Impact of Expanded Hemodialysis Using Medium Cut-off Dialyzer on Quality of Life: Application of Dynamic Patient-Reported Outcome Measurement Tool.

RATIONALE & OBJECTIVE: Current hemodialysis (HD) treatments have limited ability to clear larger-molecular-weight uremic toxins. Retention is associated with increased symptom burden, low health-related quality of life (HRQoL), and high mortality. Improved clearance, using novel medium cut-off dialyzers, termed expanded HD (HDx), may be associated with improved subjective experience. We have previously developed a dynamic patient-reported outcome measure (PROM) instrument to allow iterative recording to better appreciate the overall burden of disease and assess the impact of therapy changes. STUDY DESIGN: Single-center interventional pilot study. SETTING & PARTICIPANTS: 28 patients established on maintenance HD, London, Ontario, Canada. INTERVENTION: Initial study consisting of 2-week observation (baseline-conventional high-flux HD) followed by 12 weeks of HDx. HRQoL was assessed using the dynamic PROM instrument thrice weekly (enabled in a dedicated app as the London Evaluation of Illness [LEVIL]). Extension phase; 2-week baseline with 24 weeks of HDx and 8-week washout. OUTCOMES: Principal aim was to establish whether HDx therapy was associated with improved HRQoL, evidence of dose-dependant response, and whether effects were durable over time, using LEVIL. RESULTS: Patients with lower LEVIL scores (<70/100) at baseline showed improvement in overall HRQoL after 8 weeks of therapy with similar carryover effect. General well-being, energy, and sleep quality were improved significantly as a consequence of HDx therapy. There were no detrimental effects of HDx detected in patients with higher baseline HRQoL. LIMITATIONS: Small nonrandomized sample size. The coronavirus disease 2019 pandemic interfered with the extension phase. CONCLUSIONS: Dynamic PROM assessment effectively identified patients with lower HRQoL and higher symptom burden, demonstrating durable time/dose-dependent improvements across a range of symptom domains. The use of this instrument may allow targeted selection of patients most likely to benefit from HDx therapy and assist in monitoring response and defining effect size and treatment duration to allow optimal design of further definitive randomized controlled trials of this newly introduced technology. FUNDING: Baxter Healthcare Canada. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03640858.

A reconceptualization of the definition of binge eating for African American women: A concept analysis.

AIM: The aim of this analysis is to develop a better understanding of the concept of binge-eating behavior among African American women (AAW). BACKGROUND: Obesity is a major public health concern that is disproportionately prevalent among AAW. Among the factors that contribute to obesity development, binge eating may be of significant concern to AAW. DESIGN: A critical analysis and synthesis of the empirical literature using Walker and Avant's model for concept analysis. The databases MEDLINE, Cumulative Index to Nursing Health Literature (CINAHL) Complete, PsycINFO, and PsycARTICLES were used. Keywords included binge eating AND African American women or Black women race or ethnicity or minority. RESULTS: Binge eating is a behavior that exists on a continuum that involves the overconsumption of food, with or without loss of control (LOC), whereas binge eating with LOC is related to increased impairment and severity. While the main attribute of binge eating involves the consumption of a large amount of food, the LOC component of binge eating definition may not be culturally relevant criteria to include as a requirement, as it may exclude AAW in diagnostics and subsequent treatment as well as overlook the health implications of binge eating regardless of LOC endorsement. CONCLUSION: Including LOC in defining binge-eating behavior among AAW is significant, but should not be necessitated. This concept analysis illustrates the complexities related to binge-eating behavior among AAW, enumerating the characteristics of binge eating that may be unique to certain populations. The definition for binge eating among AAW developed from this concept analysis needs to be further explored in future studies.

Obstructive Sleep Apnea Severity is Directly Related to Suicidal Ideation in Posttraumatic Stress Disorder.

STUDY OBJECTIVES: Posttraumatic stress disorder (PTSD) is associated with suicidal ideation (SI) and obstructive sleep apnea (OSA). There are no studies of OSA diagnosed by sleep study and SI in patients with PTSD. METHODS: Forty consenting civilians with PTSD (38 female, mean ± standard deviation age: 44.60 ± 12.73) underwent a Level 3 home sleep apnea test (WatchPAT200; Itamar Medical, Israel). OSA severity was measured with the respiratory disturbance index (RDI) (number of apneas, hypopneas and respiratory effort related arousals per hour). SI was measured with Items 9, 35, 39, and 50 of the Brief Symptom Inventory (BSI). Other patient-rated measures included the Beck Depression Inventory, second edition (BDI-II), PTSD Checklist for DSM-5 (PCL-5), and the Pittsburgh Sleep Quality Index PTSD Addendum modified to include only Items 1c, 1e, 1f, and 1g that address nightmares. RESULTS: The RDI (r = .757, P < .001) and oxygen desaturation index (r = .633, P < .001) were directly correlated to SI. Multiple regression analysis using SI as the dependent variable and patient-rated measures as independent variables revealed only RDI (ß = .480, t = 4.167, P < .001) and BDI-II (ß = .469, t = 3.375, P = .002) as predictors of SI, with adjusted R2 = 0.718. In patients with RDI < 30 events/h (n = 37) correlation of SI with RDI (r = .511, P = .001) but not ODI (r = .312, P = .060) remained significant. Multiple regression analysis (when RDI < 30 events/h) revealed only BDI-II (ß = .603, t = 3.492, P = .002), and not RDI (ß = .247, t = 1.723, P = .096) as a significant predictor of SI. CONCLUSIONS: OSA severity in PTSD was directly related to SI. Depression was a significant mediator in the relationship between RDI and SI, with OSA-related intermittent hypoxemia possibly contributing to this relationship only in severe OSA.

Posttraumatic stress disorder (PTSD) and the dermatology patient.

Dermatologic symptoms can be associated with posttraumatic stress disorder (PTSD) in several situations: (1) as features of some core PTSD symptoms, such as intrusion symptoms manifesting as cutaneous sensory flashbacks, as autonomic arousal manifesting as night sweats and idiopathic urticaria, and as dissociation manifesting as numbness and dermatitis artefacta; (2) the cutaneous psychosomatic effects of emotional and physical neglect and sexual abuse (eg, infantile eczema, cutaneous self-injury, and body-focused repetitive behaviors such as trichotillomania and skin picking disorder) and eating disorders, which can have dermatologic effects; (3) the direct effect of physical or sexual abuse or catastrophic life events (eg, earthquakes) on the skin; and (4) as a result of significant alterations in hypothalamic-pituitary-adrenal and sympatho-adrenal medullary axes, which can affect neuroendocrine and immune functions, and can lead to exacerbations of stress-reactive inflammatory dermatoses such as psoriasis, chronic urticaria, and atopic dermatitis. Elevated levels of inflammatory biomarkers and impaired epidermal barrier function have been reported in situations involving sustained psychologic stress and sleep deprivation. Some PTSD patients show hypothalamic-pituitary-adrenal axis hyporesponsiveness and higher circulating T lymphocytes, which can exacerbate immune-mediated dermatologic disorders. PTSD should be considered an underlying factor in the chronic, recurrent, or treatment-resistant stress-reactive dermatoses and in patients with self-induced dermatoses.

Effects of gender on locomotor sensitivity to amphetamine, body weight, and fat mass in regulator of G protein signaling 9 (RGS9) knockout mice.

Regulator of G-protein signaling (RGS) protein 9-2 is enriched in the striatum where it modulates dopamine and opioid receptor-mediated signaling. RGS9 knockout (KO) mice show increased psychostimulant-induced behavioral sensitization, as well as exhibit higher body weights and greater fat accumulation compared to wild-type (WT) littermates. In the present study, we found gender influences on each of these phenotypic characteristics. Female RGS9 KO mice exhibited greater locomotor sensitization to amphetamine (1.0mg/kg) treatment as compared to male RGS9 KO mice. Male RGS9 KO mice showed increased body weights as compared to male WT littermates, while no such differences were detected in female mice. Quantitative magnetic resonance showed that male RGS9 KO mice accumulated greater fat mass vs. WT littermates at 5months of age. Such observations could not be explained by increased caloric consumption since male and female RGS9 KO mice demonstrated equivalent daily food intake as compared to their respective WT littermates. Although indirect calorimetry methods found decreased oxygen consumption and carbon dioxide production during the 12-hour dark phase in male RGS9 KO vs. WT mice which are indicative of less energy expenditure, male RGS9 KO mice exhibited lower levels of locomotor activity during this period. Genotype had no effect on metabolic activities when KO and WT groups were compared under fasting vs. feeding treatments. In summary, these results highlight the importance of factoring gender into the experimental design since many studies conducted in RGS9 KO mice utilize locomotor activity as a measured outcome.

Obesity in urban women: associations with sleep and sleepiness, fatigue and activity.

BACKGROUND: African-American women (AAW) have the highest prevalence of obesity and therefore are at greater risk for obesity-related symptoms and diseases. Obese individuals frequently report poorer sleep quality, more daytime sleepiness, more severe fatigue, and higher physical inactivity than normal weight individuals. The relationships among these variables have not been well-characterized in obese, urban-dwelling, AAW. METHODS: This descriptive, correlational study examined the relationships among sleep quality, daytime sleepiness, fatigue, level of physical activity, and body mass index (BMI) in AAW living in an urban setting. A convenience sample of 69 young adult women with a BMI of greater than 30 kg/m(2) completed measures of sleep quality, sleepiness, fatigue severity, sense of community, and physical activity. Further analysis was done to determine if any of the study variables predicted level of physical activity. FINDINGS: There was a strong and significant correlation between BMI and overall fatigue severity and a significant, negative correlation between BMI and physical activity performance. BMI was significantly correlated with sleep latency but not global sleep quality. There were significant relationships between fatigue severity and poorer global sleep quality and daytime sleepiness. Multiple regression analysis showed BMI and age accounted for a significant amount of the variance in physical activity. CONCLUSIONS: Higher BMI was associated with significant fatigue. Fatigue severity was associated with poorer global sleep quality, daytime sleepiness, and a sense of community. Higher BMI may be a barrier to having an active lifestyle.

Toward a Middle-Range Theory of Weight Management.

The authors of this paper present the middle-range theory of weight management that focuses on cultural, environmental, and psychosocial factors that influence behaviors needed for weight control. The theory of weight management was developed deductively from Orem's theory of self-care, a constituent theory within the broader self-care deficit nursing theory and from research literature. Linkages between the conceptual and middle-range theory concepts are illustrated using a substruction model. The development of the theory of weight management serves to build nursing science by integrating extant nursing theory and empirical knowledge. This theory may help predict weight management in populations at risk for obesity-related disorders.

The effect of α-cyclodextrin on postprandial lipid and glycemic responses to a fat-containing meal.

OBJECTIVE: α-Cyclodextrin (α-CD), a soluble dietary fiber derived from corn, marketed under the trade name FBCx®, has the potential to help individuals manage their weight and improve their lipid profiles. Initial studies in healthy overweight and/or obese diabetic individuals found that, in those consuming a normal to high fat diet over a 4 or 12 week period, α-CD use was associated with weight loss or maintenance and a reduction in triglyceride (TG) and cholesterol levels in hyperlipidemic individuals. Furthermore, α-CD use was associated with the positive effects of increasing insulin and leptin sensitivities. To date, the immediate post-prandial glucose and lipid responses to a fat-containing meal have not been reported. MATERIALS/METHOD: This double blinded placebo controlled cross-over trial examined the effect of 2 g of α-CD taken immediately following consumption of a commercially prepared high-fat breakfast meal on the acute postprandial responses in healthy adults. RESULTS: The coincidental consumption of α-CD with a fat-containing meal was associated with a significant reduction in postprandial TG responses over time when compared to placebo. When incremental area under the curve was calculated, the area under the curve associated with α-CD consumption was significantly smaller than the Placebo area (0.30±1.07 mmol/L/3 h vs. 0.98±0.88 mmol/L/3 h, p<0.05). There were no significant changes in glucose or cholesterol levels. CONCLUSION: α-Cyclodextrin was shown to significantly lower acute postprandial blood triglyceride levels.

Bridging the Digital Divide for urban seniors: community partnership.

Computers and the Internet offer older adults resources for improving health. For many older adults, the "Digital Divide" (the social, economic, and demographic factors that exist between individuals who use computers and those who do not) is a barrier to taking advantage of these resources. Bridging the Digital Divide by making computers and the Internet more accessible and making online health information more usable for older adults has the potential to improve health of older adults. This article describes a strategy for closing the Digital Divide for urban seniors through the formation of a community- university partnership with the goal of improving health and well-being through the use of online health information.

Implications of the biology of weight regulation and obesity on the treatment of obesity.

PURPOSE: The purposes of this article are to provide a brief review of the complex biology of weight regulation and obesity, to explain some of the effects of diet and exercise on the biology of weight regulation and obesity, and to propose a coherent way to assess and treat people related to weight and obesity. DATA SOURCES: Scientific publications, clinical guidelines, and government sources. CONCLUSIONS: Obesity is a complex problem requiring an understanding of how interventions interact with the biology of weight regulation in people who are obese. Promoting health in obese people requires a focus on improving insulin sensitivity. IMPLICATIONS FOR PRACTICE: Helping individuals maintain normal weight throughout life is important in order to keep the long- and short-term weight signals in balance and reflective of true energy requirements. Exercise is associated with loss of total and abdominal adipose tissue and improved insulin sensitivity. Diets inducing gradual weight loss are less likely to stimulate appetite. Diets should include antioxidants to neutralize the increase in free radical production associated with obesity and exercise. Other interventions in the treatment of obesity may include treating sleep deficits and the dysregulated endocannabinoid system.

Effects of abuse pattern of gestational toluene exposure on metabolism, feeding and body composition.

AIMS: Inhalant abuse during pregnancy lowers birth weight and impedes early development. These studies explored the effects of brief, repeated, prenatal toluene exposures in pregnant female rats on body weight, metabolic rate, body composition, and food intake in their offspring. METHOD: Rats were exposed to 0, 8000, 12,000, or 16,000 ppm of toluene twice daily for 15 min from gestational days 8 to 20. The effects of such exposures on post-weaning litter weights, oxygen consumption, carbon dioxide output, and body fat content were determined in 2 cohorts (n=23, n=24) of offspring. Food intakes and weight changes in response to 3 different diets (regular chow, purified diet, purified high fat diet) were examined in another cohort (n=24) from postnatal days 72 to 116. RESULTS: Litter weights showed a significant linear decrease as a function of toluene dose. Offspring exposed to the 16,000 ppm toluene dose displayed statistically lower energy expenditures than control rats. Male rats exposed to 8000 or 16,000 ppm toluene had significantly greater percentage of body fat as well as total body fat than the other groups. Toluene also significantly suppressed weight gain over the time chow was consumed compared to the 0 ppm control group. Finally there were trends for a main effect of toluene dose on food intake during chow and during high fat diet consumption, with rats in the 12,000 ppm group consuming more than the 0 ppm group on both diets. DISCUSSION: These data suggest that, in addition to other previously documented abnormalities in neurological development and behavior, the physiological regulation of metabolism and body composition in males as well as food intake and weight gain in both sexes may be altered by prenatal exposure to toluene.

Disordered eating and food cravings among urban obese African American women.

OBJECTIVE: The prevalence of night eating syndrome (NES), binge eating disorder (BED), and bulimia nervosa (BN) and the general experience of food cravings were examined in 88 obese urban African American women. METHOD: Participants were administered The Questionnaire on Eating and Weight Patterns-R, the Night Eating Syndrome Questionnaire, and the State and Trait Food Cravings Questionnaire, Trait version (FCQ-T). RESULTS: Twenty-eight percent reported symptoms of eating disorders (18.9% NES, 6.4% recurrent binge eating, 2.2% both NES and recurrent binge eating). Those reporting disordered eating had significantly higher total FCQ-T scores than those not reporting disordered eating. Persons endorsing recurrent binge eating had the highest mean score, followed by those reporting NES. Those who identified themselves as binge eaters and night eaters were not significantly different from each other, but both groups were significantly different than the no eating disorder symptoms group on various subscales of the FCQ-T. DISCUSSION: Obese African American women report significant levels of NES and binge eating which may contribute to the development and/ or maintenance of obesity.

The effect of kappa opioid receptor antagonism on energy expenditure in the obese Zucker rat.

Food intake and, subsequently, body weight are influenced by endogenous opioids acting in the central nervous system. Agonists for the opioid receptor increase food intake, whereas antagonists reduce food intake. Body weight, however, is the result of food consumed and energy expended. Although much has been reported about the effect of opioid antagonism on food intake, less has been reported about its effect on energy expended. This study investigated the effect of selective antagonism of the kappa opioid receptor on food intake, body weight, and indicators of energy expenditure in male obese Zucker rats (n=10). Energy expenditure was measured by indirect calorimetry, whereas general activity and body temperature were measured by implanted radio frequency telemetry. Central administration of 30 microg of the kappa opioid receptor (KOR) antagonist norbinaltorphamine resulted in a significant 34% reduction in food intake (p =.001), a small reduction in body weight, a reduction in resting energy expenditure (p = .06), a reduction in respiratory quotient (p =.06), a 14% reduction in general activity, and a reduction in core body temperature. Reduction in body weight as a result of KOR inhibition in this study was related to a decrease in food intake but not related to an increase in energy expended or activity.

Conditioned place preferences (CPPs) to high-caloric "snack foods" in rat strains genetically prone vs. resistant to diet-induced obesity: resistance to naltrexone blockade.

A previous study in our laboratory using Sprague-Dawley (SD) male rats showed that conditioned place preferences (CPPs) can be learned to two different high-caloric "snack foods"--one high in sugar (Froot Loops cereal: FL) vs. one high in fat (Cheetos: C), and that both preferences were mediated by endogenous opioids. Using the same CPP apparatus and procedures, two genetic sub-strains of SD rats, one selectively bred for diet-induced obesity (DIO) vs. another bred for diet resistance to obesity (DR), were used in this investigation. The experiment determined if (a) CPPs can be created in both strains using the same high-caloric "snack foods" and, (b) if CPPs existed, were they opioid dependent. Four non-deprived groups of eight male rats, half being of each strain, were given 20 min sessions to eat either FL or C in one side of a three-chamber CPP apparatus vs. chow on the opposite side over alternating days of a 20 day period. Each predetermined side had distinctly different environmental cues. Following conditioning, rats were tested during 10 min sessions to see if CPPs existed to the "snack food" trained sides. During conditioning and testing, bodyweights, intakes of foods, and activity were measured. Both FL and C generated strong CPPs that were equivalent in both strains. In contrast to our previous study in the parent strain, doses of 0, 0.50, 1.0, 2.5, and 5.0 mg/kg of the opioid antagonist, naltrexone, had no effect on blocking these CPPs. These results show that (a) DIO and DR rats can learn CPPs (i.e., "exhibit food cravings") as well as their parent strain after periodic access to high-caloric palatable foods, but imply that (b) some physiological system other than the endogenous opioid system mediates such learning.

Effect of opioid antagonism on conditioned place preferences to snack foods.

Previous research has shown that food-deprived rats acquire conditioned place preferences (CPPs) to sweet liquids that are largely attenuated by the opioid antagonist naltrexone (NAL). This study determined if ad libitum Chow-fed rats can learn CPPs when given relatively brief exposures to different solid snack foods (SFs) -- one high in sugar (Froot Loops cereal: FL) vs. one high in fat (Cheetos: C). Two groups of 16 male rats were trained during 20-min sessions to eat either FL or C in one side of a three-chambered CPP apparatus vs. Chow in the opposite side on alternating days for 20 days. Rats ate considerably more SFs of both types than Chow during the conditioning sessions (SFs: about 23 kcal versus Chow: about 7 kcal). Ten-minute tests for CPPs in the absence of SFs showed that the time spent on SF-conditioned sides increased significantly compared to pre-conditioning tests. Analyses of variance for re-tested CCPs after 0.1, 1.0, 2.5, and 5.0mg/kg NAL showed dose-dependent suppressions of CPPs to both SFs. These data show that consuming sweet or fatty SFs can become reliably associated with environmental cues in the non-deprived state. The endogenous opioid system, which mediates hedonic aspects of palatable food intake, appears to mediate these learned associations.

The effect of opioid antagonism on food intake behavior and body weight in a biobehavioral model of obese binge eating.

The obese Zucker rat (OZR) exhibits a hyperphagic eating pattern similar to the obese binge eater. Dynorphin, an endogenous agonist of the kappa receptor, is associated with regulation offood intake. Lessened sensitivity to opioid antagonists and/or increased central dynorphin levels may contribute to the hyperphagic eating pattern observed in the OZR. This study examined the temporal effect of a single intracerebroventricular (ICV) dose of nor-binaltorphimine (NBNI), a specific and long-lasting kappa opioid antagonist, on food intake, body weight, and satiety measures (meal size and the shape of the cumulative food intake curve [CFIC]) in adult male OZRs. Analysis of individual subjects revealed a differential response to opioid antagonism with respect to weight loss, reduction in food intake, and change in the slope of the CFIC, with some responding and others responding poorly. Repeated-measures analysis of variance showed a significant decrease in body weight (P = 0.001) and food intake (P = 0.03) in responders compared to poor responders and controls. Satiation was influenced to a greater extent in responders, who showed a significant reduction in meal size and a greater change in the CFICfor the largest meal of the day toward a pattern of satiation. These data suggest that a differential response to chronic opioid antagonism may exist in the OZR.