Testing the Efficacy of a Smartphone Application in Improving Medication Adherence, Among Children with ADHD.

BACKGROUND: Adherence to medication is a key factor for successful treatment of children with ADHD. However, most children do not adhere to their pharmacotherapy regimen, and have no contact with their physician during the first month of pharmacotherapy. A mobile health (mHealth) approach may bridge the gap between physicians and patients, allowing for more frequent communications as well as better monitoring of adherence to the prescribed treatment. METHOD: The study sample included 39 children with ADHD (27 boys), aged 9.56±2.41 years. Participants were randomly assigned to one of the following two groups: (1) a study group in which participants and their parents were prompted to use a mobile application (i.e., mobile app or app); or to (2) a control group in which participants were treated as usual, without the app. Pill counts, which is a common strategy for confirming medication adherence, was recorded at week 4 and week 8. Clinical assessment conducted at baseline, week 4, and week 8. RESULTS: Participants who were prescribed with the app demonstrated higher overall pill counts over 8-weeks period, F=4.33, p<.05. In addition, a significant improvement in total CRS score was found among the study group compared to controls in week 4 and week 8, F=4.74, p<.05. CONCLUSIONS: The current study provides initial support for the feasibility of a new mobile app in promoting adherence to stimulants among youth with ADHD.

Hyperglycemia drives intestinal barrier dysfunction and risk for enteric infection.

Obesity, diabetes, and related manifestations are associated with an enhanced, but poorly understood, risk for mucosal infection and systemic inflammation. Here, we show in mouse models of obesity and diabetes that hyperglycemia drives intestinal barrier permeability, through GLUT2-dependent transcriptional reprogramming of intestinal epithelial cells and alteration of tight and adherence junction integrity. Consequently, hyperglycemia-mediated barrier disruption leads to systemic influx of microbial products and enhanced dissemination of enteric infection. Treatment of hyperglycemia, intestinal epithelial-specific GLUT2 deletion, or inhibition of glucose metabolism restores barrier function and bacterial containment. In humans, systemic influx of intestinal microbiome products correlates with individualized glycemic control, indicated by glycated hemoglobin levels. Together, our results mechanistically link hyperglycemia and intestinal barrier function with systemic infectious and inflammatory consequences of obesity and diabetes.

Screening for psychiatric comorbidity in children with recurrent headache or recurrent abdominal pain.

BACKGROUND: Recurrent pain symptoms in children are associated with psychiatric comorbidities that could complicate treatment. We investigated the prevalence of psychiatric comorbidity in children with recurrent headache or recurrent abdominal pain and evaluated the screening potential of the Strength and Difficulties Questionnaire compared with the Development and Well-Being Assessment (DAWBA). METHODS: Eighty-three outpatients aged 5-17 years attending a tertiary medical center for a primary diagnosis of migraine (n = 32), tension-type headache (n = 32), or recurrent abdominal pain (n = 19), and 33 healthy matched controls completed the brief self-reporting Strength and Difficulties Questionnaire followed by the Development and Well-Being Assessment. Findings were compared among groups and between instruments. RESULTS: The pain groups were characterized by a significantly higher number of Development and Well-Being Assessment diagnoses (range 0-11) than controls and a significantly greater prevalence (by category) of Development and Well-Being Assessment diagnoses (P < 0.001 for both). Anxiety and depression were the most prevalent Development and Well-Being Assessment diagnoses. Comorbidities were more severe in the headache groups than the controls (P < 0.001). In general, any diagnosis by the Development and Well-Being Assessment was associated with a significantly higher Strength and Difficulties Questionnaire score (P < 0.001). Abnormal scores on the emotional, conduct, and hyperactivity Strength and Difficulties Questionnaire scales were significantly predictive of a Development and Well-Being Assessment diagnosis (P < 0.003). CONCLUSION: Children referred to specialized outpatient pediatric units for evaluation of recurrent pain are at high risk of psychopathology. The Strength and Difficulties Questionnaire may serve as a rapid cost-effective tool for initial screening of these patients.