Eosinophils from eosinophilic oesophagitis patients have T cell suppressive capacity and express FOXP3.

Eosinophilic esophagitis (EoE) is an antigen-driven T cell-mediated chronic inflammatory disease where food and environmental antigens are thought to have a role. Human eosinophils express the immunoregulatory protein galectin-10 and have T cell suppressive capacity similar to regulatory T cells (Tregs ). We hypothesized that one function of eosinophils in EoE might be to regulate the T cell-driven inflammation in the oesophagus. This was tested by evaluating the suppressive capacity of eosinophils isolated from the blood of adult EoE patients in a mixed lymphocyte reaction. In addition, eosinophilic expression of forkhead box protein 3 (FOXP3), the canonical transcription factor of Tregs , was determined by conventional and imaging flow cytometry, quantitative polymerase chain reaction (qPCR), confocal microscopy and immunoblotting. It was found that blood eosinophils from EoE patients had T cell suppressive capacity, and that a fraction of the eosinophils expressed FOXP3. A comparison of EoE eosinophils with healthy control eosinophils indicated that the patients' eosinophils had inferior suppressive capacity. Furthermore, a higher percentage of the EoE eosinophils expressed FOXP3 protein compared with the healthy eosinophils, and they also had higher FOXP3 protein and mRNA levels. FOXP3 was found in the cytosol and nucleus of the eosinophils from both the patients and healthy individuals, contrasting with the strict nuclear localization of FOXP3 in Tregs . To conclude, these findings suggest that the immunoregulatory function of eosinophils may be impaired in EoE.

The long-term effects of being bullied or a bully in adolescence on externalizing and internalizing mental health problems in adulthood.

BACKGROUND: The aim is to examine associations between bullying involvement in adolescence and mental health problems in adulthood. METHODS: Information on bullying-involvement (being bullied, bully-victim, aggressive toward others) and non-involved was collected from 2464 adolescents in Mid-Norway at mean age 13.7 and again at mean age 14.9. Information about mental health problems and psychosocial functioning was collected about 12 years later at mean age 27.2 (n = 1266). RESULTS: All groups involved in bullying in young adolescence had adverse mental health outcomes in adulthood compared to non-involved. Those being bullied were affected especially regarding increased total sum of depressive symptoms and high levels of total, internalizing and critical symptoms, increased risk of having received help for mental health problems, and reduced functioning because of a psychiatric problem in adulthood. While those being aggressive toward others showed high levels of total and internalizing symptoms. Both those being bullied and bully-victims showed an increased risk of high levels of critical symptoms. Lastly, all groups involved in bullying on adolescence had increased risk of psychiatric hospitalization because of mental health problems. CONCLUSION: Involvement in bullying in adolescence is associated with later mental health problems, possibly hindering development into independent adulthood.

Maternal and paternal psychosocial risk factors for clinical depression in a Norwegian community sample of adolescents.

BACKGROUND: Parental characteristics can increase the risk of the development of adolescent depression. In this study, we focus on the parental factors of parents in a non-intact relationship, dissatisfaction with personal economy, physical illness or disability, and internalizing and externalizing problems. The aim is to examine which of these parental risk factors, separately for mothers and fathers, are associated with clinical depression in adolescents in a community sample. METHODS: In the Youth and Mental Health study, 345 adolescents (mean age ± standard deviation 15.0 ± 0.6 years, range 13.8-16.6 years; 72.5% girls) and their parents (79% at least one parent) completed questionnaires and the diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL). Adolescents were classified into current major depressive disorder or dysthymia (n = 46), depression not otherwise specified (n = 48), or no depression (n = 251). The parental risk factors were based on interview and the Adult Self-Report. Risk factors associated with mothers (n = 267) and fathers (n = 167) were separately analyzed using ordinal logistic regression with current depression category as the dependent variable. All analyses were adjusted for youth sex and age. RESULTS: Mothers' economical dissatisfaction, physical illness/disability, internalizing problems and externalizing problems were associated with adolescent current depression (P ≤ 0.02). Adjusting for all other factors, only mothers' internalizing problems (P < 0.001) remained significantly associated with adolescent depression. Fathers' risk factors were not associated with adolescent depression. CONCLUSION: Characteristics of mothers are associated with adolescent current depression. Mothers' internalizing problems is independently strongly associated with increased risk of current adolescent depression. Clinicians should assess mothers' mental health when treating depressed adolescents.

Is involvement in school bullying associated with general health and psychosocial adjustment outcomes in adulthood?

The aim was to examine prospectively associations between bullying involvement at 14-15 years of age and self-reported general health and psychosocial adjustment in young adulthood, at 26-27 years of age. A large representative sample (N=2,464) was recruited and assessed in two counties in Mid-Norway in 1998 (T1) and 1999/2000 (T2) when the respondents had a mean age of 13.7 and 14.9, respectively, leading to classification as being bullied, bully-victim, being aggressive toward others or non-involved. Information about general health and psychosocial adjustment was gathered at a follow-up in 2012 (T4) (N=1,266) with a respondent mean age of 27.2. Logistic regression and ANOVA analyses showed that groups involved in bullying of any type in adolescence had increased risk for lower education as young adults compared to those non-involved. The group aggressive toward others also had a higher risk of being unemployed and receiving any kind of social help. Compared with the non-involved, those being bullied and bully-victims had increased risk of poor general health and high levels of pain. Bully-victims and those aggressive toward others during adolescence subsequently had increased risk of tobacco use and lower job functioning than non-involved. Further, those being bullied and aggressive toward others had increased risk of illegal drug use. Relations to live-in spouse/partner were poorer among those being bullied. Involvement in bullying, either as victim or perpetrator, has significant social costs even 12 years after the bullying experience. Accordingly, it will be important to provide early intervention for those involved in bullying in adolescence.

Longitudinal course of diagnosed depression from ages 15 to 20 in a community sample: patterns and parental risk factors.

The primary aim was to examine the associations of hypothesized maternal and paternal risk factors with course of depression diagnosis in a community sample from ages 15-20. In addition, we describe longitudinal stability and change in depression diagnosis over this period. In the Youth and Mental Health study 242 adolescents completed questionnaires and the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime interview at ages 15 and 20, and risk factors were measured by parent report including the Adult Self Report. Both groups who remained depressed and who recovered were more likely to have mothers with internalizing problems. Paternal internalizing problems was also significantly associated with course of depression. These findings suggest treatment of depression in adolescents and young adults may benefit from consideration of the parents' internalizing symptoms.

Is obesity associated with reduced health-related quality of life in Latino, Black and White children in the community?

OBJECTIVE: Few studies have examined the impact of obesity on health-related quality of life (HRQOL) in non-clinical community samples of children, and methodological limitations have hindered drawing firm conclusions, especially whether the impact is similar across racial/ethnic groups. The present aims were to examine at what levels of non-normal weight, school-aged children experience lower HRQOL and whether this differs among racial/ethnic groups, when controlling for socioeconomic status (SES) differences. DESIGN: Cross-sectional community cohort survey. SUBJECTS AND METHODS: Data are from the Healthy Passages, reporting on 4824 Latino, black and white 5th graders in a population-based survey conducted in three United States metropolitan areas. Children's weight status was classified from measured weight and height into underweight (1%), normal weight (52%), overweight (19%), obese (13%) and extremely obese (14%). Children reported their own HRQOL using the Pediatric Quality of Life Inventory and additional scales addressing global self-worth, physical appearance and body satisfaction. Parents reported children's overall health status. RESULTS: Each increment in higher non-healthy weight class-overweight to obese to extremely obese-was associated with significantly lower scores in more domains of psychosocial HRQOL compared with that in normal weight. However, only extremely obese children reported significantly lower physical HRQOL. Differences among weight classes remained when adjusting for SES and were independent of race/ethnicity. Underweight children generally reported HRQOL that was not significantly different from normal weight children. CONCLUSIONS: Overweight, obese and extremely obese 5th graders on average experience worse HRQOL than normal weight children, especially in psychosocial domains including self-worth and peer relationships, regardless of race/ethnicity. If messages can be conveyed in a sensitive and supportive manner, the desire to improve HRQOL could provide additional motivation for children and their parents in addressing unhealthy weight.

Parenting, autonomy and self-care of adolescents with Type 1 diabetes.

BACKGROUND: During adolescence diabetes creates a juncture of very complex disease management demands with developmental needs, including the striving of adolescents for greater autonomy. Parents' concerns and fears about the teen's diabetes self-management abilities during this time can heighten parental attachment behaviour and affect the parents' ability to support autonomy development necessary for effective self-care. Maternal parenting processes may be especially important for those adolescents who have Type 1 diabetes because mothers are the primary caregivers. PURPOSE: Based on attachment theory, the aim was to test a model of the influence of mother-adolescent developmental conflict, maternal separation anxiety and maternal inhibition of autonomy and relatedness on cognitive autonomy and self-care of adolescents with Type 1 diabetes. METHOD: A total of 131 families with an adolescent, aged 11-15 years, contributed data annually across three waves. Mothers and adolescents completed paper-and-pencil measures and two interaction scenarios that were coded by trained staff from audio-tapes. The adolescent also completed a structured interview and questionnaire to assess self-care. RESULTS: Maternal separation anxiety when adolescents were 11-15 years of age directly predicted cognitive autonomy at 1-year follow-up, and that cognitive autonomy was directly related to self-care 1 year later, but did not mediate between separation anxiety and self-care. CONCLUSIONS: Future investigation of the influence of separation anxiety of parents on adolescent autonomy development is warranted, as well as the contribution of autonomy development to diabetes self-management behaviours of adolescents.

Risk factors for psychopathology in children with intellectual disability: a prospective longitudinal population-based study.

BACKGROUND: This study examined risk factors for the development of psychopathology in children with intellectual disability (ID) in the developmental, biological, family and social-ecological domains. METHODS: A population sample of 968 children, aged 6-18, enrolled in special schools in The Netherlands for educable and trainable ID were assessed at Time 1. A random 58% were re-contacted about 1 year later, resulting in a sample of 474 at Time 2. RESULTS: Psychopathology was highly consistent over 1 year. Risk factors jointly accounted for significant, but small, portions of the variance in development of psychopathology. Child physical symptoms, family dysfunction and previous parental mental health treatment reported at Time 1 were uniquely associated with new psychopathology at Time 2. CONCLUSIONS: Prevention and early intervention research to find ways to reduce the incidence of psychopathology, possibly targeting family functioning, appear important.

Adaptive seasonal trend in brood sex ratio: test in two sister species with contrasting breeding systems.

Evolutionary theory predicts adaptive adjustment in offspring sex ratio by females. Seasonal change in sex ratio is one possibility, tested here in two sister species, the Common sandpiper and the Spotted sandpiper Actitis hypoleucos and A. macularia. In the monogamous Common sandpiper, males are the most competitive sex. In each of 3 years, there was a change from mainly sons in early clutches to mainly daughters in late clutches. This seasonal adjustment of clutch sex ratio took place within the female before the eggs were laid, not by differential egg or chick survival. The sex of all eggs laid in the clutches used here was determined molecularly from chick blood taken at the time of hatching. The Spotted sandpiper in contrast is polyandrous, with partly reversed sex roles. There was no seasonal trend from sons to daughters in this species. When tested together, the two species differed significantly as predicted by the hypothesis of adaptive sex ratio adjustment by females.

Bacterial translocation from defunctionalized rat small bowel.

Bacterial translocation from the intestine may cause severe infectious complications in a number of clinical situations, including the short bowel syndrome and after small bowel transplantation. The aim of the present study was to develop a simplified model for the study of bacterial translocation from a defunctionalized intestine. An ileal segment from untreated or cyclosporine-treated rats was exteriorized as a Thiry-Vella loop. After 1, 3. or 7 days, bacterial translocation and distribution of immunocompetent cells were assessed. The data obtained were compared with data from animals subjected to intestinal transplantation. Translocation to the mesenteric lymph nodes was detected in 60% of the Thiry-Vella loop animals on day 1. in 100% on day 3, and in 83% on day 7: concomitantly, the number of macrophages and T-cells in the mesenteric lymph nodes increased from day I until day 7. The degree of bacterial translocation on days 3 and 7 in animals with a Thiry-Vella loop was comparable with that observed 7 days after intestinal transplantation. Furthermore, treatment with cyclosporine A enhanced the number of translocating bacteria. In the model presented here bacterial translocation occurs from the small bowel to the mesenteric lymph nodes. The model offers possibilities to study the mechanisms and immunological phenomena associated with microbial translocation.

Maternal ratings of child behavior improve with treatment of maternal depression.

BACKGROUND AND OBJECTIVES: Maternal reports of child behavior are often the sole criterion by which childhood psychiatric disorders are diagnosed and treated, even though maternal distress or psychopathology may influence the accuracy of these reports. This study examines the effect of maternal depression and the impact of its treatment on reported behavior in the depressed women's children. METHODS: A total of 24 women with newly diagnosed major depressive disorder completed a self-rated Beck Depression Inventory (BDI) and a Conners' Parent Rating Scale (CPRS) of child behavior prior to and after 1-2 months of antidepressant treatment. RESULTS: During antidepressant treatment, mean maternal BDI declined by 53%, while mean CPRS score decreased by 20%; these improvements were significantly correlated. Changes in the conduct, learning problem, and impulsive-hyperactive CPRS-subscale scores accounted for 89% of the rated behavioral change. CONCLUSIONS: Reported behavior problems in the children of depressed mothers improved with treatment of the maternal depression, and the degree of reported behavioral improvement was highly correlated with the degree of improvement in depressive symptoms. Maternal depression must therefore be considered in the differential diagnosis of any child being evaluated for behavior or emotional problems.

Symptom management in older primary care patients: feasibility of an experimental, written self-disclosure protocol.

BACKGROUND: Distress-driven symptoms are prevalent among older primary care patients and account for a large percentage of office visits and increased medical costs. An experimental written self-disclosure protocol has been shown to reduce symptoms and use of health care services in healthy adults. Written self-disclosure as a method for reducing symptoms has not been evaluated in the primary care setting. OBJECTIVE: To evaluate the feasibility of adapting an experimental written self-disclosure protocol for the primary care setting. DESIGN: Randomized, single-blind feasibility study. SETTING: University-based geriatric and internal medicine primary care clinics. PATIENTS: 45 patients 66 years of age or older without a psychiatric diagnosis. INTERVENTION: Three 20-minute writing sessions focusing on distressing experiences (in the intervention group) or health behaviors (in the control group). MEASUREMENTS: The feasibility outcomes were patient recruitment, protocol logistics, and patient and provider satisfaction. The clinical outcomes were somatic and distress symptoms, health care utilization, and associated costs. RESULTS: One third of patients screened were recruited; 96% of patients recruited completed the protocol. Clinic contact time was an average of 55 minutes per patient. Patients and providers reported high levels of satisfaction with the protocol. Reductions in symptoms were minimal for both groups. Use of outpatient services and associated costs decreased in both groups, but the reduction was twice as great in the treatment group as in the control group. CONCLUSIONS: Findings support the feasibility of implementing the protocol as a primary care intervention.

Quality of life measurement in children and adolescents: issues, instruments, and applications.

There is increasing interest in measuring quality of life (QL) in children and adolescents, but this interest has developed without careful attention given numerous important issues. Consequently, there is much diversity and confusion in this measurement area. We discuss at a conceptual level herein how to construe and define QL, approach its measurement, and the implications of for whom this is done. Methodological issues pertaining to validation, proxy report, and child development are also discussed. Guidelines for selecting QL measures are provided and a set of generic QL measures is recommended for further consideration. Finally, applications of the QL concept in the policy, service and care, and science areas are delineated.

Growing or just getting along? Technical and adaptive competence in coping among adolescents.

This study examined coping among African American adolescents with learning disabilities. Ninety-seven African American adolescents and their mother or primary caregiver participated in the study. The study centered on a new conceptual distinction between technical competence in coping and adaptive competence in coping. Technical competence referred to short-term, reactive attempts at coping based on individuals' abilities to find techniques for reducing their feelings of distress. Adaptive competence referred to longer-term, developmental processes of adaptive change that resulted in more global benefits for the individual. Past literature was reassessed on the basis of this conceptual distinction, and a new model of technical and adaptive competence in coping was proposed based on developmental theory. Perceptions of coping efficacy and the incidence of behavioral problems were regressed on measures of technical and adaptive competence in coping. Results were explored first as a general test of the model on the total sample, and second as a comparative analysis between gender subsamples. Total sample findings were consistent with hypothesized results. Technical competence was a better predictor of feelings of efficacy and adaptive competence was a better predictor of behavioral problems. Gender subsample differences were significant and supported a picture of gender-typed approaches to coping.

[Intestinal transplantation. The first Swedish transplantation of the small intestine in an adult patient with pseudoobstruction]. / Tarmtransplantation. Första svenska tunntarmstransplantationen till en vuxen patient med pseudoobstruktion.

Recent advances, first and foremost the development of new immunosuppressive agents, have markedly improved the outcome of intestinal transplantation, which is a treatment option for patients with serious intestinal diseases who have become dependent on total parenteral nutrition. The first small bowel transplantation in Sweden was performed at Huddinge Hospital in 1997, in the adult patient with intestinal pseudo-obstruction. The article reports the course of this patient and an update of international progress in intestinal transplantation.

Cultural factors enhancing resilience and protecting against maladjustment in African American adolescents with mild mental retardation.

Researchers have found elevated risk for maladjustment associated with being an African American adolescent in an urban environment as well as being an individual with mental retardation. The culturally relevant factors of ethnic identification, intergenerational support, and church support were investigated in relation to high risk exposure on maladjustment in 147 urban African American adolescents enrolled in EMR special education classes. Maladjustment was measured with both self- and parent-report. Risk exposure was measured in the personal, social, and community domains. Results indicate that presence of cultural factors were associated with better adjustment generally. Furthermore, ethnic identification appeared to protect adolescents exposed to high-risk conditions against experiencing significantly elevated maladjustment. Implications of culture on intervention and prevention were discussed.

Effects of pediatric chronic physical disorders on child and family adjustment.

Research conducted primarily over the past 5-8 years on the psychosocial effects of pediatric chronic physical disorders on children and their families is reviewed. A large body of studies show that both children and their mothers, as groups, are at increased risk for psychosocial adjustment problems compared to peers, but that there is considerable individual variation in outcome. Since the last review on this topic (Eiser, 1990a), many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children and their mothers. Improvements are noted in the theoretical basis for this work, programmatic nature of some of the research, and efforts at producing clinically relevant information. Evaluations of interventions, however, are lagging. Critical issues and future directions regarding developmental approaches, theory, method, measurement, and intervention are discussed.

Health risk behaviors of African American adolescents with mild mental retardation: prevalence depends on measurement method.

Health risk behaviors (e.g., substance use, violence, suicide, and car safety) of 194 14- to 17-year-old African American urban adolescents with mild mental retardation from special education classes were measured. One group was assessed using a confidential individual interview method, and an individually matched group was assessed with an anonymous group survey method. Participants completing the anonymous survey reported engaging more frequently in risk behaviors that respondents typically consider sensitive. In comparison to national and state populations of African American adolescents, urban African American adolescents with mild mental retardation appear to be at substantial elevated risk for engaging in alcohol binge drinking and weapon and gun carrying. Findings were discussed relative to cognitive and social deficits inherent in mild mental retardation.