Psychological Outcomes of a Cognitive Behavioral Therapy for Youth with Inflammatory Bowel Disease: Results of the HAPPY-IBD Randomized Controlled Trial at 6-and 12-Month Follow-Up

Youth with infammatory bowel disease (IBD) often experience psychological difculties, such as anxiety and depression. This randomized controlled study tested whether a 3-month disease-specifc cognitive behavioral therapy (CBT) in addition to standard medical care versus standard medical care only was efective in improving these youth’s psychological outcomes. As this study was aimed at prevention, we included 70 youth (10–25 years) with IBD and symptoms of subclinical anxiety and/ or depression, and measured psychological outcomes at 6- and 12-month follow-up. In general, participants in both groups showed improvements in anxiety, depression, health-related quality of life, social functioning, coping, and illness perceptions, sustained until 12 months follow-up. Overall, we found no diferences between those receiving additional CBT and those receiving standard medical care only. We assume that this can be explained by the perceived low burden (both somatically and psychologically) or heightened awareness of psychological difculties and IBD

Structural Consequences of Anionic Host-Cationic Guest Interactions in a Supramolecular Assembly

The molecular structure of the self-assembled supramolecular assembly [M{sub 4}L{sub 6}]{sup 12-} has been explored with different metals (M = Ga{sup III}, Fe{sup III}, Ti{sup IV}) and different encapsulated guests (NEt{sub 4}{sup +}, BnNMe{sub 3}{sup +}, Cp{sub 2}Co{sup +}, Cp*{sub 2}Co{sup +}) by X-ray crystallography. While the identity of the metal ions at the vertices of the M{sub 4}L{sub 6} structure is found to have little effect on the assembly structure, encapsulated guests significantly distort the size and shape of the interior cavity of the assembly. Cations on the exterior of the assembly are found to interact with the assembly through either {pi}-{pi}, cation-{pi}, or CH-{pi} interactions. In some cases, the exterior guests interact with only one assembly, but cations with the ability to form multiple {pi}-{pi} interactions are able to interact with adjacent assemblies in the crystal lattice. The solvent accessible cavity of the assembly is modeled using the rolling probe method and found to range from 253-434 {angstrom}{sup 3}, depending on the encapsulated guest. Based on the volume of the guest and the volume of the cavity, the packing coefficient for each host-guest complex is found to range from 0.47-0.67

Effectiveness of disease-specific cognitive-behavioural therapy on depression, anxiety, quality of life and the clinical course of disease in adolescents with inflammatory bowel disease

_Introduction:_ Adolescents with inflammatory bowel disease (IBD) show a higher prevalence of depression and anxiety, compared to youth with other chronic diseases. The inflammation-depression hypothesis might explain this association, and implies that treating depression can decrease intestinal inflammation and improve disease course. The present multicentre randomised controlled trial aims to test the effectiveness of an IBD-specific cognitive–behavioural therapy (CBT) protocol in reducing symptoms of subclinical depression and anxiety, while improving quality of life and disease course in adolescents with IBD. _Methods and analysis:_ Adolescents with IBD (10– 20 years) from 7 hospitals undergo screening

Primary care obesity management in Hungary: evaluation of the knowledge, practice and attitudes of family physicians

BACKGROUND: Obesity, a threatening pandemic, has an important public health implication. Before proper medication is available, primary care providers will have a distinguished role in prevention and management. Their performance may be influenced by many factors but their personal motivation is still an under-researched area. METHOD: The knowledge, attitudes and practice were reviewed in this questionnaire study involving a representative sample of 10% of all Hungarian family physicians. In different settings, 521 practitioners (448 GPs and 73 residents/vocational trainees) were questioned using a validated questionnaire. RESULTS: The knowledge about multimorbidity, a main consequence of obesity, was balanced.Only 51% of the GPs were aware of the diagnostic threshold for obesity; awareness being higher in cities (60%) and the highest among residents (90%). They also considered obesity an illness rather than an aesthetic issue.There were wider differences regarding attitudes and practice, influenced by the the doctors' age, gender, known BMI, previous qualification, less by working location.GPs with qualification in family medicine alone considered obesity management as higher professional satisfaction, compared to physicians who had previously other board qualification (77%vs68%). They measured their patients' waist circumference and waist/hip ratio (72%vs62%) more frequently, provided the obese with dietary advice more often, while this service was less frequent among capital-based doctors who accepted the self-reported body weight dates by patients more frequently / commonly. Similar reduced activity and weight-measurement in outdoor clothing were more typical among older doctors.Diagnosis based on BMI alone was the highest in cities (85%). Consultations were significantly shorter in practices with a higher number of enrolled patients and were longer by female providers who consulted longer with patients about the suspected causes of developing obesity (65%vs44%) and offered dietary records for patients significantly more frequently (65%vs52%). Most of the younger doctors agreed that obesity management was a primary care issue.Doctors in the normal BMI range were unanimous that they should be a model for their patients (94%vs81%). CONCLUSION: More education of primary care physicians, available practical guidelines and higher community involvement are needed to improve the obesity management in Hungary

Aryl Bridged 1-Hydroxypyridin-2-one: Effect of the Bridge on the Eu(III) Sensitization 'Process

The efficiency of Eu3+ luminescence by energy transfer from an antenna ligand can be strongly dependent on the metal ion coordination geometry. The geometric component of the Eu(III) sensitization has been probed using series of tetradentate 1,2-HOPO derivatives that are connected by bridges of varying length and geometry. The ligands are N,N'-(1,2-phenylene)bis(1-hydroxy-6-oxo-1,6-dihydropyridine-2-carboxamide) for the ligand (L{sup 1}), 1-hydroxy-N-(2-(1-hydroxy-6-oxo-1,6-dihydropyridine-2-carboxamido)benzyl)-6-oxo-1,6-dihydropyridine-2-carboxamide (L{sup 2}) and N,N'-(1,2-phenylenebis(methylene))bis(1-hydroxy-6-oxo-1,6-dihydropyridine-2-carboxamide) (L{sup 3}). Spectroscopic characterization of both the Gd(III) and Eu(III) metal complexes, TD-DFT analysis of model compounds and evaluation of the kinetic parameters for the europium emission were completed. Some striking differences were observed in the luminescence quantum yield by altering the bridging unit. The [Eu(L{sup 2}){sub 2}]{sup -} derivative shows efficient sensitization coupled with good metal centered emission. For [Eu(L{sup 3}){sub 2}]{sup -}, the large quenching of the luminescence quantum yield compared to [Eu(L{sup 2}){sub 2}]{sup -} is primarily a result of one inner sphere water molecule bound to the europium cation while for [Eu(L{sup 1}){sub 2}]{sup -}, the low luminescence quantum yield can be attributed to inefficient sensitization of the europium ion

What do changes in inflammatory bowel disease management mean for our patients?

Treatment goals in Crohn's disease are evolving beyond the control of symptoms. A treat-to-target approach to management that features earlier initiation of TNF antagonist therapy will enable resolution of objective parameters of inflammation. The decision to initiate anti-TNF therapy should be based on a patient-specific assessment of risks and benefits. This paradigm necessitates a complex process, influenced by multiple factors that include the quality of data available, physicians' and patients' knowledge of the data, and the preferences and values of patients, physicians and society. The potential 'opportunity cost' resulting from a delay in initiation of effective therapy, a consideration that has been neglected in the past, must also enter into the equation. Our evolving approach to the management of Crohn's disease challenges patients to participate in the decision-making process and to become an active partner in their care. Ideally, this evolution should occur within the context of an enduring physician/patient relationship that is based on mutual trust. Motivational communication provides a useful technique to improve dialogue and collaboration between healthcare professionals and patients, and may help to engage and motivate patients to commit to managing their disease. (C) 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserve