The effectiveness of psychological interventions for post-traumatic stress disorder in children, adolescents and young adults: A systematic review and meta-analysis

Background: Children and adolescents display different symptoms of post-traumatic stress disorder (PTSD) than adults. Whilst evidence for the effectiveness of psychological interventions has been synthesised for adults, this is not directly applicable to younger people. Therefore, this systematic review and meta-analysis synthesised studies investigating the effectiveness of psychological interventions for PTSD in children, adolescents and young adults. It provides an update to previous reviews investigating interventions in children and adolescents, whilst investigating young adults for the first time. / Methods: We searched published and grey literature to obtain randomised control trials assessing psychological interventions for PTSD in young people published between 2011 and 2019. Quality of studies was assessed using the Cochrane Risk of Bias tool. Data were analysed using univariate random-effects meta-analysis. / Results: From 15 373 records, 27 met criteria for inclusion, and 16 were eligible for meta-analysis. There was a medium pooled effect size for all psychological interventions (d = −0.44, 95% CI −0.68 to −0.20), as well as for Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) (d = −0.30, 95% CI −0.58 to −0.02); d = −0.46, 95% CI −0.81 to −0.12). / Conclusions: Some, but not all, psychological interventions commonly used to treat PTSD in adults were effective in children, adolescents and young adults. Interventions specifically adapted for younger people were also effective. Our results support the National Institute for Health and Care Excellence guidelines which suggest children and adolescents be offered TF-CBT as a first-line treatment because of a larger evidence base, despite EMDR being more effective

A comparative study of three indices of umbilical blood flow in relation to prediction of growth retardation

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Digestive Duet: Midgut Digestive Proteinases of Manduca sexta Ingesting Nicotiana attenuata with Manipulated Trypsin Proteinase Inhibitor Expression

The defensive effect of endogenous trypsin proteinase inhibitors (NaTPIs) on the herbivore Manduca sexta was demonstrated by genetically altering NaTPI production in M. sexta's host plant, Nicotiana attenuata. To understand how this defense works, we studied the effects of NaTPI on M. sexta gut proteinase activity levels in different larval instars of caterpillars feeding freely on untransformed and transformed plants. Methodology/ Principal Findings Second and third instars larvae that fed on NaTPI-producing (WT) genotypes were lighter and had less gut proteinase activity compared to those that fed on genotypes with either little or no NaTPI activity. Unexpectedly, NaTPI activity in vitro assays not only inhibited the trypsin sensitive fraction of gut proteinase activity but also halved the NaTPI-insensitive fraction in third-instar larvae. Unable to degrade NaTPI, larvae apparently lacked the means to adapt to NaTPI in their diet. However, caterpillars recovered at least part of their gut proteinase activity when they were transferred from NaTPI-producing host plants to NaTPI-free host plants. In addition extracts of basal leaves inhibited more gut proteinase activity than did extracts of middle stem leaves with the same protein content. Conclusions/ Significance Although larvae can minimize the effects of high NaTPI levels by feeding on leaves with high protein and low NaTPI activity, the host plant's endogenous NaTPIs remain an effective defense against M. sexta, inhibiting gut proteinase and affecting larval performance

Infliximab in young paediatric IBD patients : it is all about the dosing

Infliximab (IFX) is administered intravenously using weight-based dosing (5 mg/kg) in inflammatory bowel disease (IBD) patients. Our hypothesis is that especially young children need a more intensive treatment regimen than the current weight-based dose administration. We aimed to assess IFX pharmacokinetics (PK), based on existing therapeutic drug monitoring (TDM) data in IBD patients = 10 years). Median age was 8.3 years (IQR 6.9-8.9) in YP compared with 14.3 years (IQR 12.8-15.6) in OP at the start of IFX. At the start of maintenance treatment, 72% of YP had trough levels below therapeutic range (<5.4 mu g/mL). After 1 year of scheduled IFX maintenance treatment, YP required a significantly higher dose per 8 weeks compared with OP (YP; 9.0 mg/kg (IQR 5.0-12.9) vs. OP; 5.5 mg/kg (IQR 5.0-9.3);p <0.001). The chance to develop antibodies to infliximab was relatively lower in OP than YP (0.329 (95% CI - 1.2 to - 1.01);p <0.001), while the overall duration of response to IFX was not significantly different (after 2 years 53% (n = 29) in YP vs. 58% (n = 45) in OP;p = 0.56). Conclusion: Intensification of the induction scheme is suggested for PIBD patients aged <10 years. What is Known?Peer reviewe