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Eating behaviours in childhood are considered as risk factors for eating disorder behaviours and diagnoses in adolescence. However, few longitudinal studies have examined this association.
We investigated associations between childhood eating behaviours during the first ten years of life and eating disorder behaviours (binge eating, purging, fasting and excessive exercise) and diagnoses (anorexia nervosa, binge eating disorder, purging disorder and bulimia nervosa) at 16 years.
Data on 4760 participants from the Avon Longitudinal Study of Parents and Children were included. Longitudinal trajectories of parent-rated childhood eating behaviours (8 time points, 1.3–9 years) were derived by latent class growth analyses. Eating disorder diagnoses were derived from self-reported, parent-reported and objectively measured anthropometric data at age 16 years. We estimated associations between childhood eating behaviours and eating disorder behaviours and diagnoses, using multivariable logistic regression models.
Childhood overeating was associated with increased risk of adolescent binge eating (risk difference, 7%; 95% CI 2 to 12) and binge eating disorder (risk difference, 1%; 95% CI 0.2 to 3). Persistent undereating was associated with higher anorexia nervosa risk in adolescent girls only (risk difference, 6%; 95% CI, 0 to 12). Persistent fussy eating was associated with greater anorexia nervosa risk (risk difference, 2%; 95% CI 0 to 4).
Our results suggest continuities of eating behaviours into eating disorders from early life to adolescence. It remains to be determined whether childhood eating behaviours are an early manifestation of a specific phenotype or whether the mechanisms underlying this continuity are more complex. Findings have the potential to inform preventative strategies for eating disorders.
Declaration of interest
C.M.B. reports conflict of interest with Shire (grant recipient, Scientific Advisory Board member) and Pearson and Walker (author, royalty recipient). All other authors have indicated they have no conflicts of interest to disclose.
Suicide is a serious and not uncommon consequence of mood disorders that occurs primarily when individuals are depressed. Understanding the neurobiology of suicidal activity (thoughts or behaviors) is likely to facilitate prevention.
Seventy-nine adult depressed mood disorder patients (MDP), of which 25 had attempted suicide at least once, and 66 healthy controls (HC) participated in this study. Resting-state functional MRI was used to identify neural activity differences between suicide attempters (SA) and non-attempters (NA). Specifically, differences were examined in functional connectivity both within and between four large cognitive networks [Executive Control (ECN), Default Mode (DMN), Salience (SN), and Basal Ganglia (BGN)] and their respective associations with suicidal activity.
Compared to HCs, patients had greater posterior DMN activity, but less activity in the BGN, and less low-frequency spectral power in the dorso-medial DMN. Furthermore, increased posterior DMN activity in SA was associated with recent suicidal activity, whereas NA had reduced BGN activity and less dorso-medial DMN spectral power, the latter being associated with lifelong suicidal thinking. SA also had greater activity in midline circuitry compared to both HC and NA, and the pattern of BGN and DMN co-activity differed between SA and NA.
DMN engagement raises the possibility that suicidal activity in mood disorder patients may be a consequence of impaired self-referential thought processing. Furthermore, differential BGN and DMN co-activation according to suicide attempt status suggests that attempting suicide perhaps alters cognitive flexibility. These insights are potentially useful for understanding the neural basis of suicide activity.
Refugees report elevated rates of posttraumatic stress disorder (PTSD), but are relatively unlikely to seek help for their symptoms. Mental health stigma is a key barrier to help-seeking amongst refugees. We evaluated the efficacy of an online intervention in reducing self-stigma and increasing help-seeking in refugee men.
Participants were 103 refugee men with PTSD symptoms from Arabic, Farsi or Tamil-speaking backgrounds who were randomly assigned to either receive an 11-module online stigma reduction intervention specifically designed for refugees (‘Tell Your Story’, TYS) or to a wait-list control (WLC) group. Participants completed online assessments of self-stigma for PTSD and help-seeking, and help-seeking intentions and behaviors at baseline, post-intervention, and at a 1 month follow-up.
Intent-to-treat analyses indicated that, compared to the WLC, TYS resulted in significantly smaller increases in self-stigma for seeking help from post-treatment to follow-up (d = 0.42, p = 0.008). Further, participants in the TYS conditions showed greater help-seeking behavior from new sources at follow-up (B = 0.69, 95% CI 0.19–1.18, p = 0.007) than those in the WLC. The WLC showed significantly greater increases in help-seeking intentions from post-intervention to follow-up (d = 0.27, p = 0.027), relative to the TYS group.
This is the first investigation of a mental health stigma reduction program specifically designed for refugees. Findings suggest that evidence-based stigma reduction strategies are beneficial in targeting self-stigma related to help-seeking and increasing help-seeking amongst refugees. These results indicate that online interventions focusing on social contact may be a promising avenue for removing barriers to accessing help for mental health symptoms in traumatized refugees.
To examine score validity and reliability of a child version of the twenty-one-item Three-Factor Eating Questionnaire (CTFEQ-R21) in a sample of Canadian children and adolescents and its relationship with BMI Z-score and food/taste preferences.
Children (n 158), sixty-three boys (mean age 11·5 (sd 1·6) years) and ninety-five girls (11·9 (sd 1·9) years).
Exploratory factor analysis revealed that the CTFEQ-R21 was best represented by four factors with item 17 removed (CFFEQ-R20), representing Cognitive Restraint (CR), Cognitive Uncontrolled Eating (UE 1), External Uncontrolled Eating (UE 2) and Emotional Eating (EE), accounting for 41·2 % of the total common variance with good scale reliability. ANOVA revealed that younger children reported higher UE 1 and CR scores than older children, and boys who reported high UE 1 scores had significantly higher BMI Z-scores. Children with high UE 1 scores reported a greater preference for high-protein and -fat foods, and high-fat savoury (HFSA) and high-fat sweet (HFSW) foods. Higher preference for high-protein, -fat and -carbohydrate foods, and HFSA, HFSW and low-fat savoury foods was found in children with high UE 2 scores.
The study suggests that the CFFEQ-R20 can be used to measure eating behaviour traits and associations with BMI Z-score and food/taste preferences in Canadian children and adolescents. Future research is needed to examine the validity of the questionnaire in larger samples and other geographical locations, as well as the inclusion of extraneous variables such as parental eating or socio-economic status.
The mental health and social functioning of millions of forcibly displaced individuals worldwide represents a key public health priority for host governments. This is the first longitudinal study with a representative sample to examine the impact of interpersonal trust and psychological symptoms on community engagement in refugees.
Participants were 1894 resettled refugees, assessed within 6 months of receiving a permanent visa in Australia, and again 2–3 years later. Variables measured included post-traumatic stress disorder symptoms, depression/anxiety symptoms, interpersonal trust and engagement with refugees’ own and other communities.
A multilevel path analysis was conducted, with the final model evidencing good fit (Comparative Fit Index = 0.97, Tucker–Lewis Index = 0.89, Root Mean Square Error of Approximation = 0.05, Standardized Root-Mean-Square-Residual = 0.05). Findings revealed that high levels of depression symptoms were associated with lower subsequent engagement with refugees’ own communities. In contrast, low levels of interpersonal trust were associated with lower engagement with the host community over the same timeframe.
Findings point to differential pathways to social engagement in the medium-term post-resettlement. Results indicate that depression symptoms are linked to reduced engagement with one's own community, while interpersonal trust is implicated in engagement with the broader community in the host country. These findings have potentially important implications for policy and clinical practice, suggesting that clinical and support services should target psychological symptoms and interpersonal processes when fostering positive adaptation in resettled refugees.
Exposure to armed conflict and forced displacement constitute significant risks for mental health. Existing evidence-based psychological interventions have limitations for scaling-up in low-resource humanitarian settings. The WHO has developed a guided self-help intervention, Self Help Plus (SH+), which is brief, implemented by non-specialists, and designed to be delivered to people with and without specific mental disorders. This paper outlines the study protocol for an evaluation of the SH+ intervention in northern Uganda, with South Sudanese refugee women.
A two-arm, single-blind cluster-randomised controlled trial will be conducted in 14 villages in Rhino Camp refugee settlement, with at least 588 women experiencing psychological distress. Villages will be randomly assigned to receive either SH+ with enhanced usual care (EUC), or EUC alone. SH+ is a five-session guided self-help intervention delivered in workshops with audio-recorded materials and accompanying pictorial guide. The primary outcome is reduction in overall psychological distress over time, with 3 months post-treatment as the primary end-point. Secondary outcomes are self-defined psychosocial concerns, depression and post-traumatic stress disorder symptoms, hazardous alcohol use, feelings of anger, interethnic relations, psychological flexibility, functional impairment and subjective wellbeing. Psychological flexibility is a hypothesised mediator, and past trauma history and intervention attendance will be explored as potential moderators.
This trial will provide important information on the effectiveness of a scalable, guided self-help intervention for improving psychological health and wellbeing among people affected by adversity.
To develop and validate a child and adolescent version of the Three-Factor Eating Questionnaire (CTFEQr17) and to assess its psychometric properties and factor structure. We also examined associations between the CTFEQr17 and BMI and food preferences.
A two-phase approach was utilized, employing both qualitative and quantitative methodologies.
Primary and secondary schools, UK.
In phase 1, seventy-six children (thirty-nine boys; mean age 12·3 (sd 1·4) years) were interviewed to ascertain their understanding of the original TFEQr21 and to develop accessible and understandable items to create the CTFEQr17. In phase 2, 433 children (230 boys; mean age 12·0 (sd 1·7) years) completed the CTFEQr17 and a food preference questionnaire, a sub-sample (n 253; 131 boys) had their height and weight measured, and forty-five children (twenty-three boys) were interviewed to determine their understanding of the CTFEQr17.
The CTFEQr17 showed good internal consistency (Cronbach’s α=0·85) and the three-factor structure was retained: cognitive restraint (CR), uncontrolled eating (UE) and emotional eating (EE). Qualitative data demonstrated a high level of understanding of the questionnaire (95 %). High CR was found to be significantly associated with a higher body weight, BMI and BMI percentile. High UE and EE scores were related to a preference for high-fat savoury and high-fat sweet foods. The relationships between CTFEQr17, anthropometry and food preferences were stronger for girls than boys.
The CTFEQr17 is a psychometrically sound questionnaire for use in children and adolescents, and associated with anthropometric and food preference measures.
Projected changes to post-traumatic stress disorder (PTSD) diagnostic criteria in the upcoming International Classification of Diseases (ICD)-11 may affect the prevalence and severity of identified cases. This study examined differences in rates, severity, and overlap of diagnoses using ICD-10 and ICD-11 PTSD diagnostic criteria during consecutive assessments of recent survivors of traumatic events.
The study sample comprised 3863 survivors of traumatic events, evaluated in 11 longitudinal studies of PTSD. ICD-10 and ICD-11 diagnostic rules were applied to the Clinician-Administered PTSD Scale (CAPS) to derive ICD-10 and ICD-11 diagnoses at different time intervals between trauma occurrence and 15 months.
The ICD-11 criteria identified fewer cases than the ICD-10 across assessment intervals (range −47.09% to −57.14%). Over 97% of ICD-11 PTSD cases met concurrent ICD-10 PTSD criteria. PTSD symptom severity of individuals identified by the ICD-11 criteria (CAPS total scores) was 31.38–36.49% higher than those identified by ICD-10 criteria alone. The latter, however, had CAPS scores indicative of moderate PTSD. ICD-11 was associated with similar or higher rates of comorbid mood and anxiety disorders. Individuals identified by either ICD-10 or ICD-11 shortly after traumatic events had similar longitudinal course.
This study indicates that significantly fewer individuals would be diagnosed with PTSD using the proposed ICD-11 criteria. Though ICD-11 criteria identify more severe cases, those meeting ICD-10 but not ICD-11 criteria remain in the moderate range of PTSD symptoms. Use of ICD-11 criteria will have critical implications for case identification in clinical practice, national reporting, and research.
Victoria A Bryant, UCL Great Ormond Street Institute of Child Health London, London, UK,
Neil J Sebire, UCL Great Ormond Street Institute of Child Health London, London, UK Camelia Botnar Laboratories, Great Ormond Street Hospital for Children, London, UK
Global childhood mortality rates in the under-5s were 44 per 1,000 live births in 2013, ranging from 2.3 in Singapore to 152.5 in Guinea-Bissau (Western sub-Saharan Africa), with rates of 4.9 per 1,000 live births in the United Kingdom (UK) (1). In England and Wales there are >5,000 deaths annually in children aged 0-19 years (2) from an estimated population of 12.9 million in this age group (3). Around 3,000 of these deaths are in infants (less than 1 year) with the majority having known serious medical conditions; such deaths are hence “expected”. Most are due to perinatal and immaturityrelated conditions, which account for around 40% of cases, followed by congenital anomalies. Many of these deaths occur in the early (less than 7 days) or late neonatal (7 to 27 days) period (2). The next most commonly affected age group is adolescents, who account for around 1,000 deaths annually, with more than half being due to external, non-natural causes (2).
Unexpected death occurring in an apparently healthy infant is termed “sudden unexpected death in infancy (SUDI)” and refers to such a presentation in an infant 7-365 days of age. According to most definitions, unexpected deaths in infants under 7 days of age are excluded from the SUDI category, and instead have been termed “sudden unexpected early neonatal death (SUEND)”. All cases of SUDI and SUEND require investigation to determine the cause of death. In England and Wales such cases are referred to Her Majesty's Coroner (HMC), who will direct a post-mortem examination by a specialist pediatric pathologist. The primary rationale of the postmortem examination, including its components and ancillary investigations, is to diagnose or exclude those natural (and non-natural) causes of death which are identifiable and to allow a specific cause of death to be provided (the specific details of the autopsy procedure are detailed in Chapter 24). Whilst many cases will subsequently be found to have died from previously unrecognized medical conditions, such as congenital anomalies or acquired natural diseases, a significant number will remain unexplained despite a complete autopsy including ancillary investigations (microbiology, virology, radiology, and metabolic studies).
The proportion of seasonal anoestrous ewes that ovulate in response to the introduction of rams has long been thought to be influenced by pheromone production by the rams (Watson and Radford, 1960). More recently the role of the sexual behaviour of the rams as a source of ewe stimulation has been demonstrated (Perkins and Fitzgerald, 1994). The present study investigated the hypothesis that the exposure of rams to ewes in oestrus can enhance rams’ sexual behaviour and consequently improve the efficacy of the ram effect.
Sixteen groups of 16 anoestrous ewes, described as the experimental ewes, were randomly allocated to 4 treatments and 4 periods. Treatments were as follows; ewes introduced to 2 rams (R), ewes introduced to 2 rams and 4 oestrous ewes (RE), ewes introduced to 2 rams recendy exposed to 4 oestrous ewes (ER) and ewes introduced to 2 rams recently exposed to 4 oestrous ewes plus a further 4 oestrous ewes (ERE). Treatments were replicated 4 times (4 periods) with 2-week intervals starting on 4 July. Another group of 16 ewes remained isolated from rams during the course of the experiment (C).
The Taipan galaxy survey (hereafter simply ‘Taipan’) is a multi-object spectroscopic survey starting in 2017 that will cover 2π steradians over the southern sky (δ ≲ 10°, |b| ≳ 10°), and obtain optical spectra for about two million galaxies out to z < 0.4. Taipan will use the newly refurbished 1.2-m UK Schmidt Telescope at Siding Spring Observatory with the new TAIPAN instrument, which includes an innovative ‘Starbugs’ positioning system capable of rapidly and simultaneously deploying up to 150 spectroscopic fibres (and up to 300 with a proposed upgrade) over the 6° diameter focal plane, and a purpose-built spectrograph operating in the range from 370 to 870 nm with resolving power R ≳ 2000. The main scientific goals of Taipan are (i) to measure the distance scale of the Universe (primarily governed by the local expansion rate, H0) to 1% precision, and the growth rate of structure to 5%; (ii) to make the most extensive map yet constructed of the total mass distribution and motions in the local Universe, using peculiar velocities based on improved Fundamental Plane distances, which will enable sensitive tests of gravitational physics; and (iii) to deliver a legacy sample of low-redshift galaxies as a unique laboratory for studying galaxy evolution as a function of dark matter halo and stellar mass and environment. The final survey, which will be completed within 5 yrs, will consist of a complete magnitude-limited sample (i ⩽ 17) of about 1.2 × 106 galaxies supplemented by an extension to higher redshifts and fainter magnitudes (i ⩽ 18.1) of a luminous red galaxy sample of about 0.8 × 106 galaxies. Observations and data processing will be carried out remotely and in a fully automated way, using a purpose-built automated ‘virtual observer’ software and an automated data reduction pipeline. The Taipan survey is deliberately designed to maximise its legacy value by complementing and enhancing current and planned surveys of the southern sky at wavelengths from the optical to the radio; it will become the primary redshift and optical spectroscopic reference catalogue for the local extragalactic Universe in the southern sky for the coming decade.
Imaging bundles provide a convenient way to translate a spatially coherent image, yet conventional imaging bundles made from silica fibre optics typically remain expensive with large losses due to poor filling factors (~40%). We present the characterisation of a novel polymer imaging bundle made from poly(methyl methacrylate) (PMMA) that is considerably cheaper and a better alternative to silica imaging bundles over short distances (~1 m; from the middle to the edge of a telescope’s focal plane). The large increase in filling factor (92% for the polymer imaging bundle) outweighs the large increase in optical attenuation from using PMMA (1 dB/m) instead of silica (10−3 dB/m). We present and discuss current and possible future multi-object applications of the polymer imaging bundle in the context of astronomical instrumentation including: field acquisition, guiding, wavefront sensing, narrow-band imaging, aperture masking, and speckle imaging. The use of PMMA limits its use in low-light applications (e.g., imaging of galaxies); however, it is possible to fabricate polymer imaging bundles from a range of polymers that are better suited to the desired science.
We examine the effects of two distinct forgiveness motives, self-oriented and other-oriented, on relationship quality within supervisor–subordinate relationships. We provide empirical evidence that both forgiveness motives are positively associated with leader–member exchange and differentially associated with interpersonal citizenship behavior and suggest that previous forgiveness research may be incomplete. We demonstrate that high-quality leader–member relationships and interpersonal citizenship behavior can be enhanced by self-oriented forgiveness motive and other-oriented forgiveness motive. We further show that the association between forgiveness motive and leader–member exchange can be strengthened by one’s disposition, such that proactive personality strengthens the influence of self-oriented forgiveness motive on leader–member exchange and empathic concern strengthens the influence of other-oriented forgiveness motive on leader–member exchange. This manuscript aims to empirically examine two key pathways to forgiveness: one driven by self-orientation and the other driven by other-orientation.
This paper outlines a dating program designed to test the reproducibility of radiocarbon dates on different materials of Late-Glacial age (plant macrofossils, fossil beetle remains, and the “humic” and “humin” chemical fractions of limnic sediments) using a combination of radiometric (beta counting) and accelerator mass spectrometry (AMS) techniques. The results have implications for the design of sampling strategies and for the development of improved dating protocols, both of which are important if a high-precision 14C chronology for the Late-Glacial is to be achieved.
For more than 15 years, the radiocarbon community has participated in a series of laboratory intercomparisons in response to the issue of comparability of measurements as perceived within the wider user communities (Scott et al. 1990; Rozanski et al. 1992; Gulliksen and Scott 1995; Scott et al. 1997). In this report, we provide an update on the current 14C laboratory intercomparison and reflect on future issues linked to the laboratory intercomparison program, not least those resulting from a significant growth in the number of accelerator mass spectrometry (AMS) facilities providing routine dating of small samples (milligram size).