Intolerance of uncertainty, anxiety and worry in children and adolescents: a meta-analysis

Background Intolerance of uncertainty (IU) has been implicated in the development and maintenance of worry and anxiety in adults and there is an increasing interest in the role that IU may play in anxiety and worry in children and adolescents. Method We conducted a systematic review and meta-analysis to summarize existing research on IU with regard to anxiety and worry in young people, and to provide a context for considering future directions in this area of research. The systematic review yielded 31 studies that investigated the association of IU with either anxiety or worry in children and adolescents. Results The meta-analysis showed that IU accounted for 36% of the variance in anxiety and 39.69% in worry. Due to the low number of studies and methodological factors, examination of potential moderators was limited; and of those we were able to examine, none were significant moderators of either association. Most studies relied on questionnaire measures of IU, anxiety, and worry; all studies except one were cross-sectional and the majority of the studies were with community samples. Limitations The inclusion of eligible studies was limited to studies published in English that focus on typically developing children. Conclusions There is a strong association between IU and both anxiety and worry in young people therefore IU may be a relevant construct to target in treatment. To extend the existing literature, future research should incorporate longitudinal and experimental designs, and include samples of young people who have a range of anxiety disorder

Intolerance of uncertainty, anxiety, and worry in children and young people: improving assessment of intolerance of uncertainty in preadolescent children

Anxiety disorders are one of the most common mental health problems among children and adolescents. Studies in adults suggest that intolerance of uncertainty (IU) is closely linked to a range of anxiety disorders; however, there is a relative lack of research focusing on IU in children and young people. Four studies are presented in this thesis that together aim to: 1. review existing evidence for associations between IU, anxiety, and worry in children and adolescents; 2. begin addressing issues around the assessment of IU in preadolescent children. Study 1, a meta-analysis of the current literature on IU, anxiety, and worry in children and adolescents revealed robust relationships between IU and both anxiety and worry. Following this, study 2 assessed the psychometric properties of the current child IU questionnaire measure in a preadolescent sample. Although the measure showed good psychometric properties, younger children had some difficulty understanding certain items. Studies 3 and 4 adapted behavioural tasks designed to assess IU and evaluated the suitability of these tasks for preadolescent children. Further, these studies examined children’s reactions to uncertainty and explored whether these tasks can capture reactions to uncertainty that are related with self-reported IU, anxiety and worry. Both studies concluded that the tasks were suitable for preadolescent children. In addition, general reactions to uncertainty manipulations such as increased worry, more information seeking and longer reaction times were found, although there was some task specificity. There was some evidence that responses on these tasks may be associated with IU, but this was strongest for subjective reports of task-related certainty rather than objective measures of task performance. Overall, these studies provide a systematic overview of the current IU literature in children and young people, reveal shortcomings of the self-reported IU for younger children and provide new assessments to measure IU in preadolescent children. The work presented in this thesis underlines the importance of taking age and cognitive development into account when designing and selecting IU assessments in children and leads to several suggestions for future research in order to improve understanding of the IU specific mechanisms across development

Immunomodulatory function and in vivo properties of pediococcus pentosaceus OZF, a promising probiotic strain

Some of the important properties of probiotics are the ability to survive during gastrointestinal transit and to modulate the immune functions. The objectives of the reported study were to assess in vivo gastrointestinal survival of orally administered Pediococcus pentosaceus OZF using an animal model BALB/c mice, and to examine its effects on the immune response. Following oral administration to mice, the ability of Pediococcus pentosaceus OZF to pass and survive through the mouse gastrointestinal system was investigated by analyzing the recovery of the strain in fecal samples. Microbiological and polymerase chain reaction (PCR) methods proved that the strain OZF could overcome specific conditions in the gastrointestinal tract of mice and reach the intestine alive after ingestion. To observe the effect of oral administration on immune response, IL-6, IL-12 and IFN-γ were measured by ELISA, and the strain OZF was found to cause increases in IL-6 synthesis in regularly fed mice. However, stimulation was carried out with various concentrations of bacterial ssDNA and heat killed cells of Pediococcus pentosaceus OZF. The heat killed cells of the strain OZF were shown to produce IFN- γ independently from IL-12. On the other hand, a significant difference between control and experimental group was noticed when lipopolysaccharide, a TLR4 (toll like receptor) ligand, was used. Overall, Pediococcus pentosaceus OZF may be a valuable probiotic strain for therapeutic uses. Nevertheless, further studies on the mechanisms of immunomodulatory effect will allow for better clarification of the immune functions of this strain. © Springer-Verlag Berlin Heidelberg and the University of Milan 2012

The HELLP syndrome: Clinical issues and management. A Review

<p>Abstract</p> <p>Background</p> <p>The HELLP syndrome is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. The present review highlights occurrence, diagnosis, complications, surveillance, corticosteroid treatment, mode of delivery and risk of recurrence.</p> <p>Methods</p> <p>Clinical reports and reviews published between 2000 and 2008 were screened using Pub Med and Cochrane databases.</p> <p>Results and conclusion</p> <p>About 70% of the cases develop before delivery, the majority between the 27th and 37th gestational weeks; the remainder within 48 hours after delivery. The HELLP syndrome may be complete or incomplete. In the Tennessee Classification System diagnostic criteria for HELLP are haemolysis with increased LDH (> 600 U/L), AST (≥ 70 U/L), and platelets < 100·10⁹/L. The Mississippi Triple-class HELLP System further classifies the disorder by the nadir platelet counts. The syndrome is a progressive condition and serious complications are frequent. Conservative treatment (≥ 48 hours) is controversial but may be considered in selected cases < 34 weeks' gestation. Delivery is indicated if the HELLP syndrome occurs after the 34th gestational week or the foetal and/or maternal conditions deteriorate. Vaginal delivery is preferable. If the cervix is unfavourable, it is reasonable to induce cervical ripening and then labour. In gestational ages between 24 and 34 weeks most authors prefer a single course of corticosteroid therapy for foetal lung maturation, either 2 doses of 12 mg betamethasone 24 hours apart or 6 mg or dexamethasone 12 hours apart before delivery. Standard corticosteroid treatment is, however, of uncertain clinical value in the maternal HELLP syndrome. High-dose treatment and repeated doses should be avoided for fear of long-term adverse effects on the foetal brain. Before 34 weeks' gestation, delivery should be performed if the maternal condition worsens or signs of intrauterine foetal distress occur. Blood pressure should be kept below 155/105 mmHg. Close surveillance of the mother should be continued for at least 48 hours after delivery.</p