Systematic Review and Meta-Analysis: Accuracy of Both Gamma Delta+ Intraepithelial Lymphocytes and Coeliac Lymphogram Evaluated by Flow Cytometry for Coeliac Disease Diagnosis.

It has been suggested that in doubtful cases of coeliac disease, a high CD3+ T-cell receptor gamma delta+ (TCRγδ+) intraepithelial lymphocyte count increases the likelihood of coeliac disease. AIM: To evaluate the diagnostic accuracy of both an isolated increase of TCRγδ+ cells and a coeliac lymphogram (increase of TCRγδ+ plus decrease of CD3- intraepithelial lymphocytes) evaluated by flow cytometry in the diagnosis of coeliac disease. METHODS: The literature search was conducted in MEDLINE and EMBASE. The inclusion criteria were: an article that allows for the construction of a 2 × 2 table of true and false positive and true and false negative values. A diagnostic accuracy test meta-analysis was performed. RESULTS: The search provided 49 relevant citations, of which 6 were selected for the analysis, which represented 519 patients and 440 controls. Coeliac lymphogram: The pooled S and Sp were 93% and 98%, without heterogeneity. The area under the SROC curve (AUC) was 0.98 (95% CI, 0.97-0.99). TCRγδ+: Pooled S and Sp were both 95%, with significant heterogeneity. The AUC was 0.97 (95% CI, 0.95-0.98). Conclusions: Both TCRγδ+ count and coeliac lymphogram assessed by flow cytometry in duodenal mucosal samples are associated with a high level of diagnostic accuracy for and against coeliac disease.

Proton pump inhibitors reduce the accuracy of faecal immunochemical test for detecting advanced colorectal neoplasia in symptomatic patients.

BACKGROUND: The faecal immunochemical test (FIT) is used in colorectal cancer (CRC) screening and for the detection of advanced colorectal neoplasia (AN) in symptomatic patients, but its accuracy could be improved. Our objective was to assess the impact of proton pump inhibitors (PPI) on the accuracy of the FIT in the detection of AN, namely advanced colorectal adenoma and CRC. METHODS AND FINDINGS: We performed a prospective study of 1002 individuals referred for a diagnostic colonoscopy at Bellvitge University Hospital from September 2011 through to October 2012. An exhaustive interview was performed by a gastroenterologist, prescription drug dispensing database was reviewed and the patient was given a FIT prior to colonoscopy. The positivity threshold of FIT used was ≥ 20 µg Hb/g feces and the main outcome was AN. AN was detected in 13.2% (133) of patients. The accuracy of FIT for detecting AN in the PPI users and non-PPI users were: sensitivity 43.0% vs 65.6%, P = 0.009; specificity 86.9% vs 92.3%, P = 0.010; and, predictive positive value 34.4% vs 55.5%, P = 0.007, respectively. In multivariate analysis, adjusting for potential confounders, PPIs were associated with false positives in AN detection by FIT (OR 1.63 CI 95% 1.02-2.59, P < 0.037). The ROC curve for the FIT in the detection of AN in the PPI users and non-PPI users was 0.68 (CI 95% 0.61-0.76) and 0.85 (CI 95% 0.79-0.90). CONCLUSIONS: PPI therapy reduces the accuracy of FIT for detecting AN in symptomatic patients.

Parents' Executive Functions, Parenting Styles, and Oppositional Defiant Disorder Symptoms: A Relational Model / Funciones ejecutivas de los padres, estilos de crianza y síntomas del Trastorno Oposicionista Desafiante: un modelo relacional

Abstract The present study examined the role of mother's and father's executive functions (EF), warmth and harsh parenting, and child oppositional defiant disorder symptoms (ODD). A total of 100 families with preschool children participated. The mothers answered three questionnaires: EMBU, ECI-4, and the BRIEF; the fathers answered only the BRIEF. The analysis was done by testing two structural equation models (SEM). The results showed that both models had an excellent fit and presented a significant path from mother's EF toward harsh parenting; the second model presented a significant path from harsh parenting to ODD symptoms. Our findings are concluded in light of the importance of addressing parenting interventions to prevent further conduct/disruptive disorders.

Resumen El siguiente estudio analizó el papel de las FE de la madre y del padre, el estilo de crianza y la sintomatología del TOD en los niños. Un total de 100 familias con niños en edades preescolares participaron en este estudio. La madre contestó tres cuestionarios: el EMBU, el ECI-4, y el BRIEF, mientras que el padre solo contestó su propio BRIEF. El análisis se realizó con el modelo de ecuaciones estructurales. Los resultados muestran que hay una trayectoria significativa de las FE de la madre hacia un estilo de crianza duro y severo, y esta relación continua significativa hacia la sintomatología de TOD. Nuestros resultados aluden a la importancia de las intervenciones en los estilos de crianza para prevenir el desarrollo de trastornos de conducta.

A wearable computing platform for developing cloud-based machine learning models for health monitoring applications.

Wearable sensors have the potential to enable clinical-grade ambulatory health monitoring outside the clinic. Technological advances have enabled development of devices that can measure vital signs with great precision and significant progress has been made towards extracting clinically meaningful information from these devices in research studies. However, translating measurement accuracies achieved in the controlled settings such as the lab and clinic to unconstrained environments such as the home remains a challenge. In this paper, we present a novel wearable computing platform for unobtrusive collection of labeled datasets and a new paradigm for continuous development, deployment and evaluation of machine learning models to ensure robust model performance as we transition from the lab to home. Using this system, we train activity classification models across two studies and track changes in model performance as we go from constrained to unconstrained settings.

Executive function associated to symptoms of attention deficit hyperactivity disorder and paediatric bipolar disorder / Função executiva associado a sintomas do transtorno de déficit de atenção/hiperatividade e do transtorno bipolar pediátrico

Very little is known about the differences of the neurocognitive functioning of Attention Deficit Hyperactivity Disorder (ADHD) and Paediatric Bipolar Disorder (PBD), since current studies do not agree on a differentiation of Executive Function (EF) between the two disorders. The aim of this study was to determine the EF deficits associated with symptomatology of ADHD and the PBD phenotype. Participants were 76 children/adolescents aged 6-17 years and their parents, submitted to a diagnostic interview and a tool for assessing EF, Behaviour Rating Inventory of Executive Function. Structural Equation Modeling was used to examine associations between symptoms of ADHD and the PBD phenotype, and the EF. A model for parents and a model for children/adolescents were performed. The model indexes showed a satisfactory fit. ADHD was found to be associated with deficits in all areas of EF, especially when the predominant symptom is inattention. The presence of symptoms of PBD phenotype was associated only with difficulties in finding new strategies to solve problems and inhibiting new behaviour. The article concluded that the presence of ADHD symptoms is associated with cognitive deficits different from those that may occur with PBD symptoms. It is advisable that professionals consider patients' neurocognitive profiles in order to achieve an appropriate differential diagnosis.

Ainda é pouco o que se sabe do funcionamento do Transtorno de Déficit de Atenção/Hiperatividade (TDAH) e do Transtorno Bipolar Pediátrico (TBP), já que atualmente os investigadores não concordam quanto a uma diferenciação da Função Executiva (FE) nos dois transtornos. O objetivo deste estudo é determinar os déficits da FE associados às sintomatologias de TDAH e do fenótipo do TBP. Foram avaliados 76 crianças/adolescentes com idades entre 6-17 anos e seus pais, com uma entrevista diagnóstica e um instrumento para avaliação da FE, Behaviour Rating Inventory of Executive Function. Modelos de equações estruturais foram usados para examinar associações entre a sintomatologia de TDAH e do fenótipo de TBP, e a FE. Foi realizado um modelo para pais e outro para crianças/adolescentes. Os índices do modelo indicaram um ajuste satisfatório. Foi encontrado que o TDAH está associado a deficiências em todas as áreas da FE, sobretudo se a sintomatologia predominante é a desatenção. A presença de sintomatologia do fenótipo de TBP somente apresentou associação a dificuldades na busca de novas estratégias na solução de problemas e na inibição de novas condutas. Conclui-se que a presença de sintomatologia de TDAH está associada a deficiências cognitivas diferentes das que podem estar presentes no TBP. É recomendável que os profissionais considerem o perfil neurocognitivo de seus pacientes para alcançarem um diagnóstico diferencial adequado.

Executive functioning in children and adolescents with symptoms of sluggish cognitive tempo and ADHD.

OBJECTIVE: The aim of this study was to observe whether the independent presence of Sluggish Cognitive Tempo (SCT) directly impacts on the Executive Function (EF), and to determine whether there are deficits in EF that are unique to ADHD predominantly inattentive (ADHD-I) or SCT. METHOD: Seventy-six participants aged 6 to 17 years and their parents were assessed using a diagnostic interview, an instrument that assesses the EF, and another instrument that assesses the SCT. Two hierarchical linear regression models were performed. The first one analyzed the independent relationship between SCT and EF, and the second model added the symptomatology of ADHD-I. RESULTS: The SCT has a statistically significant direct relation on the EF deficits and remains in the second model even with the inclusion of the ADHD-I. CONCLUSION: The SCT and ADHD-I symptoms independently promote executive deficits. Children with ADHD-I symptoms showed deficits in most areas of the EF. Deficits in inhibition and initiative are unique to inattention.

Executive Function Deficits and Symptoms of Disruptive Behaviour Disorders in Preschool Children / Déficits en la función ejecutiva y síntomas de trastornos disruptivos de la conducta en niños preescolares

The Executive Function is a set of cognitive processes that are developed from the earliest ages. Recent studies in children with disruptive behaviour disorders suggest the presence of effects on the executive functioning. The aim of this study is to know the association among symptoms of Attention Deficit with Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder, and Executive Function in children from 3 to 6 years old. Method: A descriptive cross-sectional study was conducted. An assessment was performed on a sample of 444 subjects from Spain; it was made through an inventory for parents and teachers to estimate the capacity of Executive Function. Results: a relation between the symptoms of Attention Deficit with Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, and the Executive Function deficit was found. The presence of symptoms of Attention Deficit with Hyperactivity Disorder inattentive type is associated with deficiencies in all areas of Executive Function, which does not occur with other symptoms. Conclusion: It is important to know the specific characteristics of each symptomatology by taking into account their executive functioning, in order to achieve accurate diagnoses in the clinical setting, as well as appropriate therapy according to the deficiencies presented by children.

Las funciones ejecutivas son un conjunto de procesos cognitivos que se desarrollan desde los estadios iniciales. Recientes estudios en niños con trastorno de comportamiento adaptativo sugieren la presencia de efectos sobre el funcionamiento ejecutivo. El objetivo del presente trabajo es conocer la asociación entre síntomas del síndrome por déficit de atención con hiperactividad, síndrome opositivo desafiante y trastorno de conducta y función ejecutiva en niños de 3 a 6 años. La investigación de tipo descriptivo transversal se llevó a cabo sobre una muestra de 444 niños españoles. Para estimar la capacidad de funciones ejecutivas, se estructuró un inventario para padres y educadores. Se encontró una relación entre los síntomas del síndrome de défict de atención con hiperactividad, síndrome opositivo desafiante y trastorno de conducta, y déficit en funciones ejecutivas. La presencia de los síntomas del síndrome de défict de atención con hiperactividad de tipo inatento se asoció con deficiencias en todas las áreas de funciones ejecutivas, lo que no ocurre con otros síntomas. Por lo tanto, es importante conocer las características específicas de cada sintomatología, tomando en cuenta su funcionamiento ejecutivo, con el ánimo de lograr diagnósticos adecuados en el ámbito clínico y la terapia apropiada acorde a las deficiencias presentadas en niños.

Prevalencia de la sintomatología del Síndrome de Asperger y variables asociadas en preescolares españoles / Prevalence of Asperger Syndrome symptomatology and associated variables in Spanish preschoolers

El Síndrome de Asperger (AS) forma parte del espectro de trastornos autistas, su estudio es reciente para el caso de edades tempranas. El objetivo de esta investigación es determinar la prevalencia de los síntomas del AS en población preescolar general, rural y urbana en preescolares de España. Además, analizamos las áreas de desarrollo y síntomas de ansiedad asociados a la presencia de sintomatología del AS. La muestra de este estudio se conforma de 1104 preescolares de 3 a 6 años de edad. La presencia de síntomas del AS se evaluó con base en el reporte de padres y maestros, mediante un instrumento de detección de desórdenes psiquiátricos. La prevalencia informada por padres fue de 11,7%, mientras que para los maestros fue de 8,1%. La presencia de sintomatología del AS se asoció a retrasos en el desarrollo de la comprensión del lenguaje, la coordinación motora, las habilidades de autoayuda y la práctica de juegos. Además, nuestros resultados indican que el AS tiene una fuerte relación con síntomas de fobia específica y tics. Concluimos que es posible hacer una detección temprana de la sintomatología del AS, ya que encontramos prevalencias similares a otras descritas en investigaciones recientes. Dada la afectación asociada al AS, su detección es altamente recomendable.

Asperger's Syndrome (AS) forms part of the whole spectrum of autistic disorders. Until recently it has not been studied in early ages. The aim of this study is to determine the AS's prevalence of symptoms in general preschool, rural and urban population. In addition, the association of the development areas and symptoms of anxiety and the presence of symptoms of AS was analized. The sample of this study consisted in 1104 preschool children between 3-6 years old. The presence of AS's symptoms was evaluated by a screening tool for psychiatric disorders. This tool was applied to both, preschooler's parents and their teachers. The prevalence of symptoms of AS for parents and teachers was 11.7% and 8.1%, respectively. The presence of AS's symptoms was associated with language compression delays, general and fine motor coordination, self-help skills and impairment in game activities. In addition, our results showed that the AS has a strong association with specific phobia symptoms and tics. We conclude that an early detection of AS's symptoms is possible since we found similar prevalence described in other recent researches. Given the impairment associated with AS, its detection is highly recommended.

Age gender and negative life events in anxiety and depression self-reports at preadolescence and early adolescence

Objective: to examine the associations between age, gender, negative life events and anxiety and depressive symptoms in preadolescent and early adolescent. Method: A cluster sampling procedure was used for this cross-sectional study, with 1.514 randomly selected 4th to 6th grade pupils attending 13 randomly selected schools in Reus (Catalonia). Information on negative life events and anxiety and depression symtoms was collected by means of self-reports. Results: Through linear regression models, significant negative associations were found between age, general anxiety and panic and separation anxiety symptoms. A significant positive association was found between age and generalized anxiety symptoms. Girls obtained significantly higher scores for almost all types of anxiety symptoms: separation anxiety. General anxiety, depressive symptoms and generalized anxiety symptoms were significantly more associated with negative life events. Conclusion: age, gender and negative life events are important factors in the manifestation of anxiety and depression (AU)

Objetivos: examiner las asociaciones entre edad, género, acontecimientos vitales estresantes y la sintomatología ansiosa y depresiva. Método: a partir de un muestreo aleatorio por conglomerados, se seleccionó a 1514 estudiantes de Educación Primaria, de 8 a 13 años, procedentes de 13 colegios de Reus (Cataluña). La información acerca de la sintomatología ansiosa, depresiva y sobre los acontecimientos estresantes se recogió mediante autoinformes. Resultados: a través de modelos de regresión lineal, se obtuvieron asociaciones negativas – y significativas- entre edad, ansiedad general, pánico y ansiedad de separación. Se halló asociación positiva y significativa entre edad y ansiedad generalizada. Las chicas obtuvieron puntuaciones más altas que los chicos en los siguientes tipos de ansiedad: ansiedad de separación, pánico, ansiedad generalizada y ansiedad en general. La ansiedad en general, los síntomas depresivos y la ansiedad generalizada son las escalas que más se asocian con los acontecimientos vitales estresantes. Conclusiones: la edad, el género y los acontecimientos vitales estresantes son factores importantes en la expresión de la sintomatología ansiosa y depresiva (AU)

The ocular pulse amplitude at different intraocular pressure: a prospective study.

PURPOSE: To investigate changes in ocular pulse amplitude (OPA) during a short-term increase in intraocular pressure (IOP) and to assess possible influences of biometrical properties of the eye, including central corneal thickness (CCT) and axial length. METHODS: In a prospective, single centre study, OPA and IOP as measured by dynamic contour tonometry (DCT) were taken before baseline- and post-OPA (delta) intravitreal injection of 0.05 ml anti-vascular endothelial growth factor agents. Analysis was performed employing linear regression with baseline- and post (delta)-OPA differences as the dependent and post-IOP as well as delta IOP as the independent variable. A multilinear regression analysis with delta OPA as the dependent variable and baseline IOP, post-IOP, CCT and axial length as independent variables was conducted. RESULTS: Forty eyes of 40 patients were included. IOP and OPA increased significantly after injection (IOP mean increase ± SD: 17.83 ± 9.83 mmHg, p < 0.001; OPA mean increase ± SD: 1.39 ± 1.16 mmHg, p < 0.001). For every mmHg increase in IOP, the OPA showed a linear increase of 0.05 mmHg (slope 0.05, 95% CI: 0.02-0.09, p = 0.003, r(2) = 0.20). Multiple regression analysis with delta OPA as the dependent variable revealed a partial correlation coefficient of 0.47 (p = 0.003) for post-IOP as the only significant contribution. CONCLUSION: A clear positive relationship between OPA measurements and IOP levels was shown in a clinical routine setting using DCT focusing on baseline and postinterventional comparisons of OPA values after intravitreal injections in patients with exudative age related macular degeneration. When considering the OPA for diagnostic purposes, we recommend indication of corresponding IOP values.

¿El rasgo temperamental ira/frustración afecta en la sintomatología interiorizada? Estudio en una muestra clínica infantil de 8-10 años / Is tait ange temperament associated to internalizing symptomatology? Study in a clinical sample of 8 to 10 year old

Los rasgos temperamentales ira/frustración pueden predecir la aparición de sintomatología interiorizada. El objetivo de este estudio fue identificar la relación del rasgo temperamental ira/frustración en la presentación de sintomatología ansiosa y/o depresiva en población clínica infantil. Participaron 80 niños/as de entre 8 y10 años de edad, positivos en un cribado por ansiedad, de dos Centros de Salud Mental Infantojuvenil de Cataluña. Los resultados muestran que el rasgo temperamental de ira no es estadísticamente significativo para la sintomatología ansiosa, pero si para la depresiva. El estudio muestra diferentes asociaciones entre este rango de edad. Los parámetros diagnósticos y las evaluaciones deben tener en cuenta la importancia de esto, así como las estrategias de prevención (AU)

Trait anger temperament can predict the onset of internalizing symptoms. The aim of this study was to analyze the relationship between anger temperament and the onset of anxiety and depressive symptoms in clinical school age children. Participants were 80 children with high scores in anxiety, aged 8 to 10 years old, recruited from two infant and adolescent mental health centers in Catalonia. Results showed that anger temperament is not associated with anxiety symptoms, but it is significantly associated with depressive symptoms. The study shows a different association between this temperament trait and the types of symptomatology of both internalizing disorders at these ages. Diagnostic parameters and assessments, as well as the prevention strategies used, need to take this into account (AU)

[Evaluation of oppositional defiant symptoms in 6- to 8 year-old children: Agreement between parents and teachers]. / Evaluación de la sintomatología negativista desafi ante en niños de seis a ocho años: concordancia entre padres y maestros.

The main goal of this study is to determine the degree of agreement between the reports provided by parents and teachers about oppositional defiant symptoms in school children between the ages of 6 and 8 years. In addition, it attempts to determine whether children's age and sex affect the level of agreement between informants. Parents and teachers assessed 702 girls and boys at 25 schools in the Region of Osona, Barcelona (Spain) with the Child Symptom Inventory-4 (parents' and teachers' version). The results indicate a very low agreement -practically null- between the valuations of both informants; furthermore, no significant difference due to the variables age and sex of the children was observed in the above-mentioned valuations. The parents tended to appraise most of the symptoms of the Oppositional Defiant Disorder as present and to evaluate their severity as being more intense.

Evaluación de la sintomatología negativista desafiante en niños de seis a ocho años: concordancia entre padres y maestros / Evaluation of oppositional defiant symptoms in 6- to 8 year-old children: Agreement between parents and teachers

El objetivo principal de este estudio es conocer el grado de concordancia entre los informes proporcionados por padres y maestros acerca de la sintomatología negativista desafiante en niños en edad escolar (6-8 años). Además, se pretende analizar si la edad y el sexo del niño afectan el nivel de acuerdo entre informantes. Padres y maestros evaluaron a 702 niños y niñas de 25 escuelas de la Comarca de Osona, Barcelona (España), mediante el Child Sympton Inventory-4 (versión padres y maestros). Los resultados indican una concordancia muy baja, casi nula, entre las valoraciones de ambos informantes; además, las variables edad y sexo de los niños no representan una diferencia significativa en dichas valoraciones. Los padres tienden a evaluar más síntomas del Trastorno Negativista Desafiante como presentes, y a percibir con mayor intensidad su severidad(AU)

Agreement between parents and teachers. The main goal of this study is to determine the degree of agreement between the reports provided by parents and teachers about oppositional defiant symptoms in school children between the ages of 6 and 8 years. In addition, it attempts to determine whether children’s age and sex affect the level of agreement between informants. Parents and teachers assessed 702 girls and boys at 25 schools in the Region of Osona, Barcelona (Spain) with the Child Symptom Inventory-4 (parents’ and teachers' version). The results indicate a very low agreement -practically null-between the valuations of both informants; furthermore, no significant difference due to the variables age and sex of the children was observed in the above-mentioned valuations. The parents tended to appraise most of the symptoms of the Oppositional Defiant Disorder as present and to evaluate their severity as being more intense(AU)