Experiences of coeliac disease in a changing gluten-free landscape.

BACKGROUND: Coeliac disease is an autoimmune disorder triggered by the ingestion of gluten. In recent years, there has been considerable increase in the availability of gluten-free products in North America. The present study investigated how the recent proliferation of the gluten-free industry has affected individuals living with coeliac disease, with a primary focus on their social lives and relationships. METHODS: Interpretive phenomenology was utilised for study design and analysis. Semi-structured interviews were conducted with 17 adults diagnosed with coeliac disease in Calgary, Alberta. Interviews were audio recorded and then transcribed for analysis. RESULTS: People living with coeliac disease experience the growth of the gluten-free industry as a 'double-edged sword'. Although they are grateful for more palatable gluten-free options, they are increasingly faced with misunderstandings about the severity of coeliac disease as a result of many noncoeliac disease individuals subscribing to the gluten-free diet. This 'double-edged sword' made certain types of social situations more easily manageable (e.g. more gluten-free options available at restaurants), whereas others produced distress (e.g. increased risk of inadvertently consuming gluten). Participants also felt they may be perceived or even perceived themselves differently (e.g. felt high maintenance). To help mitigate these social ramifications of following the gluten-free diet, participants utilised various strategies. CONCLUSIONS: The sole medical recommendation of a gluten-free diet fails to acknowledge the ongoing difficulties those with coeliac disease can endure in the current gluten-free landscape. Recommendations beyond the gluten-free diet are advisable to alleviate many of the indirect burdens revealed in the present study.

Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm: the POPMACT study.

BACKGROUND: We carried out a large randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behaviour therapy (MACT) versus treatment as usual (TAU) for deliberate self-harm. METHOD: Patients presenting with recurrent deliberate self-harm in five centres were randomized to either MACT or (TAU) and followed up over 1 year. MACT patients received a booklet based on cognitive behaviour therapy (CBT) principles and were offered up to five plus two booster sessions of CBT from a therapist in the first 3 months of the study. Ratings of parasuicide risk, anxiety, depression, social functioning and global function, positive and negative thinking, and quality of life were measured at baseline and after 6 and 12 months. RESULTS: Four hundred and eighty patients were randomized. Sixty per cent of the MACT group had both the booklet and CBT sessions. There were seven suicides, five in the TAU group. The main outcome measure, the proportion of those repeating deliberate self-harm in the 12 months of the study, showed no significant difference between those treated with MACT (39%) and treatment as usual (46%) (OR 0.78, 95% CI 0.53 to 1.14, P=0.20). CONCLUSION: Brief cognitive behaviour therapy is of limited efficacy in reducing self-harm repetition, but the findings taken in conjunctin with the economic evaluation (Byford et al. 2003) indicate superiority of MACT over TAU in terms of cost and effectiveness combined.

Future-directed thinking in eating disorders.

OBJECTIVES: The aim of the study was to examine future-directed thinking in individuals with eating disorders, given the possible role of such cognitions in the maintenance of anorexia nervosa and bulimia nervosa. METHOD: Twenty-six anorexics, 18 bulimics and 34 female controls were interviewed using the 'Future Thinking Task', assessing quantitative and qualitative aspects of positive and negative anticipated events. RESULTS: Patients with anorexia nervosa had similar levels of positive future-oriented cognitions and significantly more negative future-oriented cognitions than controls. The most common positive themes in this group concerned the social/interpersonal and leisure/pleasure domains. The negative theme most commonly mentioned by anorexics was that of their own health, followed by the social/interpersonal domain, whereas controls were most preoccupied with achievement/failure and a broad range of other issues. Bulimics had significantly fewer positive future-oriented cognitions and significantly more negative future-oriented cognitions than controls, most commonly concerning the patient's own health. CONCLUSION: In anorexia nervosa, anticipated positive future outcomes may to some extent help to maintain the disorder; however, these patients are also highly preoccupied with the possibility of negative future outcomes, i.e. a failure of recovery. Bulimia nervosa sufferers are relatively hopeless about their future. The clinical implications of these findings are discussed.

Psychosocial interventions for individuals with dementia: an integration of theory, therapy, and a clinical understanding of dementia.

We reviewed six psychosocial interventions for individuals with dementia. Interventions are described in terms of theoretical basis, how knowledge about dementia is incorporated, techniques, and empirical support. Psychodynamic approaches appear helpful for understanding intrapsychic concerns of demented individuals. Support groups and cognitive/behavioral therapy assist early stage individuals to build coping strategies and reduce distress. Reminiscence and life review provide mild to moderate stage individuals with interpersonal connections. Behavioral approaches and memory training target specific cognitive and behavioral impairments and help to optimize remaining abilities. Reality orientation reflects a similar goal, yet is probably more useful for its interpersonal functions.

Executive dysfunction predicts nonresponse to fluoxetine in major depression.

BACKGROUND: Functional brain imaging studies of major depression have consistently revealed hypometabolism or hypoperfusion in specific regions of the prefrontal cortex and basal ganglia. Studies of cognitive functioning in major depression have suggested that some but not all subjects exhibit cognitive deficits that are consistent with frontal-subcortical dysfunction, although the reasons for this heterogeneity are unclear. In this study, we explored this heterogeneity among depressed subjects by examining the relationship between cognitive functioning and treatment outcome. METHOD: Subjects with major depression were administered a complete neuropsychological test battery prior to treatment with fluoxetine. RESULTS: There were no significant differences between responders and nonresponders to fluoxetine in terms of age, educational achievement, number of past episodes of depression, and estimated premorbid IQ. However, nonresponders performed significantly worse than responders on several pretreatment measures of executive functioning, after controlling for baseline group differences in depression severity. LIMITATIONS: The results are based on a small sample of primarily female subjects, resulting in low statistical power and less generalizability to samples of male subjects with depression. CONCLUSIONS: The findings suggest that subtle prefrontal dysfunction in subjects with major depression may be predictive of poor response with particular medications. Assessment of the executive functions may play a particular role in pretreatment identification of subjects likely to respond to specific medications.

Body shape ideals across gender, sexual orientation, socioeconomic status, race, and age in personal advertisements.

OBJECTIVE: To assess body shape ideals across gender, sexual orientation, race, socio-economic status, and age, METHOD: An analysis of personal advertisements was conducted across seven different publications which targeted the groups of interest. RESULTS: Women advertised body weight much less often than men, and lesbians reported body shape descriptors significantly less often than heterosexual women. Gay men and African-American men described their body shape significantly more often than did other groups. However, their reported body mass indices (BMI) were significantly different-African-American men reported a higher BMI, and gay men a lower BMI, than Euro-American heterosexual men. DISCUSSION: Race and sexual orientation may influence the importance of size of body shape ideals for men. For women, however, their advertised weights conformed to the thin ideal across all groups surveyed. Gender roles affecting body shape ideals and mate attraction are discussed.

Regulation of the gastrin promoter by epidermal growth factor and neuropeptides.

The regulation of gastrin gene transcription was studied in GH4 pituitary cells transfected with constructs comprised of the first exon of the human gastrin gene and various lengths of 5' regulatory sequences ligated upstream of the reporter gene chloramphenicol acetyltransferase. Gastrin reporter gene activity in GH4 cells was equal to the activity of a reporter gene transcribed from the endogenously expressed growth hormone promoter. The effect of a variety of peptides on gastrin gene transcription including epidermal growth factor (normally present in the gastric lumen), gastrin-releasing peptide, vasoactive intestinal peptide, and somatostatin (present in gastric nerves) was assessed. Epidermal growth factor increased the rate of gastrin transcription almost 3-fold, whereas thyrotropin-releasing hormone and vasoactive intestinal peptide increased gastrin transcription 2- and 1.5-fold, respectively. Gastrin-releasing peptide, a peptide that strongly stimulates gastrin release, weakly increased gastrin transcription (1.3-fold). Somatostatin inhibited the increase in gastrin transcription induced by epidermal growth factor, thyrotropin-releasing hormone, and vasoactive intestinal peptide. Constructs containing various lengths of 5' regulatory sequences defined a response element -40 to -82 base pairs (bp) 5' to the transcription initiation site. This 40-bp sequence contains Sp1 and AP2 binding sites, which suggests that epidermal growth factor and thyrotropin-releasing hormone stimulate gastrin gene transcription through transcription factors that bind to Sp1 and/or AP2 motifs.

Pseudomonas cepacia peritonitis associated with contamination of automatic peritoneal dialysis machines.

During a 3-month period, Pseudomonas cepacia was recovered from the peritoneal fluid of 10 patients having chronic dialysis therapy at a peritoneal dialysis center. Six patients developed clinical evidence of peritonitis; one patient developed septicemia. Epidemiologic studies showed that dialysis on specific peritoneal dialysis machines was associated with an increased risk of infection. Laboratory investigation showed contamination of two machines with P. cepacia. Inadequacies in the cleaning and disinfection practices of the automatic peritoneal dialysis machines were identified. Cross-contamination between machines probably occurred through the peritoneal fluid discharge from infected patients during dialysis. Also, the intermittent 2-hour exposure of the machine to 2% formaldehyde may have been inadequate. P. cepacia has not been isolated from the peritoneal fluid of any peritoneal dialysis patient after machine cleaning and disinfection practices were altered.