Case report: KETOLAND the psychoeducation program for ketogenic diet.

Glucose transporter type 1 deficiency syndrome (GLUT1DS) is a rare neurological disorder characterized by a wide spectrum of symptoms: epilepsy, movement disorders and neurocognitive impairment. The gold standard treatment for GLUT1DS are ketogenic dietary therapies (KDTs), specifically classical ketogenic diet (CKD). Despite the benefits, CKD often represents a challenge for patients and their families since meal preparation is extremely demanding and deviates a lot from normal diet. To assure an optimal compliance to CKD a psychological support for parents and patients with GLUT1DS is highly recommended. Specifically, a psychoeducational intervention that ameliorates the knowledge about the illness and its therapy improves treatment' s adherence and efficacy. The aim of this case report is to investigate the effectiveness of a psychoeducational program, partially implemented through telepsychology, based on the theoretical model of Cognitive Behavioral Play Therapy (CBPT) to support KDT knowledge and adherence in a patient with GLUT1DS who presented a worsening of her clinical picture due to a sparse knowledge of KDTs principles which determined a low adherence. Thus, with this case report we propose a model of intervention with psychoeducation in a patient with a complex chronic disease.

Temperament and Social-Emotional Difficulties: The Dark Side of Learning Disabilities.

The authors compared the relations between general psychological difficulties and dimensions of temperament in children with and without learning disability (LD). The main aim was to analyze whether and to what extent children's temperament dimensions contribute to their general psychological difficulties when LD diagnosis, age, and gender are taken into account. Participants were 52 elementary school children 7-11 years old (M age = 8.61 years, SD = 1.21 years). Twenty-six of them had been diagnosed with LD. Six teachers rated their pupils with and without LD in relation to their general psychological difficulties (Strengths and Difficulties Questionnaire) and temperament dimensions (Italian Questionnaires of Temperament). In children with LD, the main dimensions of temperament with the power to predict general psychological difficulties (i.e., emotionality and social orientation) concern these students' relationships with others (teachers and peers). The findings of the current study draw educators' and practitioners' attention to the fact that children's temperamental characteristics may affect how they experience their LD, with significant implications for their later social adjustment.

[Differences in coping strategies of preadolescents with and without exposure to the L'Aquila (Central Italy) 2009 earthquake]. / Differenze nella scelta delle strategie di coping in preadolescenti esposti e non esposti al sisma dell'Aquila del 6 aprile 2009.

OBJECTIVES: to assess the presence of a characteristic coping strategy profile in a wide sample of preadolescents following a traumatic exposure (i.e., L'Aquila earthquake). DESIGN: we have investigated the coping strategies through the Brief-Cope Coping Orientation towards Problems Experienced - new Italian version (COPE-NVI) devised to measure coping strategies on five levels: problem-oriented coping strategies, avoidance strategies, social-support strategies, positive attitude, transcendent orientation. SETTING AND PARTICIPANTS: 129 preadolescents exposed (75 females and 54 males) and 107 non-exposed to the trauma (54 females and 53 males), age-ranged 11-14 years, coming from L'Aquila and from another Italian region far away from the epicentre of the earthquake. The trauma exposure was assessed through a checklist considering the presence of negative factors such as death of relatives and friends and displacement from home. Participants were tested collectively at school during school time in accordance with their teacher. An exclusion criterion was the presence of psychic disorders following or preceding the trauma. MAIN OUTCOME MEASURES: the need to develop a diagnostic protocol including coping measures aim to planning preventive actions for avoiding post-traumatic diseases. RESULTS: the trauma exposure without consequent psychiatric disorders causes a high heterogeneity within coping dimensions, such phenomenon does not happen in the non-exposed group. Coping strategies are not affected by age and gender, but only by the exposure to the trauma. Furthermore, death of relatives/friends and displacements from home predict the use of specific coping strategies (i.e., social-support strategies and transcendent orientation). CONCLUSION: coping is a dynamic process of adjustment to critical events that requires to direct cognitive and behavioural resources. The trauma exposure modifies coping strategies and dimensions. This study shows the importance to use coping tools for helping people in using positive and active resource of coping.

Perceived self-efficacy and coping styles related to stressful critical life events.

OBJECTIVE: The study examined the personal resources, Self-efficacy and Coping Strategies, in a sample of pre-adolescents who experienced an emotionally and socially critical event, such as the earthquake of the 6(th) of April 2009, related to age and gender. METHODS: 198 pre-adolescents, 84 girls and 114 boys (Age Mean 12 years), attending Secondary School in L'Aquila meso-seismic area. The emotional, behavioural and social capacities have been assessed with specific questionnaires administered collectively ten months after the earthquake. RESULTS: Multidimensional analyses produced differentiated profiles according to gender and age: self-efficacy-perception and coping strategy profiles, based on quartiles calculations, revealed the difficulties of the subjects in estimating their ability to cope with the world of relations and emotions after the critical event. CONCLUSIONS: The intervention could be specific to the cognitive, emotional and relational state of children and adolescents and differentiated before (prevention), during (intervention) and after the event (intervention and prevention).

The hemorrhoid laser procedure technique vs rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids.

BACKGROUND: Hemorrhoid laser procedure is a new laser procedure for outpatient treatment of hemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is stopped by means of Doppler-guided laser coagulation. OBJECTIVE: Our aim was to compare the hemorrhoid laser procedure with rubber band ligation for outpatient treatment of symptomatic hemorrhoids with moderate mucosal prolapse. DESIGN: This was a randomized controlled trial with balanced allocation to hemorrhoid laser procedure or rubber band ligation, with stratification by study center. SETTING: This study was conducted at 2 teaching hospitals in Italy. PATIENTS: Patients with symptomatic grade II or grade III hemorrhoids with minimal mucosal prolapse were eligible for the study. INTERVENTIONS: In the hemorrhoid laser procedure operation, a Doppler probe was inserted into the anal canal through a dedicated disposable proctoscope to identify the terminal branches of superior hemorrhoidal arteries approximately 3 cm above the dentate line. Five pulsed laser shots were delivered to each identified artery through the proctoscope to close the terminal branches. The procedure was repeated for each artery through clockwise rotation of the proctoscope. Absence of a Doppler signal after treatment confirmed arterial coagulation. Rubber band ligation was performed by positioning rubber bands at the base of left lateral, right anterior, and right posterior piles. No anesthesia was given for either technique. MAIN OUTCOME MEASURES: Operative time, complications, postoperative pain (visual analog scale), postoperative downgrading of hemorrhoids, resolution of symptoms, and quality of life were evaluated. RESULTS: A total of 60 patients (35 women, 25 men; mean age, 46 years) entered the trial and were analyzed. No significant differences between rubber band ligation and hemorrhoid laser procedure were observed in operative time or intraoperative morbidity. The median postoperative pain score was 2.9 (range, 1-5) with rubber band ligation vs 1.1 (range, 0-2) for hemorrhoid laser procedure (P < .001). At 6 months, resolution of symptoms was observed in 16 patients (53%) with ligation vs 27 (90%) with hemorrhoid laser procedure (P < .001), and reduction of hemorrhoids by at least 1 grade was observed in 12 patients (40%) with ligation vs 24 (80%) with hemorrhoid laser procedure (P < .001). Significantly higher quality of life was seen in the hemorrhoid laser procedure group (P = .002). LIMITATIONS: Follow-up was not longer than 1 year (median, 6 mo). CONCLUSIONS: Despite higher cost, the hemorrhoid laser procedure technique was more effective than rubber band ligation in reducing postoperative pain, resolving symptoms, and improving quality of life in patients with grade II or III hemorrhoids with incomplete mucosal prolapse.

Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment.

BACKGROUND: According to the "vascular" theory, arterial overflow in the superior hemorrhoidal arteries would lead to dilatation of the hemorrhoidal venous plexus. A 980-nm diode laser-pulsed shot causes shrinkage of tissue. The depth of shrinkage can be regulated by the power and duration of the laser beam. Through a 1000-micron conic fiber, five laser shots generated at a power of 13 W with duration of 1.2 s each and a pause of 0.6 s caused shrinkage of tissues to the depth of approximately 5 mm. Terminal branches of the superior hemorrhoidal artery in the anal canal, if precisely identified through a Doppler signal, can be closed with the use of this laser. METHODS: A specially designed proctoscope has a small window that allows introducing a Doppler probe whose function is to identify hemorrhoidal arteries. Approximately 3 cm above the dentate line, the terminal branches of the superior hemorrhoidal artery (usually 8-12) are recognized through a clockwise rotation of the proctoscope and progressively fulgurated through a laser optic fiber. The procedure does not require anesthesia and can be performed as an ambulatory treatment. RESULTS: Thirty patients (16 men) with second to third grade symptomatic hemorrhoids have been treated with the described technique. The procedure proved to be successful at 3 months' follow-up in 92% of cases. No major adverse effects or complications were reported. Bleeding was observed in four cases. In two cases surgical hemostasis was necessary. Minor pain that required medication was reported in three cases. CONCLUSIONS: The hemorrhoidal laser procedure (HeLP) represents a new nonexcisional, mini-invasive treatment for patients suffering from second and third degree hemorrhoids without severe mucosal prolapse. Thermal occlusion of the hemorrhoidal arteries causes a progressive shrinkage of hemorrhoidal cushions. The procedure does not require anesthesia, is technically easy, repeatable, and can be performed as an office treatment.

Theories of intelligence in children with reading disabilities: a training proposal.

A recent trend in the study of reading difficulties promotes multidimensional intervention, focusing on the reciprocal influences exerted by cognitive and emotional-motivational variables. This study evaluated improvements in reading performance as a function of metacognitive training in 36 children (M age = 8.7 yr.) with different representations of intelligence. Posttest evaluations show significantly more improvement in reading comprehension in children with an incremental theory of intelligence. These results indicate the importance of treatment programmes that take into account both the specificity of deficits and factors relating to the domain of motivation.

Noninvasive assessment of cardiac resynchronization therapy for congestive heart failure using myocardial strain and left ventricular peak power as parameters of myocardial synchrony and function.

INTRODUCTION: Although invasive studies have shown that cardiac resynchronization therapy by biventricular pacing improves left ventricular (LV) function in selected heart failure patients, it is impractical to apply such techniques in the clinical setting. The aim of this study was to assess the acute effects of cardiac resynchronization therapy by noninvasive techniques. METHODS AND RESULTS: Twenty-two patients enrolled in the InSync trial (age 64 +/- 9 years, 18 men and 4 women; all with ejection fraction < 35% and QRS > 130 msec) were studied 1 to 12 months after pacemaker implantation during pacing, and while ventricular pacing was inhibited. Regional myocardial strains of the interventricular septum, LV free wall, and right ventricular free wall were derived from color Doppler tissue echocardiography. Peak power index was calculated as a product of simultaneously recorded noninvasive blood pressure and pulse-wave (PW) Doppler velocity of the LV outflow tract. The Z ratio (sum of LV ejection and filling times divided by RR interval) and tei index were calculated from PW Doppler data. During pacing, overall regional strain improved (P = 0.01), while the LV strain coefficient of variation decreased from 2.7 +/- 2.4 to 1.3 +/- 0.7 (P = 0.009). Additionally, peak power index improved from 84 +/- 24 to 94 +/- 27 cm x mmHg/sec (P = 0.004). The Z ratio increased from 0.71 +/- 0.08 to 0.78 +/- 0.07 (P = 0.0005), while the tei index decreased from 0.86 +/- 0.33 to 0.59 +/- 0.16 (P = 0.0002). CONCLUSION: Using novel noninvasive indices, we demonstrated that cardiac resynchronization therapy improves LV performance.