean age 16.9 years) having either anorexia nervosa (AN) or bulimia nervosa (BN) were studied by semi-structured interviews and structured self-report questionnaires considering the timing of menarche, dating and attitudes to sexuality. The age at menarche did not differ statistically significantly between AN and BN. It was significantly lower in the BN group than in the normal population, but no statistically significant difference was found between the AN group and normal population. The general attitudes to sexuality were more negative in the AN group than in the BN group. In the AN group, there were also fewer dating experiences and interest in dating than in the BN group. After controlling for the effect of age, age at menarche and duration of ED, negative attitudes to sexuality and no dating experiences were still best predicted by AN. The results suggest different ways of coping with the developmental challenges in sexuality in AN and BN during adolescence.

9 alpha,11 beta-prostaglandin F2 in pregnancies at high risk for hypertensive disorders of pregnancy, and the effect of acetylsalicylic acid

Our purpose was to determine urinary 9 alpha,11 beta-prostaglandin F2, the primary metabolite of prostaglandin D2, in pregnancies at high risk for hypertensive disorders and the effect of acetylsalicylic acid on 9 alpha,11 beta-prostaglandin F2. Ninety high risk women were randomised to acetylsalicylic acid and placebo groups at 12-14 weeks of gestation, with 43 women in both groups followed up successfully. 9 alpha,11 beta-prostaglandin F2 was determined at baseline, at 24-26, and at 32-34 weeks of gestation. Fifteen normotensive non-pregnant women, 17 normotensive pregnant women at 12-14, and 15 at 30-34 weeks of gestation served as controls. Urinary 9 alpha,11 beta-prostaglandin F2 was significantly higher in pregnant women at 12-14 weeks of gestation as compared to non-pregnant women. High risk pregnancies had higher 9 alpha,11 beta-prostaglandin F2 as compared to normotensive pregnancies at 12-14, and at 30-34 weeks of gestation. Urinary 9 alpha,11 beta-prostaglandin F2 increased throughout pregnancy unrelated to the outcome of the pregnancy or to the treatment.

Frequency of and risk factors for necrotizing enterocolitis in infants born before 33 weeks of gestation

AIM

To investigate the frequency of and risk factors for necrotizing enterocolitis (NEC) among infants of <33 wk of gestation.

METHODS

Prospective follow-up of 140 inpatients.

RESULTS

26 (18.6%) subjects developed NEC stage I-III and 12 (8.6%) severe NEC (stage II-III). Breast milk fortifier and duration of morphine infusion emerged as the statistically significant factors associated with NEC stage I-III, but only the latter had a significant association with severe NEC.

CONCLUSION

Future studies are needed to be established whether morphine is a causative factor in NEC.

Geographical differences in the prevalence of hypospadias in Finland

Hypospadias is one of the most common congenital anomalies but the etiology is not fully understood. There seem to be genetic, endocrinological, and environmental factors involved. Great geographical variation in the prevalence of hypospadias has been reported both between and within countries. We studied the determinants of geographical variation in the prevalence of hypospadias in Finland. All patients treated for hypospadias in 1970-1996 before the age of 9 years among boys born in 1970-1986 were identified in the national hospital discharge registry. Prevalence of hypospadias was calculated for each of the 355 municipalities in Finland. Demographic data were obtained from Statistics Finland. Association of the explanatory factors with prevalence of hypospadias was assessed using Poisson regression methods. The prevalence of operated hypospadias varied between provinces and between university hospital districts, from a ratio of 0.65 to a ratio of 1.01. An association between the prevalence of hypospadias and the remoteness from the closest city was observed. There was no association with level of education, social class, or occupation. The observed differences in the prevalence of operated hypospadias in Finland may have several explanations. Different levels of ascertainment and both genetic and environmental factors can not be ruled out.

Employment status passages and psychosocial well-being

Medical students entering the labor market were studied to find out whether the improvement of psychosocial well-being depends on characteristics of their careers. Psychosocial well-being was described on the basis of psychosomatic stress symptoms, psychological distress (General Health Questionnaire), and strain resistance resources (Sense of Coherence). The 3-year follow-up showed that among women the improvement of strain resistance resources was delayed in the group with several entries into work. Among men the findings suggested associations between stress symptoms and career characteristics. Most of the results, however, did not support the hypothesis about the division of the participants into those with a stable career and improving well-being and those with a fragmented career and low well-being.

Schizophrenic patients in different treatment settings during the era of deinstitutionalization: three-year follow-up of three discharge cohorts in Finland

OBJECTIVE

We investigated differences in psychosocial and clinical characteristics, as well as the use of services, of schizophrenic patients in different treatment settings three years after their discharge from a psychiatric hospital. Furthermore, we examined secular changes in these phenomena during the era of rapid deinstitutionalization in Finland.

METHOD

Three nationally representative samples comprised 3257 schizophrenic patients who had been discharged in 1986, 1990 and 1994. The patients were interviewed three years after discharge by each district's psychiatric professionals using a structured interview schedule specifically designed for the purposes of the present study. Psychosocial functioning was assessed on the Global Assessment Scale and on a modified version of the Medical Research Council Practices Profile.

RESULTS

In the 1990s, more patients with a poor clinical and psychosocial state were transferred from hospital to alternative outpatient facilities, such as sheltered workshops or supported residences. In successive cohorts, the proportion of patients who had dropped out of treatment decreased and the psychiatric and somatic state of the drop-outs improved.

CONCLUSION

In general, the psychiatric treatment system has worked well for most deinstitutionalized patients. In the future, however, it is important that the quality of care and adequate resources in the alternative outpatient facilities are ensured.

Oral ascorbic acid increases plasma oestradiol during postmenopausal hormone replacement therapy

OBJECTIVES

To study the possible interaction between ascorbic acid (AA) and oestradiol (E2) in postmenopausal women on hormone replacement therapy (HRT).

METHODS

We studied 25 healthy postmenopausal women who had used percutaneous E2 gel at same dose for 10-12 months, at which time the plasma E2 concentrations were stabilized. The subjects were treated with 1000 mg of AA daily for 3 months and blood samples for assay of AA and E2 were taken at 0, 1 and 3 months.

RESULTS

After 1 month of AA treatment, there was an overall increase of 20.8% in E2 levels in the group as a whole. Greater responses were seen in two subgroups. In women with initially the lowest plasma concentrations of AA (<70 micromol/l), there was an increase of 55% in plasma E2 levels which was close to significance (P=0.063). In another subgroup with initially the lowest E2 levels (<0.20 nmol/l) there was a marked and significant increase (from 0.13 to 0.26 nmol/l) in plasma E2 concentrations (P=0.028).

CONCLUSIONS

Our results support early findings that AA may interact with oestrogen therapy. Possible interaction of AA with E2 at the level of antioxidation is discussed.

Isolated ultrafiltration affects dynamic vectorcardiographic ischemia monitoring parameters

AIMS

The present study was undertaken to assess the role of isolated ultrafiltration (UF phase) and hemodialysis with minimal ultrafiltration (HD phase) in changes in parameters reflecting myocardial ischemia: QRS vector difference (QRS-VD), ST change vector magnitude (STC-VM) and ST vector magnitude (ST-VM6) registered by MIDA (myocardial infarction dynamic analysis).

PATIENTS AND METHODS

Twelve patients on maintenance hemodialysis were first ultrafiltrated for 2.5 h without dialysis (UF) followed by a 2.5-hour session of hemodialysis with minimal ultrafiltration (HD). Computerized vectorcardiography (VCG) was used for on-line dynamic analysis of ST segment and QRS complex changes. Blood volume (BV) changes were monitored non-invasively and continuously with the CRIT-LINE instrument. Whole-body bioelectric impedance analysis (BIA) was used for extracellular water (ECW) estimation.

RESULTS

During the UF phase QRS-VD and STC-VM showed a statistically significant increasing linear trend (time effect for both QRS-VD and STC-VM p < 0.0001, while no changes were noted in ST-VM6; time effect p = 0.986). During the HD phase none of these parameters changed (time effect for QRS-VD p = 0.855, for STC-VM p = 0.275 and for ST-VM6 p = 0.976). During the UF, phase changes in QRS-VD were in close relation to those in ECW.

CONCLUSION

Isolated ultrafiltration leads to an increase in the VCG ischemia monitoring parameters QRS-VD and STC-VM. The increase of QRS-VD is related to changes in ECW. Hemodialysis with minimal ultrafiltration has no effect on VCG ischemia monitoring parameters.

Mortality in chronic schizophrenia during decreasing number of psychiatric beds in Finland

Mortality, especially mortality due to suicides, is higher among patients suffering from schizophrenia than among the general population. Little is known about the factors predicting the mortality of schizophrenia patients. It has also been suggested that mortality among psychiatric patients increases as the number of beds in mental hospitals decreases. These questions were studied in 4338 schizophrenia patients discharged in 1982, 1986, 1990 and 1994 from mental hospitals in Finland. During this period, the number of beds in mental hospitals in Finland decreased from 3.8 to 1.3 per 1000 inhabitants. During the three-year follow-up, 226 patients or 5.2% died. There were no statistically significant differences in mortality between the cohorts. The total mortality was higher in males than in females. Age, physical illness and number of hospital days predicted increased mortality due to natural causes. Mortality due to unnatural causes (suicides and accidents) was predicted by number of prescribed psychosedatives, number of hospitalisations and short duration of illness. Mortality due to unnatural causes was higher in the first year after index discharge from hospital. The reduction in number of beds in mental hospitals does not seem to be associated with increased mortality in chronic schizophrenia. The high mortality of schizophrenia patients indicates the need for careful medical examinations and treatment of physical illnesses, as well as counselling for a healthy lifestyle. Need for psychosedative medication at discharge from hospital and multiple previous hospitalisations may indicate an increased suicide risk and thus requires special attention. In outpatient treatment, it is important to remember that the risk of unnatural death increases during the first years after discharge from hospital.

Gestational health and predictors of newborn weight amongst pregnant women in rural Malawi

This study was conducted to provide community-based data on maternal health and predictors of newborn weight in rural Malawi. Data were obtained prospectively from a community-based cohort of 581 pregnant women who attended an antenatal clinic and delivered a term, live-born, singleton infant in Lungwena, rural Malawi. Morbidity from infectious diseases and anaemia was common. Maternal weight gain in rural Malawi was slower but fundal height gain was comparable to that of an affluent western population. The mean +/- SD weight of term newborns was 3.2 +/- 0.5 kilograms. A regression model including data from all routine investigations explained only 24% of the variance in newborn weights, suggesting that routine antenatal measurements had a limited power to predict the size of term live-born babies. Maternal parity, initial weight, the duration of pregnancy and gestational weight gain were associated with newborn weights and should, therefore, be systematically recorded in rural Malawian antenatal clinics.