Exploring the Mechanisms in Cognitive Behavioural Therapy for Anxious Children: Does Change in Emotion Regulation Explain Treatment Effect?

Cognitive behavioural therapy (CBT) for childhood anxiety has shown moderate effects. However, inconsistency in findings during the last decades of treatment research and lack of measurable treatment gains over time has led to a call for optimizing interventions by identifying the active mechanisms involved and for whom such interventions are effective. It has been suggested that the moderate effects may be explained by the fact that emotion regulation rarely is directly targeted in CBT-interventions and that interventions may be more effective for children with a certain level of problems with emotion regulation. Using data from a randomized controlled trial with 160 children and their mothers at baseline (t1) and posttreatment (t2), we examined whether being randomized to CBT predicted change in anxiety symptoms from t1 to t2 and whether this change was mediated by change in emotion regulation from t1 to t2. We also investigated whether the strength of this indirect pathway depended on the level of emotion regulation problems at baseline. Latent baseline target moderated mediation analyses within a structural equation modelling framework were conducted. Results showed a significant indirect pathway between receiving CBT to improved emotion regulation, which again was significantly associated with reductions in anxiety symptoms. The findings suggest that the effect of CBT is similar for children irrespective of initial levels of emotion regulation measured broadly, whereas there was some evidence of a baseline moderation effect of the subdomain emotional control. Emotion regulation, and especially emotional control, seems to be an underlying mechanism for positive effects of CBT for anxiety disorders in children, possibly indicating that a greater emphasis on emotion regulation may optimize the intervention.

Iodine nutrition and toxicity in Atlantic cod (Gadus morhua) larvae.

Copepods as feed promote better growth and development in marine fish larvae than rotifers. However, unlike rotifers, copepods contain several minerals such as iodine (I), at potentially toxic levels. Iodine is an essential trace element and both under and over supply of I can inhibit the production of the I containing thyroid hormones. It is unknown whether marine fish larvae require copepod levels of I or if mechanisms are present that prevent I toxicity. In this study, larval Atlantic cod (Gadus morhua) were fed rotifers enriched to intermediate (26 mg I kg(-1) dry weight; MI group) or copepod (129 mg I kg(-1) DW; HI group) I levels and compared to cod larvae fed control rotifers (0.6 mg I kg(-1) DW). Larval I concentrations were increased by 3 (MI) and 7 (HI) fold compared to controls during the rotifer feeding period. No differences in growth were observed, but the HI diet increased thyroid follicle colloid to epithelium ratios, and affected the essential element concentrations of larvae compared to the other groups. The thyroid follicle morphology in the HI larvae is typical of colloid goitre, a condition resulting from excessive I intake, even though whole body I levels were below those found previously in copepod fed cod larvae. This is the first observation of dietary induced I toxicity in fish, and suggests I toxicity may be determined to a greater extent by bioavailability and nutrient interactions than by total body I concentrations in fish larvae. Rotifers with 0.6 mg I kg(-1) DW appeared sufficient to prevent gross signs of I deficiency in cod larvae reared with continuous water exchange, while modelling of cod larvae versus rotifer I levels suggests that optimum I levels in rotifers for cod larvae is 3.5 mg I kg(-1) DW.

Carcinoid tumours in the gastrointestinal tract--a population-based study from Western Norway.

OBJECTIVE: To analyze population-based incidence, anatomic distribution and patient characteristics of gastrointestinal carcinoid tumours. BACKGROUND: Neuroendocrine carcinomas (NE, carcinoid tumours) arise from neuroendocrine cells and are most commonly found in gastrointestinal tract and lungs. Previous studies on carcinoids report varying incidence rates, location of tumours and patient survival rates. METHODS: Retrospective study. 88 patients were diagnosed with carcinoids located in the gastrointestinal tract in the period 1983-2003 in the Norwegian counties Hordaland and Sogn og Fjordane. Patient and tumour characteristics, treatment and survival were analyzed in a sub-group of 51 patients treated at Haukeland University Hospital. RESULTS: Incidence of carcinoids was 0.8 when analyzed from the counties Hordaland and Sogn og Fjordane as well as when analyzed from Haukeland University Hospital. There were 26 men and 25 women. Median age at surgery was 61 years (range 17-87 years). The tumours were located in the small bowel in 53%, appendix 18%, colon 4%, rectum 4%, stomach 8% and duodenum 10%. Five-year survival rate was 50% in stomach, 80% in duodenum, 43% in the small bowel, 100% for tumours in appendix, 40% in colon and 100% in rectum. CONCLUSION: Carcinoid tumours are relatively uncommon neoplasms and most of them are found in the small bowel. Carcinoids in the ileum tend to be more aggressive and carry a poorer prognosis than carcinoids at other locations. Tumours in the appendix are found at lower age and in an early stage. They rarely metastasize and have an excellent prognosis.

Coping with exacerbation in psoriasis and eczema prior to admission in a dermatological ward.

Chronic dermatologic diseases, such as psoriasis and eczema, may cause significant psycho-social problems and stress. Our objectives were to characterize how hospitalised patients coped with psoriasis and eczema, and to investigate the relationship between coping and quality of life. Data are based on survey forms completed upon admission to the dermatology ward from 212 patients with chronic dermatological diseases, 146 with psoriasis and 66 with eczema. 108 were men, average age 48 years. The Norwegian versions of the standardized survey questionnaires, Jalowiec Coping Scale and Dermatological Life Quality Index, were used to evaluate coping and quality of life. We found that optimism, belief-in-oneself and confrontational coping strategies were most frequently used. Long duration of the disease was correlated to the belief-in-oneself strategy, while short duration was related to supportive strategies. More frequent use of confrontational and optimistic modes was significantly related to better quality of life. More frequent use of emotional and evasive modes was significantly related to poorer quality of life. There was no significant difference between the psoriasis and eczema groups in terms of use of coping strategies, with exception of emotional strategies. Knowledge of coping strategies and quality of life among patients with chronic dermatological diseases is important for improvement in health services for these patients.

Polymorphism of PCR-based markers targeting exons, introns, promoter regions, and SSRs in maize and introns and repeat sequences in oat.

Sequence databases could be efficiently exploited for development of DNA markers if it were known which gene regions reveal the most polymorphism when amplified by PCR. We developed PCR primer pairs that target specific regions of previously sequenced genes from Avena and Zea species. Primers were targeted to amplify 40 introns, 24 exons, and 23 promoter regions within 54 maize genes. We surveyed 48 maize inbred lines (previously assayed for simple-sequence repeat (SSR) polymorphism) for amplification-product polymorphism. We also developed primers to target 14 SSRs and 12 introns within 18 Avena genes, and surveyed 22 hexaploid oat cultivars and 2 diploid Avena species for amplification-product polymorphism. In maize, 67% of promoter markers, 58% of intron markers, and 13% of exon markers exhibited amplification-product polymorphisms. Among polymorphic primer pairs in maize, genotype diversity was highest for SSR markers (0.60) followed by intron markers (0.46), exon markers (0.42), and promoter markers (0.28). Among all Avena genotypes, 64% of SSR markers and 58% of intron markers revealed polymorphisms, but among the cultivars only, 21% of SSR markers and 50% of intron markers were polymorphic. Polymorphic-sequence-tagged sites for plant-breeding applications can be created easily by targeting noncoding gene regions.

Dental gold alloys and contact hypersensitivity.

A total of 172 patients referred to the Norwegian National Adverse Reaction Group were patch-tested with a dental series. Of these, 25% showed a positive reaction to gold sodium thiosulfate or potassium dicyanoaurate. There was a statistically significant correlation (p=0.0019) between the presence of dental gold and a positive patch test to gold. There was a statistically significant correlation between ear piercing and a positive patch test to gold (p=0.04). In most cases, we did not find clinical correlates to positive patch tests to gold. 2 patients with objective and subjective oral/perioral and general symptoms are described as case reports. Their symptoms disappeared when gold restorations were removed. We conclude that there is an overrepresentation of gold allergies among those with dental restorations containing gold.

[Occupational skin problems among dental personnel]. / Yrkesrelaterte hudplager blant tannhelsepersonell.

Occupational dermatological problems are common among dental health personnel. We conducted a questionnaire survey to investigate the frequency of occupational dermatological problems among dental health personnel in Hordaland county, Norway. 333 of 394 employees (85%) answered the questionnaire. 148 of 333 respondents (44%) reported skin complaints. The proportion of respondents with skin complaints was lower among those with more than 20 years experience in dental health care. Hands were almost always involved. Use of gloves were reported to be the main cause of skin problems, especially the use of powdered gloves. Other frequently reported causes were soaps and methacrylates. Skin complaints from methacrylates occurred more often among employees wearing gloves most past of the working day. 3% of the respondents reported test-proven rubber allergy and 1% a methacrylate allergy. Our study confirm that occupational dermatological problems among dental health personnel are frequent. Irritant reactions are probably much more common than allergy. The most important allergens causing allergic contact dermatitis are rubber and methacrylates. Dental personnel should use non-powdered non-latex gloves and use non-touch techniques while handling methacrylates.

Clobetasol propionate followed by calcipotriol is superior to calcipotriol alone in topical treatment of psoriasis.

BACKGROUND: Although potent, topical corticosteroids offer effective and rapid healing of psoriatic lesions. Their long term use is limited because of the risk of side effects. Calcipotriol is safe for long-term treatment, but its initial efficacy is lower than with topical corticosteroids. OBJECTIVES: To investigate whether 2 weeks of treatment with clobetasol propionate 0.05% ointment bd followed by 4 weeks of treatment with calcipotriol 50 microg/g bd would offer therapeutic advantages over 6 weeks of continuous treatment with calcipotriol. METHODS: Forty-nine patients with moderate to severe plaque psoriasis were recruited from five centres in Norway. In a randomised, double-blind, right- versus left-side comparison, ointments were applied to two symmetrically-located areas. RESULTS: Two weeks of treatment with clobetasol propionate produced a significantly greater decrease in total symptom score (combined scores of erythema, induration and scaling) than calcipotriol treatment (P < 0.0001). This improvement on the clobetasol propionate-treated side of the body was maintained throughout a subsequent 4-week treatment period when calcipotriol was applied to both sides of the body (P < 0.0001). The superiority of the clobetasol propionate followed by calcipotriol treatment was maintained during a 4-week, treatment-free, observation period. Treatments were well tolerated with no rebound effect. CONCLUSIONS: Clobetasol propionate ointment bd for 2 weeks followed by treatment with calcipotriol ointment bd for 4 weeks was superior to calcipotriol ointment alone in the treatment of plaque psoriasis.

Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis. A double-blind, multicentre study.

The purpose of this study was to investigate whether fish oil and/or corn oil had a beneficial effect on the clinical state of atopic dermatitis, and to evaluate the dietary intake of nutrients in this group of patients. In a double-blind, multicentre study lasting 4 months, during wintertime, 145 patients with moderate to severe atopic dermatitis were randomly assigned to receive either 6 g/day of concentrated n-3 fatty acids, or an isoenergetic amount of corn oil. As local treatment, only an emollient cream or hydrocortisone cream was allowed. The fatty acid pattern in serum phospholipids, and the dietary intake of nutrients were monitored in a subgroup of patients, and the results were compared with a group of patients with psoriasis. The overall clinical score, as evaluated by the physicians, improved during the trial by 30% in the fish oil (P < 0.001) and 24% in the corn oil group (P < 0.001). This was also consistent with the results from a selected skin area, and it was further confirmed by the total subjective clinical score reported by the patients. There were no significant differences in the clinical scores between the two groups at baseline, and at the end of the study. In the fish oil group, the amount of n-3 fatty acids in serum phospholipids was significantly increased at the end of the trial, compared with pretreatment values (P < 0.001), whereas the level of n-6 fatty acids was decreased (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Renal effects of maintenance low-dose cyclosporin A treatment in psoriasis.

The renal effects of low-dose cyclosporin A (CsA) treatment in severe psoriasis was investigated in 10 patients treated with a mean CsA dose of 3.23 (range 1.94-4.10) mg/kg/day for 12 months. The psoriasis area and severity index was reduced by 63-76%. Ambulatory GFR (iothalamate-125I), ERPF (hippuran-131I), RVR and MAP were examined at 3-months intervals. A control renal biopsy was performed shortly before treatment start and a second biopsy was taken after 12 months of therapy. GFR was slightly but significantly reduced after 6 and 9 months; after 12 months the decrease was not significant (121.0 +/- 7.6 versus 115.2 +/- 7.8 ml/min/1.73M2, P > 0.10). After 12 months serum creatinine increased from 82 +/- 4 to 94 +/- 7 mumol/litre (P < 0.05), while an insignificant increase of ERPF was seen and FF decreased from 0.29 +/- 0.01 to 0.26 +/- 0.01 (P < 0.05). MAP remained unchanged. GFR and serum creatinine correlated significantly within each 3-month interval. A slight de novo interstitial fibrosis was seen in the second biopsy in 4 of 10 patients receiving a mean CsA dose of 3.2-4.1 mg/kg/day. In three of these patients a concomitant rise in serum creatinine was seen. In conclusion, low-dose CsA was associated with reversible fall in GFR and potentially progressive structural changes not always accompanied by corresponding functional alterations. One should consider reducing the daily dose of CsA to 3.0 mg/kg bodyweight or less in CsA therapy up to 1 year.

Effect of dietary supplementation with very-long-chain n-3 fatty acids in patients with psoriasis.

BACKGROUND: In several studies dietary fish oil has been found to have beneficial effect on psoriasis, but the results are contradictory and based mainly on open studies or studies of small numbers of patients. METHODS: In a four-month double-blind, multicenter trial, we randomly assigned 145 patients with moderate-to-severe psoriasis to receive in their diet either highly purified ethyl esters of n-3 fatty acids ("fish oil"; 6 g of oil per day, containing 5 g of eicosapentaenoic and docosahexaenoic acid) or an isoenergetic amount of corn oil containing mainly n-6 fatty acids. All the patients were advised to reduce their intake of saturated fatty acids. A 48-hour dietary recall was performed, and the fatty-acid pattern in the serum phospholipids was monitored in a subgroup of patients. RESULTS: In the fish-oil group, n-3 fatty acids were increased in serum phospholipids (P < 0.001), the ratio of arachidonic acid to eicosapentaenoic acid decreased (P < 0.001), and the level of n-6 fatty acids decreased (P < 0.001). In the corn-oil group, only docosahexaenoic acid increased significantly (P < 0.05). The ratio of polyunsaturated to saturated fatty acids increased in both groups. Plasma concentrations of triacylglycerol decreased from base line in the fish-oil group (P < 0.05). The score on the Psoriasis Area and Severity Index, as evaluated by the physicians, did not change significantly during the trial in either group. This was also true of a total subjective score reported by the patients, but a selected area of skin in the corn-oil group showed a significant reduction in the clinical signs (P < 0.05). Scaling was reduced from base line in both groups (P < 0.01). The fish-oil group had less cellular infiltration (P < 0.01), and the corn-oil group had improvement in desquamation and redness (P < 0.05). There was no significant difference in clinical manifestations between the groups. Among the patients in the fish-oil group, an increase in the concentration of n-3 fatty acids in serum phospholipids was not accompanied by clinical improvement, whereas in the corn-oil group there was a significant correlation between clinical improvement and an increase in eicosapentaenoic acid and total n-3 fatty acids. CONCLUSIONS: Dietary supplementation with very-long-chain n-3 fatty acids was no better than corn-oil supplementation in treating psoriasis. Clinical improvement was not correlated with an increase in the concentration of n-3 fatty acids in serum phospholipids among the patients in the fish-oil group, whereas there was a significant correlation between clinical improvement and an increase in eicosapentaenoic acid and total n-3 fatty acids in the corn-oil group.

[Dermatological laser treatment]. / Dermatologisk laserbehandling.

This article reviews the different lasers used in dermatology. Special emphasis is placed on the treatment of naevus flammeus ("portwine stain") where lasers are the treatment of choice. Argon laser and pulsed dye laser are the main lasers used in vascular skin diseases, and the article focuses on these two types. Copper vapour laser, neodymium-YAG-laser and CO2-laser are also presented. Information is provided about the availability of laser technology in the different health regions in Norway.

[Hypertrophic granulation tissue as a complication to isotretinoin treatment]. / Hypertrofisk granulasjonsvev som komplikasjon til isotretinoinbehandling.

Isotretinoin is a highly effective drug in the treatment of nodulocystic acne. The most common side effects are mucocutaneous. An uncommon complication is excess granulation tissue response to isotretinoin therapy. We present a case history and summarize different methods of treatment.

Fasting plasma homocysteine as a sensitive parameter of antifolate effect: a study of psoriasis patients receiving low-dose methotrexate treatment.

We have investigated the effect of low-dose methotrexate (25 mg weekly) on plasma homocysteine in 13 patients who had psoriasis. Total, free, and protein-bound homocysteine were determined both during fasting and after methionine loading. Psoriasis patients had significantly higher basal plasma homocysteine levels than age-matched control subjects. In addition, the methionine loading test was abnormal in four of the patients, but this was not significant. Psoriasis patients, although not folate deficient, did have lower serum folate levels than control subjects. There was a significant and transient increase in fasting plasma homocysteine levels within 48 hours after administration of low-dose methotrexate. This response was repeated after each administration and was observed eight to 20 times in three patients whose progress was monitored for 2 to 6 months. Notably, methotrexate did not affect the plasma profile for homocysteine after methionine loading. This study showed the level of fasting plasma homocysteine to be a sensitive and responsive parameter of antifolate drug treatment.

[Acyclovir creme in recurrent herpes genitalis]. / Acyklovirkrem ved residiverende herpes genitalis.

A multicenter clinical, double-blind crossover trial was conducted in 65 men and 31 women experiencing recurrent episodes of genital herpes in order to compare the effect of acyclovir in propylenglycol (40% cream) with that of cream alone (placebo). 59.4 of the patients on acyclovir experienced a beneficial effect in relation to the usual clinical course of their herpetic eruptions. The corresponding figure for placebo was 34.4%. These percentages were 76.6 and 33.3 respectively if the treatment started within four hours after appearance of symptoms or skin lesions. Pain and burning lasted less than four days in 70.8% of the patients on acyclovir and in 36.4% of those on placebo cream (p less than 0.001). The average duration until complete healing of all skin lesions was 32 hours shorter for patients on acyclovir. In 42 patients on acyclovir and 31 patients on placebo (p less than 0.001) it was less than four days. As regards duration of symptoms and skin lesions, the effect was significantly better if treatment was started early (e.g. less than 4 h). Slight to moderate side-effects were reported in 13.5% of the patients on both treatment regimens.

Infusion and sampling site effects on two-pool model estimates of leucine metabolism.

To assess the effect of site of isotope infusion on estimates of leucine metabolism infusions of alpha-[4,5-3H]ketoisocaproate (KIC) and [U-14C]leucine were made into the left or right ventricles of sheep and pigs. Blood was sampled from the opposite ventricle. In both species, left ventricular infusions resulted in significantly lower specific radioactivities (SA) of [14C]leucine and [3H]KIC. [14C]KIC SA was found to be insensitive to infusion and sampling sites. [14C]KIC was in addition found to be equal to the SA of [14C]leucine only during the left heart infusions. Therefore [14C]KIC SA was used as the only estimate for [14C]SA in the equations for the two-pool model. This model eliminated the influence of site of infusion and blood sampling on the estimates for leucine entry and reduced the impact on the estimates for proteolysis and oxidation. This two-pool model could not compensate for the underestimation of transamination reactions occurring during the traditional venous isotope infusion and arterial blood sampling.

In vivo metabolism of leucine and alpha-ketoisocaproate in the pig: influence of dietary glucose or sucrose.

The influence of dietary glucose (G) and sucrose (S) on leucine metabolism was evaluated in 10 immature pigs. The diets were isoenergetic and isonitrogenous with 40% of energy being derived from G or S. Animals were fed their diets at least 1 wk prior to the study. Each animal was studied by using a continuous infusion of L-[4,5-3H]leucine and [U-14C] alpha-ketoisocaproate (KIC) to permit measurement of the metabolism of leucine. After a meal, the pigs fed the glucose meal had higher mean plasma glucose and insulin concentrations than pigs fed a sucrose-containing meal. Arterial KIC concentration decreased after feeding either meal, but the arterial leucine concentration remained unchanged. In pigs fed sucrose, plasma fructose increased after the meal and was cleared by the hind limb in the same proportion as plasma glucose (11%). The hind limb glucose clearance was 16% in the glucose-fed pigs. Animals fed the glucose meal had three times greater hind limb uptake of leucine than animals fed the sucrose meal. No dietary influence on hind limb metabolism of KIC could be detected from arterial-venous differences. The whole-body leucine-KIC kinetic data suggested that preprandial tissue proteolysis was greater in pigs fed glucose than in those fed sucrose. Postprandial protein synthesis increased (24%) over fasting values only in pigs fed glucose. This was accompanied by a decrease in the percentage of the leucine pool converted to KIC. These observations indicate that both pre- and postprandial aspects of protein metabolism can be influenced by the dietary carbohydrate source.