Cynthia Radnitz

Posttraumatic stress disorder in veterans with spinal cord injury: Trauma‐related risk factors

Trauma-related risk factors for posttraumatic stress disorder (PTSD) were examined in a sample of 125 veterans with spinal cord injury. Category of injury was found to be the most consistent predictor of PTSD diagnosis and symptom severity with paraplegia predicting more PTSD symptoms than quadriplegia. The occurrence of a head injury at the time of the trauma was found to predict PTSD symptom severity measures, but not PTSD diagnosis. Trauma recency consistently predicted Impact of Event score (IES) and was found to be related to current PTSD severity and lifetime PTSD diagnosis in multiple but not simple regression models. Trauma severity was found to be significantly related to self-reported PTSD symptoms and lifetime PTSD diagnosis in simple but not in multiple regression analyses. Type of trauma, alcohol or other drug (AOD) use during the trauma and loss of consciousness (LOC) during the trauma were not consistently associated with PTSD symptom severity or diagnosis.

A comparison of posttraumatic stress disorder in veterans with and without spinal cord injury

The authors assessed effects of paraplegic and quadriplegic spinal cord injuries (SCIs) on posttraumatic stress disorder (PTSD) by comparing severity and prevalence of PTSD in these groups to a sample of controls who experienced traumatic injuries other than SCI. The authors found that veterans with quadriplegia reported significantly less severe current PTSD symptoms than controls who were not significantly different from veterans with paraplegia. These results suggest that sustaining a quadriplegic SCI decreases risk of current PTSD, whereas sustaining a paraplegic SCI is associated with greater risk of PTSD, although the risk is no greater than that incurred from experiencing the trauma itself.

Investigation of lifestyle choices of individuals following a vegan diet for health and ethical reasons.

The proportion of individuals choosing to follow a vegan diet has increased in recent years. The choice is made for different reasons, primarily concern for animals (ethics) and health, which may impact both specific food choices and other lifestyle behaviors linked to health outcomes. To determine the extent to which the reason for following a vegan diet was associated with health behaviors, we conducted an online survey recruiting an international sample of 246 individuals who reported adhering to a vegan diet. We hypothesized that compared to those following the diet for ethical reasons, those doing so for health reasons would consume foods with higher nutritional value and engage in other healthier lifestyle behaviors. Our hypotheses were partially supported in that those citing health reasons (n = 45) reported eating more fruit (U = 3503.00, p = 0.02) and fewer sweets (U = 3347.00, p <0.01) than did those citing ethical reasons (n = 201). Individuals endorsing ethical reasons reported being on the diet longer (U = 3137.00, p <0.01), and more frequent consumption of soy (U = 2936.00, p <0.01), foods rich in vitamin D (U = 3441.00, p = 0.01), high-polyphenol beverages (U = 3124.50, p <0.01), and vitamin supplements (vitamin D: χ(2)=4.65, p = 0.04; vitamin B12: χ(2)=4.46, p = 0.03) than did those endorsing health reasons. As these factors may affect outcome in studies investigating the impact of vegan diets on health, they should be taken into account when studying persons following a vegan diet.

The effect of prior trauma exposure on the development of PTSD following spinal cord injury.

Posttraumatic stress disorder (PTSD) occurs in only a subset of individuals who sustain traumatic spinal cord injuries (SCIs). Several previous studies have examined the effects of additive trauma on the development of PTSD and found that a history of prior trauma increases the risk for later development of PTSD. The present study examines additive trauma by investigating the effects of previous combat exposure on the development of PTSD following spinal cord injury. Significant differences in prevalence rates for current PTSD were found for the comparisons of war theater (both combat and noncombat) versus non-war theater veterans but not for the comparison between combat and noncombat war theater veterans. Moreover, for all the comparisons, no significant differences were found in lifetime PTSD diagnoses. This implies that veterans with SCI who served in a war zone have increased difficulty recovering from their PTSD following a spinal cord injury than do non-war theater veterans.

Substance Misuse in Individuals with Spinal Cord Injury

The literature addressing substance misuse in spinal cord injury (SCI) is reviewed with special attention paid to differences in substance misuse in the spinal cord injury and general populations. Studies examining epidemiology indicate that while substance misuse often is present when spinal cord injuries occur, the exact prevalence of it in the SCI population has yet to be determined. The literature also suggests that risk factors unique to SCI predispose substance misuse in this population in addition to risk factors commonly present in the general population. Articles examining issues relevant to substance misuse in SCI identify some concerns specific to this population. Although treatment outcome literature for substance misuse in SCI is scarce, it is clear that treatment facilities must be adapted to suit the needs of the spinal cord injured. However, it has yet to be determined how treatment content should differ.

Confirmatory factor analysis of the Children's Eating Behaviour Questionnaire in a low-income sample

Although pediatric obesity is prevalent in low-income and African American and Hispanic communities, validated measures of child eating habits are lacking for these communities. In this study, confirmatory factor analysis was used to validate the hypothesized 7-factor structure of the Childrens Eating Behaviour Questionnaire (CEBQ). The sample included 229 parent-child pairs, the majority low-income and Hispanic (57%) or African American (25%). The a priori structure of the CEBQ failed to replicate. Exploratory factor analysis revealed 3 factors: Disinhibition, Food interest, and Undereating, none predicting child BMI. Although limited by the observational, cross-sectional design, results indicate that the CEBQ needs additional study.

Protective Factors and Posttraumatic Stress Disorder in Veterans With Spinal Cord Injury

This study examined the effects of putative protective factors, including current family structure (marital status and children), level of education, and perceived social support, upon posttraumatic stress disorder (PTSD) symptomatology in veterans with spinal cord injury (SCI). Participants were 124 veterans with traumatic spinal cord injuries, recruited from SCI services at Veterans Affairs Medical Centers in the Bronx, NY, Castle Point, NY, and East Orange, NJ. We found that the most consistent predictor of PTSD symptomatology was perceived social support from friends. In both univariate and multivariate analyses, it predicted current level of PTSD symptoms. Level of education was also a significant predictor of current PTSD symptoms in multivariate analyses. In contrast to the significant findings, perceived social support from family, marital status, and having children did not significantly correlate with the PTSD variables.

Vegans report less stress and anxiety than omnivores

Abstract Objective Studies investigating mood in vegetarian diets have yielded conflicting results, either demonstrating risk for mental disorders or mood protection. Our objective was to investigate mood, as well as factors that potentially impact mood in vegans (VG), vegetarians (VEG), and omnivores (OMN). Methods We surveyed mood, diet, and lifestyle factors in a broad geographic online sample of adult VG (n = 283), VEG (n = 109), and OMN (n = 228) who were recruited via diet-related social networks. Mood was measured with the Depression Anxiety Stress Scale-21 (DASS-21). Results The sample was mostly female (78.5%), and age was inversely correlated with all DASS scores (p < 0.05). Mean DASS-A (anxiety) and DASS-S (stress) scores differed by group (F(2,616) = 4.73, p = 0.009, η2 = 0.015, and F(2, 615) = 8.23, p < 0.001, η2 = 0.026, respectively), with VG scores lower than OMN scores, indicating less mood disturbance. Analyses of covariance were conducted by gender, adjusting for age. Anxiety scores were different in males only (F(2,128) = 5.39, p = 0.006, ηp2 = 0.078) and lower anxiety in males was related to a vegan diet and daily fruit and vegetable intake. Mean stress scores were different in females only (F(2,476) = 3.82, p = 0.023, ηp2 = 0.016) and lower stress in females was related to a vegan diet and lower daily intake of sweets. Discussion A strict plant-based diet does not appear to negatively impact mood, in fact, reduction of animal food intake may have mood benefits. The improved mood domains were not consistent with those found in other studies, which may be due to methodological differences.

The role of family variables in fruit and vegetable consumption in pre-school children

Most Americans, including children, continue to eat fewer fruit and vegetables than is recommended, putting themselves at increased risk of various health conditions. The aim of this study was to evaluate the relative importance of several family environment variables (food availability and accessibility, modelling of food consumption, parenting style, and family mealtime environment) in predicting children’s consumption of fruit and vegetables in a sample of pre-school children from low income, predominantly ethnic minority families. Two hundred and twenty-nine primary caregivers and their pre-school children were recruited from Head Start programmes in New York and New Jersey. Caregivers gave their consent to the study, completed a series of paper and pencil questionnaires, and had both their height and weight and their children’s height and weight measured. Higher availability, accessibility, and parental modelling were associated with higher consumption of fruit and vegetables in children. Availability and Accessibility were the best predictors, but Parental Modelling significantly enhanced prediction over the other variables. Public health interventions should be geared toward helping poorer families increase the availability of fruit and vegetables in their homes, advising parents on how to make them accessible, and encouraging parents to model their consumption. Funding RLG receives research funding from Covidien.

Feeding Strategies Derived from Behavioral Economics and Psychology Can Increase Vegetable Intake in Children as Part of a Home-Based Intervention: Results of a Pilot Study

BACKGROUND Behavioral economics and psychology have been applied to altering food choice, but most studies have not measured food intake under free-living conditions. OBJECTIVES To test the effects of a strategy that pairs positive stimuli (ie, stickers and cartoon packaging) with vegetables and presents them as the default snack. DESIGN A randomized controlled trial was conducted with children who reported consumption of fewer than two servings of vegetables daily. Children (aged 3 to 5 years) in both control (n=12) and treatment (n=12) groups received a weeks supply of plainly packaged (ie, generic) vegetables, presented by parents as a free choice with an alternative snack (granola bar), during baseline (Week 1) and follow-up (Week 4). During Weeks 2 and 3, the control group continued to receive generic packages of vegetables presented as a free choice, but the treatment group received vegetables packaged in containers with favorite cartoon characters and stickers inside, presented by parents as the default choice. Children in the treatment group were allowed to opt out of the vegetables and request the granola bar after an imposed 5-minute wait. STATISTICAL ANALYSIS General Linear Model repeated measures analysis of variance was conducted to compare vegetable and granola bar intake between control and treatment groups across the 4-week study. Both within- and between-subjects models were tested. RESULTS A time×treatment interaction on vegetable intake was significant. The treatment group increased vegetable intake from baseline to Week 2 relative to control (P<0.01), but the effects were not sustained at Week 4 when the treatment was removed. Granola bar intake decreased in the treatment group at Week 2 (P≤0.001) and Week 3 (P≤0.005) relative to baseline. CONCLUSIONS Parents were able to administer feeding practices derived from behavioral economics and psychology in the home to increase childrens vegetable intake and decrease intake of a high-energy-density snack. Additional studies are needed to test the long-term sustainability of these practices.