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The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was not promoted by Karanacs 17:32, 22 September 2009 [1].

Rumination syndrome

[edit]
Nominator(s): ʄɭoʏɗiaɲ τ ¢ 08:43, 13 September 2009 (UTC)[reply]
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I am nominating this for featured article because I've essentially nurtured it from dung pile[2] to glory (or something along those lines). My significant other had this disorder for some time, and was recently and successfully treated. One of the major problems with this illness is the huge lack of awareness by doctors and the general public as to its existence (who would favour to instead label its sufferers as bulimic). A successful candidacy and eventual appearance on the front page would be a significant step forward for the awareness of this disorder.

I have terrible command of sentence structure, so there may be some grammar mistakes here and there that other reviewers have missed. Please temporarily excuse the bulleted list under Diagnosis, as I will be cleaning that up tomorrow. I'm happy to fix any problems necessary. Cheers ʄɭoʏɗiaɲ τ ¢ 08:43, 13 September 2009 (UTC)[reply]

  • Oppose. The article needs significant work to be FA quality. I suggest going through peer review first. Here's a first cut of problems that I found, but I didn't read the whole thing carefully.
  • Isn't Rasquin-Weber et al. 1999 (PMID 10457047) a bit dated? It talks about Rome II, whereas Rome III is current. Let's stick with Rome III unless there's a good reason to mention Rome II.
    It isn't used in the discussion of the classification of the disease. The article contains far more information that is irrelevant to both Rome II and Rome III. The Papadolpoulus and Chial reviews deal with classification and nosology. - ʄɭoʏɗiaɲ τ ¢ 22:57, 13 September 2009 (UTC)[reply]
    OK, but still I'd feel better citing newer reviews than a 10-year-old one. 10 years is fairly old in a medical topic that's evolving, as this one is. Are newer reviews available to support the claims that Rasquin-Weber et al. supports? Eubulides (talk) 00:45, 14 September 2009 (UTC)[reply]
    The WebMD website also deals specifically with the childhood illness (Nothing specific)... Is it reliable enough? Tbh, most of the studies cite the Rasquin-Weber article for the limited statements on childhood rumination, so I could just cite the papadopoulis one (Really, almost the entire article could be cited with the chial and papa... studies. I've just gone through them and pulled THEIR citations out so that I reference the journal that they do. This may explain why many statements seem misleading alongside their source. - ʄɭoʏɗiaɲ τ ¢ 15:41, 14 September 2009 (UTC)[reply]
    Normally WebMD is not considered to be as reliable as a peer-reviewed journal article. If all the studies cite Rasquin-Weber to support routine background statements, I suppose it's OK. Is that the most recent review on the overall topic of rumination syndrome? Eubulides (talk) 08:30, 16 September 2009 (UTC)[reply]
    Its the only reliable source that focuses on the disorder in children. - ʄɭoʏɗiaɲ τ ¢ 02:23, 17 September 2009 (UTC)[reply]
  • I checked the citations in Epidemiology and found problems in nearly every sentence:
  • The citations for the claim "Rumination disorder is historically documented" have nothing to do with historical documentation.
    Sure they do. They are recent, but they still show that it is grouped as an infant/childhood disorder, which almost every reference goes on to say otherwise.
    It's true that the ICD classification groups it under infant/childhood disorders, but I don't see anything in the ICD that talks about "historical documentation" or anything like that. If the point is that the ICD is "historical", then that point needs to be directly supported by a reliable source; the ICD classification itself cannot be used to support the claim that the ICD is a historical document. Eubulides (talk) 00:45, 14 September 2009 (UTC)[reply]
  • The citation for the claim "affecting infants and individuals with mental and functional disabilities (the cognitively handicapped)" talks only about infants; it does not talk about the handicapped.
    With the exception of very general and brief claims made in papad(...) and other sources, I haven't found anything on the disorder in the developmentally handicapped. - ʄɭoʏɗiaɲ τ ¢ 15:41, 14 September 2009 (UTC)[reply]
    Weird. Who do they cite? Clearly the most that our article can say would be equally brief and general, perhaps so much so that it should be eliminated? Eubulides (talk) 08:30, 16 September 2009 (UTC)[reply]
    I've cited who they cite (Which is why most of the citations do not directly support the sentence they follow - The sentence is contrived from a review, and cites whatever that review cited. I can see why this would make a lot of information appear as OR and SYN (Although I'm sure that in the process of writing this entire article, I could have synthesized some information by reading so many sources and creating my own "review". Anyways, I haven't gone beyond general statements on the DH version of the disorder. Just what appears in the sources: The 6-10%; that the disorder is the same in infants, but different from the one that affects adults/adolescents, that the disorder is usually the result of under- or over-stimulation, and that aversive behavior therapy is the preferred treatment - ʄɭoʏɗiaɲ τ ¢ 02:31, 17 September 2009 (UTC)[reply]
  • The citations for the claim "Recently, studies have confirmed the presence of the disorder in otherwise healthy adults and adolescents, with a possible equal prevalence." are dated 1995 and 1997, which is hardly recent. The phrase "equal prevalence" is ambiguous: equal in adults versus adolescents, or equal in otherwise normal people versus cognitively handicapped? Papadopoulos & Mimidis 2007 describe the condition as "rare", which hardly squares with the impression given in this section that it affects 6–10% of the population.
    In terms of the overall history of the disease, the recognition and acceptance of it in adults in the past 10-15 years is undeniably recent. - ʄɭoʏɗiaɲ τ ¢ 02:23, 17 September 2009 (UTC)[reply]
  • For the claim "Its occurrence within the general population is largely unknown, due to the privacy of those afflicted, and the improper diagnosis of most sufferers." the cited sources are Papadopoulos & Mimidis 2007 (PMID 17699999) and Chial et al. 2003 (PMID 12509570). I don't see anything in these sources that directly supports the claim. Papadopoulos & Mimidis says it's "rare" and that more investigation is needed, but that's quite a bit different from "largely unknown". Chial et al. is a primary source and doesn't talk about prevalence at all, as far as I can see.
    Tack et al. goes on to explain "The epidemiology of rumination syndrome in the adult general population remains to be carefully defined". Would this be an acceptable reference? I'm just changing "remains to be defined" to "unknown" to simplify it. - ʄɭoʏɗiaɲ τ ¢ 15:41, 14 September 2009 (UTC)[reply]
    I dunno, saying only "unknown" implies that it could be quite common. It'd be more accurate to say something like "rare, with the detailed epidemiology unknown". Eubulides (talk) 08:30, 16 September 2009 (UTC)[reply]
    It now reads "The occurrence of rumination syndrome within the general population has not been defined. (tack et al)
  • For the claim "Studies have shown a mostly female predominance for the condition." but the cited sources (Tack et al. 2006, PMID 16678560) merely says that there is a female predominance (saying nothing about studies) and Chial et al. is a primary source, which shouldn't be directly cited for such a claim. I suggest removing the phrase "Studies have shown" and sticking with something more like the "The overall clinical impression derived from the existing small series of patients, is that rumination is a rare condition that affects more commonly women than men." that is found in Papadopoulos & Mimidis 2007.
    If I copied it word for word from the sources, is it not be plagiarism? I'm taking information from 20 odd sources (Which all agree on the female predominance) and creating a general picture (of the studies), but if it needs to be word for word for word exactly as the sources state then I will make those changes. - ʄɭoʏɗiaɲ τ ¢ 15:41, 14 September 2009 (UTC)[reply]
    Yes, it would be plagiarism, and I wasn't suggesting that. Sorry I wasn't clear. I was trying to say that the article should stick with something that is directly supported by the quoted sentence. Eubulides (talk) 08:30, 16 September 2009 (UTC)[reply]
  • For the claim "The typical age of adolescent onset is 12.9, give or take 0.4 years (±), with males affected sooner than females (11.0 ± 0.8 for males versus 13.8 ± 0.5 for females)." the cited source is a WebMD page that does not discuss age of adolescent onset at all.
    Those are from Chial et al. I'll add that as a citation there.
  • The claim about "the lack of a large study base" is supported only by a citation dated 1907! The article should not be citing ancient sources, except perhaps for the History section.
    It seems the biggest problem is not the lack of citations, but the correct placement of them. - ʄɭoʏɗiaɲ τ ¢ 15:41, 14 September 2009 (UTC)[reply]
The large number of problems in the one section that I looked at carefully is not a good sign, I'm afraid.
Give me 24 hours and I'll have it fixed - ʄɭoʏɗiaɲ τ ¢ 00:07, 14 September 2009 (UTC)[reply]
  • The lead says "Past studies of rumination syndrome have described it as benign. However, more recent studies have described otherwise." and cites Chial et al. to support the latter claim. However, Chial et al. says 'In general, rumination syndrome is a “benign” condition.' The wording in the lead misleadingly implies the reverse of what Chial et al. says. I fear (though I have not read the entire article as carefully as I read Epidemiology) that there is a systematic problem in the article as characterizing rumination syndrome more seriously than the sources do.
    I mistakingly cited it from memory. The other reference does say otherwise though. Chial has been removed. - ʄɭoʏɗiaɲ τ ¢ 15:41, 14 September 2009 (UTC)[reply]
    Actually, a more careful examination of chial brings up "In general, rumination syndrome is a “benign” condition.(ref) However, our study demonstrates significant functional disability related to weight loss, school and work absenteeism, hospitalization, and extensive diagnostic testing in pediatric and adolescent patients with rumination."
    This to me rings of "This study says benign,(ref) however, our results show significant non-benign traits" - ʄɭoʏɗiaɲ τ ¢ 16:10, 14 September 2009 (UTC)[reply]
    And after a bit more searching, I found this journal entry that claims "Originally rumination was labeled benign;{ref: Levine et al. (Rumination, a benign disorder)} however, it is now known to cause such complications as weight loss, malnutrition, dental erosions, halitosis, electrolyte abnormalities,{ref: O'Brien et al.} abdominal discomfort, weight loss,{ref: Chial et al.} choking, aspiration, and pneumonia.{new ref that isn't in the wikipedia article}" - ʄɭoʏɗiaɲ τ ¢ 02:19, 16 September 2009 (UTC)[reply]
    None of those sources are contradictory. They all paint a picture of a syndrome that is generally benign, but which in some cases can cause significant complications. Eubulides (talk) 08:30, 16 September 2009 (UTC)[reply]
    Perhpas we get different ideas. I see it as them labelling that it has been described benign by another study (Which every article that says it is benign points solely to that one study from 1983!), but that they have found all these clearly non-benign symptoms (insert long list here).
Eubulides (talk) 19:13, 13 September 2009 (UTC)[reply]
I can make the changes necessary. Please change oppose to comment for now, and I will respond shortly when I have made your changes. I placed some responses to some of your points, as they seem to come from the angle that the studies are flawed based on dates. None of the studies have been contradicted by later studies.
Thanks for responding to the comment and volunteering to work on the article. I'll strike the oppose once the article's state improves enough (isn't that the normal way things are done? I'm not up to speed on etiquette here). Eubulides (talk) 00:45, 14 September 2009 (UTC)[reply]
Yes, that's the norm. SandyGeorgia (Talk) 04:22, 14 September 2009 (UTC)[reply]
I have no idea... I'm more familiar with the village pump proposals where comments are made first and then its put to a vote. This is my first FAC actually so I don't know the drills, besides the broad criteria. I think the main problem is that I cited my references pretty casually, assuming that they could just be brought up at the end of long statements. Anyways, I've made some changes/replies. I imagine you will find more stuff in other section. It's odd because the article did go through a peer review. Don't respond right away, I've made a mess and I need to get my bearings straight on what I have fixed and what I need to fix. - ʄɭoʏɗiaɲ τ ¢ 15:39, 14 September 2009 (UTC)[reply]
Ok, I think I've fixed Epidemiology up. If you notice every section has this problem, just say that, and I'll withdraw and open a peer review. I'd ask you to do it... You seem extra, extra thorough, and that's exactly what this needs. - ʄɭoʏɗiaɲ τ ¢ 16:22, 14 September 2009 (UTC)[reply]
Break
I looked again at Epidemiology. But I'm afraid that it still has problems:
  • The lead image is nearly impossible to make out at typical Wikipedia thumbnail sizes. And I'm not sure it's appropriate here. It's from a primary study, and reflects just one study with a not-that-large sample size. The image connotes far more precision than the data actually have.
    That image is from a single patient, it isn't a collection of results made into a single graph. I'm not sure what you mean by the last sentence, but the graph is a visual representation of something that almost every study mentions (That is, the characteristic R-waves in the abdomen. I'm certain a better image is possible in the lead, but I think that image belongs somewhere in the article at the least. - ʄɭoʏɗiaɲ τ ¢ 02:23, 17 September 2009 (UTC)[reply]
    Sorry... Not sure if you mean the lead photo of the article, or the leaf photo in Epidemiology. If it's the latter, I only added it because there are no useful images. I have no quarrel to removing it. Perhaps one of those Haagstrom(?) diagrams would be good for the article? - ʄɭoʏɗiaɲ τ ¢ 02:59, 17 September 2009 (UTC)[reply]
  • The lead sentence "Rumination disorder is historically documented affecting newborns, infants, children and individuals with mental and functional disabilities (the cognitively handicapped)." appears to be original research, in the sense that none of the cited sources directly support the central claim that RD is "historically documented". To support that claim one cannot merely cite a list of old papers and diagnostic criteria; instead, one must cite a source saying that there's historical documentation.
    Changed to "rumination syndrome was classified affecting only..."
  • Rogers et al. 1992 (PMID 1562309) is quite a dated and limited primary source, focusing on institutionalized adults with severe MR. It cannot be used to support a more general claim about "individuals with mental and functional disabilities (the cognitively handicapped)", a much larger set of people. Particularly when the next sentence makes it clear that this larger set includes children. Let's not be citing ancient primary sources in this article. Better yet, let's not be citing primary sources at all; I don't see the need for them given that we have good reviews.
    As I mentioned, some people have made mention of relying too heavily on one source. If I only include the reviews, there'd be max 6 sources that are each referenced 25 odd times. Rogers et al focuses on institutionalized adults (Which no other source or review does). Every other study makes the claim that it occurs in individuals with mental and functional disabilities. Likewise, I shouldn't cite an ancient (1983) study which studied the disease in 9 patients, 7 of which the study later explains had likely had the disease since infancy (And thus a completely different situation that those who acquire it in adolescence and adulthood).
  • "Among the latter, it is described with almost equal prevalence among infants (6–10% of the population) and adults (8–10%)." The cited source doesn't compare MR infants to MR adults; it compares MR infants to institutionalized MR adults.
    Fixed - ʄɭoʏɗiaɲ τ ¢ 02:43, 17 September 2009 (UTC)[reply]
  • "In mentally healthy infants, it typically occurs within the first 3–12 months of age and can lead to can lead to malnutrition." The cited source does not talk about "mentally healthy". It says infant rumination syndrome must (not "typically") start between 3 and 8 (not "12") months of age. The phrase "can lead to" is duplicated. Not sure why a complication (malnutrition) is mentioned here.
    It doesn't talk about cognitively impaired infants either. I have to add more sources to that because those ranges are not agreed upon between some study (somewhere), and Rome III - ʄɭoʏɗiaɲ τ ¢ 02:43, 17 September 2009 (UTC)[reply]
  • "Studies have confirmed the presence of the disorder in otherwise healthy adults and adolescents." This cites two primary studies. For a sentence like this "Studies have confirmed" we need a review that says that studies have confirmed it. Citing the primary sources directly in order to assert an overall pattern is original research.
    changed to "It has since been recognized to occur in both males and females of all ages and cognitive abilities." citing Papad(...) and Olden et al. - ʄɭoʏɗiaɲ τ ¢ 02:43, 17 September 2009 (UTC)[reply]
  • "Its occurrence within the general population is unknown, due to the privacy of those afflicted, and the improper diagnosis of most sufferers." The cited sources don't talk about privacy or improper diagnosis. One of them says that clinical impression suggests it is rare in adults; this rareness should be mentioned.
    Removed extra stuff. Its mentioned somewhere, but not in connection with the lack of a known epidemiology. That rareness, however, is refuted by fox et al. (2006) And it would be impossible to determine something as rare or not when you've studied about 150 patients, especially in terms of a disorder that is so often diagnosed as Bulimia. It is a flawed generalization. - ʄɭoʏɗiaɲ τ ¢ 02:43, 17 September 2009 (UTC)[reply]
  • Other sources do. It's going to be absolutely insane to have to source 6 different papers in order to use each individual word that is used in a sentence. - ʄɭoʏɗiaɲ τ ¢ 02:23, 17 September 2009 (UTC)[reply]
  • "Studies have shown a mostly female predominance" The cited source doesn't say that studies have shown it.
    I'm just trying to be less absolute. Changed it to a fact rather than a claim. - ʄɭoʏɗiaɲ τ ¢ 02:23, 17 September 2009 (UTC)[reply]
  • "The typical age of adolescent onset is 12.9, give or take 0.4 years (±), with males affected sooner than females (11.0 ± 0.8 for males versus 13.8 ± 0.5 for females)." These are numbers taken from a single primary study, which may well not be representative; they should not be given as gospel.
    Until another study is released that deals with epidemiology, those are the only results. I will include as much information as possible, but this isn't influenza, so most of it rests upon a single source. Chial et al is sourced by every paper released after it. Primary or not, it is perhaps the most significant and in-depth study done on the subject. - ʄɭoʏɗiaɲ τ ¢ 02:23, 17 September 2009 (UTC)[reply]
  • "The lack of a large study base has produced little evidence concerning the impact of race and hereditary causes in rumination syndrome." This claim is unsourced.
    Fixed. - ʄɭoʏɗiaɲ τ ¢ 02:23, 17 September 2009 (UTC)[reply]
  • "However, case reports involving entire families with rumination exist." This claim has just the 1907 source. Is that the best we've got? It's pretty weak.
    Why? It is a familial case report. Thats a pretty good source to backup the claim that "case reports involving entire families with rumination exist." - ʄɭoʏɗiaɲ τ ¢ 02:23, 17 September 2009 (UTC)[reply]
Eubulides (talk) 08:30, 16 September 2009 (UTC)[reply]
Fixed. Totally missed filling those in yesterday. - ʄɭoʏɗiaɲ τ ¢ 15:33, 17 September 2009 (UTC)[reply]
The image is created entirely by me based upon a (potentially) copyrighted work, which is perfectly acceptable by our rules I've been told many times. I've released my version to CC 3.0 - ʄɭoʏɗiaɲ τ ¢ 15:33, 17 September 2009 (UTC)[reply]
OK, fair enough. Image check complete. Stifle (talk) 14:54, 19 September 2009 (UTC)[reply]
The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.
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