Background: Alcohol consumption has been causally related to the incidence of coronary heart disease, but the role of alcohol before the event has not been explored in depth. This study tested the hypothesis that heavy drinking (binge drinking) increases the risk of subsequent acute myocardial infarctions (AMI), whereas light to moderate drinking occasions decrease the risk. Methods: Case-crossover design of 250 incident AMI cases in Switzerland, with main hypotheses tested by conditional logistic regression. Results: Alcohol consumption 12 h before the event significantly increased the risk of AMI (OR 3.1; 95% CI 1.4–6.9). Separately, the effects of moderate and binge drinking before the event on AMI were of similar size but did not reach significance. In addition, AMI patients showed more binge drinking than comparable control subjects from the Swiss general population. Conclusions: We found no evidence that alcohol consumption before the event had protective effects on AMI. Instead, alcohol consumption increased the risk. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

[pt] A atual pesquisa tem como objetivo estudar os aspectos psíquicos da compulsão alimentar em sujeitos submetidos à cirurgia bariátrica a partir de um referencial teórico psicanalítico, além de desenvolver uma reflexão sobre as influências exercidas pelo procedimento cirúrgico nos transtornos alimentares e comportamentos compulsivos. As intervenções bariátricas são importantes componentes no tratamento da obesidade, tendo como objetivo promover a redução do peso e melhora das comorbidades clínicas associadas a esta condição. Todavia, o procedimento bariátrico não é um tratamento para compulsão alimentar e as pesquisas sobre o tema apresentam resultados contraditórios, o que evidencia a necessidade de mais investigações sobre o tema. Propomos um estudo embasado psicanaliticamente para tentar refletir sobre possíveis arranjos que levariam a fixação na alimentação e no corpo, de aspectos psíquicos da compulsão alimentar inalcançáveis ao bisturi e à redução física do estômago. Para tanto, contemplamos os primórdios do desenvolvimento infantil, suas fases mais arcaicas, a relação precoce mãe-bebê e as vicissitudes da função alimentar inerente a função materna. Sempre valorizando o diálogo com as demais áreas de conhecimento envolvidas na etiologia e tratamento da obesidade e dos transtornos alimentares. Dessa forma, pretendemos construir uma abordagem que leve em conta a singularidade de cada sujeito escondida atrás do peso da obesidade e da ação compulsiva estereotipada. / [en] The current research aims to study the psychic aspects of binge eating in subjects submitted to bariatric surgery based on psychoanalytic theory, as well as to develop a reflection on the influences exerted by the surgical procedure on eating disorders and compulsive behaviors. t Bariatric interventions are important components in the treatment of obesity, aiming to promote weight reduction and improve the clinical comorbidities associated with this condition. However, the bariatric procedure is not a treatment for binge eating and the research on the subject presents contradictory results, which evidences the need for further investigations on the subject. We propose a study based psychoanalytically to try to reflect on possible arrangements that would lead to fixation in the diet and body, psychic aspects of binge eating unattainable to the scalpel and physical reduction of the stomach. To do so, we contemplate the early stages of infant development, its most archaic phases, the early mother-baby relationship and the vicissitudes of the alimentary function inherent to the maternal function, always valuing the dialogue with the other areas of knowledge involved in the etiology and treatment of obesity and eating disorders. In this way, we intend to build a approach that takes into account the singularity of each subject hidden behind the weight of obesity and compulsive stereotyped action. / [fr] Le but de cette recherche est d étudier les aspects psychologiques de la boulimie chez les sujets ayant subi une chirurgie bariatrique, sous le point de vue psychanalytique, ainsi que de développer une réflexion sur les influences exercées par l intervention chirurgicale dans les troubles de l alimentation et les comportements compulsifs. Les interventions bariatriques sont des éléments importants dans le traitement de l obésité, visant à promouvoir la réduction du poids et l amélioration des comorbidités cliniques associés à cette condition. Cependant, la chirurgie bariatrique est pas un traitement pour des crises de boulimie. Les recherches sur ce sujet présentent des résultats contradictoires, qui mettent en évidence la nécessité de poursuivre les recherches. Nous vous proposons une étude appuyé sur la théorie psychanalytiques pour essayer de réfléchir sur les arrangements possibles qui conduiraient à la fixation sur les aliments et dans le corps, les aspects psychologiques de la frénésie alimentaire qui ne peut pas se réduire à la réduction physique de l estomac. Par conséquent, nous contemplons les débuts du développement de l enfant, dans ses phases les plus archaiques, la relation précoce mère-nourrisson et les vicissitudes de la fonction alimentaire, inhérente a La fonction maternelle. Nous valorisons le dialogue avec d autres domaines de la connaissance impliqués dans l étiologie et le traitement de l obésité et des troubles alimentaires, afin de construire ainsi une approche large et globale qui tient compte du caractère unique de chaque sujet caché derrière le poids de l obésité et l action compulsive stéréotypée.

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The thesis deals with risk factors for eating disorders. The theoretical part describes the various disorders and thein symptoms and consequences. Further theoretical part analyzes of the emergence of these disorders and thein gradual historical development, which during its existence passed. Another part of the risk factors for eating disorders and possible wals of thein treatment. The practical part is focused on research of modeling as one of the risk factors for eating disorders. This section is based on information obtained through personál interview conducted with respondents from the field of modeling and acting outsider the scope. The resulting data are recorded by means of case studies, tables and graphs.

INTRODUÇÃO: A obesidade na infância e adolescência representa uma epidemia global e figura como um problema de saúde pública proeminente de prevalência crescente. A obesidade frequentemente está associada à compulsão alimentar periódica (CAP) e componentes genéticos participam de sua etiologia multifatorial. Polimorfismos de nucleotídeo único (SNPs) no gene da leptina (LEP) e do receptor da leptina (LEPR) podem modificar a expressão da leptina e de suas vias de sinalização e, consequentemente, alterar a regulação do apetite e da saciedade, contribuindo assim para a etiopatogenia e manutenção da CAP. O objetivo deste trabalho foi investigar a influência dos polimorfismos rs7799039 (G > A) no gene LEP e rs1137100 (A > G), rs1137101 (A > G) e rs8179183 (G > C) no gene LEPR sobre a CAP em crianças e adolescentes obesos, além de caracterizar a população quanto à CAP e verificar a associação dos SNPs com o risco cardiometabólico (RCM) e a obesidade. MÉTODOS: Estudo transversal que incluiu 465 crianças e adolescentes obesos com idade entre 7 e 19 anos avaliados quanto a variáveis antropométricas e metabólicas. Os fatores de RCM consistiram de hipertensão arterial sistêmica, glicemia de jejum alterada, HDL-colesterol baixo e hipertrigliceridemia. A CAP foi avaliada por meio da Escala de Compulsão Alimentar Periódica (ECAP). Para investigar o efeito dos SNPs no risco para a obesidade foi incluído um grupo controle composto por 135 crianças e adolescentes eutróficos. A genotipagem foi realizada por PCR em tempo real e para análise dos SNPs, adotou-se o modelo dominante. Foi calculado o desequilíbrio de ligação entre os SNPs e estimada as frequências dos haplótipos. As comparações entre os grupos foram realizadas estratificadamente por gênero e estádio puberal. Para avaliar a magnitude do risco dos SNPs sobre a CAP e a obesidade foi realizada regressão logística ajustada para variáveis de confusão (idade, Z-IMC e estádio puberal). RESULTADOS: As crianças e adolescentes obesos (12,5 ± 2,9 anos; 52,7% meninas) classificados com CAP apresentaram maior adiposidade e a frequência da CAP foi mais elevada no gênero feminino (OR= 2,146; IC 95% 1,461-3,152; p < 0,001). A frequência do alelo A do rs7799039 foi mais elevada no grupo de obesos (OR= 1,530; IC 95% 1,022-2,292; p= 0,039) e o alelo associou-se ao maior nível de leptina e colesterol total em meninas e à maior glicemia em meninos (p < 0,05). No rs1137100 e o rs1137101, a presença do alelo G em meninas conferiu risco para a hipertrigliceridemia (OR= 1,926; IC 95% 1,010-3,673; p= 0,047 e OR= 2,039; IC 95% 1,057-3,931; p= 0,033, respectivamente). O alelo C do rs8179183 relacionou-se, em meninas, à relação cintura-estatura e glicemia mais elevadas e, em meninos, ao maior percentil de pressão arterial diastólica, glicemia, colesterol total e LDL-colesterol (p <0,05). CONCLUSÃO: Os polimorfismos não foram associados à compulsão alimentar periódica. A CAP foi relacionada ao pior grau de adiposidade e o maior risco foi observado no gênero feminino. O SNP rs7799039 no gene LEP conferiu risco para obesidade, enquanto o rs1137100, rs1137101 e rs8179183 no gene LEPR relacionaram-se ao pior perfil cardiometabólico em crianças e adolescentes obesos / INTRODUCTION: Obesity during childhood and adolescence represents a global epidemic and consists in a prominent public health issue of increasing prevalence. Obesity is frequently associated with binge eating (BE) and genetic factors participate of its multifactorial etiology. Single nucleotide polymorphisms (SNPs) in the leptin (LEP) and leptin receptor (LEPR) genes may modify the leptin expression and its signaling pathways and, consequently, alter appetite and satiety regulation, thus contributing to the etiopathogeny and maintenance of BE. The aim of this study was to investigate the influence of polymorphisms rs7799039 (G > A) in the LEP gene and rs1137100 (A > G), rs1137101 (A > G) and rs8179183 (G > C) in the LEPR gene on BE in obese children and adolescents, besides characterize the population regarding to BE and examine the association of SNPs with cardiometabolic risk (CMR) and obesity. METHODS: Cross-sectional study in which 465 obese children and adolescents aged from 7 to 19 years were enrolled and had anthropometric and metabolic variables assessed. The CMR factors consisted of systemic hypertension, impaired fasting glucose, low HDL-cholesterol levels and hypertriglyceridemia. The BE was evaluated through the Binge Eating Scale (BES). To investigate the effect of SNPs on obesity risk, a control group of 135 eutrophic children and adolescents was enrolled. Genotyping was performed by real-time PCR and for the SNPs analysis, the dominant model was adopted. The linkage disequilibrium between SNPs was calculated and the haplotype frequencies were estimated. Comparisons between groups were performed stratified by gender and pubertal stage. To assess the risk magnitude for the SNPs on BE and obesity, logistic regression adjusted for confounding variables (age, Z-BMI and pubertal stage) was performed. RESULTS: Obese children and adolescents (12.5 ± 2.9 years, 52.7% girls) classified with BE showed greater adiposity and BE frequency was higher among females (OR= 2.146; 95% CI 1.461-3.152; p < 0.001). The observed frequency of A allele of rs7799039 was a higher in the obese group (OR= 1.530; 95% CI 1.022-2.292; p= 0.039) and the allele was associated with higher leptin and total cholesterol levels in girls and higher glucose levels in boys (p < 0.05). For the rs1137100 and rs1137101, the presence of the G allele among girls, conferred risk for hypertriglyceridemia (OR= 1.926; 95% CI 1.010-3.673; p= 0.047 and OR= 2.039; 95% CI 1.057-3.931; p= 0.033, respectively). The C allele of rs8179183 was associated, among girls, with a higher waist-to-height ratio and glucose levels and, among boys, with greater diastolic blood pressure percentile, glucose, total cholesterol and LDL-cholesterol levels (p < 0.05). CONCLUSION: Polymorphisms were not associated with binge eating. BE was related with a more severe adiposity and an increased risk was observed among females. The SNP rs7799039 in the LEP gene contributed to the risk of obesity, whereas the rs1137100, rs1137101 and rs8179183 in LEPR gene were related to a worse cardiometabolic profile in obese children and adolescents

La consommation d’alcool (CA) à l’adolescence est souvent associée à des conséquences négatives. L’un de ses meilleurs prédicteurs est la CA des amis. Deux mécanismes peuvent l’expliquer, soit la socialisation et la sélection des pairs. Les études comparant les deux mécanismes ont des résultats incohérents, peut-être dus à des variations et des limites méthodologiques. D’autres études sont donc nécessaires et l’analyse de modérateurs possibles est encouragée. L’attachement des adolescents pourrait en être un, vu son association avec les relations interpersonnelles. Objectifs. À l’aide de modèles à décalage croisé, cette étude vise à analyser, à l’aide d’une cohorte de participants de 14 ans au premier temps de mesure, (1) les relations bidirectionnelles entre la CA et la CA excessive des participants et celles autorapportées des amis et (2) le rôle modérateur de l’attachement dans ces relations. Méthode. Les participants proviennent d’une étude longitudinale Québécoise, où 182 d’entre eux et jusqu’à cinq de leurs amis ont rapporté annuellement leur CA et leur CA excessive lorsque les participants avaient entre 14 et 16 ans. Les participants ont complété les échelles« Évitement des relations sociales » et « Préoccupation d’être aimé » du Questionnaire des styles d’attachement à 15 ans. Résultats et conclusion. Pour les deux types de consommation, les coefficients des relations entre la CA du participant à 14 ou 15 ans et celle de ses amis un an plus tard étaient plus grands que les coefficients des relations entre la CA des amis à 14 ou 15 ans et celle du participant un an plus tard. Cela supporte le mécanisme de sélection plutôt que celui de socialisation. Deux modérations utilisant l’échelle d’évitement avec le modèle de CA étaient significatives, indiquant que les coefficients correspondant à la sélection (de 14 à 15 ans) et à la socialisation (de 15 à 16 ans) étaient plus faibles pour les adolescents évitant. Cela suggère que les adolescents non évitant sont plus sensible à l’influence des pairs. / Alcohol use (AU) in adolescence is often linked with immediate or long-term negative consequences. Among the best-known predictors of adolescent AU is friend use. Two mechanisms can explain this association: socialization and peer selection. Studies comparing both mechanisms have had inconsistent results, perhaps because of methodological variations or limitations. Thus, further studies are needed and examination of possible moderator is advised. Adolescent attachment is an interesting potential moderator as it is closely linked with interpersonal relationships. Study aims. Thus, using cross-lagged models to account for bidirectional associations and independent assessments of adolescent and friend alcohol use, this study aims to examine in a cohort of 14-year-old children followed over two years (1) the relations between participant and friend self-reported alcohol use and binge drinking frequency and (2) the moderating role of attachment style in these relations. Method. Participants come from a Quebec longitudinal study where 182 adolescents and up to five of their friends reported annually on their AU and binge drinking (BD) frequency between 14 and 16 years. Participants completed the “Avoidance of social relations” and “Preoccupation with being loved” scales of the Attachment Style Questionnaire at 15. Results and conclusion. Results show that the cross-lagged path coefficients between participant AU at 14 or 15 and friend use a year later were stronger than the ones between friend use at 14 or 15 and participant use a year later for both the AU and BD models. As such, the selection mechanism prevails over the socialization one between 14 and 16. Two significant moderation using the avoidance scale in the AU models were found, showing that selection (14-15 years old) and socialization (15-16 years old) weights were weaker for avoidant adolescents, suggesting that adolescents with low avoidance are more susceptible to peer influence related to alcohol use.

Background/Aims: Adolescent alcohol binge-induced hospital admissions (BIHAs) are an increasing problem in Europe. We investigated whether psychosocial factors (e.g., drinking situations, drinking occasions and neighborhood unemployment) are associated with particularly risky patterns of alcohol or substance use. Method: We performed a systematic retrospective chart review of all the respective cases in 2003–2008 (n = 586; age range: 12–17 years) from both pediatric hospitals in the city of Dresden, Germany. Results: The vast majority of adolescent BIHAs were associated with drinking together with peers at weekend parties. Compared to this ‘typical’ drinking pattern, adolescents drinking ‘atypically’ (i.e., drinking either alone, to cope or despite the fact that the next day was a school/work day) more often had already used alcohol and illegal substances before and were more often diagnosed with substance use disorders and other mental disorders prior to BIHA. The unemployment rate in the patients’ neighborhood was positively related to the incidence proportion of adolescent BIHAs in the respective subdistricts (r s = 0.61). Conclusion: Adolescent atypical drinking may indicate an increased risk for the development of alcohol and substance use disorders. This information is quickly accessible and can alert clinicians to initiate psychosocial aftercare; their infrastructure should address the strong relation between BIHA probability and neighborhood unemployment rates.

Background: Eating disorders are psychiatric illnesses whose treatment is difficult and usually the classic procedures fail. Recently, the number of researches in neuromodulatory methods has increased. I present an overview of basic stimulation methods, their use in the treatment of anorexia nervosa (AN), bulimia nervosa and binge-eating and the results of our study focused on the treatment of AN by transcranial direct current stimulation (tDCS). Methods: It was a randomized, double-blind, sham-controlled trial. Forty-three inpatients with AN were divided to receive either active (n=22) or sham (n=21) tDCS over the left DLPFC (anode F3/cathode Fp2, 2mA for 30 minutes). All patients filled the Eating Disorder Examination Questionnaire (EDE-Q) and Zung depression scale (ZUNG), we measured them the thermal pain threshold, the objective dissatisfaction with their own body by Anamorfic program and evaluated BMI before the first and after the last tDCS. Follow-up was after 2 and 4 weeks. It was evaluated using ANOVA and OPLS model. Results: Compared to sham tDCS, active tDCS improved self-evaluation based on one's body shape (p < 0,05) and significantly decreased the need of excessive control over calorie intake (p < 0,05) in 4-week follow-up (questions 4 and 23 in EDE-Q). Question 21 in EDE-Q was more...

Department of Curriculum Studies and Education Management / MEDEM

Background: Alcohol consumption has been causally related to the incidence of coronary heart disease, but the role of alcohol before the event has not been explored in depth. This study tested the hypothesis that heavy drinking (binge drinking) increases the risk of subsequent acute myocardial infarctions (AMI), whereas light to moderate drinking occasions decrease the risk. Methods: Case-crossover design of 250 incident AMI cases in Switzerland, with main hypotheses tested by conditional logistic regression. Results: Alcohol consumption 12 h before the event significantly increased the risk of AMI (OR 3.1; 95% CI 1.4–6.9). Separately, the effects of moderate and binge drinking before the event on AMI were of similar size but did not reach significance. In addition, AMI patients showed more binge drinking than comparable control subjects from the Swiss general population. Conclusions: We found no evidence that alcohol consumption before the event had protective effects on AMI. Instead, alcohol consumption increased the risk. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.