An analysis of integrated health care for Internet Use Disorders in adolescents and adults

Background and aims Although first treatment approaches for Internet Use Disorders (IUDs) have proven to be effective, health care utilization remained low. New service models focus on integrated health care systems, which facilitate access and reduce burdens of health care utilization, and stepped-care interventions, which efficiently provide individualized therapy. Methods An integrated health care approach for IUD intended to (a) be easily accessible and comprehensive, (b) cover a variety of comorbid syndromes, and (c) take heterogeneous levels of impairment into account was investigated in a one-armed prospective intervention study on n = 81 patients, who were treated from 2012 to 2016. Results First, patients showed significant improvement in Compulsive Internet Use over time, as measured by hierarchical linear modeling. Effect sizes of outcome change from baseline to 6-month follow-up ranged from d = 0.48 to d = 1.46. Second, differential effects were found depending on patients’ compliance, demonstrating that high compliance resulted in significantly higher rates of change. Third, patients referred to minimal interventions did not differ significantly in amount of change from patients referred to intensive psychotherapy. Discussion Tailored interventions result in higher efficiency through optimized resource allocation and equal amounts of symptom change in all treatment conditions. Moreover, comprehensive, low-threshold interventions seem to increase health service utilization

Nejapa Tephra: The youngest (c. 1kaBP) highly explosive hydroclastic eruption in western Managua (Nicaragua)

Nejapa Maar (2.5 × 1.4 km, c. 120 m deep), the largest maar along the 15-km-long Holocene Nejapa–Miraflores Lineament (NML), is the source vent of the youngest relatively widespread basaltic tholeiitic tephra blanket (Nejapa Tephra: NT) in western central Nicaragua, as shown by isopachs and isopleths (Rausch and Schmincke, 2008). The NT covers an area of > 10 km2 in W/NW Managua. The minimum total magma volume erupted is estimated as 0.09 km3. Juvenile, dominantly slightly vesicular (20–40 vol.%) basically tachylitic cauliflower-shaped lapilli with an average density of 2.1 g/cm3, make up > 90 vol.% of the deposit, while lithoclasts comprise < 10 vol.% except proximally. This, the paucity of fine-grained tuffs and the dominant plane-parallel bedding all suggest fragmentation by shallow interaction of a rising magma starting to vesiculate and fragment pyroclastically with external water. The complex particles so generated erupted in moderately high eruption columns (at least 7–10 km) and were dominantly deposited as dry to damp, warm to cool fallout. Minor surge transport is inferred from fine-grained, locally cross-bedded tephra beds chiefly north of Nejapa and just west of Asososca Maars. Synvolcanic faulting along the NML is inferred. Faults in the study area indicate that activation of the N–S-trending Nejapa–Miraflores Fault (NMF), representing the western flank of Managua Graben, preceded deposition of NT and underlying Masaya Tuff (c.1.8 ka BP), Chiltepe Pumice (c. 1.9 ka BP) and Masaya Triple Layer (2.1 ka BP). The NT deposit is underlain regionally by a paleosol and topped by a soil. The basal paleosol contains pottery sherds made by the Usulután negative technique during the Late Formative period (700 BCE–300 CE) (2.7–1.7 ka BP). The soil overlying NT contains pottery related to the Ometepe technique dated as between 1350 and 1550 CE (650–450 a BP). These, and the radiocarbon dates of the pottery-bearing paleosols (1245 ± 125 and 535 ± 110 a BP) obtained by Pardo et al. (2008) indicate that Nejapa Maar erupted between c. 1.2 and 0.6 ka BP. Future eruptions in this area of similar magnitude, eruptive and transport mechanisms would represent a major hazard and risk to the densely populated western suburbs of Managua, a city expanding rapidly westward. Assuming a similar eruption scenario, poor-quality roofs, common in Nicaragua, would be prone to collapse up to 12 km peripheral to Nejapa Maar or another close-by eruptive site, and buildings at a distance of up to 500 m are likely to be severely affected. In view of the past frequency of eruptions along the NML, further eruptions are likely to occur in the near future

Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial.

BACKGROUND & AIMS: Swallowed topical-acting corticosteroids are recommended as first-line therapy for eosinophilic esophagitis (EoE). Asthma medications not optimized for esophageal delivery are sometimes effective, although given off-label. We performed a randomized, placebo-controlled trial to assess the effectiveness and tolerability of a budesonide orodispersible tablet (BOT), which allows the drug to be delivered to the esophagus in adults with active EoE. METHODS: We performed a double-blind, parallel study of 88 adults with active EoE in Europe. Patients were randomly assigned to groups that received BOT (1 mg twice daily; n = 59) or placebo (n = 29) for 6 weeks. The primary end point was complete remission, based on clinical and histologic factors, including dysphagia and odynophagia severity ≤2 on a scale of 0-10 on each of the 7 days before the end of the double-blind phase and a peak eosinophil count <5 eosinophils/high power field. Patients who did not achieve complete remission at the end of the 6-week double-blind phase were offered 6 weeks of open-label treatment with BOT (1 mg twice daily). RESULTS: At 6 weeks, 58% of patients given BOT were in complete remission compared with no patients given placebo (P < .0001). The secondary end point of histologic remission was achieved by 93% of patients given BOT vs no patients given placebo (P < .0001). After 12 weeks, 85% of patients had achieved remission. Six-week and 12-week BOT administration were safe and well tolerated; 5% of patients who received BOT developed symptomatic, mild candida, which was easily treated with an oral antifungal agent. CONCLUSIONS: In a randomized trial of adults with active EoE, we found that budesonide oral tablets were significantly more effective than placebo in inducing clinical and histologic remission. Eudra-CT number 2014-001485-99; ClinicalTrials.gov ID NCT02434029