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Objective: Assessment of the longer‐term outcome of anorexia nervosa (AN) in female adolescent inpatients (N = 132). Method: A follow‐up (mean 8.2 years) after treatment was conducted. A subsample of 39 patients with at least 10 years of follow‐up (mean 14 years) was defined. Results: Over the 8‐year follow‐up period, the body mass index (BMI) increased from 14.33 (1.65) to 19.04 kg/m2 (2.97; t[112] = 17.33, p < 0.001, d = 1.63), and BMI percentiles increased from 0.50 (1.14) to 24.96 (26.81; t[112] = 9.83, p < 0.001, d = 0.92). Remission was found in 32.5% (8‐year total sample) and 48.6% (14‐year subsample). In the 8‐year total sample, 15.1% still had AN or had relapsed (8.1% in the 14‐year subsample). A cross‐over from AN to binge‐eating disorder was rare. The main cross‐over occurred from AN to an eating disorder not otherwise specified (37.5% and 27.0%, respectively). The standardized mortality ratio was 21.7. Discussion: In the long run, eating disorder diagnoses decreased significantly. Although a considerable proportion of patients recovered from their eating disorder, the number of recovered patients remained limited, with long‐term negative consequences in a large proportion of patients. Standardized mortality was excessive, calling for ever‐better therapies. Additional studies are needed to show if improved therapies lead to a better long‐term outcome. [ABSTRACT FROM AUTHOR]

Background: Minimizing harm from antimicrobials requires use of the narrowest spectrum drug, at an effective dose for the minimum effective duration. Many prescribers are not currently following these guidelines. To address suboptimal antimicrobial use, the underlying reasons must be understood. Objectives: To identify factors influencing choices of antimicrobial drug, dose, and duration for companion animals. Subjects: Twenty‐two veterinarians treating companion animals in Australia. Diversity of participants was deliberately sought. Methods: Semistructured interviews were conducted online. Two case studies were discussed, and then a range of broader questions was posed. Transcripts were analyzed thematically, using an inductive approach. Results: Few participants chose guideline‐concordant management for the case studies. Prescribing choices were influenced by a complex array of factors associated with the clinical case, pet owner, drug, veterinarian, veterinary colleagues, and external factors. Key factors driving broad‐spectrum antimicrobial use included a sense of safety, habit, ease of administering the drug (especially in cats), pharmaceutical marketing, and the self‐perpetuating dispensary cycle. Many participants were concerned about antimicrobial resistance, but insufficiently informed about how to minimize this risk. Several participants believed that longer duration of treatment and ensuring patients finish a predetermined course would decrease the risk of antimicrobial resistance and improve clinical outcomes. Conclusions and Clinical Importance: Veterinarians are engaged with the concept of antimicrobial stewardship, but face numerous practical barriers and require more information. In particular, improved education is needed on enhancing patient safety by minimizing both spectrum of activity and duration of treatment, and dispelling myths about "finishing the course." [ABSTRACT FROM AUTHOR]

Objective: Patients with back pain (BP) and radiating leg pain have poorer clinical outcomes compared to patients with BP alone. We aimed to describe the 1‐year clinical course and to identify prognostic factors associated with non‐recovery in older BP patients with radiating leg pain. Design: Patients in the BACE cohort aged >55 years with a new episode of BP and radiating leg pain were included (n = 377). Data on clinical outcomes were collected until 1‐year follow‐up. Uni‐ and multivariable regression analyses were performed to investigate the association between potential prognostic factors and three non‐recovery outcomes at the 1‐year follow‐up. Results: More than half of the patients (65%) did not recover after 12 months. In multivariable analyses, poor self‐rated health (odds ratio [OR] 2.34, 95% CI: 1.20–4.56) and BP duration at baseline (OR 1.48, 1.12–1.96) were significantly associated with non‐recovery for BP as outcome; age (OR 1.04, 1.03–1.05), smoking (OR 1.14, 1.00–1.30), depressive symptomatology (OR 1.03, 1.02–1.04), kinesiophobia (OR 1.03, 1.02–1.04), poor self‐rated health (OR 2.09, 1.83–2.39), baseline disability (OR 1.16, 1.14–1.17), BP duration (OR 1.49, 1.41–1.57), leg pain (OR 1.52, 1.37–1.68), pain during rotation (OR 1.71, 1.53–1.90) and other musculoskeletal complaints (OR 1.34, 1.17–1.52) were associated with disability. No factors were associated with leg pain. Conclusions: Several prognostic factors were associated with non‐recovery in older patients with BP and radiating leg pain. Primary care clinicians should be aware of these factors in managing these patients. [ABSTRACT FROM AUTHOR]

In this special issue, international researchers investigate how atypical anorexia nervosa (atypical AN) differs from anorexia nervosa (AN) and other eating disorders with respect to demographics, psychological and physiological morbidity, as well as treatment course and outcome. Manuscripts in this special issue report that atypical AN is associated with substantial medical and psychological morbidity, and the majority of studies find few differences between atypical AN and AN. While much remains to be learned about the long‐term course and treatment response of individuals with atypical AN to psychological and pharmacological interventions, the evidence supports conceptualization of atypical AN as part of a spectrum‐based restrictive eating disorder. These findings together with the potentially stigmatizing use of the term "atypical" suggest it may be time to revise the existing definition of atypical AN. [ABSTRACT FROM AUTHOR]

Objective: We previously reported that participants with atypical anorexia nervosa (atypical AN) had higher historical and admission weights, greater eating disorder psychopathology, but similar rates of amenorrhea and weight suppression at baseline as compared to anorexia nervosa (AN); here, we compare 1‐year outcomes. Method: Weight, % median body mass index (%mBMI), Eating Disorder Examination Questionnaire (EDE‐Q) scores, resumption of menses, and rehospitalizations were examined at 3, 6, and 12 months post‐discharge. Analyses (N = 111) compared changes in %mBMI, weight suppression, and EDE‐Q scores over time between atypical AN and AN. Results: Among the participants (48 atypical AN, 63 AN), both groups gained weight but those with atypical AN had lower gains than those with AN in %mBMI (p =.02) and greater weight suppression (p =.002) over time. EDE‐Q scores improved over time, independent of weight suppression, with no significant difference between atypical AN and AN. Groups did not differ by rates of resumption of menses (80% atypical AN, 76.9% AN) or rehospitalization (29.2% atypical AN, 37.9% AN). Greater weight suppression predicted longer time to restore menses and more days of rehospitalization. Discussion: Individuals with atypical AN regained a smaller proportion of body mass and were more weight suppressed over time. Change in eating disorder cognitions, resumption of menses, and rehospitalization rates at 1‐year follow‐up did not differ between groups. There was no significant difference in weight suppression between groups for those who were psychologically improved at 12 months. Findings highlight limitations in our understanding of weight recovery in atypical AN. New metrics for recovery are urgently needed. Public Significance: Little is known about outcome in atypical anorexia nervosa (atypical AN). We examined recovery metrics in young people with atypical AN and anorexia nervosa (AN) 1 year after medical hospitalization. Individuals with atypical AN showed slower weight gain and remained further from their pre‐illness weight. There were no differences in the rates of psychological recovery, resumption of menses, or rehospitalization. New metrics are needed to assess recovery in atypical AN. [ABSTRACT FROM AUTHOR]

Background: Tremor is one of the most troublesome manifestations of Parkinson's Disease (PD) and its response to dopaminergic medication is variable; an evidence‐based framework of PD tremor is lacking yet needed to inform future investigations. Objective: To perform a comprehensive longitudinal analysis on the clinical characteristics, course and response to dopaminergic medication of tremor in de‐novo PD. Methods: Three hundred ninety‐seven participants were recruited in the Parkinson Progressive Markers Initiative, a prospective observational cohort study in early de‐novo PD. Rest, postural and kinetic tremor scores were extracted from the Movement Disorders Society—Unified Parkinson's Disease Rating Scale. Progression from baseline to 7‐year follow‐up of rest, postural and kinetic tremor scores, and their response to in‐clinic dopaminergic medication were analyzed through linear mixed‐effects models adjusted for age, sex and disease duration at enrollment. A sensitivity analysis was conducted through subgroup and imputation analyses. Results: 382 (96.2%) participants showed tremor and 346 (87.2%) showed rest tremor in at least one assessment over 7 years. Off‐state rest, postural and kinetic tremor scores increased significantly over time, coupled with a significant effect of dopaminergic medication in reducing tremor scores. However, at each assessment, tremor was unresponsive to in‐clinic dopaminergic medication in at least 20% of participants for rest, 30% for postural and 38% for kinetic tremor. Conclusions: PD tremor is a troublesome manifestation, with increasing severity and variable response to medications. This analysis details the current clinical natural history of tremor in early‐to‐mid stage PD, outlining an evidence‐based framework for future pathophysiological and interventional studies. [ABSTRACT FROM AUTHOR]

Minoritized populations have historically been underrepresented within school psychology. Furthermore, school psychology is in the midst of what has been termed the shortages crisis. Previous research suggests that undergraduate psychology students have little knowledge or exposure to school psychology as compared with other branches of professional psychology. Research suggests that increased knowledge and exposure to school psychology is related to increased intentions to pursue school psychology. Scholars have advocated for the creation of undergraduate school psychology courses to increase exposure to school psychology. However, to our knowledge, this is the first study to investigate the effectiveness of such courses. This study took place at a highly diverse northeastern public university and included 210 undergraduate students who were enrolled in an undergraduate school psychology course. Participants were asked to complete measures examining their knowledge, exposure, self‐efficacy, outcome expectations, and choice intentions for school psychology at the beginning and end of the course. Results indicate that students enrolled in school psychology courses demonstrated significant increases in perceived knowledge, exposure, self‐efficacy, and outcome expectations for school psychology. In addition, minoritized students demonstrated significantly greater increase in their knowledge and self‐efficacy after course completion than nonminoritized students. Implications for minoritized and general recruitment are discussed. Practitioner Points: Students demonstrated increases in knowledge, exposure, self‐efficacy, and expectations regarding school psychology.Minoritized students demonstrated greater increase in their knowledge and self‐efficacy after course completion than nonminoritized students. [ABSTRACT FROM AUTHOR]

Objectives: Subthreshold manic symptoms (subM) are a risk factor for the onset and recurrence of bipolar disorder (BD). Individuals with subM may benefit from preventive interventions, however, their development is hampered by a lack of knowledge on subM prevalence and subsequent course. This study examines subM characteristics, course, and risk factors for an unfavourable course. Methods: In a Dutch representative, population‐based sample aged 18–64 (N = 4618), we assessed subM, defined as the occurrence of manic core symptoms (elation/irritability), without meeting full DSM‐IV criteria for BD I or II in the past 3 years. Comparison groups had either no manic symptoms (noM) or hypomania/mania in the context of BD (mBD) in the past 3 years. Furthermore, we differentiated a mild and moderate type of subM, based on the number of manic symptoms. A subsequent three‐year course was assessed prospectively. Results: SubM had a three‐year prevalence of 4.9%. Its prevalence, characteristics, and course were in between noM and mBD, and there were few differences between mild and moderate subM. Over the 3‐year follow‐up, 25.0% of individuals with subM had persistent subM and another 6.1% transitioned to mBD. Eleven significant risk factors for this unfavourable course were found. The most important were a history of depression/dysthymia (OR 3.75, p ≤ 0.001), living alone (OR 2.61, p ≤ 0.01) and elevated neuroticism score (OR 1.21, p ≤ 0.001). Conclusions: This study supports the validity and clinical relevance of subM as a BD prodrome. It demonstrates that subM symptoms often persist or increase during follow‐up and identifies 11 risk factors that are associated with an unfavourable course. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to determine the compassionate communication levels of nursing students and the predictive roles of empathic skills and nursing communication courses. Design and Methods: This descriptive study was conducted with 430 nursing students and data were analyzed using a descriptive information form, Compassionate Communication Scale (CCS), and Empathic Skill Scale (ESS). Findings: A positive relationship was found between the students' ESS and CCS scores (r =.23 p = 0.001). Empathic skills (β = 0.43, p = 0.001), predicted compassionate communication (β = 0.23, p = 0.001), compassionate conversation (β = 0.43, p = 0.001), and compassionate touch (β = 0.18, p = 0.001). Practice Implications: Skills of compassion and empathy positively affect each other; therefore, it is important to adopt strategies that strengthen the empathic skills of nursing students during academic education and to include empathy and compassion in the curriculum. [ABSTRACT FROM AUTHOR]

Objective: We assessed the detection, treatment and outcomes of DSM‐5 eating disorders in a nationwide community setting. Method: The FinnTwin12 cohort comprises twins born in 1983–1987 in Finland (n = 5,600), with follow‐up starting at age 12. We outline treatment and outcomes of the 127 females and 15 males diagnosed with a lifetime DSM‐5 eating disorder in interviews conducted for a subsample (n = 1,347) in their early 20s. Results: Only 45 (32%) of those diagnosed with eating disorder in the interviews had their condition detected in healthcare, and even fewer received treatment (30% of females, 13% of males). Anorexia nervosa (AN), bulimia nervosa, and atypical AN were detected and treated more often than other eating disorders. Five years after disease onset, 41% of those diagnosed had recovered. There were no statistically significant differences in the course of different eating disorders (log‐rank p = 0.66) but the outcome was more favourable among males (log‐rank p = 0.008). The likelihood of 5‐year recovery did not differ between those who had and who had not received treatment (41.1% vs. 40.5%, log‐rank p = 0.66). Conclusion: Although eating disorders are common and symptoms are persistent for many, they remain under‐diagnosed and under‐treated. In real‐world settings, effectiveness of provided treatments may be limited. Key points: Although eating disorders affected one in six females and one in 40 males in the community, only one‐third of these cases were detected by healthcare providers, and even fewer received any treatment. Atypical disorders remain rarely recognized and treated.Eating disorder symptoms can be persistent for many sufferers; 5 years after disease onset, less than two‐fifths of the females and two‐thirds of the males had recovered.Real‐world treatments available in healthcare may have limited effectiveness, as the likelihood of recovery within 5 years was 40 percent in both treated and untreated groups. [ABSTRACT FROM AUTHOR]

Over recent years, the Internet has become an important teaching tool in universities. However, existing online course modes still have some obvious disadvantages, such as fewer learning restraints, interactions, and atmosphere. To improve online course quality, this article presents an online flip classroom with teacher‐led adaptive learning. The online classroom environment includes community as well as knowledge, learner, and assessment centers. Furthermore, we proposed a remote learning mode that uses theories of cognitive psychology and includes microlectures, class interactions, exercises after class, and programming training. Using CAD geometric modeling course as an example, the method has been applied for three teaching classes with different studying abilities in the spring semester in 2020. Two official network big data assessment methods have shown that the online course mode is better than other course modes. Consequently, our improved online course mode is efficient and popular with students. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Basic knowledge at the molecular level is necessary to care for the orofacial complex as part of the whole body. Many undergraduate dentistry students struggle to engage with biochemistry during the degree due to difficulty in appreciating the relevance of biochemistry to clinical practice. This study investigated student experiences, perception and engagement with biochemistry as part of the dental curriculum and explored how the teaching of biochemistry might be further developed. Methods: Focus groups were conducted with 21 participants, in groups of four to six students from the 3rd year to 5th year, as well as with recent graduates and post‐graduate students from a prominent Australasian dental school. Data were analysed using a general inductive approach. Results: Focus group participants viewed the oral biochemistry module as well organised and professionally run. However, participants reported that the large amount of material taught in the module made them feel overwhelmed and demotivated. Biochemistry was regarded by undergraduate participants as relevant to dental practice, but graduate participants thought it was only relevant to those sitting examinations for further training. Biochemistry was perceived as most relevant to dental research and expanding scientific literacy. Discussion/Conclusions: Participants in this study suggested that reducing the amount of material taught, focusing on dentally relevant biochemical concepts and overtly stating the connection of biochemistry to clinical practice could increase engagement and enhance the module within the dental curriculum. [ABSTRACT FROM AUTHOR]

Objectives: Research on factors that contribute to recurrence in older adults with bipolar disorder (OABD) is sparse. Previous research showed that clinical factors (e.g., age of onset, lifetime psychotic features, and suicide risk) were not associated with the recurrence in OABD. In younger adults, worse social functioning, coping style, and worse cognitive functioning are found to be associated with an unfavorable course of bipolar disorder. Therefore, this study is focusing on social, psychological, and cognitive factors in OABD. More insight in these factors is essential in order to develop and further specify preventive and treatment interventions. Methods: Data were used from the Dutch Older Bipolars (DOBi) cohort study. We included 64 patients for 3‐year follow‐up measurements, who were divided in a recurrent group and a nonrecurrent group. Logistic regression analyses were conducted to assess associations between social, psychological, and cognitive factors, and nonrecurrence. Results: 39.1% reported at least one recurrence during the 3‐year follow‐up period. No significant associations were found between the social, psychological, and cognitive factors and having a recurrence during the follow‐up period. Discussion: Participants in the recurrent group were younger, more often female and less likely to have children. Our results suggest that results from the adult bipolar disorder population cannot be extrapolated to OABD patients, underlining the need for longitudinal studies in OABD. [ABSTRACT FROM AUTHOR]

Higher education institutions are catching up on their high competition and challenges are in their analysis productivity. The major challenge is to monitor and analyze student progress through learning outcomes in the curriculum. One of the approaches is the outcome‐based education (OBE) model to deal with learning outcomes. OBE is an integral part of higher education institutions. The OBE system is a key step for accreditation in engineering education. OBE focuses on a student‐centered approach. The OBE is not restricted to well‐defined teaching strategies or direct evaluations but also encompasses indirect evaluations to help students achieve the intended outcomes. In this investigation, engineering students' data have been analyzed forming three distinct clusters to group students according to best, average, and worst achievement of learning outcomes in two different computer engineering courses generally taught in the early semesters in higher education institutions. A data mining clustering approach is used to segment students using k‐means and k‐medoids techniques. Clustering can be regarded as a data modeling technique that provides summary data that interact with multiple disciplines and plays an important role in a wide range of computer applications. The investigation comprises of two parts for analysis: one part of the analysis is the mid‐term and final exam scores, the quiz and assignment results, the laboratory results, and the evaluation, together with the learning outcomes achieved, and the other part is the comparative analysis of learning outcomes achieved in both engineering courses clustering with the best, average, and worst attainments, respectively. In this investigation, the results obtained from clustering data points show that the same group of clusters with the best, average, and worst learning outcomes achievements formed using both k‐means and k‐medoid clustering for one course. On the other hand, a diverse group of clusters with the best, average, and worst learning outcomes achievements formed using both k‐means and k‐medoids clustering for another course. [ABSTRACT FROM AUTHOR]

Objective: We report on the long‐term outcome of males compared to females treated for anorexia nervosa (AN) or bulimia nervosa (BN). Methods: A total of 119 males with AN and 60 males with BN were reassessed 5.8 ± 4.6 and 7.5 ± 5.9 years (respectively) after treatment and compared to matched female patients. Results: At follow‐up, males with AN had a higher body weight than females. For AN, remission rates (40% males vs. 41% females) did not differ at follow‐up. And at follow‐up, more males (34%) than females (19%) had an eating disorder not otherwise specified (ED‐NOS; p < .01). At follow‐up of AN, there was no binge‐eating disorder (BED) and obesity was rare. For BN, remission rates (44% males vs. 50% females) and frequency of AN, BN, BED and ED‐NOS did not differ at follow‐up. Males with AN scored lower than females at follow‐up on most subscales of the Eating Disorder Inventory (EDI) and on somatization, obsessive–compulsive symptoms, and depression (Brief Symptom Inventory). Males with BN scored lower than females with BN on perfectionism and higher on interpersonal distrust (EDI) at follow‐up. Discussion: Results from the scarce literature on males with ED are inconclusive regarding longer term outcome. In the present study, males with AN showed a slightly better outcome than females. In BN, outcome was about the same in males and females. According to our study, existing treatment is equally effective in both males and females. Additional research on the need of gender‐specific diagnosis and therapy is required. [ABSTRACT FROM AUTHOR]

There is an urgent need to improve access to safe surgical and anaesthetic care for children living in many low- and middle-income countries. Providing quality training for healthcare workers is a key component of achieving this. The 3-day Safer Anaesthesia from Education (SAFE)® paediatric anaesthesia course was developed to address the specific skills and knowledge required in this field. We undertook a project to expand this course across five East and Central African countries (Ethiopia, Kenya, Malawi, Uganda and Zambia) and train local faculty. This study reports the outcomes from course evaluation data, exploring the impact on knowledge, skills and behaviour change in participants. Eleven courses were conducted in a 15-month period, with 381 participants attending. Fifty-nine new faculty members were trained. Knowledge scores (0-50 scale) increased significantly from mean (SD) 37.5 (4.7) pre-course to 43.2 (3.5) post-course (p < 0.0001). Skills scores (0-10 scale) increased significantly from 5.7 (2.0) pre-course to 8.0 (1.5) post-course (p < 0.0001). One hundred and twenty-six participants in Malawi, Uganda and Zambia were visited in their workplace 3-6 months later. Knowledge and skills were maintained at follow-up, with scores of 41.5 (5.0) and 8.3 (1.4), respectively (p < 0.0001 compared with pre-course scores). Content analysis from interviews with these participants highlighted positive behaviour changes in the areas of preparation, peri-operative care, resuscitation, management of the sick child, communication and teaching. This study indicates that the SAFE paediatric anaesthesia course is an effective way to deliver training, and could be used to help strengthen emergency and essential surgical care for children as a component of universal health coverage. [ABSTRACT FROM AUTHOR]

Objective: To assess the long‐term outcome and identify outcome predictors in a very large sample of inpatients treated for bulimia nervosa (BN). Method: Out of a total of 2,033 patients admitted consecutively to specialized treatment, 1,351 patients (mean age at treatment 25.94) were assessed for follow‐up on average 11 (SD 6) years after admission. Also a very long‐term (21 years) subsample (N = 147; mean age 25.92) was defined. Bivariate and logistic regression analyses identified predictors of poor outcome. Results: For more than 70% of the patients follow‐up information could be gathered. Severity of eating disorder (ED) and other symptoms decreased over time but remained higher than in healthy controls, using published normative data. Remission rate was 38% after 11 years and 42% in the subsample after 21 years. Out of the total sample of N = 2,033 patients, 49 had died (2.4%). Persistent BN was found in 14.2% and the most frequent crossover was to ED not otherwise specified. Predictors of poor outcome were fewer follow‐up years, higher drive for thinness, higher age at treatment, and less global functioning. Discussion: Based on clinical indicators, patients presented with a high level of ED and psychiatric symptomatology. With less than half of the patients remitted after 22 years, efforts are needed to improve treatment outcome. [ABSTRACT FROM AUTHOR]

Objective: To compare long term outcome between childhood‐onset Anorexia Nervosa (AN) and low‐weight Avoidant/Restrictive Food Intake Disorder (ARFID) in regard to psychiatric diagnoses, social and occupational functioning. Method: A consecutive series of 56 children originally treated for low‐weight restrictive eating disorder (ED) were followed up after a mean of 15.9 years. ARFID‐diagnoses were assigned retrospectively. Results: Thirty‐seven patients originally had AN and 19 patients were diagnosed retrospectively with ARFID. At follow‐up, in the AN‐group 21.6% had a current ED, 24.3% had another psychiatric diagnosis, and 54.1% did not have any psychiatric diagnosis. In the ARFID‐group, 26.3% had a current ED, 26.3% had another psychiatric diagnosis, and 47.4% had no psychiatric diagnosis. In the ARFID‐group ED diagnoses at follow‐up were all ARFID, whereas the AN‐group showed heterogeneity. Morgan Russell Outcome Assessment Schedule indicated similar outcome in the AN‐ and ARFID‐group. Occupational functioning did not differ significantly between the AN‐ and ARFID‐group. Discussion: The AN‐group showed high rate of ED at follow up. The ARFID‐group had a similar outcome to AN. In the ARFID‐group, all ED‐cases at follow up had ARFID, possibly indicating symptomatic stability. Low‐weight ARFID should be treated as seriously as childhood onset AN. [ABSTRACT FROM AUTHOR]

Since the Four‐Dimensional Ecology Education (4DEE) framework was endorsed in the fall of 2018 by the ESA Governing Board, activities of the nine‐member 4DEE Subcommittee have focused on developing a self‐assessment rubric, a guide for assessing student learning, support for majors and non‐majors courses, and a comprehensive report. Together, these resources will advance implementation of the 4DEE framework. The subcommittee is also planning to form communities of practice and host online conversations in support of education innovation by all members of the ecological community. [ABSTRACT FROM AUTHOR]

Objective Assessment of the long-term outcome of anorexia nervosa (AN) in a very large sample of inpatients ( N = 1,693) and identification of predictors for poor outcome. Method Over 25 years (mean 10 years), consecutively admitted inpatients of a specialized hospital were followed. A subsample of 112 patients with 20-year follow-up was defined. Bivariate comparisons and logistic regression analysis identified risk factors of poor outcome. Results Body mass index (BMI) increased during the follow-up period. Eating behavior as well as general psychopathology improved but did not reach the level of healthy controls. Remission was found in 30% (total sample) and in 40% (20-year follow-up subsample). Crossover from AN to binge-eating disorder or obesity was rare. The predictors of a negative course of illness included lower BMI at admission; a higher score on the Eating Disorder Inventory Maturity Fears subscale at admission; fewer follow-up years; and higher age at admission. The main diagnostic crossover occurred from AN to eating disorder not otherwise specified. Motherhood was related to better outcome. Discussion Many patients with very severe AN recover from their illness but AN also shows considerable long-term negative consequences. Over long time periods, survivors show improvement but better treatments for severe cases are still needed. Predictors of outcome included symptom severity, chronicity, and length of follow-up but not psychiatric comorbidity. [ABSTRACT FROM AUTHOR]

Objective: To examine the influence of specific chronic somatic diseases and overall somatic diseases burden on the course of depression in older persons.Methods: This was a prospective cohort study with a 2-year follow-up. Participants were depressed persons (n = 285) from the Netherlands Study of Depression in Older Persons. The presence of chronic somatic diseases was based on self-report. Diagnosis of depression was assessed with the Composite International Diagnostic Interview, and severity of depression was measured with the Inventory of Depressive Symptomatology Self-report.Results: Cardiovascular diseases (odds ratio [OR] = 1.67, 95% confidence interval [CI] = 1.02-2.72, p = 0.041), musculoskeletal diseases (OR = 1.71, 95% CI = 1.04-2.80, p = 0.034), and the number of chronic somatic diseases (OR = 1.37, 95% CI = 1.16-1.63, p < 0.001) were associated with having a depressive disorder at 2-year follow-up. Furthermore, chronic non-specific lung diseases, cardiovascular diseases, musculoskeletal diseases, cancer, or cumulative somatic disease burden were associated with a chronic course of depression.Conclusions: Somatic disease burden is associated with a poor course of late-life depression. The course of late-life depression is particularly unfavorable in the presence of chronic non-specific lung diseases, cardiovascular diseases, musculoskeletal diseases, and cancer. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To investigate the impact of childhood trauma on the clinical course of panic disorder and possible contributing factors. Method Longitudinal data of 539 participants with a current panic disorder were collected from the Netherlands Study of Depression and Anxiety (NESDA). Childhood trauma was assessed with a structured interview and clinical course after 2 years with a DSM-IV-based diagnostic interview and the Life Chart Interview. Results At baseline, 54.5% reported childhood trauma, but this was not predictive of persistence of panic disorder. Emotional neglect and psychological abuse were associated with higher occurrence of anxiety disorders other than panic disorder (social phobia) and with higher chronicity of general anxiety symptoms (anxiety attacks or episodes and avoidance). Baseline clinical features (duration and severity of anxiety and depressive symptoms) and personality traits (neuroticism and extraversion) accounted for roughly 30-60% of the total effect of childhood trauma on chronicity of anxiety symptoms and on occurrence of other anxiety disorders. Conclusion After two years, childhood trauma is associated with chronicity of anxiety symptoms and occurrence of social phobia, rather than persistence of panic disorder. These relationships are partially accounted for by duration and severity of anxiety and depressive symptoms, and neuroticism and extraversion. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical presentation of children with anorexia nervosa (AN group) with that of children with low-weight food intake disorder without weight and shape-related psychopathology (non-AN group). Method Medical and psychiatric data were obtained from the case records of a consecutive series of 102 children with an eating disorder and a pronounced low weight who were below the age of 13 at the start of treatment. Results Fifty-eight patients constituted the AN group, and 44 constituted the non-AN group. The non-AN group was younger and had a longer duration of symptoms than the AN group. The non-AN group also had a lower maximum premorbid weight and shorter stature. There were no differences in medical severity, but the AN group had more psychiatric treatment. Discussion The non-AN group seems to have a medically equally severe disorder as the AN group, but is less often detected and properly treated. Copyright © 2016 The Authors European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The aim of this paper was to internally validate previously reported relations (Knoph Berg et al., Aust N Z J Psychiatry, 42, 396-404, 2008) between psychosocial factors and bulimia nervosa (BN) outcomes during pregnancy. Method This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Participants were women enrolled during pregnancy ( N = 69,030). Internal validity was evaluated by way of bootstrapped parameter estimates using the overall sample and a split sample calibration approach. Results Bootstrap bias estimates were below the problematic threshold, and extend earlier findings (Knoph Berg et al., Aust N Z J Psychiatry, 42, 396-404, 2008) by providing support for the validity of the models at the population level of all pregnant women in Norway. Bootstrap risk ratios indicated that prevalence, incidence, and remission of BN during pregnancy were significantly associated with psychosocial factors. The split sample procedure showed that the models developed on the training sample did not predict risks in the validation sample. Discussion This study characterizes associations between psychosocial exposures and BN outcomes among pregnant women in Norway. Women with lifetime and current self-reported psychosocial adversities were at a much higher risk for BN during pregnancy. Psychosocial factors were associated with BN remission during pregnancy, inviting the prospect of enhancing therapeutic interventions. We consider the findings in the context of reproducibility in science. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:654-662) [ABSTRACT FROM AUTHOR]

To describe the incidence, 12-month prevalence, and course of lower extremity injuries that occurred during and after the Amgen Singelloop Breda in 2009. The design was based on a prospective cohort study with a population-based setting. In total, 3605 registered runners received a web-based baseline questionnaire of which 713 participants completed and returned it. Information about previous injuries, training programs, and demographic data were gathered at baseline. Site and intensity of running injuries and occurrence of new injuries were obtained from five post-race questionnaires. The main outcome measurement was lower extremity injury. The incidence of running injuries during the Amgen Singelloop Breda itself was 7.8%; most of these injuries occurred in the calf muscle, thigh, and knee joint. Three-month incidence of injuries during follow-up varied between 13.5% and 16.3%. During the 12-month follow-up period, 277 new running injuries were reported. Runners who ran more than 10 km are more susceptible to injury in comparison with runners who ran short distances (10 km or less). In total, 69.1% of running injuries resolves within 10 days. Running injuries are very common among recreational runners. Injuries mostly occur in the knee, thigh, and calf muscle. [ABSTRACT FROM AUTHOR]

Background and Aims Alcohol and nicotine dependence are associated with considerable morbidity and mortality, especially when cases are persistent. The risk for alcohol and nicotine dependence is increased by childhood maltreatment. However, the influence of childhood maltreatment on dependence course is unknown, and is evaluated in the current study. Design Physical, sexual and emotional abuse, and physical and emotional neglect, were evaluated as predictors of persistent alcohol and nicotine dependence over 3 years of follow-up, with and without control for other childhood adversities. Setting National Epidemiologic Survey on Alcohol and Related Conditions ( NESARC). Participants NESARC participants completing baseline and follow-up who met criteria at baseline for past-year alcohol dependence ( n = 1172) and nicotine dependence ( n = 4017). Measurements Alcohol Use Disorder and Associated Disabilities Interview Schedule ( AUDADIS) measures of alcohol/nicotine dependence, childhood maltreatment and other adverse childhood experiences (e.g. parental divorce). Findings Controlling for demographics only, physical, sexual and emotional abuse and physical neglect predicted 3-year persistence of alcohol dependence [adjusted odds ratio ( AOR) = 1.50-2.99; 95% CI = 1.04-4.68] and nicotine dependence ( AOR = 1.37-1.74; 95% CI = 1.13-2.11). With other childhood adversities also controlled, maltreatment types remained predictive for alcohol persistence ( AOR = 1.53-3.02; 95% CI = 1.07-4.71) and nicotine persistence ( AOR = 1.35-1.72; 95% CI = 1.11-2.09). Further, a greater number of maltreatment types incrementally influenced persistence risk ( AOR = 1.19-1.36; 95% CI = 1.11-1.56). Conclusions A history of childhood maltreatment predicts persistent adult alcohol and nicotine dependence. This association, robust to control for other childhood adversities, suggests that maltreatment (rather than a generally difficult childhood) affects the course of dependence. [ABSTRACT FROM AUTHOR]

Objective This study compares diagnostic and symptom course trajectories across different anxiety disorders, and examines the role of anxiety arousal vs. avoidance behaviour symptoms in course prediction. Method Data were from 834 subjects with a current anxiety disorder from the Netherlands Study of Depression and Anxiety ( NESDA) who were re-interviewed after 2 years. DSM- IV-based diagnostic interviews and Life Chart Interviews ( LCI) were used to assess the diagnostic and symptom course trajectory over 2 years. Anxiety arousal and avoidance behaviour symptoms were measured with LCI, Beck Anxiety Inventory and Fear Questionnaire. Results Prognosis varied across disorders, with favourable remittance rates of 72.5% for panic disorder without agoraphobia and 69.7% for generalized anxiety disorder; gradually declining to 53.5% for social phobia and 52.7% for panic disorder with agoraphobia. Only 42.9% of those with multiple anxiety disorder remitted, and this group showed a more chronic course than pure anxiety disorders. Both baseline duration and severity were course predictors. Avoidance behaviour symptoms predicted the outcome better than anxiety arousal symptoms. Conclusions These data suggest that the specific anxiety disorders such as recognized by DSM- IV are useful in predicting the outcome and that this may be determined largely by the relative severity of avoidance behaviour that patients have developed. [ABSTRACT FROM AUTHOR]

Objectives Emergency medicine ( EM) was recognized as a specialty by the Medical Council of India ( MCI) in July 2009. As India undergoes urbanisation, cost-effective transition from managing infectious diseases to emergency management of trauma and cardio-respiratory diseases is crucial. Trained emergency healthcare workers are needed to respond effectively to these challenges. The objective was to determine the current status of academic EM training and related issues in India, and to discuss those that need to be addressed. Methods The authors conducted electronic literature searches for articles published over an 18 year period from January 1994 to February 2013 using Pub Med, Google and Yahoo databases. The references listed in the publications identified from these databases were also reviewed. Results Electronic literature searches revealed a multitude of 1 to 3 year training programmes, many affiliated with various foreign universities. The majority of these training programmes are offered in private healthcare institutions. MCI recognition has opened the doors for medical colleges to set up Indian specialty training programmes. Two separate Academic Councils are currently looking at EM training. Conclusion The variety of programmes and separate efforts on academic development begets a need to address the issues of short-term courses being passed off as specialty training programmes, and a need for working together on national curriculum development, certification, accreditation systems and common examinations. The different organisations and academic councils could collaborate to give EM a unified scope for development. [ABSTRACT FROM AUTHOR]

Objective: To investigate course and predictors of eating disorders in the postpartum period. Method: A total of 77,807 women, participating in the Norwegian Mother and Child Cohort Study (MoBa), completed questionnaires during pregnancy including items covering DSM-IV criteria for prepregnancy anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS-P), and binge eating disorder (BED). Additional questionnaires were completed at 18 and 36 months postpartum. Results: Proportions of women remitting at 18 months and 36 months postpartum were 50% and 59% for AN, 39% and 30% for BN, 46% and 57% for EDNOS-P, and 45% and 42% for BED, respectively. However, disordered eating persisted in a substantial proportion of women meeting criteria for either full or subthreshold eating disorders. BN during pregnancy increased the risk for continuation of BN. BMI and psychological distress were significantly associated with course of BED. Discussion: This is the first large-scale population-based study on course of eating disorders in the postpartum period. The results indicated that disordered eating persists in a substantial proportion of women with prepregnancy eating disorders. Health care professionals working with women in this phase of life need to pay specific attention to eating disorder symptoms and behaviors. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013) [ABSTRACT FROM AUTHOR]

Objective In the past, the comparability of empirical studies that examined the course and outcome of schizophrenia was limited by their use of different diagnostic systems. Focussing on the psychopathological long-term outcome, the present article aims to review follow-up studies that used modern operationalized diagnostic criteria for schizophrenia ( DSM- III, DSM- III-R, DSM- IV and ICD-10). Method We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, Psyc INFO and PSYNDEX for relevant studies up to the year 2011. Twenty-one studies were included in the final analysis. Results The long-term outcome of schizophrenia was heterogeneous and included full remissions as well as severe chronic states. Schizophrenia, however, showed a considerably more unfavourable outcome than other diagnostic groups such as schizoaffective or affective disorders. Psychopathological symptoms remained relatively stable in the course of illness. Several predictors for a poor outcome were identified, such as male gender or pronounced negative symptoms. Conclusion Recent studies using modern diagnostic systems largely confirm the results of earlier studies. Current diagnostic criteria for schizophrenia identify a heterogeneous sample of patients. The influence of therapeutic interventions on long-term outcome remains unclear. [ABSTRACT FROM AUTHOR]

Introduction Poor prescribing is probably the most common cause of preventable medication errors and many of these events involve junior doctors. In 2009, an electronic problem-based therapeutics course developed at the University of Michigan Medical School ( UMMS) was translated and adapted for use at the University of Zagreb Medical School ( UZMS). Methods After students from both schools took the course in 2010, we compared their responses with an online questionnaire addressing the course quality and its effectiveness. Results There were no statistically significant differences in the overall average grades awarded for the course ( UZMS 4.11 ± 0.86 vs. UMMS 3.96 ± 0.93; 95% CI mean difference ( MD) - 0.36, 0.07; P = 0.175) with both student groups expressing high satisfaction rates with its quality, accessibility and overall design. UZMS students reported spending less time working through the course than their American colleagues (2.14 ± 1.01 vs. 2.89 ± 1.02 on a five point Likert scale; 95% CI MD 0.51, 0.99; P < 0.05). Furthermore, Croatian students indicated greater difficulty with course materials (3.54 ± 0.59 vs. 3.25 ± 0.59; 95% CI MD - 0.42, - 0.15; P < 0,05) and weekly multiple choice questions (3.83 ± 0.62 vs. 3.4 ± 0.61; 95% CI MD - 0.58, - 0.29; P < 0,05) compared with the UMMS students. Conclusion It is possible to adapt and translate successfully whole online teaching resources and implement them internationally in different countries and health care systems, achieving similar, high student satisfaction rates while decreasing administrative and cost burdens. Web based learning may have great potential to offer a cost effective and safe environment in which prescribing skills can be improved. [ABSTRACT FROM AUTHOR]

Objective: Duration of untreated illness represents a potentially modifiable component of any diagnosis-treatment pathway. In bipolar disorder (BD), this concept has rarely been systematically defined or not been applied to large clinically representative samples. Method: In a well-characterized sample of 501 patients with BD, we estimated the duration of untreated bipolar disorder (DUB: the interval between the first major mood episode and first treatment with a mood stabilizer). Associations between DUB and clinical onset and the temporal sequence of key clinical milestones were examined. Results: The mean DUB was 9.6 years (SD 9.7; median 6). The median DUB for those with a hypomanic onset (14.5 years) exceeded that for depressive (13 years) and manic onset (8 years). Early onset BD cases have the longest DUB ( P < 0.0001). An extended DUB was associated with more mood episodes ( P < 0.0001), more suicidal behaviour ( P = 0.0003) and a trend towards greater lifetime mood instability (e.g. rapid cycling, possible antidepressant-induced mania). Conclusion: Duration of untreated bipolar disorder (DUB) will only be significantly reduced by more aggressive case finding strategies. Reliable diagnosis (especially for BD-II) and/or instigation of recommended treatments is currently delayed by insufficient awareness of the early, polymorphous presentations of BD, lack of systematic screening and/or failure to follow established guidelines. [ABSTRACT FROM AUTHOR]

In half of Obsessive Compulsive Disorder (OCD) patients the disorder runs a chronic course despite treatment. The factors determining this unfavourable outcome remain unknown. The Netherlands Obsessive Compulsive Disorder Association (NOCDA) study is a multicentre naturalistic cohort study of the biological, psychological and social determinants of chronicity in a clinical sample. Recruitment of OCD patients took place in mental health organizations. Its design is a six-year longitudinal cohort study among a representative clinical sample of 419 OCD patients. All five measurements within this six-year period involved validated semi-structured interviews and self-report questionnaires which gathered information on the severity of OCD and its co-morbidity as well as information on general wellbeing, quality of life, daily activities, medical consumption and key psychological and social factors. The baseline measurements also include DNA and blood sampling and data on demographic and personality variables. The current paper presents the design and rationale of the study, as well as data on baseline sample characteristics. Demographic characteristics and co-morbidity ratings in the NOCDA sample closely resemble other OCD study samples. Lifetime co-morbid Axis I disorders are present in the majority of OCD patients, with high current and lifetime co-morbidity ratings for affective disorders (23.4% and 63.7%, respectively) and anxiety disorders other than OCD (36% current and 46.5% lifetime). Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to determine the course of delirium in older long-term care (LTC) residents. Methods A prospective cohort study of 279 residents in seven LTC facilities in Montreal and Quebec City, Canada, was conducted. The Mini Mental State Examination (MMSE), Confusion Assessment Method (CAM), Delirium Index (DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. Information on medical problems and medication was abstracted from resident charts. Data were analyzed using descriptive statistics, Cox proportional hazard regression, and logistic regression. Results Of the 279 residents, 41 (14.7%) had 61 CAM-defined incident episodes of delirium: 28 (10%) had one episode and 13 (4.7%) had two or more episodes. Episode duration was 7-63 days, mean, 11.3 (SD, 10.1) days. The mean episode DI score was 11.5 (SD, 3.5). Rates of recovery at 1, 2, 4, and 24 weeks were 57.4%, 67.2% 77.1%, and 80.3%, respectively. Most episodes were preceded or followed by one or more CAM core symptoms of delirium, sometimes lasting many weeks. Conclusions Confusion Assessment Method-defined incident episodes of delirium in older LTC residents appear to last longer than episodes in acute care hospital patients, but rates of recovery at 4 and 24 weeks are similar. Notably, most episodes were preceded or followed by one or more CAM core symptoms of delirium. These findings have implications for clinical practice and research in LTC settings. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To describe Confusion Assessment Method ( CAM) core symptoms of delirium occurring before and after incident episodes of delirium in older long-term care ( LTC) residents. A secondary objective was to describe the mean number of symptoms before and after episodes by dementia status. Design Secondary analysis of data collected for a prospective cohort study of delirium, with repeated weekly assessments for up to 6 months. Setting Seven LTC facilities in Montreal and Quebec City, Canada. Participants Forty-one older LTC residents who had at least one CAM-defined incident episode of delirium. Measurements The Mini- Mental State Examination ( MMSE), CAM, Delirium Index ( DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. The frequency, mean number, type, and duration of CAM core symptoms of delirium occurring before and after incident episodes were examined using descriptive statistics, frequency analysis, and survival analysis. Results CAM core symptoms of delirium preceded 38 (92.7%) episodes of delirium for many weeks; core symptoms followed 37 (90.2%) episodes for many weeks. Symptoms of inattention and disorganized thinking occurred most commonly. The mean number of symptoms was higher in residents with dementia but not significantly so. Conclusion CAM core symptoms of delirium were frequent and protracted before and after most incident episodes of delirium in LTC residents with and without dementia. If replicated, these findings have potentially important implications for clinical practice and research in LTC settings. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To identify independent risk factors of the recurrence of alcohol dependence (AD) in people with a remitted disorder at baseline and persistence of AD in people with a current disorder at baseline. Design Prospective cohort study with assessments at baseline and 2-year follow-up. Setting Recruitment from the general population, primary care and out-patient mental health-care services. Participants People with remitted AD ( n = 253) and current AD ( n = 135). Measurements Recurrence and persistence of AD during 2-year follow-up were established using the Composite International Diagnostic Interview (CIDI) interview based on DSM-IV. Logistic regression analyses were performed to explore the role of potential risk factors (i.e. baseline severity of alcohol problems, measures for depression and anxiety, socio-demographics, vulnerability factors and addiction-related factors) as independent predictors of a negative course. Findings Overall recurrence and persistence rates of AD were 14.6 and 40.7%, respectively, and were highly conditional on the severity of alcohol problems [adjusted odds ratio (OR) per standard deviation (SD) increase: OR = 3.64, 95% confidence interval (CI): 2.21-6.01 and OR = 2.12, 95% CI: 1.32-3.40, respectively). Severity of depressive/anxiety symptoms was an additional independent predictor of the recurrence of AD, whereas male gender and high education were significant independent risk factors of the persistence of AD. Conclusions Alcohol dependence has a dynamic course, with only moderate levels of diagnostic stability. Both recurrence and persistence of alcohol dependence are highly dependent on severity of baseline alcohol problems, whereas severity of depressive/anxiety symptoms predicts only the recurrence of alcohol dependence. Both measures may be useful in identifying people at an increased risk of a negative course and who could be targeted by prevention strategies. [ABSTRACT FROM AUTHOR]

Background Stressful life events ( SLEs) are associated with the onset of psychiatric disorders but little is known about the effects of SLEs on individuals already diagnosed with an anxiety disorder, particularly generalized anxiety disorder ( GAD) in which worry about life events is a defining characteristic. This study examined the impact of SLEs on relapse in adults already diagnosed with GAD. Methods Data are obtained from the Harvard/Brown Anxiety Research Project ( HARP), a naturalistic longitudinal study of adults with a current or past history of anxiety disorders . One hundred and twelve adults recovered from an episode of GAD and 27 subsequently relapsed during the study. Eight categories of SLEs were assessed via interview and were examined as predictors of GAD relapse. Results An increased total number of SLEs was associated with a higher cumulative probability of relapse into episode of GAD and there was a nonsignificant statistical trend indicating specific categories of SLEs including health, death, and family/friends/household were related to an increased probability of relapse into episodes of GAD. Conclusions SLEs impact the course of GAD and certain types of stressors may be more relevant to symptomatology than others. The change and uncertainty associated with SLEs may exacerbate existing worry tendencies even among those who have recovered from GAD. [ABSTRACT FROM AUTHOR]

Magalhães PV, Kapczinski F, Nierenberg AA, Deckersbach T, Weisinger D, Dodd S, Berk M. Illness burden and medical comorbidity in the Systematic Treatment Enhancement Program for Bipolar Disorder. Objective: Coexisting chronic medical conditions are common in bipolar disorder. Here, we report the prevalence and correlates of medical comorbidity in patients enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). We were particularly interested in associations between variables reflecting illness chronicity and burden with comorbid medical conditions. Method: We used intake data from the open-label component of the STEP-BD. History of medical comorbidity was obtained from the affective disorders evaluation, and its presence was the outcome of interest. The sample size in analyses varied from 3399 to 3534. We used multiple Poisson regression to obtain prevalence ratios. Results: The prevalence of any medical comorbidity in the sample was 58.8%. In addition to demographic variable, several clinical characteristics were associated with the frequency of medical comorbidity. Having more than 10 previous mood episodes, childhood onset, smoking, lifetime comorbidity with anxiety, and substance use disorders were independently associated with having a medical comorbidity in the final multivariate model. Conclusion: The results presented here reveal strong associations between variables related to illness chronicity and medical burden in bipolar disorder. This lends further support to recent multidimensional models incorporating medical morbidity as a core feature of bipolar disorder. [ABSTRACT FROM AUTHOR]

Objectives: To describe the longitudinal course of three core eating disorder symptoms-low body weight, binge eating, and purging-in women with anorexia nervosa (AN) and bulimia nervosa (BN) using a novel statistical approach. Method: Treatment-seeking women with AN ( n = 136) or BN ( n = 110) completed the Eating Disorders Longitudinal Interval Follow-Up Evaluation interview every 6 months, yielding weekly eating disorder symptom data for a 5-year period. Semiparametric mixture modeling was used to identify longitudinal trajectories for the three core symptoms. Results: Four individual trajectories were identified for each eating disorder symptom. The number and general shape of the individual trajectories was similar across symptoms, with each model including trajectories depicting stable absence and stable presence of symptoms as well as one or more trajectories depicting the declining presence of symptoms. Unique trajectories were found for low body weight (fluctuating presence) and purging (increasing presence). Conjunction analyses yielded the following joint trajectories: low body weight and binge eating, low body weight and purging, and binge eating and purging. Discussion: The course of individual eating disorder symptoms among patients with AN and BN is highly variable. Future research identifying clinical predictors of trajectory membership may inform treatment and nosological research. © 2010 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [ABSTRACT FROM AUTHOR]

Abstract: Background: The long-term course of long-standing low back pain is largely unknown since long-term data are scarce. Objective: We examined the course of self-reported low back pain in the prospective population-based Doetinchem cohort over a period of 10years. Methods: Between 1993 and 2007, around 5700 randomly selected men and women in four age groups of originally 20–29, 30–39, 40–49, 50–59years were measured three times. Logistic regression analysis was used to study the association of sociodemographic (gender, age, education, work status) and lifestyle characteristics (BMI, smoking, physical activity) with persistent and new episodes of long-standing low back pain. Results: The prevalence of long-standing low back pain is quite stable over a 10year period, approximately 20% on population level. On individual level, around 30% of the population was completely free of low back pain during the entire period, 6% can be characterized as persistent back pain sufferers. Individuals with persistent and a varying pattern have a more unhealthy lifestyle (BMI and smoking) than those without low back pain. Age, smoking, obesity and not having a paid job are associated with 10-year persistent back pain in the general population, whereas age and not having a paid job are associated in those with long-lasting back pain at baseline. New episodes of long-standing back pain are relatively frequent among women and smokers. Conclusions: Low back pain in the population is characterized as very dynamic which challenges epidemiological studies highly. Long-term information on the course of back pain is needed to define severe subgroups. [Copyright &y& Elsevier]

Aim: Bipolar disorder (BD) is often comorbid with obsessive-compulsive disorder (OCD). In this study, we compared clinical profile and course of subjects with a primary diagnosis of OCD with and without BD. Methods: We compared 34 subjects with primary diagnosis of OCD with BD and 57 subjects with a diagnosis of OCD without BD. Structured interview schedules, clinical rating scales, and information from clinical charts were utilized to assess patients. Results: OCD with BD was characterized by: (i) an episodic course; (ii) a higher number of depressive episodes, greater suicidality and a higher rate of hospitalization; (iii) fewer pathological doubts and more miscellaneous compulsions; and (iv) poorer insight into obsessive-compulsive symptoms. Conclusions: Episodic course appears to be typical of OCD with BD. Bipolarity has a pathoplastic effect on OCD and it is possible that some forms of OCD and BD are pathophysiologically related. Bipolar OCD is associated with a higher rate of depressive episodes, higher suicidality and more frequent hospitalizations, suggesting greater morbidity. Long-term prospective follow-up studies and studies addressing pathophysiology and genetic basis are needed to understand the complexity of such comorbidity. [ABSTRACT FROM AUTHOR]

Rhebergen D, Batelaan NM, de Graaf R, Nolen WA, Spijker J, Beekman ATF, Penninx BWJH. The 7-year course of depression and anxiety in the general population. Insight into the long-term course of depression and anxiety. Data were derived from Netherlands Mental Health Survey and Incidence Study/Netherlands Study of Depression and Anxiety, epidemiologic surveys in the adult population in the Netherlands. Three hundred and three respondents with depressive and/or anxiety Composite International Diagnostic Interview (CIDI) disorder were interviewed, examining the 7-year course of depression ( n = 141), anxiety ( n = 102) and the comorbid state ( n = 60) and possible prognostic factors. Outcomes were CIDI diagnostic status after 7 years and percentage of time during 7 years with depressive and/or anxiety symptoms, retrospectively assessed by the Life Chart Interview (LCI). After 7 years, 60.7% of the subjects were free from a 12-month CIDI depression or anxiety diagnosis. The odds were higher for subjects with anxiety and comorbidity compared to subjects with depression. Low physical functioning and high neuroticism predicted the presence of a diagnosis after 7 years. During 7-year follow-up, 37.3% of the subjects were free from depressive and anxiety symptoms according to the LCI, 51.8% had symptoms <50% of the time, and 10.9%≥50% of the time. (Comorbid) anxiety resulted in a poorer course. High neuroticism and childhood adversity predicted more follow-up time with symptoms. Course trajectories were more favorable than expected, although comorbidity resulted in poorer course. Neuroticism, physical functioning, and childhood adversity predicted an unfavorable course. [ABSTRACT FROM AUTHOR]

Objective: To identify factors associated with incidence and course of broadly defined binge eating disorder (BED) in pregnancy. Method: As a part of the Norwegian Mother and Child Cohort Study (MoBa), 45,644 women completed a questionnaire at approximately 18 weeks of gestation. Results: Incidence of BED was significantly associated with lifetime sexual abuse, lifetime physical abuse, lifetime major depression, symptoms of anxiety and depression, low life satisfaction, low self-esteem, low partner relationship satisfaction, smoking, alcohol use, lack of social support, and several weightrelated factors. Continuation was negatively associated with thoughts of being overweight before pregnancy. Remission was positively associated with thoughts of being overweight before pregnancy and negatively associated with overvaluation of weight. Discussion: Onset of BED in pregnancy was associated with psychological, social and weight-related factors, as well as health behaviors and adverse life events. In women with prepregnancy BED, thoughts of being overweight before pregnancy and overvaluation of weight were associated with course of BED during pregnancy. [ABSTRACT FROM AUTHOR]

In 2005, a new curriculum was introduced at the School of Dentistry at the University of Copenhagen. Amongst many changes, the pedagogical concept behind theoretical teaching was changed. The main emphasis was previously on lectures and teacher controlled teaching, but the emphasis has now shifted to a more dialogue-based teaching style for smaller groups where the students became much more active. Thus, the learning principle was now given the pride of place. The present article focuses on the pedagogical reorganisation of the course in oral microbiology where, based on interviews with students and teachers, an evaluation is made regarding how the changes were implemented and developed. Despite the fact that the students themselves wanted to abandon the lecture-based teaching style, there was great dissatisfaction with the new dialogue-based teaching style as the students did not think that it was possible for them to take responsibility for their learning. They would much rather listen to teachers who know the material. Initially, the teachers were very surprised by the negative attitude of the students and had to change the teaching style to more traditional teaching in groups whilst still maintaining the dialogue principle to a certain degree. In this article, the need to enter into a teaching contract between students and teachers prior to introducing new pedagogical principles is discussed. [ABSTRACT FROM AUTHOR]

This paper presents the experience of the authors in teaching the Matlab™ software to students with different levels of academic training, even though all of them belong to the field of Science. Matlab™ is a worldwide standard in technical programming and computing, and its use is still growing; therefore, it is taught in many different university degree programs (Physics, Mathematics, Engineering, etc.). The course analyzed in this paper contains examples of different fields of knowledge to show the students the versatility and power of this tool. At the end of each course, which consists of 30 h, the students expressed their opinions about the content in a private opinion poll (questionnaire). The results of these opinion polls show that the methodology followed is considered appropriate and useful by the students who attended the course. © 2009 Wiley Periodicals, Inc. Comput Appl Eng Educ 18: 750-756, 2010; View this article online at ; DOI 10.1002/cae.20282 [ABSTRACT FROM AUTHOR]

Background: Social Phobia (SP) is a prevalent disorder in primary-care settings. To date, few researchers have examined the natural course of SP in primary care. We examined the natural course and predictors of recovery in a large sample of primary-care patients. Methods: Data are obtained from the Primary Care Anxiety Project, a naturalistic, longitudinal study of anxiety disorders in primary-care patients. This report pertains to 182 patients with SP at intake. We examined intake demographic and clinical variables as predictors of recovery within the 5 years of follow-up. Results: The probability of recovery from SP during the 5-year follow-up period was .40. At intake, a longer duration of SP episode, comorbid Panic Disorder with Agoraphobia, and lower psychosocial functioning predicted lower rates of recovery. Conclusions: These findings highlight the chronicity of SP, as well as factors that may affect its naturalistic course. It is imperative that primary-care physicians and mental health specialists assess for and treat SP in their practices. Future research is warranted to further examine the effect of medical and psychiatric comorbidity on SP course. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Background Pemphigus vulgaris is a chronic autoimmune mucocutaneous blistering disease. In the last 20 years, immunomodulatory agents have been added to the therapeutic armamentarium. Only few recent studies have evaluated the long-term outcome of pemphigus and possible prognostic parameters in a large group of patients. The aim of this study was to evaluate and analyse the course and prognostic factors of pemphigus in patients followed from 1976 to 2004. Patients and methods The study group consisted of 155 patients attending the pemphigus clinic of a major tertiary-care medical centre. Background, clinical and treatment data were derived from the patient files and telephone contact. Statistical analysis was performed with Pearson correlation, Fisher exact test, and univariate and multivariate logistic regression models. Results Age < 40 years at disease onset, Sephardic Jewish origin, and mucosal involvement at diagnosis and high number of relapses were found to be independent prognostic factors of poor outcome. A long (> 1 year) primary remission was a good prognostic factor. During the 26-year study period, 16 patients died. None of the deaths was directly related to either the disease or a complication of treatment. Conclusions The course and outcome of pemphigus are worse in patients who are young at diagnosis (< 40 years) or of Sephardic Jewish origin. Mucosal involvement at diagnosis and poor response to treatment also predict poor outcome. The mortality rate of pemphigus is apparently lower than reported in the literature, perhaps because of the contemporary use of adjuvant immunomodulatory therapeutic agents. [ABSTRACT FROM AUTHOR]

The term ‘switching’ is often used in bipolar disorder when describing polarity changes in bipolar disorder, but this term is ambiguous and imprecise, and is sometimes used interchangeably with the term ‘cycling’. Furthermore, polarity changes in bipolar disorder can be understood in different ways, because their clinical manifestations range from the emergence of subthreshold symptoms to a full episode of the opposite pole. Besides the need to tighten the meaning of the term ‘switching’, this paper also argues that switching does not adequately describe the complex phenomena that occur with course aggravation of bipolar disorder, such as alteration in episode frequency or amplitude. A more-fine grained approach to course aggravation in bipolar disorder is proposed, which incorporates trans-polar switching, index polarity aggravation, as well as alterations in episodic amplitude, episodic duration, and inter-episode length. This approach has the potential to capture a broader, more fine-grained and clinically relevant picture of the process of aggravation of the bipolar cycle. [ABSTRACT FROM AUTHOR]

The clinical course of myasthenia gravis (MG) is variable, and spontaneous remission is still uncommon. Knowledge of the prognostic factors may help understand the course of MG and thus optimize its management. A systematic review search was conducted in MEDLINE and EMBASE for English language studies from 1985 through 2009. We identified additional studies by reviewing bibliographies of retrieved articles and hand search main journal of neurology. Studies evaluating variables associated with or predictive of remission in adult patients with MG were included. Because of methodological heterogeneity, we refrained from statistical pooling, instead, a best evidence synthesis was used for summarizing the results. From 1810 potentially relevant studies, 13 cohort studies met the inclusion criteria. The included studies were heterogeneous considerably in sample size, disease duration, follow-up years, definition of remission, and analysis. Study quality was limited by retrospective design in most studies and lack of multivariate analysis. Time of diagnosis from onset (<1 year) showed strong evidence of predicting a better remission. In studies using completely stable remission outcomes, there was strong evidence that age at onset (<40 years) was of prognostic importance. Furthermore, gender showed no association with remission. Time of diagnosis from onset and age at onset were found to be predictors of remission. Gender does not seem to predict the course of MG. Our findings should be interpreted with caution because of the clinical and methodological heterogeneity of included studies. [ABSTRACT FROM AUTHOR]