Self-esteem and mood in obese children and their mothers: A pilot study

Objective: A test-retest pilot study was conducted to examine the relationship between overweight/obesity, self-esteem and mood in a group of school-age children, and the degree to which they changed after a tailored psycho-educational intervention. Before and after administering the psycho-educational training, the following aspects were assessed: the child's weight (BMI); the child's and mother's levels of self-esteem and mood; the mother's perception of their child; and the child's general quality of life. Method: Subject to their prior informed consent, 12 overweight/obese children aged between 8 and 13 years, and their mothers were involved in a psycho-educational intervention, which consisted in four meetings with both the children and their mothers. The study consisted in measuring anthropometric parameters and administering specific psychological tests (the CDI, TMA, BDI, B-SE, and CBCL) to both the children and their mothers before and after the psycho-educational intervention. Results: The results showed that a high BMI was associated with depressive symptoms (anhedonia, negative mood) and low self-esteem (family life, body experience). Low levels of self-esteem were also found in 50% of the mothers, with no correlations between the mother's and child's self-esteem. On analyzing the mothers' clinically significant depressive symptoms (cognitive-affective sphere), it emerged that they included the perception of more problems in their child. After the psycho-educational intervention, there were improvements in: the children's BMI; the children's depressive symptoms and self-esteem; the mothers' depressive symptoms and self-esteem; and the mothers' perceptions of their child's problems. Conclusions: Our case series confirmed the association between overweight/obesity and psychological issues. Overweight/obese children need to be also addressed regarding the psychological fallout of their physical condition. Any intervention must also include the parents, to make them more aware, more committed, and better able to help their child change

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Action observation training for rehabilitation in brain injuries: A systematic review and meta-analysis

Background : To systematically review and analyse the effects of Action Observation Training on adults and children with brain damage. Methods : Seven electronic databases (Cochrane, EBSCO, Embase, Eric, PubMed, Scopus and Web of Science) were searched up to 16 September 2018 to select Randomized Controlled Trials focused on adults and children with brain damage that included AOT training on upper and/or lower limb carried out for at least 1 week. Identification of studies and data extraction was conducted with two reviewers working independently. Oxford Centre for Evidence-based Medicine (March2009) – Levels of Evidence and Physiotherapy Evidence Database scale were used to grade studies. The data collected from the articles were analysed using software R, version 3.4.3. Hedge’s g values were calculated and effect size estimates were pooled across studies. Separate meta-analyses were carried out for each ICF domain (i.e. body function and activity) for upper and lower limb. Results : Out of the 210 records identified after removing duplicates, 22 were selected for systematic review and 19 were included in the meta-analysis. Thirteen studies included in the meta-analysis focused on upper limb rehabilitation (4 in children and 9 in adults) and 6 on lower limb rehabilitation (only studies in adults). A total of 626 patients were included in the meta-analysis. An overall statistically significant effect size was found for upper limb body function (0.44, 95% CI: [0.24, 0.64], p<0.001) and upper limb activity domain (0.47, 95% CI: [0.30, 0.64], p<0.001). For lower limb, only the activity domain was analysed, revealing a statistically significant overall effect size (0.56, 95% CI: [0.28, 0.84], p<0.001). Conclusions : Action Observation Training (AOT) is an innovative rehabilitation tool for individuals with brain damage, which shows promising results in improving the activity domain for upper and lower limbs, and also the body function domain for the upper limb. However, the examined studies lack uniformity and further well-designed, larger controlled trials are necessary to determine the most suitable type of AOT particularly in childre

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Thermal Transformation of NH4-Clinoptilolite to Mullite and Silica Polymorphs

Clinoptilolite is a natural zeolite used for the abatement of ammonium in the treatment of urban wastewater. By considering that mullite was obtained through thermal treatment of NH4-exchanged synthetic zeolites, this work aimed to evaluate if this phase can be obtained from NH4-clinoptilolite. A material containing about 90 wt % of clinoptilolite, prepared using a Sardinian zeolite-rich rock, was NH4-exchanged and subjected to treatments up to 1200 °C. After dehydration, de-ammoniation, and dehydroxylation processes, the clinoptilolite structure collapsed at 600 °C. An association of mullite, silica polymorphs, and glass, whitish in color, was obtained for treatments between 1000 and 1200 °C. The higher degree of crystallinity was reached after a 32 h heating at 1100 °C: mullite 22 wt %, cristobalite 59 wt %, tridymite 10 wt %, glass 9 wt %. It is possible to speed up the kinetics of the transformation by increasing the temperature to 1200 °C, obtaining the same amount of mullite in 2 h, but increasing the residual amorphous fraction (16 wt %). These results indicate that NH4-clinoptilolite could represent a raw material of potential interest in the ceramic field, in particular in the production of acid refractory, opening scenarios for a possible reuse of clinoptilolite-based exchangers employed in ammonium decontamination

The Dual Value of the Web: Risks and Benefits of the Use of the Internet in Disorders with A Self-Destructive Component in Adolescents and Young Adults

Eating disorders (ED) and non-suicidal selfinjury (NSSI) present common aspects and factors which contribute to their onset and development. The last decade has seen an increasing circulation of online materials and interactions connected to ED and NSSI. There is a general agreement among mental health clinicians and researchers that this kind of online content involves serious risks, such as normalization and reinforcement of unhealthy behaviors, alongside with some benefits, like receiving peer support and validation. The aim of this paper is to offer an overview of major research contributions on this topic. After describing common aspects between these disorders, we analyze data concerning the usage of harm-advocating websites on internet and the characteristics of users. Furthermore, we define and explore the contents of both pro-ED and NSSI websites, and we extensively inspect risks and benefits of the exposure to these online content. Finally, we present clinical guidelines for assessment, intervention and prevention, particularly focusing on family interventions. Due to the rapidity of changes when technology is involved, the research on this topic is far from being concluded; more in-depth studies are needed, not only to explore long term effects of the use of the websites described, but also to investigate new alarming tendencies such as the diffusion of websites challenging self-destructive behavior

Parental Bonding and Children’s Psychopathology: A Transgenerational View Point

Literature confirmed parental bonding as one of key factors influencing offspring’s psychopathology; the present study aimed to investigate, with a case-control study, the relationship between parental bonding and psychopathology in an Italian adolescent sample. The clinical sample was composed of 64 adolescents from 12 to 18 years old (Mage 15.00; S.D. 1.70) attending a Neuropsychiatric Unit of Veneto; the non-clinical sample was composed of 61 adolescents, from 13 to 18 years old (Mage 14.80; S.D. 1.32) attending middle and high school in the province of Padua and Pesaro (Italy); their parents (mothers and fathers) were also involved. In the study, self-reported tests were administered (Parental Bonding Instrument, Child Behavior Checklist, Youth Self Report). Our study confirmed a correlation between parental bonding and adolescent psychopathology: dysfunctional parenting styles (characterized by low care and high control) were more frequent among cases in contrast to controls. An effect of gender also appeared. In the Italian adolescent clinical sample, parental bonding, especially low parental care, was correlated to the emergence of psychopathology

Symptomatic, Alexithymic, and Suicidality-Related Features in Groups of Adolescent Self-Harmers: A Case-Control Study

Non-suicidal self-injury (NSSI) is an increasing phenomenon among both clinical and nonclinical adolescent groups and is associated with several psychopathological symptoms, in addition to being one of the main risk factors for suicidality. Nevertheless, differences between clinical and nonclinical samples of self-harmers in symptom dimensions, alexithymia, suicidality, and NSSI-related variables are still scarcely investigated. The current study aimed to fill this gap by enrolling a sample of Italian girls (age range: 12–19 years) that included 63 self-harmers admitted to mental health outpatient services (clinical group), 44 self-harmers without admission to mental health services (subclinical group), and 231 individuals without an NSSI history (control group). Questionnaires investigating psychopathological symptoms, alexithymia, and NSSI-related variables were administered. The results highlighted that all symptom-related variables and alexithymic traits were more severe in the NSSI groups than in the control group; in particular, self-depreciation, anxiety, psychoticism, and pathological interpersonal relationships were distinguished between the clinical and subclinical groups. Compared to the subclinical group, the clinical group was characterized by higher NSSI frequency, NSSI disclosure, self-punishment as the main reason for engagement in NSSI, and suicidal ideation. These findings were then discussed in terms of clinical practice and primary and secondary prevention in the adolescent population

Is the aquatic thermal environment a suitable place for providing rehabilitative treatment for person with Parkinson's disease? A retrospective study

Many authors showed that aquatic physiotherapy could improve quality of life and reduce postural instability and risk of falling in elderly subjects. The aim of this research was to explore if the thermal aquatic environment is a suitable place for rehabilitative training in person with Parkinson disease (PwP) with results comparable to the standard physiotherapy. A retrospective study was conducted on a database of 14 persons with Parkinson who were admitted to a thermal aquatic rehabilitation to undergo treatments made to improve gait and balance impairments. The rehabilitation training consisted of 45-min sessions conducted twice a week, on non-consecutive days, over 4\ua0weeks of functional re-education and kinesitherapy in the thermal pool. Educational and prevention instructions were also given to the patients during each session. Additionally, nutrition (diet), health education, and cognitive behavioral advice were given to our patients by therapists. The clinical characteristics of the sample were age 66\u2009\ub1\u20099, disease duration 7\u2009\ub1\u20095, and Hoehn and Yahr 1.5\ua0\ub1\u20090.5. The statistical analysis showed a statistically significant improvement for the UPDRS p\u2009=\u20090.0005, for The Berg Balance Scale p\u2009=\u20090.0078, for the PDQ8 p\u2009=\u20090.0039, Tinetti p\u2009=\u20090.0068, and for Mini BESTest p\u2009=\u20090.0002. Our data suggest that this intervention could become a useful strategy in the rehabilitation program of PwP. The simplicity of treatment and the lack of side effects endorse the use of thermal aquatic environment for the gait and balance recovery in PwP