Placebo response in binge eating disorder.

OBJECTIVE: Placebo response in studies of binge eating disorder (BED) has raised concern about its diagnostic stability. The aims of this study were (1) to compare placebo responders (PRs) with nonresponders (NRs); (2) to investigate the course of BED following placebo response; and (3) to examine attributions regarding placebo response. METHOD: The baseline placebo run-in phase (BL) was part of a RCT investigating sibutramine hydrochloride for BED; it included 451 participants, ages 19-63, diagnosed with BED. Follow-up (FU) included 33 PRs. RESULTS: : In this study, 32.6% of participants responded to placebo (PRs = 147; NRs = 304). PRs exhibited significantly less symptom severity. At FU (n = 33), many PRs reported continued symptoms. CONCLUSION: PRs exhibited significantly less severe pathology than NRs. Placebo response in BED may transitory or incomplete. The results of this study suggest variable stability in the BED diagnosis.

Spirituality among young women at risk for eating disorders.

OBJECTIVE: This study examined the spiritual and religious (S/R) beliefs and practices of college-age women at high-risk for eating disorders, and the relationship between body image distress, coping, and S/R. METHOD: Two hundred fifty-five college-age women with elevated weight and shape concerns, assessed using the Weight/Shape Concerns Scale and the Eating Disorder Examination (EDE), completed surveys about their S/R beliefs and practices. RESULTS: Women with strong S/R beliefs and practices cope with body dissatisfaction differently than women without strong S/R beliefs. Participants with strong S/R were significantly more likely to pray, meditate, or read religious/spiritual texts to cope with body image distress. Participants without strong beliefs and practices were more likely to cope utilizing distraction. Women with strong beliefs who prayed found it effective. DISCUSSION: Study participants were heterogenenous in their S/R beliefs and practices. These beliefs and practices may be underutilized resources for coping with body image concerns.

Forced midexpiratory time: reference values and the effect of cigarette smoking.

BACKGROUND: Forced midexpiratory time (FET25-75%), the time required to exhale from 25 to 75% of forced vital capacity (FVC), has been advocated as a relatively volume-independent measure of obstruction. Previous estimates of normal FET25-75% have not systematically studied the effect of age, height, sex, and smoking history. METHODS: We analyzed flow-volume loops from 369 normal lifetime nonsmokers and smokers, a random sample of the population of Michigan. Linear models including age and/or height were considered, with and without logarithmic transformation. RESULTS: The best models used age, or age and height, and no transformation. Age and height contributed much less to the variability of FET25-75% than to spirometric flows previously investigated. The largest r2 was found in the male smokers, with the largest contribution from age, suggesting a smoking effect. CONCLUSIONS: As age was the major contributor to the value of FET25-75% and that contribution was small, we suggest the use of simplified age-stratified reference values derived from our data.

Lung function in former intravenous drug abusers: the effect of ubiquitous cigarette smoking.

PURPOSE: To determine whether former intravenous drug abusers (IVDAs) demonstrate reductions in pulmonary function, especially in the diffusing capacity (DLCO), after adjustment for the effects of their ubiquitous smoking habit. Knowledge of baseline DLCO in this high-risk group is important in evaluating the effects of human immunodeficiency virus (HIV) and ensuing opportunistic infections. PATIENTS AND METHODS: Measurements of single-breath DLCO, forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) were compared with predictive values that adjust for the effects of smoking. Patients were 98 ambulatory former IVDAs regularly attending a methadone maintenance program (62 men and 36 women; 94 current smokers, two ex-smokers, and two nonsmokers). RESULTS: When adjusted for smoking, FEV1 and DLCO were no different in the study sample than in cross sections of the general population: mean FEV1 105% predicted (men) and 97% predicted (women), mean DLCO 95% predicted (men) and 99% predicted (women). Eleven percent of the IVDAs had abnormal values for DLCO; only one subject had a value less than 50% of predicted. CONCLUSIONS: Most former IVDAs who regularly attend an ambulatory methadone program have normal DLCO values when the effects of smoking are taken into account. A decrease in DLCO in such subjects is presumptive evidence of superimposed disease, most likely related to opportunistic infections or HIV-associated malignancy or alveolitis.

Respiratory drive and pattern during inertially-loaded CO2 rebreathing: implications for models of respiratory mechanics in obesity.

Chest wall inertance (Iw) constitutes a mechanical load which is small in normal individuals, but increases in the morbidly obese. The effect of increased Iw on respiratory drive and pattern has not previously been investigated. We studied this effect by measuring rebreathing CO2 response in 10 normal subjects with and without a 45.5 kg inertial load. Changes in inspiratory occlusion pressure (P0.1), ventilation, respiratory rate, mean inspiratory flow (VT/TI) duty cycle (TI/TT), inspiratory and expiratory times, and [P0.1/(VT/TI)] were assessed. The P0.1 vs. PETCO2 response shifted to the left during inertial loading, while the slope remained unchanged (x-intercept = 36.7 +/- 4.9 mm Hg unloaded vs. 32.7 +/- 7.5 mm Hg loaded, P less than 0.05), increasing P0.1 from 18.5 +/- 8.0 to 21.0 +/- 7.6 cm H2O at PETCO2 = 6.5 mm Hg (P less than 0.005). Respiratory pattern was unchanged with the inertial load except for a slight decrease in tidal volume. The inspiratory transfer characteristic [P0.1/(VT/TI)] at PETCO2 = 65 mm Hg increased significantly (8.3 +/- 2.0 to 10.5 +/- 2.9 cm H2O.(L.sec-1)-1, P less than 0.025) illustrating the strategy of maintaining similar ventilation by increasing inspiratory force against the load.