Binge eating in obese adolescents: emotional and behavioral characteristics and impact on health-related quality of life.

PURPOSE: This study explored binge eating among an adolescent obese population to ascertain the prevalence of bingeing, the relationship between binge eating and body mass index (BMI), and to evaluate significant relationships between binge eating, emotional/behavioral functioning, and health-related quality of life. METHODS: Participants included 102 overweight adolescents aged 12-17 years presenting to a multidisciplinary outpatient obesity clinic. Data obtained included height, weight, and self-report questionnaire data on emotional and behavioral functioning. RESULTS: Binge eating prevalence included 33% moderate to severe binge eating. Binge eating was significantly positively related to BMI and depression, negative mood, feelings of ineffectiveness, negative self-esteem and significantly negatively related to somatic complaints and all aspects of health-related quality of life. Important demographic differences emerged with regard to the impact of binge eating on health-related quality of life with Caucasians, females, and older groups experiencing more pervasive impact. CONCLUSIONS: This research suggests that bingeing behaviors have pervasive and important implications for health-related quality of life for obese adolescents.

Psychosocial functioning in children and adolescents with extreme obesity.

The aim of this study was to investigate the psychosocial differences among obese pediatric patients, particularly those who are "extremely obese" as compared to "obese." Information was collected for 249 subjects at a multidisciplinary treatment clinic for obese youth. A battery of measures was administered and demographic data and height/weight was obtained. The results showed positive correlations between degree of obesity, psychosocial functioning, and quality of life. Specifically, the "extremely obese" were significantly more depressed, more socially anxious, and had poorer quality of life than the "obese" group. Girls and Caucasians were more socially anxious than boys and African Americans, respectively. There is mounting evidence that children and adolescents who are extremely obese are most at risk for psychiatric and medical disorders. Thus, targeting this group for assessment and/or designing treatment options specific for "extremely obese" youth is critical for the successful management of this population.

A comparison of asthma prevalence and morbidity between rural and urban schoolchildren in Arkansas.

BACKGROUND: Asthma disproportionately affects minority and low-income children. Investigations that focus on high-risk pediatric populations outside the inner city are limited. OBJECTIVE: To compare asthma prevalence and morbidity in urban and rural children in Arkansas. METHODS: We administered a validated survey to parents of children enrolled in urban and rural school districts in Arkansas. Rates of asthma diagnosis, asthma symptoms, medication use, and health care utilization were compared between urban and rural groups. RESULTS: Age and sex distributions were similar; however, 85% of rural and 67% of urban children were black and 78% of rural and 37% of urban children had state-issued medical insurance (P < .001 for both). Provider-diagnosed asthma was similar in the rural vs urban groups (19% vs 20%); however, rural children were more commonly diagnosed as having chronic bronchitis (7% vs. 2%, P < .001). Rural children had more asthma morbidity compared with urban children, including recurrent trouble breathing (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.5-2.2), recurrent cough (OR, 2.2; 95% CI, 1.9-2.6), recurrent chest tightness (OR, 1.8; 95% CI, 1.5-2.2), and repeated episodes of bronchitis (OR, 2.2; 95% CI, 1.7-2.8) during the preceding 2 years. Rural children were more likely to report symptoms consistent with moderate to severe asthma compared with urban children (46% vs. 35%, P < .001). There were no differences in health care utilization between groups. CONCLUSION: Asthma prevalence was similar between representative rural and urban groups in Arkansas, but asthma morbidity was significantly higher in the rural group.

Effect of face mask dead volume, respiratory rate, and tidal volume on inhaled albuterol delivery.

INTRODUCTION: Pediatric patients often require metered-dose inhaler (MDI) with holding chamber (HC) to overcome lack of coordination when receiving inhaled therapy. In infants and young children unable to use a mouthpiece, it is necessary to use a mask interface. We compared the effect of varying mask static dead volume (SDV), respiratory rate (RR), and tidal volume (VT) on albuterol captured at the mouth opening (ACMO) in an in vitro model. METHODS: An Aerochamber Max(R) without and with three mask sizes (SDV of 10, 36, 85, and 200 ml, respectively) was connected in series to a filter holder and breathing simulator. ACMO was measured at VTs = 36, 72, 145, and 290 ml and RR of 12 and 24. Each experiment comprised 10 puffs run for six respiratory cycles each. Albuterol was quantified via spectrophotometry at 276 nm. A P-value of 0.05 was considered significant. RESULTS: Increasing VT increased ACMO (all SDVs and RRs). Adding SDV decreased ACMO, except for the small mask at VTs = 145 and 290 ml at RR = 12. Increasing SDV decreased ACMO, except at VT = 36 ml (all masks) and VT = 72 ml (small = medium) at RR = 12 and VT = 36 ml (small = other and medium > large) at RR = 24. Increasing RR increased ACMO for all SDVs at VTs = 36 and 72 ml, but not for VTs = 145 and 290 ml, except for no and large mask at VT = 145 ml. CONCLUSION: In general, decreasing SDV, increasing VT, and increasing RR increase ACMO. Early transition from face mask to mouthpiece should be considered in children receiving albuterol via MDI with HC.

Underdiagnosed and uncontrolled asthma: findings in rural schoolchildren from the Delta region of Arkansas.

BACKGROUND: Studies of asthma in school-aged rural children in the United States are limited, and there are no studies of high-risk pediatric populations in rural environments. OBJECTIVES: To examine the prevalence of asthma and to evaluate markers of morbidity in 2 rural school districts in the Arkansas Delta region. METHODS: Children at risk for asthma were identified by using a cross-sectional asthma case-finding survey. Surveys were distributed to students enrolled in the Marvell and Eudora school districts during the 2005-2006 school year. RESULTS: The response rate was 81% (964 of 1,190). The mean age of the 964 children who completed the survey was 10.3 years (age range, 4-17 years); 85% were African American, and 78% had state-issued insurance. Twenty-eight percent (268 of 964) of the children were categorized as being at risk for asthma by previous physician diagnosis (33%), algorithm diagnosis (16%), or both (51%). Of the 268 at-risk children, 79% reported persistent symptoms and 21% reported intermittent or no current symptoms. In the previous 4 weeks, 59% of the children experienced daytime and nocturnal symptoms and 62% used rescue medications. Activity limitation and treatment in the emergency department or hospitalization for asthma in the previous 2 years were reported by 82% and 49% of the children, respectively. CONCLUSIONS: Active asthma symptoms are prevalent in this predominantly minority, low-income, rural population. High rates of undiagnosed and uncontrolled asthma are suggested by frequent asthma symptoms, activity limitation, rescue medication use, and emergency health care utilization. Future studies of pediatric asthma should focus on high-risk populations in rural locales.

Effect of the AIN-93M purified diet and dietary restriction on survival in Sprague-Dawley rats: implications for chronic studies.

Survival, growth and dietary intake (DI) variables were monitored in a chronic 114-wk study in which male Sprague-Dawley rats [n = 120; National Center for Toxicological Research (NCTR) colony] consumed the AIN-93M purified diet ad libitum (AL), or an amount reduced by 31% of total AL intake inclusive of all macro- and micronutrients. The main objectives were to ascertain the survival characteristics of rats fed the AIN-93M diet and to determine whether dietary restriction (DR) increases longevity of rats fed this casein-based diet compared with the use of mixed-protein sources of the NIH-31 cereal-based diet in an earlier study. Body, liver, brain, the brain/body ratio, spleen, thymus and kidney weights, body length and body density were decreased (P < 0.05) by DR, whereas testis weight and skull length were not altered by DR. Significant age effects at 58 and 114 wk were found for body, brain, the brain/body ratio, liver and testis weights, and body density. Survival rates for the AL and 31% DR groups were 43.3 and 57.5%, respectively. Survival curves were not significantly different. The survival rate for AL rats fed the AIN-93M diet was not different from that of AL rats fed the NIH-31 diet (43.3 and 51.7%, respectively). However, the survival rate for 31% DR rats fed the AIN-93M diet was significantly lower than 25% DR rats fed the NIH-31 diet (57.5 and 87.5%, respectively) although both groups had similar body weights and energy intake at various ages. Nutritional components in the NIH-31 diet that are missing and/or reduced in the AIN-93M diet may interact with DR to increase 114-wk survival. Although the survivability, growth and anatomical results of this study suggest that the AIN-93M diet is suitable for chronic rodent studies, additional studies such as comprehensive histopathologic and physiologic investigations must be undertaken to complete the evaluation process.