Mary S. Dietrich

Obese adults have visual attention bias for food cue images: evidence for altered reward system function

Background:The major aim of this study was to investigate whether the motivational salience of food cues (as reflected by their attention-grabbing properties) differs between obese and normal-weight subjects in a manner consistent with altered reward system function in obesity.Methodology/Principal Findings:A total of 18 obese and 18 normal-weight, otherwise healthy, adult women between the ages of 18 and 35 participated in an eye-tracking paradigm in combination with a visual probe task. Eye movements and reaction time to food and non-food images were recorded during both fasted and fed conditions in a counterbalanced design. Eating behavior and hunger level were assessed by self-report measures. Obese individuals had higher scores than normal-weight individuals on self-report measures of responsiveness to external food cues and vulnerability to disruptions in control of eating behavior. Both obese and normal-weight individuals demonstrated increased gaze duration for food compared to non-food images in the fasted condition. In the fed condition, however, despite reduced hunger in both groups, obese individuals maintained the increased attention to food images, whereas normal-weight individuals had similar gaze duration for food and non-food images. Additionally, obese individuals had preferential orienting toward food images at the onset of each image. Obese and normal-weight individuals did not differ in reaction time measures in the fasted or fed condition.Conclusions/Significance:Food cue incentive salience is elevated equally in normal-weight and obese individuals during fasting. Obese individuals retain incentive salience for food cues despite feeding and decreased self-report of hunger. Sensitization to food cues in the environment and their dysregulation in obese individuals may play a role in the development and/or maintenance of obesity.

An Internet-Based Program to Improve Self-Management in Adolescents With Type 1 Diabetes

OBJECTIVE To report results from YourWay, an Internet-based self-management intervention for adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 72 adolescents with type 1 diabetes, ages 13–17 years, were randomized to a usual-care-plus-Internet support or a usual-care group. The intervention was designed to enhance problem-solving barriers to self-management. A1C was obtained from medical records, and problem-solving and self-management were obtained via adolescent report. RESULTS Group differences were not statistically significant using intent-to-treat analyses. Using as-treated analyses, adolescents in the treatment condition showed statistically significant improvement in self-management (d = 0.64; P = 0.02) and important improvements in problem-solving (d = 0.30; P = 0.23) and A1C (d = −0.28; P = 0.27). Mean A1C for the intervention group remained constant (−0.01%), while the control group increased (0.33%). CONCLUSIONS This brief trial suggests that self-management support delivered through a secure website may improve self-management and offset typical decreases in adolescent glycemic control.

CHANGES IN BODY MASS, ENERGY BALANCE, PHYSICAL FUNCTION, AND INFLAMMATORY STATE IN PATIENTS WITH LOCALLY ADVANCED HEAD AND NECK CANCER TREATED WITH CONCURRENT CHEMORADIATION AFTER LOW-DOSE INDUCTION CHEMOTHERAPY

We aimed to determine changes in body mass and body composition in relation to energy balance, inflammatory state, and physical function before and after concurrent chemoradiation (CCR).

The ahmed shunt versus the baerveldt shunt for refractory glaucoma: A single-surgeon comparison of outcome

PURPOSE To compare the surgical outcome of Baerveldt and Ahmed shunt implants in the treatment of refractory glaucoma. DESIGN Retrospective, nonrandomized, comparative trial. METHODS AND PARTICIPANTS Medical records of 118 consecutive patients who underwent glaucoma shunt implantation (70 Baerveldt, 48 Ahmed) by a single surgeon were reviewed. MAIN OUTCOME MEASURES The primary outcome measure was surgical success (6 mmHg <or= intraocular pressure [IOP] <or= 21 mmHg without additional glaucoma surgery or devastating complication) at 12 months after surgery. Secondary outcome measures included mean IOP and number of medications used at the following postoperative visits: day 1, 1 week, 1 month, 3 months, 6 months, and every 6 months thereafter. Additional outcome measures evaluated include visual acuities, prevalence and timing of postoperative choroidal detachment, and clinical bleb encapsulation. RESULTS Survival curve analysis showed success rates of 82.9% of the Ahmed group and 72.9% of the Baerveldt group at 12 months after surgery (P = 0.257). Patients in the Ahmed group exhibited lower IOPs at 1 day (P < 0.001) and 1 week (P < 0.001) after surgery and were taking fewer glaucoma medications at 1 week (P < 0.001) and 1 month (P < 0.001) after surgery. A higher proportion of Ahmed patients experienced clinical bleb encapsulation than did the Baerveldt patients (60.4% vs. 27.1%; P < 0.001). Moreover, the first observation of postoperative bleb encapsulation was sooner after surgery for the Ahmed patients (50.0 +/- 43.8 days) than for the Baerveldt patients (69.8 +/- 22.6 days; P = 0.001). CONCLUSIONS The Ahmed shunt implant exhibited better control of IOP in the early postoperative period (1 day and 1 week) with patients requiring fewer glaucoma medications at 1 week and 1 month after surgery. There was both a higher prevalence and earlier onset of bleb encapsulation observed with the Ahmed shunt implant.

Quality of life in hearing-impaired adults: The role of cochlear implants and hearing aids

OBJECTIVE: To compare the quality-of-life (QOL) benefit received from cochlear implants (CIs) and hearing aids (HAs) among hearing-impaired adults. STUDY DESIGN: Health-related questionnaire. METHODS: Twenty-seven CI users compared to control group of 54 HA users, both older than 49. Questionnaires for the pre-rehab state (without HA or CI use) and post-rehab state (after HA or CI for 12 months) were mailed 2 weeks apart. RESULTS: Twenty-six (96.3%) CI and 30 (55.6%) HA users responded (P < 0.001, chi-square). Compared to HA patients, CI users showed twice as much overall QOL improvement (P = 0.082, multiple linear regression) as HA users. Multivariate analysis of variance showed greater QOL benefit in CI than HA users across the physical, psychological, and social subdomains (P = 0.03). CONCLUSION: Cochlear implants provide at least comparable benefit for those with profound hearing loss as hearing aids bring for those with less severe hearing loss.

A Sense of Urgency: Evaluating the Link between Clinical Trial Development Time and the Accrual Performance of Cancer Therapy Evaluation Program (NCI-CTEP) Sponsored Studies

Purpose: Postactivation barriers to oncology clinical trial accruals are well documented; however, potential barriers prior to trial opening are not. We investigate one such barrier: trial development time. Experimental Design: National Cancer Institute Cancer Therapy Evaluation Program (CTEP)–sponsored trials for all therapeutic, nonpediatric phase I, I/II, II, and III studies activated between 2000 and 2004 were investigated for an 8-year period (n = 419). Successful trials were those achieving 100% of minimum accrual goal. Time to open a study was the calendar time from initial CTEP submission to trial activation. Multivariate logistic regression analysis was used to calculate unadjusted and adjusted odds ratios (OR), controlling for study phase and size of expected accruals. Results: Among the CTEP-approved oncology trials, 37.9% (n = 221) failed to attain the minimum accrual goals, with 70.8% (n = 14) of phase III trials resulting in poor accrual. A total of 16,474 patients (42.5% of accruals) accrued to those studies were unable to achieve the projected minimum accrual goal. Trials requiring less than 12 months of development were significantly more likely to achieve accrual goals (OR, 2.15; 95% confidence interval, 1.29-3.57, P = 0.003) than trials with the median development times of 12 to 18 months. Trials requiring a development time of greater than 24 months were significantly less likely to achieve accrual goals (OR, 0.40; 95% confidence interval, 0.20-0.78; P = 0.011) than trials with the median development time. Conclusions: A large percentage of oncology clinical trials do not achieve minimum projected accruals. Trial development time appears to be one important predictor of the likelihood of successfully achieving the minimum accrual goals. Clin Cancer Res; 16(22); 5557–63. ©2010 AACR.

Using Mobile Phones to Measure Adolescent Diabetes Adherence

OBJECTIVES 1) describe and determine the feasibility of using cell-phone-based ecological momentary assessment (EMA) to measure blood glucose monitoring and insulin administration in adolescent Type 1 diabetes, 2) relate EMA to traditional self-report and glycemic control, and 3) identify patterns of adherence by time of day and over time using EMA. METHOD Adolescents with Type 1 diabetes (n = 96) completed baseline measures of cell phone use and adherence. Glycemic control (measured by levels of HbA1c) was obtained from medical records. A subgroup of adolescents (n = 50) completed 10 days of EMA to assess blood glucose monitoring frequency, timing of glucose monitoring, insulin administration, and insulin dosing. One third of adolescents were not allowed to use their cell phones for diabetes at school. Parental restrictions on cell phone use at home were not prevalent. RESULTS The EMA response rate (59%) remained stable over the 10-day calling period. Morning time was associated with worse monitoring and insulin administration, accounting for 59-74% of missed self-care tasks. EMA-reported missed glucose checks and missed insulin doses were correlated to traditional self-report data, but not to HbA1c levels. Trajectory analyses identified two subgroups: one with consistently adequate adherence, and one with more variable, and worse, adherence. The latter adherence style showed worse glycemic control. CONCLUSION Mobile phones provide a feasible method to measure glucose monitoring and insulin administration in adolescents, given a limited assessment duration. The method provided novel insights regarding patterns of adherence and should be explored in clinical settings for targeting or tailoring interventions.

Aerobic exercise training reduces cannabis craving and use in non-treatment seeking cannabis-dependent adults.

Background Cannabis dependence is a significant public health problem. Because there are no approved medications for this condition, treatment must rely on behavioral approaches empirically complemented by such lifestyle change as exercise. Aims To examine the effects of moderate aerobic exercise on cannabis craving and use in cannabis dependent adults under normal living conditions. Design Participants attended 10 supervised 30-min treadmill exercise sessions standardized using heart rate (HR) monitoring (60–70% HR reserve) over 2 weeks. Exercise sessions were conducted by exercise physiologists under medical oversight. Participants Sedentary or minimally active non-treatment seeking cannabis-dependent adults (n = 12, age 25±3 years, 8 females) met criteria for primary cannabis dependence using the Substance Abuse module of the Structured Clinical Interview for DSM-IV (SCID). Measurements Self-reported drug use was assessed for 1-week before, during, and 2-weeks after the study. Participants viewed visual cannabis cues before and after exercise in conjunction with assessment of subjective cannabis craving using the Marijuana Craving Questionnaire (MCQ-SF). Findings Daily cannabis use within the run-in period was 5.9 joints per day (SD = 3.1, range 1.8–10.9). Average cannabis use levels within the exercise (2.8 joints, SD = 1.6, range 0.9–5.4) and follow-up (4.1 joints, SD = 2.5, range 1.1–9.5) periods were lower than during the run-in period (both P<.005). Average MCQ factor scores for the pre- and post-exercise craving assessments were reduced for compulsivity (P  = .006), emotionality (P  = .002), expectancy (P  = .002), and purposefulness (P  = .002). Conclusions The findings of this pilot study warrant larger, adequately powered controlled trials to test the efficacy of prescribed moderate aerobic exercise as a component of cannabis dependence treatment. The neurobiological mechanisms that account for these beneficial effects on cannabis use may lead to understanding of the physical and emotional underpinnings of cannabis dependence and recovery from this disorder. Trial Registration ClinicalTrials.gov NCT00838448]

Antecedents of child neglect in the first two years of life

To determine the prenatal antecedents of child neglect by low-income women, data from a prospective study of child maltreatment were reviewed. Mothers determined to be at high risk prenatally for maltreatment were more likely to be identified as neglectful within 24 months of the interview. Neglectful mothers were less likely to have completed high school, had more children younger than 6 years of age, and had more aberrant responses on parenting skills and support systems scales. Neglected children were lower in birth weight, were rated more difficult temperamentally, and had poorer mental and motor developmental scores.

Vanderbilt head and neck symptom survey version 2.0: Report of the development and initial testing of a subscale for assessment of oral health

The prevalence, severity, and functional implications of adverse oral health outcomes attributed to head and neck cancer therapy are largely undefined. We report development of an oral health outcome subscale for the Vanderbilt Head and Neck Symptom Survey (VHNSS).