A Randomized Controlled Trial of an Online Intervention to Improve Gluten-Free Diet Adherence in Celiac Disease

Objectives: To test the effectiveness of an interactive online intervention to improve gluten free diet adherence in adults with celiac disease. Methods: A Randomized controlled trial was conducted. A total of 189 adults with biopsy-confirmed celiac disease were recruited and randomized to receive the intervention (n=101) or to a waitlist control condition (n=88). Post-intervention data was available for 70 intervention and 64 waitlist participants. Three month follow-up data was obtained for 46/50 completers from the intervention group. The primary outcome measure was gluten-free diet adherence. Secondary outcomes were gluten-free diet knowledge, quality of life and psychological symptoms. Results: Results were based on intention-to-treat analyses. The intervention group evidenced significantly improved gluten-free diet adherence, and gluten-free diet knowledge following the treatment period relative to the waitlist control group. The change in knowledge did not contribute to the change in adherence. These improvements were maintained at 3-month’ follow-up. Conclusions: The online program was effective in improving adherence and represents a promising resource for individuals with celiac disease who are struggling to achieve or maintain adequate gluten free diet adherence

Cerebellar mutism syndrome in children with brain tumours of the posterior fossa

Background: Central nervous system tumours constitute 25% of all childhood cancers; more than half are located in the posterior fossa and surgery is usually part of therapy. One of the most disabling late effects of posterior fossa tumour surgery is the cerebellar mutism syndrome (CMS) which has been reported in up to 39% of the patients but the exact incidence is uncertain since milder cases may be unrecognized. Recovery is usually incomplete. Reported risk factors are tumour type, midline location and brainstem involvement, but the exact aetiology, surgical and other risk factors, the clinical course and strategies for prevention and treatment are yet to be determined. Methods: This observational, prospective, multicentre study will include 500 children with posterior fossa tumours. It opened late 2014 with participation from 20 Nordic and Baltic centres. From 2016, five British centres and four Dutch centres will join with a total annual accrual of 130 patients. Three other major European centres are invited to join from 2016/17. Follow-up will run for 12 months after inclusion of the last patient. All patients are treated according to local practice. Clinical data are collected through standardized online registration at pre-determined time points pre- and postoperatively. Neurological status and speech functions are examined pre- operatively and postoperatively at 1-4 weeks, 2 and 12 months. Pre- and postoperative speech samples are recorded and analysed. Imaging will be reviewed centrally. Pathology is classified according to the 2007 WHO system. Germline DNA will be collected from all patients for associations between CMS characteristics and host genome variants including pathway profiles. Discussion: Through prospective and detailed collection of information on 1) differences in incidence and clinical course of CMS for different patient and tumour characteristics, 2) standardized surgical data and their association with CMS, 3) diversities and results of other therapeutic interventions, and 4) the role of host genome variants, we aim to achieve a better understanding of risk factors for and the clinical course of CMS - with the ultimate goal of defining strategies for prevention and treatment of this severely disabling condition.Peer reviewe

The role of adverse childhood experiences as determinants of non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings

Celem badania było określenie rozpowszechnienia oraz wpływu negatywnych doświadczeń w dzieciństwie na występowanie samookaleczeń bez intencji samobójczych (non-suicidal self-injury, NSSI) u dzieci i młodzieży, w kontekście środowiskowej oraz szpitalnej opieki zdrowia psychicznego. Dane do badania uzyskano ze zbioru interRAI – Zdrowie Psychiczne Dzieci i Młodzieży (Child and Youth Mental Health). Zbadano łącznie 2038 dzieci i nastolatków w wieku 8–18 lat (M = 12,49, SD = 2,88, 61,1% badanych było płci męskiej). Przeprowadzono dwuczynnikową regresję logistyczną w celu identyfikacji predyktorów NSSI jako funkcji negatywnych doświadczeń z dzieciństwa, depresji i wsparcia społecznego, przy jednoczesnym kontrolowaniu wieku, płci, typu pacjenta, opieki prawnej, stanu cywilnego rodziców/opiekunów, historii umieszczenia w rodzinie zastępczej i diagnozy zdrowia psychicznego. Spośród 2038 badanych dzieci i nastolatków u 592 (29%) występowały NSSI. W wieloczynnikowym modelu regresji logistycznej wykazano, że szanse wystąpienia NSSI u dzieci i nastolatków, które doświadczyły przemocy fizycznej, były o 49% większe, a u dzieci i nastolatków, które zostały wykorzystane seksualnie, o 60% większe, w porównaniu z osobami, które nie doświadczyły przemocy. Inne predyktory NSSI to: starszy wiek, płeć żeńska, hospitalizacja, depresja, zespół nadpobudliwości psychoruchowej z deficytem uwagi, destrukcyjne zaburzenia zachowania i zaburzenia nastroju. U dzieci i nastolatków, które otrzymały jakąś formę wsparcia społecznego, szanse wystąpienia NSSI malały o 26%. Procedury oceny wskaźników zdrowia psychicznego, zwłaszcza u dzieci i nastolatków z historią negatywnych doświadczeń w dzieciństwie, powinny zatem uwzględniać NSSI. Wzmocnienie sieci wsparcia społecznego oraz zwrócenie uwagi na depresję i powiązane z nią umiejętności regulacji emocji w dzieciństwie mogą pomóc zapobiegać NSSI wśród dzieci i młodzieży.The objectives of this study were to examine the prevalence of, and determine the effect of adverse childhood experiences on non-suicidal self-injury among children and adolescents referred to community and inpatient mental health settings. Data for this study were obtained from the interRAI Child and Youth Mental Health dataset. A total of 2038 children and adolescents aged 8–18 years (M = 12.49; SD = 2.88, 61.1% males) were analyzed. Binary logistic regression was fitted to identify predictors of non-suicidal self-injury as a function of adverse childhood experiences, depression, and social support while simultaneously controlling for age, gender, type of patient, legal guardianship, marital status of parents/caregivers, history of foster family placement, and mental health diagnoses. Of the 2038 children and adolescents examined, 592 (29%) of this clinical sample engaged in non-suicidal self-injury. In the multivariate logistic regression model, children and adolescents who were physically abused had 49% higher odds of engaging in non-suicidal self-injury and children and adolescents who were sexually abused had 60% higher odds of engaging in non-suicidal self-injury, when compared to their non-abused counterparts. Other predictors of non-suicidal self-injury include: older age, female gender, inpatient status, depression, attention deficit-hyperactivity disorder, disruptive behavior disorder, and mood disorders. Children and adolescents who had some form of social support had a 26% decrease in the odds of engaging in non-suicidal self-injury. Assessment procedures for indicators of mental health, particularly among children and adolescents with a history of adverse childhood experiences, should also take into account non-suicidal self-injury. In addition to bolstering social support networks, addressing depression and related emotion regulation skills in childhood may help prevent future non-suicidal self-injury behaviors