The relative importance of social anxiety facets on disordered eating in pediatric obesity.

PURPOSE: Children with obesity demonstrate increased risk for eating disorders and internalizing psychopathology. Research in adults indicates unique facets of social anxiety differentially relate to eating pathology. These associations remain understudied in pediatric samples. The current study evaluated associations between social anxiety and disordered eating, and tested the relative importance of distinct social anxiety constructs-fear of negative evaluation, social anxiety in general situations, and social anxiety in new situations-for disordered eating in weight-loss treatment-seeking youth with obesity. METHODS: One-hundred and thirty-five youth (Mage 12.6 years; Range 8-17 years; MBMIz = 2.6) from a multidisciplinary outpatient pediatric obesity clinic completed questionnaires assessing dimensions of social anxiety and the Children's Eating Attitudes Test (ChEAT). Dominance analyses were used to evaluate the relative importance of social anxiety facets associated with ChEAT subscales. RESULTS: Social anxiety subscales did not correlate with Dieting scores. Dominance analyses indicated Fear of Negative Evaluation (FNE) evinced complete dominance, thus, emerging as the most important predictor relative to other social anxiety components for Body/Weight Concern and Food Preoccupation. General dominance weights for FNE accounted for more than twice the shared and unique variance, relative to other independent variables within the Body/Weight Concern and Food Preoccupation models, respectively. CONCLUSIONS: Unique facets of social anxiety differentially relate to disordered eating in youth with obesity. Findings suggest nuanced assessment of anxiety constructs, such as FNE, in pediatric obesity treatment settings may aid in identifying youth at risk for disordered eating attitudes and behaviors. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

A Single Integrated Behavioral Health Appointment Improves Patients' Perceptions of Behavioral Health Treatment.

OBJECTIVE: To determine if a single behavioral health appointment in primary care would result in improvements in participants' perceptions of mental health treatment. METHODS: Survey data from 32 patients seen in a Veterans Affairs medical center primary care clinic were collected (May 2017 to December 2017) before and after a brief appointment with a behavioral health provider. The primary outcome measure was change in pre- to post-session response to 6 items measuring perceptions of treatment taken from the Perceptions About Services Scale-Revised. RESULTS: The single behavioral health appointment resulted in improved perceptions of behavioral health treatment. Pre- to post-session ratings on 5 of 6 measured variables improved, including the perception that patients would have fewer bothersome symptoms as a result of attending a behavioral health appointment, feeling treatment would be valuable and beneficial, feeling they would have time to spend in treatment, and feeling that behavioral health specialists are understanding (Ps < .05). Patients were highly satisfied with the single integrated behavioral health session. Further, more than two-thirds of patients for whom further treatment was recommended attended a second behavioral health appointment. CONCLUSIONS: This study adds to the growing body of literature on the benefits associated with integrated behavioral health and investigates the potential mechanisms associated with the success of the single appointment.

Facial emotion recognition in children with high functioning autism and children with social phobia.

Recognizing facial affect is essential for effective social functioning. This study examines emotion recognition abilities in children aged 7-13 years with High Functioning Autism (HFA = 19), Social Phobia (SP = 17), or typical development (TD = 21). Findings indicate that all children identified certain emotions more quickly (e.g., happy < anger, disgust, sad < fear) and more accurately (happy) than other emotions (disgust). No evidence was found for negative interpretation biases in children with HFA or SP (i.e., all groups showed similar ability to discriminate neutral from non-neutral facial expressions). However, distinct between-group differences emerged when considering facial expression intensity. Specifically, children with HFA detected mild affective expressions less accurately than TD peers. Behavioral ratings of social effectiveness or social anxiety were uncorrelated with facial affect recognition abilities across children. Findings have implications for social skills treatment programs targeting youth with skill deficits.

Quality of life impairments among adults with social phobia: the impact of subtype.

Social phobia is characterized by extreme fear in social or performance situations in which the individual may be exposed to embarrassment or scrutiny by others, which creates occupational, social and academic impairment. To date, there are few data examining the relationship of social phobia impairments to quality of life. In this investigation, we examined how demographic characteristics, comorbidity, and social competence are related to quality of life among patients with social phobia and normal controls. In addition, we examined the impact of social phobia subtype. Results indicated that individuals with generalized social phobia had significantly impaired quality of life when compared to individuals with no disorder or individuals with nongeneralized social phobia. Comorbid disorders decreased quality of life only for patients with nongeneralized social phobia. Hierarchical linear regression revealed that a diagnosis of social phobia and observer ratings of social effectiveness exerted strong and independent effects on quality of life scores. Results are discussed in terms of the role of social anxiety, social competence, and comorbidity on the quality of life for adults with social phobia.

Children with generalized anxiety disorder do not have peer problems, just fewer friends.

A common assumption is that all youth with anxiety disorders (AD) experience impaired peer relationships relative to healthy control children. Social impairments have been identified among youth with certain AD (e.g., social anxiety disorder; SAD), but less is known about the peer relationships of children with generalized anxiety disorder (GAD). We therefore compared the interpersonal functioning of youth with GAD, SAD, and controls (6-13 years). Despite having relatively fewer friends overall, children with GAD did not differ from controls in terms of the likelihood of having a best friend, participation in groups/clubs, and parent ratings of social competence. In comparison, youth with SAD were less socially competent, had fewer friends and difficulty making new friends compared to controls. Findings suggest that peer difficulties are not a universal feature of all childhood AD and highlight a need to better understand the social experiences and functioning of children with GAD.

Multicomponent behavioral treatment for chronic combat-related posttraumatic stress disorder: a randomized controlled trial.

This study examined the efficacy of a multicomponent cognitive-behavioral therapy, Trauma Management Therapy, which combines exposure therapy and social emotional rehabilitation, to exposure therapy only in a group of male combat veterans with chronic posttraumatic stress disorder (PTSD). Thirty-five male Vietnam veterans with PTSD were randomly assigned to receive either Trauma Management Therapy (TMT) or Exposure Therapy Only (EXP). Participants were assessed at pre-treatment, mid-treatment, and post-treatment. Primary clinical outcomes were reduction of PTSD symptoms and improved social emotional functioning. Results indicated that veterans in both conditions showed statistically significant and clinically meaningful reductions in PTSD symptoms from pre- to post-treatment, though consistent with a priori hypotheses there were no group differences on PTSD variables. However, compared to the EXP group, participants in the TMT group showed increased frequency in social activities and greater time spent in social activities. These changes occurred from mid-treatment (after completion of exposure therapy) to post-treatment (after completion of the social emotional rehabilitation component); supporting the hypothesis that TMT alone would result in improved social functioning. Although the TMT group also had a significant decrease in episodes of physical rage, that change occurred prior to introduction of the social emotional component of TMT. This study demonstrates efficacy of exposure therapy for treating the core symptoms of PTSD among combat veterans with a severe and chronic form of this disorder. Moreover, multi-component CBT shows promise for improving social functioning beyond that provided by exposure therapy alone, particularly by increasing social engagement/interpersonal functioning in a cohort of veterans with severe and chronic PTSD.

Social skills and social phobia: an investigation of DSM-IV subtypes.

Social phobia is characterized as pervasive social timidity in social settings. Although much is known about this disorder, aspects of its clinical presentation remain unexplored, in particular characteristics that distinguish the generalized and non-generalized subtypes. For example, it remains unclear whether patients with the non-generalized subtype display social skills deficits in social interactions, and if so, are these deficits clinically, as well as statistically, significant? In this study, adults with either the non-generalized (NGSP; n=60) or generalized (GSP; n=119) subtype of social phobia and adults with no psychological disorder (n=200) completed an extensive behavioral assessment of social skill and social anxiety. As expected, adults with NGSP and GSP reported equal distress and displayed similar rates of avoidance during an Impromptu Speech Task when compared to adults with no disorder. In contrast, the three groups were distinctly different when interacting with another person in various social situations. Adults with NGSP displayed social skill deficits when compared to individuals with no disorder, but they had fewer deficits than the GSP subtype. However, the identified skill deficits were clinically as well as statistically significant only for the GSP subtype. The results are discussed in terms of the contribution of skill deficits to the conceptualization and treatment of social phobia.

Reflux profile of Chinese gastroesophageal reflux disease patients with combined multichannel intraluminal impedance-pH monitoring.

BACKGROUND AND AIMS: To investigate the reflux profile of Chinese gastroesophageal reflux disease (GERD) patients with the aid of combined multichannel intraluminal impedance-pH (MII-pH) monitoring technique. METHODS: Consecutive patients presented with GERD symptoms were enrolled to erosive esophagitis (EE) group, non-erosive reflux disease (NERD) group and functional heartburn (FH) group after upper endoscopy, combined MII-pH monitoring and rabeprazole test. Another 20 healthy controls (HC) were recruited. RESULTS: Sixty-four GERD patients (EE:20, NERD:22, FH:22, HC:20) were enrolled. There were more episodes of liquid reflux and proximal reflux in EE and NERD groups than that in FH and HC groups (P < 0.05). Patients in FH and HC groups had higher proportion of mixed reflux (P = 0.000). The percentage of acid reflux in EE and NERD was much higher, while there was a higher percentage of weakly acidic reflux in FH and HC (P = 0.000). No significant difference was found in MII-pH parameters between groups with and without response to rabeprazole test except recumbent percentage time of esophageal pH value below 4 and episodes of proximal reflux. CONCLUSION: Erosive esophagitis and NERD patients had more liquid and proximal reflux episodes than FH patients and healthy controls. Acid and liquid reflux was predominant in the former two groups, while weakly acidic and mixed reflux was predominant in the latter two groups.

Normal values of 24-hour combined esophageal multichannel intraluminal impedance and pH monitoring in the Chinese population.

BACKGROUND: There is a lack of data on combined esophageal multichannel intraluminal impedance and pH (MII-pH) monitoring in the Chinese population. GOALS: To define the normal range and compare the parameters to those of the Western population. STUDY: Healthy volunteers were recruited and underwent 24-hour ambulatory combined MII-pH monitoring. Gastroesophageal reflux episodes were detected and characterized by pH (acidic, weakly acidic and weakly alkaline reflux) and composition (liquid, mixed and gas reflux). RESULTS: Seventy healthy volunteers (male:female 33:37) were recruited. The median and 95th percentile number of the total reflux episodes over 24 h in the Chinese population was 40 and 75, respectively, whereas the corresponding numbers of acidic, weakly acidic and weakly alkaline reflux episodes were 22 and 54, 16 and 40, and 0 and 4, respectively. Among all reflux episodes 53.3% were acidic, 44.7% were weakly acidic, and 2% weakly alkaline. More than half (52.4%) of the reflux episodes were mixed, 37.2% were liquid, and 10.4% were gas. A total of 26.6% of reflux episodes reached 15 cm above the lower esophageal sphincter. Male gender was associated with an increased number of acid, liquid, mixed and proximal reflux episodes (p < 0.05). CONCLUSIONS: This study provides normal values for the Chinese population. Differences between genders in impedance parameters required caution during data interpretation. The number of reflux episodes in the Chinese population was similar to that in the Western population.

Increasing dietary fiber intake in terms of kiwifruit improves constipation in Chinese patients.

AIM: To investigate if increased dietary fiber, in terms of kiwifruit, is effective in Chinese constipated patients. METHODS: 33 constipated patients and 20 healthy volunteers were recruited for a 4-wk treatment of kiwi fruit twice daily. Response during wk 1-4 was defined as an increase in complete spontaneous bowl, motion (CSBM) > or = 1/wk. Secondary efficacy included response during wk 1-4, individual symptoms and scores of bowel habits and constipation. Responses were compared with the baseline run-in period. Colonic transit time and anorectal manometry were performed before and after treatment. RESULTS: Responder rate was 54.5% in the constipated group. The mean CSBM increased after treatment (2.2 +/- 2.6 vs 4.4 +/- 4.6, P = 0.013). There was also improvement in the scores for bothersomeness of constipation (P = 0.02), and satisfaction of bowel habit (P = 0.001), and decreased in days of laxative used (P = 0.003). There was also improvement in transit time (P = 0.003) and rectal sensation (P < 0.05). However, there was no change in the bowel symptoms or anorectal physiology in the healthy subjects. CONCLUSION: Increasing dietary fiber intake is effective in relieving chronic constipation in Chinese population.

Symptom resolution does not predict healing of erosive oesophagitis in Chinese.

BACKGROUND: Previous studies suggested that Chinese have a milder spectrum of gastro-oesophageal reflux disease and a lower dose of proton pump inhibitors (PPI) is sufficient for the control of symptoms as compared with the Western population. AIMS: To determine if 8 weeks of esomeprazole 20 mg daily would be adequate for both symptom resolution and oesophagitis healing in Chinese patients and the predictive factors for the response. METHODS: 66 patients with oesophagitis were included. Oesophagitis severity was graded by Los Angeles (LA) classification. 61 patients underwent 24-hour ambulatory pH study at baseline. All were given esomeprazole 20 mg daily for 8 weeks. Symptom response and healing of oesophagitis was assessed at the end of the treatment period. RESULTS: 75.8% of the patients had complete reflux symptom resolution but only 48% had complete healing of the oesophagitis at endoscopy after 8 weeks of treatment. LA classification grading at baseline endoscopy (p < 0.0001) and total number acid reflux episodes on 24-hour pH monitoring prior to treatment (p = 0.007) were both good predictors of oesophagitis healing but not for symptom resolution. CONCLUSIONS: Our results suggested that 8 weeks of lower dose PPI is not sufficient for oesophagitis healing. Symptom resolution with PPI does not predict oesophagitis healing in Chinese.

Influence of positive family history on clinical characteristics of functional constipation.

BACKGROUND & AIMS: We observed that there is familial aggregation in patients with functional constipation. Their clinical characteristics have not been studied. The aim of this study was to investigate the clinical characteristics of patients with functional constipation with and without a positive family history. METHODS: Patients with functional constipation satisfying Rome II criteria were recruited. A Rome II questionnaire on constipation was given to the patients' families to identify whether there were any family members with idiopathic constipation. The clinical characteristics between those with and without positive family history were evaluated. RESULTS: There were 118 patients with at least one first-degree relative with idiopathic constipation and 114 patients without a positive family history. The patients in the 2 groups were comparable in mean age (P = .3) and sex distribution (P = .09). Patients with positive family history had a younger age of onset (median, 11-20 years vs 21-30 years, P < .0001); longer duration of constipation (20 +/- 14 vs 15 +/- 13, P = .016); more complications, eg, symptomatic hemorrhoids, anal fissure, and rectal prolapse (54.2% vs 40.4%, P = .034); less precipitating factors leading to the onset of constipation (35.6% vs 49.1%, P = .037); more frequent use of digital evacuation (27.1% vs 13.2%, P = .008), but no difference in the association with psychological disorders (P = .3); transit time (P = .5); or manometric dyssynergia (P = .5). CONCLUSIONS: Patients with idiopathic constipation and with a positive family history exhibited different clinical characteristics. This might be related to the early age of onset of the symptoms, which might, in turn, give clues to the underlying etiology.

Differing coping mechanisms, stress level and anorectal physiology in patients with functional constipation.

AIM: To investigate coping mechanisms, constipation symptoms and anorectal physiology in 80 constipated subjects and 18 controls. METHODS: Constipation was diagnosed by Rome II criteria. Coping ability and anxiety/depression were assessed by validated questionnaires. Transit time and balloon distension test were performed. RESULTS: 34.5% patients were classified as slow transit type of constipation. The total colonic transit time (56 h vs 10 h, P<0.0001) and rectal sensation including urge sensation (79 mL vs 63 mL, P = 0.019) and maximum tolerable volume (110 mL vs 95 mL, P = 0.03) differed in patients and controls. Constipated subjects had significantly higher anxiety and depression scores and lower SF-36 scores in all categories. They also demonstrated higher scores of 'monitoring' coping strategy (14+/-6 vs 9+/-3, P = 0.001), which correlated with the rectal distension sensation (P = 0.005), urge sensation (P=0.002), and maximum tolerable volume (P = 0.035). The less use of blunting strategy predicted slow transit constipation in both univariate (P = 0.01) and multivariate analysis (P = 0.03). CONCLUSION: Defective or ineffective use of coping strategies may be an important etiology in functional constipation and subsequently reflected in abnormal anorectal physiology.

Pathophysiology of gastroesophageal reflux diseases in Chinese--role of transient lower esophageal sphincter relaxation and esophageal motor dysfunction.

BACKGROUND AND AIMS: Transient lower esophageal sphincter relaxation (TLESR) is the major mechanism for gastroesophageal reflux in the Western population. The major reflux mechanism in Chinese patients with GERD has not been studied before. METHODS: Fifty-four patients with GERD and 28 controls underwent stationary baseline manometry and the 24-h ambulatory esophageal pH monitoring. TLESRs were measured before and after an 850 kcal meal in the supine position. Primary peristalsis, secondary peristalsis, and esophageal acid clearance were measured by esophageal manometry. RESULTS: Total time esophageal pH

Fondaparinux: a synthetic selective factor-Xa inhibitor.

Fondaparinux is the first synthetic selective factor-Xa inhibitor. It is indicated for prophylaxis of deep vein thrombosis in patients undergoing hip fracture, hip replacement, and knee replacement surgeries. In these patients, fondaparinux appears to be more efficacious than enoxaparin. It is a safe and effective, but expensive, alternative to the available antithrombotic agents. Its long half-life allows for once-daily dosing, yet a truly viable antidote is not available in the event of overanticoagulation. Trials are currently underway to determine its efficacy and safety for the treatment of deep vein thrombosis, unstable angina, and acute myocardial infarction, as well as its role in coronary angioplasty.

Tinzaparin.

Low-molecular-weight heparins (LMWH) are efficacious agents that offer clinical and pharmacoeconomic advantages over unfractionated heparin (UFH) for the treatment of ACS and venous thromboembolism. Tinzaparin is a LMWH approved for the treatment of deep venous thrombosis with and without pulmonary embolism, when used in conjunction with warfarin. In studies with hospitalized patients who had deep venous thrombosis or pulmonary embolism, tinzaparin was at least as efficacious as UFH, with fewer adverse bleeding events. It is also efficacious for thromboembolic prophylaxis in patients undergoing general and orthopedic surgery. Studies have shown that tinzaparin is at least as effective as UFH for patients undergoing surgery and in other patients at risk for developing thromboembolism. It is currently not recommended for use in patients with ischemic strokes. There are minimal data available regarding its use in the management of patients with unstable angina (UA) and non-ST-segment elevation myocardial infarction.