Guts over fear : internet therapy for abdominal pain in children

Background: Pediatric functional abdominal pain disorders (FAPDs) are prevalent and associated with painful symptoms, low quality of life, and functional impairments. The origin is likely multifactorial and includes psychological factors (e.g., anxiety and coping mechanisms), biological factors (e.g., visceral sensitivity and gut microbiota), and social factors (e.g., interaction with parents or teachers). There is limited support for dietary and pharmacological treatments in FAPDs, but support for the effectiveness of cognitive behavioral therapy (CBT) is growing. Aims: The overall aim of the thesis was to develop and evaluate a therapist-supported exposure-based CBT for children 8-12 years with FAPDs, which could, if proven effective, increase accessibility of treatments for children with FAPDs. The specific aims were to: - Assess feasibility, acceptability, and potential effectiveness of the preliminary protocol of exposure-based CBT in a face-to-face setting (Study I). - Assess feasibility, acceptability, and potential effectiveness of the exposure-based CBT converted to an internet platform (Internet-CBT, Study II). - Evaluate effectiveness and cost effectiveness of the Internet-CBT compared with treatment as usual (Study III). - Investigate if gastrointestinal-specific anxiety and avoidance behaviors mediated a change in gastrointestinal symptoms in Internet-CBT compared with treatment as usual and if baseline values of the proposed mediators moderated the mediation (Study IV). Methods: All participants were children 8-12 years with FAPDs referred to the studies by their physicians. Treatment consisted of therapist-supported exposure-based CBT, delivered face-to-face (Study I) or online (studies II-IV) along with parental sessions or modules. All measures were self-assessed by children and parents. Primary outcome was pain intensity (Study I) and gastrointestinal symptoms (Study II-IV). Secondary outcomes included quality of life, school absence, anxiety, and parental responses to their children´s symptoms (Studies I-III), cost effectiveness and parental catastrophizing (Study III), gastrointestinal-specific anxiety (Study II-IV), and avoidance behavior (Study I-IV). Statistical analyses used to test within- and between-group effects were t-tests (Study I) and multi-level linear mixed models (Study II and III). Differences in costs between groups were assessed with generalized linear models (Study III). Univariate and multivariate growth models were used to assess mediation and moderated mediation (Study IV). Results: Therapist-supported exposure-based CBT, delivered face-to-face or online, rendered high adherence and treatment completion (Study I-III). Participating children and parents were satisfied with the treatment and perceived it to be helpful in dealing with abdominal symptoms (Study I-III). There were significant treatment effects in gastrointestinal symptoms, quality of life, gastrointestinal-specific anxiety, avoidance behavior, anxiety, parental catastrophizing, and parental responses to their child’s symptoms for Internet-CBT when compared with treatment as usual (Study III). Internet-CBT was found to be cost effective and even cost saving compared with treatment as usual (Study III). A reduction in gastrointestinal-specific anxiety and avoidance behavior mediated a reduction in gastrointestinal symptoms for children receiving Internet-CBT compared with children receiving treatment as usual (Study IV). Baseline values of gastrointestinal specific-anxiety and avoidance behavior moderated the mediation (Study IV). Conclusions: Internet-CBT based on exposure exercises and parental support for children with FAPDs is feasible, acceptable, clinically effective, and cost effective compared with treatment as usual. Gastrointestinal-specific anxiety and avoidance behavior are potential mechanisms of change in exposure-based Internet-CBT compared with treatment as usual. Internet-CBT seems to be particularly effective for children with high levels of gastrointestinal-specific anxiety and avoidance behaviors. The treatment has the potential to increase the availability of evidence-based treatments a large group of children with FAP

Antibioterapia em medicina dentária, a luta contra as resistências : uma revisão narrativa da literatura

Hoje em dia, os médicos dentistas são grandes prescritores de antibióticos, no entanto devem estar cientes do crescente problema da resistência bacteriana aos antibióticos e ser prudentes na prescrição dos mesmos. A resistência aos antibióticos representa um dos desafios dos tempos actuais. É necessária uma tomada de consciência colectiva de todos dentistas e outros profissionais de saúde, bem como da população, para proteger a eficácia dos antibióticos. Neste trabalho iremos abordar os modos de resistência das bactérias aos antibióticos, o papel do cirurgião-dentista neste combate contra a resistência aos antibióticos, bem como os meios de luta contra esta ameaça para a saúde pública.Nowadays, dentists are great prescribers of antibiotics, however they must be aware of the growing problem of bacterial resistance to antibiotics and be prudent in prescribing them. Antibiotic resistance represents one of the challenges of today. A collective awareness of dentist and other healthcare professionals as well as the general public is necessary to protect the effectiveness of antibiotics. In this thesis we will discuss the ways in which bacteria resist antibiotics, the role of the dentist in this fight against antibiotic resistance, as well as the means of combating this threat to public health

A high degree of direct torque control applied to a grid-connected wind energy system based on a DFIG

This paper presents the performances improvement of a doubly fed induction generator (DFIG) driven by a wind turbine (WT) using direct torque control (DTC). However, the major drawbacks related to DTC are high torque/flux ripples that produce mechanical vibration and disagreeable noise. The use of multilevel inverters seems to be an interesting solution. A three-level voltage source (inverter) converter (3LVSI) connected to the rotor side of the DFIG is considered in this paper. The high freedom degree of the voltage vectors selection in the 3LVSI allows a control with minimal torque and flux ripples. In addition, a fuzzy logic approach is introduced, to ensure an intelligent extraction of the energy sweeping the WT blades. A variable adjustment step enables an optimal extraction in a minimum tracking time with significant reduction of oscillations in the steady state. Simulation results obtained using MATLAB/SIMULINK demonstrate the effectiveness of the 3LVSI-DTC control based on Fuzzy MPPT in the wind energy conversion system (WECS)

Performance Improvement of Hybrid System Based DFIG-Wind/PV/Batteries Connected To DC And AC Grid By Applying Intelligent Control

One of the main causes of CO2 emissions is the production of electrical energy. Therefore, many researchers goal’s is to develop renewable power systems. This paper proposes a new intelligent control development of hybrid PV–Wind-Batteries. Neuro-Fuzzy Direct Power Control (NF-DPC) is invested in order to enhance system performance and generated currents quality. An improved MPPT algorithm based on Fuzzy Controller (FC) is invested for PV power optimization. In addition, a new Modified Fuzzy Direct Power Control (MF-DPC) is developed and applied to the grid side converter to control the active and reactive power by monitoring the involved active power flow and providing a unit power factor by imposing a zero reactive power. An Energy Management Algorithm (EMA) is developed to maintain energy balance, meet the DC load demand, mitigate fluctuations caused by weather condition variations (wind speed and solar irradiance), and minimize battery overcharge and deep discharge. To test the proposed hybrid microgrid system operation, the different parts of the system are modeled, the wind turbine associated to the DFIG, the photovoltaic system as well as the battery storage system. Furthermore, the associated power converters with their control strategies are also presented. Global system simulation, using MATLAB/Simulink, is carried out to validate the effectiveness of both EMA and control techniques. The obtained results show significant reduction of active/reactive power ripples and THD by about 64%, 72%, and 50%, respectively. The EMA ability to manage the energy flow, produced and requested by the load. The THD rate of all injected currents is less than 4%, meaning that the proposed controls will increase the used equipments’ life span, minimize their maintenance and then reduce the hybrid power system cost

Energy Management of a Photovoltaic System with Hybrid Energy Storage Battery-Super capacitor

This paper describes a method for regulating the voltage of a DC bus of the hybrid power system pv/wind associated with storage devices. A hybrid energy storage system (HESS) that combines batteries and super capacitors (SCs) is an interesting solution. The batteries are employed to meet long-term energy requirements, while the using of SCs, to meet immediately the demand for instantaneous power. In this paper, we propose a new management strategy that manages energy flows between storage devices, by maintaining the SOC of super capacitor and the SOC of the batteries at acceptable levels and to reduce stress on batteries and improve their life cycle. the simulation results demonstrate the efficiency of the proposed energy management strategy for the sudden change in power generation and load demand

Internet-delivered cognitive behavior therapy for adolescents with irritable bowel syndrome : a randomized controlled trial

OBJECTIVES: Few treatments have been able to effectively manage pediatric irritable bowel syndrome (IBS). Internet-delivered cognitive behavior therapy (Internet-CBT) based on exposure for abdominal symptoms is effective for adult IBS. The objective of this study was to evaluate the efficacy of Internet-CBT based on behavioral exposure for adolescents with IBS. METHODS: Adolescents with IBS fulfilling the Rome III criteria were randomized to either Internet-CBT or a wait-list control. The Internet-CBT was a 10-week intervention where the main component was exposure to IBS symptoms by reduction of avoidance of abdominal symptoms and instead stepwise provocation of symptoms. The primary outcome was total score on Gastrointestinal Symptoms Rating Scale for IBS (GSRS-IBS). Secondary outcomes included adolescent- and parent-rated quality of life and parent-rated gastrointestinal symptoms. Difference between groups was assessed from pretreatment to posttreatment and the Internet-CBT group was also evaluated at 6 months after treatment completion. RESULTS: A total of 101 adolescents with IBS (13-17 years of age) were included in this study. Dropout rates were low (6%) and all randomized patients were included in intent-to-treat analyses based on mixed effects models. Analyses showed a significant larger pretreatment to posttreatment change on the primary outcome GSRS-IBS (B=-6.42, P=0.006, effect size Cohen's d=0.45, 95% confidence interval (0.12, 0.77)) and on almost all secondary outcomes for the Internet-CBT group compared with the control group. After 6 months, the results were stable or significantly improved. CONCLUSIONS: Internet-CBT based on exposure exercises for adolescents with IBS can effectively improve gastrointestinal symptoms and quality of life.Jane and Dan Olsson foundation, 4-1559/2013Kempe-Carlgrenska foundationRuth and Richard Julin foundation, 2012Juli0048Ishizu Matsumurais DonationMajblomman foundationBengt Ihre research fellowshipBengt Ihre foundation, SLS-331861The Samariten foundationThe Swedish society of medicine, SLS-331681, SLS-410501VärkstadststiftelsenGadelius foundationSwedish Research Council, 521-2013-2846Regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, 20130129Accepte

Development and cross-national investigation of a model explaining participation in WHO-recommended and placebo behaviours to prevent COVID-19 infection

To protect themselves from COVID-19, people follow the recommendations of the authorities, but they also resort to placebos. To stop the virus, it is important to understand the factors underlying both types of preventive behaviour. This study examined whether our model (developed based on the Health Belief Model and the Transactional Model of Stress) can explain participation in WHO-recommended and placebo actions during the pandemic. Model was tested on a sample of 3346 participants from Italy, Japan, Poland, Korea, Sweden, and the US. It was broadly supported: objective risk and cues to action showed both direct and indirect (through perceived threat) associations with preventive behaviours. Moreover, locus of control, decision balance, health anxiety and preventive coping moderated these relationships. Numerous differences were also found between countries. We conclude that beliefs about control over health and perceived benefits of actions are critical to the development of interventions to improve adherence to recommendations

Development and cross‑national investigation of a model explaining participation in WHO‑recommended and placebo behaviours to prevent COVID‑19 infection

To protect themselves from COVID-19, people follow the recommendations of the authorities, but they also resort to placebos. To stop the virus, it is important to understand the factors underlying both types of preventive behaviour. This study examined whether our model (developed based on the Health Belief Model and the Transactional Model of Stress) can explain participation in WHO-recommended and placebo actions during the pandemic. Model was tested on a sample of 3346 participants from Italy, Japan, Poland, Korea, Sweden, and the US. It was broadly supported: objective risk and cues to action showed both direct and indirect (through perceived threat) associations with preventive behaviours. Moreover, locus of control, decision balance, health anxiety and preventive coping moderated these relationships. Numerous differences were also found between countries. We conclude that beliefs about control over health and perceived benefits of actions are critical to the development of interventions to improve adherence to recommendations