Transdiagnostic vs. disorder-focused perspective in children and adolescents with eating disorders: Findings from a large multisite exploratory study.

BACKGROUND: The transdiagnostic model of eating disorders (ED) proposes common cognitive mechanisms in patients with ED psychopathology. Little is known about their role in the maintenance of ED in children and adolescents. This study aimed to determine whether the relationships between key factors (low self-esteem, weight and shape control, clinical perfectionism, interpersonal problems, distress and mood instability) and core maintaining mechanisms (binge-eating and restraint) would support a transdiagnostic theory in young patients. METHODS: A total of 419 patients (mean age 14.7 ±â€¯2.14 years; age range: 7-18 years; males 13.8%) diagnosed with an ED were assessed in six Italian clinical centers in 2013. Multiple comparisons between ED diagnosis, correlation analysis and principal component analysis (PCA) were performed. RESULTS: Of the entire collective, 51.5% of patients were diagnosed with Anorexia Nervosa (AN), 12.3% were diagnosed with Bulimia Nervosa (BN) and 36.2% with Eating Disorder Not Otherwise Specified (EDNOS). In PCA, the core ED mechanisms, dietary restraint and binge eating, acted as poles of attraction of the other variables. The AN group was particularly linked to restraint and the BN group was particularly related to "Bulimia". Considering the diagnostic subtypes, there were no significant differences between the anorexic binge-purging group, bulimic purging group and bulimic non-purging group, which constituted a unique cluster related to affective, interpersonal problems and to perfectionism, indicating a very homogeneous subgroup. Restricting anorexic group (AN-R), related to shape concern and anxious-depressed mood, was not linked to the other subtypes. EDNOS appeared to be opposed to the AN-R group; the binge eating disorder group appeared to be independent from others. CONCLUSION: Our results suggest the presence of both specific and transdiagnostic mechanisms in ED subtypes, whose knowledge is of relevance for clinical practice.

Antibodies against hepatitis C virus in hemodialysis patients in the central Italian region of Umbria: evaluation of some risk factors.

The epidemiology of non-A, non-B hepatitis (NANBH) is still incomplete. To define the prevalence of antibodies against the main causative agent of NANBH, the hepatitis C virus (HCV) and the role of some risk factors, we tested sera from 269 patients on chronic dialysis at the hemodialysis units in our region in central Italy. We utilized the recently developed serological assay. Twenty-nine hemodialysis patients (13.3%) and 3 peritoneal dialysis patients (4.8%) were anti-HCV positive. Of these, 13 (40.6%) had antibodies to hepatitis B core antigen (anti-HBc) indicating prior hepatitis B infection. The anti-HCV seropositive patients had been on dialysis longer than the seronegative ones; they had received more transfusions than the others but without a significant difference. The prevalence rate of anti-HCV was statistically significantly higher among hemodialysis patients utilizing the same dialysis equipment for the previous 12 months.

Polycentric 384-month study of biofiltration (BF) with AN69s.

Polycentric 384-month study of biofiltration (BF) with AN69s. Since January 1984, 39 uremic dialyzed patients have been included in a randomized prospective study, to evaluate the clinical utility of BF. The trial lasted 9.85 months/pt (384.15 months of total observations) and patients admitted had some not well controlled clinical signs: major acidosis, intradialytic cardiovascular instability, intolerance to acetate dialysis, hypercatabolism, neuropathy, etc. We obtained some positive effects: the incidence of intradialytic hypotension decreased 26.6%; interdialytic body weight gain fell from 3.1 to 2.7 kg (p less than 0.05) and the dialytic time per week was reduced from 12.3 to 10.0 hours (p less than 0.01). At the same time dry body weight increased from 62.4 to 64.6 kg with worthwhile improvement of the acid-base status (ABS) in all patients. This controlled trial showed that BF is particularly useful for patients suffering from severe acidosis and/or cardiovascular instability.

Effects of chronic biofiltration with PAN membranes on acid-base status: polycentric study.

Effects of chronic biofiltration (BF) with PAN membranes on acid-base status (ABS): polycentric study. From the 39 cases in a polycentric study we selected 13 patients with metabolic acidosis (pH 7.23 +/- 0.03), marked reduction of plasma bicarbonate (15.4 +/- 2.2 mEq/l) and hyperkalemia (6.2 +/- 0.6 mEq/l). BF was performed with a continuous post-dilutional supply of HCO3 (85 mmol/h), and attained rapid normalisation of blood bicarbonates and serum potassium during the treatment. After 6 months of BF treatment the pre-dialytic ABS showed remarkable improvement, and values were normal after one year. The remaining 26 patients in the polycentric study, treated by chronic BF without severe acidosis, showed good dialytic tolerance. In 15 of them the supply of bicarbonate was too high (because of moderate post-BF alkalosis) and we had to reduce the buffer inflow to about 50 mmol/h.