Interoceptive hunger, eating attitudes and beliefs.

Interoceptive individual differences have garnered interest because of their relationship with mental health. One type of individual difference that has received little attention is variability in the sensation/s that are understood to mean a particular interoceptive state, something that may be especially relevant for hunger. We examined if interoceptive hunger is multidimensional and idiosyncratic, if it is reliable, and if it is linked to dysfunctional eating and beliefs about the causes of hunger. Participants completed a survey just before a main meal, with most retested around 1 month later. We found that interoceptive hunger has 11 dimensions, and while people differ considerably in their combinations of interoceptive hungers, these represent only 4% of all possible permutations. Hunger reports were reliable. We found relationships between variability in hunger interoception and dysfunctional eating, especially for uncontrolled eating. We also found that hunger beliefs were in some cases strongly related to aspects of hunger interoception. The implications of these findings are discussed.

The development of interoceptive hunger signals.

Hunger is often reported when people experience certain internal sensations (e.g., fatigue) or when they anticipate that a food will be good to eat. The latter results from associative learning, while the former was thought to signal an energy deficit. However, energy-deficit models of hunger are not well supported, so if interoceptive hungers are not "fuel gauges," what are they? We examined an alternate perspective, where internal states signaling hunger, which are quite diverse, are learned during childhood. A basic prediction from this idea is offspring-caregiver similarity, which should be evident if caregivers teach their child the meaning of internal hunger cues. We tested 111 university student offspring-primary caregiver pairs, by having them complete a survey about their internal hunger states, alongside other information that may moderate this relationship (i.e., gender, body mass index, eating attitudes, and beliefs about hunger). We observed substantial similarity between offspring-caregiver pairs (Cohen's ds from 0.33 to 1.55), with the main moderator being beliefs about an energy-needs model of hunger, which tended to increase similarity. We discuss whether these findings may also reflect heritable influences, the form that any learning might take, and the implications for child feeding practices.

In vitro activity of new generation fluoroquinolones against genotypically distinct and indistinguishable Clostridium difficile isolates.

We compared the activities of ciprofloxacin and levofloxacin with those of the newer fluoroquinolones grepafloxacin, moxifloxacin, sparfloxacin and trovafloxacin against Clostridium difficile isolates. As there is good evidence of marked clonal spread of C. difficile, we studied both genotypically distinct (n = 26) and indistinguishable (n = 28) isolates as determined by random amplified polymorphic DNA and ribosomal spacer PCR fingerprinting. The indistinguishable strains examined represent the main UK epidemic C. difficile clone. For 17 of 54 strains (31%) we were unable to read MICs following inocula preparation using Mueller-Hinton broth. Using Schaedler's broth for inocula preparation 93% of strains had readable MICs, although geometric mean MICs were uniformly higher (2.5- to 5.4-fold) compared with results using Mueller-Hinton broth. Moxifloxacin and trovafloxacin, followed by grepafloxacin, were the most active fluoroquinolones tested and were 3- to 4-fold more active than older agents such as ciprofloxacin by both MIC methods. Unexpectedly, clonal C. difficile strains had markedly reduced susceptibility compared with the distinct strains to each of the fluoroquinolones tested. Clonal strains were more than seven-fold or 12- to 29-fold less susceptible (according to geometric mean MICs) than distinct strains to both moxifloxacin and trovafloxacin, depending on the MIC method used. It remains to be seen whether the enhanced activity of new fluoroquinolones such as moxifloxacin in comparison with other fluoroquinolones against C. difficile implies that these agents are unlikely to be associated with C. difficile infection. However, clinical use of new generation fluoroquinolones in elderly hospitalized patients where C. difficile is endemic requires further study, particularly given the reduced antibiotic susceptibility to all fluoroquinolones of the readily transmissible UK C. difficile clone.

Combined cervical swab and urine specimens for PCR diagnosis of genital Chlamydia trachomatis infection.

OBJECTIVES: Sampling of both the cervix and urine increases the chance of detection of Chlamydia trachomatis compared with sampling either site alone. We determined the effect of combining urine and cervical swab specimens in the clinic setting on the sensitivity of C trachomatis polymerase chain reaction (PCR) testing. METHODS: For each of 100 women attending a genitourinary medicine clinic with high likelihood of genital C trachomatis infection, one endocervical swab was placed in transport medium and another in one of two aliquots of first void urine. Four PCR assays per patient (urine + swab, swab alone, and urine alone both pre- and post-freeze-thawing) were processed by automated C trachomatis PCR (Cobas, Amplicor). An inhibition control was included with each assay to identify specimens containing PCR inhibitors. RESULTS: 71% of women were Amplicor C trachomatis PCR positive (according to the results of at least one specimen). PCR test results were concordant for 95/100 patients, and of the five discordant result sets there was only one major discrepancy. Inhibitors of PCR were present in 22/400 specimens from 20 patients, and 16/22 were cervical swabs (p < 0.001). CONCLUSIONS: Combining a cervical swab with a urine specimen is acceptable for PCR testing for genital C trachomatis infection, and has the potential to increase further the cost effectiveness of DNA based screening for C trachomatis genital infection.

Klebsiella species in hospital food and kitchens: a source of organisms in the bowel of patients.

Hospital food was examined for the presence of Klebsiella species. Salads and cold meat were most frequently contaminated, often containing more than 10(3) organisms per g. Klebsiella species were also widely distributed in the kitchen environment which was considered, at least in part, to be the source of the organisms in food. By the use of serological and bacteriocin typing, intestinal carriage of strains ingested in food could be demonstrated.

Comparison of minocycline and ampicillin in gonococcal urethritis.

A prospective, randomised, single-blind trial was carried out to compare the efficacy and tolerability of minocycline and ampicillin in the treatment of gonorrhoea in men. One hundred and twenty men were treated with minocycline 300 mg and 121 men with ampicillin 2 g and probenecid 1 g. Cure rates were similar in both groups of patients. There were few side effects. Of 135 strains of Neisseria gonorrhoeae tested to different concentrations of minocycline and penicillin, two were resistant to penicillin (minimum inhibitory concentration (MIC) greater than or equal to 0.1 microgram/ml) and seven to minocycline (MIC greater than 1.0 microgram/ml). The incidence of PGU was 31% in those patients treated with minocycline and 34% in those treated with ampicillin plus probenecid, the difference not being statistically significant. PGU occurred more often after treatment with minocycline than in previous studies.

Further studies on the sources of Klebsiella aerogenes in hospital patients.

We report an investigation into faecal carriage of Klebsiella aerogenes and the distribution of this organism in the environment of three wards. In all three wards faecal carriage rates were high (60-70%). The faecal carriage rate increased with antibiotic administration and with length of in-patient stay. K. aerogenes was widely distributed in the ward environment and was found on the hands of nursing staff. Clusters of isolations of K. aerogenes of the same serotype were demonstrated indicating either patient-to-patient transfer or a common source of infection. The results indicate that even under conditions in which there are no outbreaks of K. aerogenes infection, there is a large reservoir of this organism both in the bowel of patients and in the ward environment.

An investigation into the incidence and sources of klebsiella infections in hospital patients.

Coliforms isolated from infections over a period of 22 months were examined and 16% were shown to be klebsiellas. The biochemical reactions and serotypes of these klebsiellas were determined and the relationship between species, serotype and type of infection investigated. Although no obvious outbreaks of infection occurred during this period a number of clusters of isolations of the same serotype of klebsiella were found. Using an enrichment method for the isolation of klebsiellas from faeces, sero and bacteriocin typing, and the examination of ten colonies, it was demonstrated that half of the patients carried a klebsiella of the same type in the bowel as caused the infection.

Acquisition of Klebsiella aerogenes by neonates.

The acquisition of Klebsiella aerogenes by neonates born in hospital has been studied by sero- and klebecin typing. This organism was more commonly carried in the bowel of breast-fed babies than of bottle-fed babies. Only very rarely did babies acquire strains of K. aerogenes from their mothers. K. aerogenes was widely distributed in the ward environment and on the hands of nurses and mothers. Some strains were able to spread on the ward. These results are relevant to the control of K. aerogenes infection in maternity units.