Symptoms Have Modest Accuracy in Detecting Endoscopic and Histologic Remission in Adults With Eosinophilic Esophagitis.

BACKGROUND & AIMS: It is not clear whether symptoms alone can be used to estimate the biologic activity of eosinophilic esophagitis (EoE). We aimed to evaluate whether symptoms can be used to identify patients with endoscopic and histologic features of remission. METHODS: Between April 2011 and June 2014, we performed a prospective, observational study and recruited 269 consecutive adults with EoE (67% male; median age, 39 years old) in Switzerland and the United States. Patients first completed the validated symptom-based EoE activity index patient-reported outcome instrument and then underwent esophagogastroduodenoscopy with esophageal biopsy collection. Endoscopic and histologic findings were evaluated with a validated grading system and standardized instrument, respectively. Clinical remission was defined as symptom score <20 (range, 0-100); histologic remission was defined as a peak count of <20 eosinophils/mm(2) in a high-power field (corresponds to approximately <5 eosinophils/median high-power field); and endoscopic remission as absence of white exudates, moderate or severe rings, strictures, or combination of furrows and edema. We used receiver operating characteristic analysis to determine the best symptom score cutoff values for detection of remission. RESULTS: Of the study subjects, 111 were in clinical remission (41.3%), 79 were in endoscopic remission (29.7%), and 75 were in histologic remission (27.9%). When the symptom score was used as a continuous variable, patients in endoscopic, histologic, and combined (endoscopic and histologic remission) remission were detected with area under the curve values of 0.67, 0.60, and 0.67, respectively. A symptom score of 20 identified patients in endoscopic remission with 65.1% accuracy and histologic remission with 62.1% accuracy; a symptom score of 15 identified patients with both types of remission with 67.7% accuracy. CONCLUSIONS: In patients with EoE, endoscopic or histologic remission can be identified with only modest accuracy based on symptoms alone. At any given time, physicians cannot rely on lack of symptoms to make assumptions about lack of biologic disease activity in adults with EoE. ClinicalTrials.gov, Number: NCT00939263.

Análisis de los apoyos que reciben los jóvenes con discapacidad intelectual en su transición a la vida adulta en España: una investigación a partir de experiencias de profesionales y personas con discapacidad = Analysis of support received by young people with intellectual disabilities in their transition to adulthood in Spain: an investigation based on the experiences of professionals and people with disabilities

The objective of this study is to gather information regarding the adaptation of the range of socio educational projects and services aimed at the transition to an adult life of young persons with intellectual disabilities in Spain. The research of the study has been done in three stages. During each stage, a specific tool has been used. One to one in-depth interviews have been undertaken with 45 professionals and 20 individuals with intellectual disabilities. The Delphi method has been applied to two panels consisting of 20 experts each. Firstly, results focus on the approach to different issues related to the devices. Secondly, the training opportunities that these individuals receive to ease the transition period is addressed. And finally, the study refers to the participation of the individuals themselves and their families in the process. The developed analysis allows us to propose strategies to improve the transition to adult life

The role of emotional state, sexual arousal, and alcohol intoxication as situational factors associated with adults’ online sexual contact with children and adolescents

In the present study we explored whether and how the situational factors; emotional states, sexual arousal, and alcohol intoxication influenced the propensity in adults to engage in online sexual contact with children (13 or younger) and adolescents (14 – 17 year olds). The results were compared to a group of adults that had engaged in online sexual contact with adults only (18 or older). We also looked at the variation over time within these situational factors during the online sexual contact with a child, an adolescent, or an adult. The present study was an online self-report survey to the adult populations in Finland, Sweden, and Germany, with a final sample (N = 776) of women and men who were active on the Internet. The participants were asked to report whether, how, and with whom they had engaged in online sexual contact. The results showed that more men than women reported online sexual contact with persons of all age groups, and that the situational factors; emotional states and sexual arousal influenced the propensity in both women and men to engage in online sexual contact with children and adolescents. However, the effects of alcohol intoxication were small and significant only for men. These results indicate that higher levels of emotional state and sexual arousal might increase the propensity to go against social norms and contact children and adolescents online for sexual purposes, but it can also imply that that those who look for online sexual contact online with children and adolescents, are more emotionally and/or sexually aroused than the group that only seek adult company or that these are post-hoc explanations for such sexual activities.

Benzodiazepines and Cognitive Functioning in Older Adults. With Emphasis on Long-Term Use and Withdrawal

Benzodiazepines (BZD) and benzodiazepine related drugs (RD) are the most commonly used psychotropics among the aged. The use of other psychotropics taken concomitantly with BZD/ RD or their cognitive effects with BZD/RD have not been studied frequently. The aim of this academic thesis was to describe and analyse relationships between the use of BZD/RD alone or concomitantly with antipsychotics, antidepressants, opioids, antiepileptics, opioids and anticholinergics in the aged and their health. Especially, the relationships between long-term use of BZD/RD and cognitive decline were studied. Additionally, the effect of melatonin on BZD/RD withdrawal and the cognitive effects of BZD/RD withdrawal were studied. This study used multiple data sets: the first study (I) was based on clinical data containing aged patients (≥65 years; N=164) admitted to Pori City Hospital due to acute disease. The second data set (Studies II and III) was based on population-based data from the Lieto Study, a clinico-epidemiological longitudinal study carried out among the aged (≥65 years) in the municipality of Lieto. Follow-up data was formed by combining the cohort data collected in 1990-1991 (N=1283) and in 1998-1999 (N=1596) from those who participated in both cohorts (N=617). The third data set (Studies IV and V) was based on the Satauni Study’s data. This study was performed in the City of Pori in 2009-2010. In the RCT part of the Satauni Study, ninety-two long-term users of BZD/RD were withdrawn from their drugs using melatonin against placebo. The change of their cognitive abilities was measured during and after BZD/ RD withdrawal. BZD/RD use was related to worse cognitive and functional abilities, and their use may predict worse cognitive outcomes compared with BZD/RD non-users. Hypnotic use of BZD/RD could be withdrawn with psychosocial support in motivated participants, but melatonin did not improve the withdrawal results compared to those with placebo. Cognitive abilities in psychomotor tests did not show, or showed only modest, improvements for up to six months after BZD/RD withdrawal. This suggests that the cognitive effects of BZD/RD may be longlasting or permanent.

Heart rate variability in young adults - Reference values and associations with cardiometabolic risk factors and vascular properties. The Cardiovascular Risk in Young Finns Study.

Background: The function of the autonomic nervous system (ANS) can be evaluated with heart rate variability (HRV). Decreased HRV is associated with aging, the male sex, increased heart rate, and overall increased cardiometabolic risk. It has been hypothesized that early atherosclerotic vascular changes and ANS function are related. Aims: The aims were to assess reference values on HRV in young adults, and examine associations with HRV and cardiometabolic risk factors and metabolic syndrome (MetS) and to study relations between HRV and ultrasonographically measured vascular properties. Participants and methods: The present thesis is part of the Cardiovascular Risk in Young Finns Study. The thesis is based on the follow-up study in 2001, when the study individuals were 24-39 years of age. HRV data were available on 1 956 individuals. Results: HRV was inversely associated with age and heart rate (for all p<0.001). Highfrequency HRV (HF) was higher, and low-frequency HRV (LF) lower in women than men (p<0.0001 for both). MetS was associated with 11% decreased HF and 12% increased LF/HF-ratio in women, and 8% decreased HF and 4% increased LF/HF-ratio in men. Carotid artery distensibility was independently associated with HF and total HRV (for both p<0.05). Conclusions: The reference values in young adults were generated. Decreased HRV was associated with age, the male sex and increased heart rate. Women had higher HF and lower LF variability than men. MetS was related to decrease in HRV. The observed associations between carotid elasticity and HRV, supports the hypothesis that reduction in carotid elasticity may lead to decrease in autonomic cardiac control.

Characterization and analysis of the outcome of adults with acute myeloid leukemia treated in a Brazilian University hospital over three decades

We evaluated the outcome of 227 patients with acute myeloid leukemia during three decades (period 1 - 1980’s, N = 89; period 2 - 1990’s, N = 73; period 3 - 2000’s, N = 65) at a single institution. Major differences between the three groups included a higher median age, rates of multilineage dysplasia and co-morbidities, and a lower rate of clinical manifestations of advanced leukemia in recent years. The proportion of patients who received induction remission chemotherapy was 66, 75, and 85% for periods 1, 2, and 3, respectively (P = 0.04). The median survival was 40, 77, and 112 days, and the 5-year overall survival was 7, 13, and 22%, respectively (P = 0.01). The median disease-free survival was 266, 278, and 386 days (P = 0.049). Survival expectation for patients with acute myeloid leukemia has substantially improved during this 30-year period, due to a combination of lower tumor burden and a more efficient use of chemotherapy and supportive care.

Physical access for persons with disabilities

For persons with disabilities, the activities that able-bodied people take for granted can be major, often insurmountable challenges. Attempting to enter a restaurant for lunch with friends can result in lengthy and adversarial litigation if the facility is not accessible to a person with a disability or other mobility impairment. This litigation would be initiated after the individual was effectively refused service; a refusal based on hislher personal physical characteristics. If a shopping mall is not equipped with "access amenities", then the disabled person may be excluded from shopping there and thus exercising consumer freedom. If workplaces are not equipped to accommodate the access needs of persons with disabilities, then those people are effectively barred from gainful employment there. If a municipal goveniment building is inaccessible to disabled persons, then they may be excluded from participating in council meetings. These are all activities that the majority of the population enjoys as a matter of course, in that they represent the functions of a free citizen in a free society. If a person is excluded from such activities because of some personal characteristic, then that person is subjected to differential or discr~minatory treatment. The guarantees provided in Canadian feden! and provincial rights legislation, are such that people are not to be discriminated againsL Where buildings and facilities othen\iise open to the public are not accessible for persens with disabilities, then those people are being discriminated against. To challenge these discriminatory practices, individuals initiate complaints through the administrative justice system. To address the extent to which this is a problem, many sources were consulted. Constitutional lawyers, tribunal members, advocates for the disabled and land use planners were interviewed. Case law and legislation were reviewed. Literature on citizenship theory, dispute resolution and dispute avoidance was compiled and assessed. And, the field of land use planning was analyzed (drawing on the WTiter's educational and experiential background) as a possible alternative method for effecting systemic access for persons with disabilities. The conclusion of this study is that there does exist a proactive method for assuring access, a method that can apply the systemic remedy needed to deal with this problem. The current method, which is an adversarial and piecemeal complaint process, has proven ineffective in remedying this discrimination problem~ Failure to provide an appropriate remedy means that persons with disabilities will not enjoy the degree of citizen status enjoyed by the able-bodied. This is the current circumstance, and since equity is the aim of rights legislation, and since such legislative and administrative frameworks have failed in that purpose, then an alternative method is necessary. An alternative model is the one in which land use planning is based. It has conflict avoidance and conflict minimization as underpinnings. And, most importantly, land use planning is already a proyen method of combatting discrimination.

School integration and the friendships of youth with developmental disabilities

- The present study was an investigation into the effect ofschool integration on the friendships ofyouth with developmental disabilities and their peers without disabilities. The youths, their parents, and their teachers provided insights into the youths' friendships. A qualitative paradigm was used in this research. The researcher guided the collection and analysis ofthe data with the phenomenologicallifeworld existentials of body, space, time, and human relation (Van Manen, 1990). Individual interviews were conducted with each youth, and group interviews were conducted with each triad (a youth, their parent(s), and their teacher) to discuss the youth's friendships and the supports necessary to facilitate the friendships. Through phenomenological analysis of the data, four thematic statements emerged: friendships are far from perfect, to have a friend you have to be a friend, parents as choreographers offriendship, and teachers as reluctant partners in friendship facilitation. Based on the results ofthis study, it was concluded that the development of friendships between youth with developmental disabilities and their peers without disabilities was happening in integrated school settings. However, it was also evident that the support ofteachers and parents alike were required to facilitate the development and maintenance ofsuch friendships. Recommendations for practice are discussed, including the need for active participation by the youth's parents in the facilitation offriendships, and the use ofa "circle offriends" to facilitate friendship development. Also discussed are the recommendations for further research, including the need for the youth's friends to be interviewed regarding their friendships with the youth with disabilities, and the need for researcher observation ofth~ friendships in action. Further research could also explore the role ofthe mother versus the father in facilitating friendships, and the role of recreation and leisure opportunities in the ,development offriendships.

Therapeutic riding : learning and recovery for people with disabilities

The purpose ofthis study was to explore the process oftherapeutic riding as an experiential and holistic approach to learning and recovery for people with disabilities as perceived by the providers oftherapeutic riding. To enhance the connection between theory and practice and to suggest future research, the researcher endeavoured to develop a theory that contributed to the knowledge base oftherapeutic riding, animal-assisted therapy and education, experiential education, and experiential therapy in addition to contributing to connections among them. This topic was investigated because ofthe lack ofresearch about the process of therapeutic riding, particularly from learning and a recovery perspective. Few studies have addressed how therapeutic riding outcomes are achieved or how the therapeutic riding process actually works. This study was identified as grounded theory using qualitative data through interviews and narrative reflections with therapeutic riding providers, a researcher's journal, field notes, and written documents. Grounded theory analysis was used to analyze the qualitative data. This consisted ofdoing open, axial, and selective coding. This study provided detailed descriptions ofthe research approach, researcher's involvement, participant and site selection, data collection and analysis, methodological assumptions and limitations, credibility established, and ethical considerations. The findings ofthe data analysis revealed the theme ofrelationships as central to the learning and recovery process oftherapeutic riding for people with disabilities. The significance ofthe team relationships, the horse and rider relationship, and the providers and rider relationship was found. The essential components ofthe learning and recovery process were presented in a diagram in the selective coding phase. Goals oftherapeutic riding included psycho-education; behavioural and social; physical; and equestrian. Parts ofthe process ofhow outcomes were achieved included motivation; "opens new doors;" risk; task analysis; control; communication; and environmental factors. Outcomes of therapeutic riding included independence and mobility; confidence; and transfer abilities or skills. The implications ofthese findings for theory, practice, and further research were also. explored.

Ontario's curriculum for individuals with disabilities : a textual analysis

The purpose of this study was to examine the disability discourses present in Ontario elementary schools curriculum. The study used a critical social analysis perspective to employ a textual discourse analysis on the Planning [title of subject] Programs for Students with Special Education Needs (PPSSEN) section of the curriculum. The present study utilized Parker's (1992) seven criteria for distinguishing discourses and discovered five main discourses; Independent, dependent, legal, scientific and agency discourses. The second step to this research was the placement and discussion of these five discourses on three diverse texts, Paulo Freire's (2008) Pedagogy o/ the Oppressed, Psychiatry Inside Out, Selected writings of Franco Basaglia, written by Scheper-Huges and Lovell (1987) and Aronowitz and Giroux's (1985) Education Under Siege: The Conservative, Liberal and Radical Debate over Schooling. These unique perspectives were used as methods of analysis tools to further analyze the dominate disability discourses. The texts provided textual support in three major areas; dialectics, critical education and structural conditions of power and language of traditional roles and responsibilities. The findings and discussions presented in this project contain significant implications for anyone involved with students with disabilities in any education system.

Lived experiences of children with disabilities in various movement programs

This research offered children with disabilities the opportunity to express their voices in the description of their movement experiences. Three children aged 10-13 shared their experiences in school physical education and adapted physical activity. Observations of participants using interactive media activities in an adapted physical activity program were used to supplement interviews. The aim of this research was to discover how future professionals are prepared to design and implement physical activity and physical education programs for children with disabilities. A document analysis of Ontario university course calendars in the fields of physical education and kinesiology, disability studies, and teacher education was utilized. Data from each data context underwent four levels of reduction: 1) content, 2) categorical, 3) thematic, and 4) indigenous typologies. Findings are presented at each level leading to the presentation of indigenous typologies. Typologies of Forbidden-ness and Dichotomous Thinking were identified in the research.

Back to Basics: Exploring gestural habits as cues for anticipating self-injurious episodes in a child with Autism and Deafness

This research project is a longitudinal qualitative case study. It contributes to an understanding of self-injurious behaviour (SIB) by inviting the reader through the narrative of the lived experience of a fifteen year old child-informant and the network of individuals in his life. The value and importance of a case-study is that it focuses on the authenticity of the experience of living with disability. Through the use of detailed field observations, interviews and photo documents, the study thoroughly explores three main areas: quality of movements, potential cues as pre-cursors to episodes of self-injury, and purposeful communication. The research begins with a review of literature on Autism, Deafness and Self-injury, formulates the research design and orientation of Physical Education, Phenomenology and Semiotics, and then systematically explores four distinct phases in the analytical process. The aim was to explore self-injurious episodes in the child informant in hopes to translate the meaning of the behaviour and potentially utilize this to provide more opportunities for adapted physical activity. The findings reveal distinct patterns of movement cues utilized for different purposes. The implications of the findings are self-injurious episodes in the child informant are preceded by distinct patterns of movement that are potentially communicative. Suggested future direction of the research is expanding the scope to other disabilities for which verbal communication is challenging, and standardizing the translating tools to assist in understanding the communication of movement.

Coping with a Learning Disability: A Case Study

The purpose of this qualitative case study was to understand a child’s experience with a learning disability (LD) through the way that they cope with it, and how self-esteem, self-efficacy, attribution style, and social support contribute to this process. Qualitative interviews were conducted with one child, his parents, and his teacher, accompanied by a content analysis of the child’s psychosocial assessment report. It was found that the child copes well with having a learning disability, employing a problem-focused/approach coping style by seeking help and practicing for skills he struggles with, an emotion-focused coping style by implementing strategies to alleviate frustration, and compartmentalizing his disability. Further, self-esteem, self-efficacy, attribution style, social support and sports and leisure engagement were found to contribute positively to the coping process. These findings offer useful implications for parents, teachers, and practitioners to support other students with LD.

Needs of High Functioning Teenagers and Adults with Autism (Tips from a Recovered Autistic)

Some of the topics discussed in the article include: Direct Fixations, Gradual Introduction to a Career, Talent and Deficit Areas, Thinking in Pictures, Reading and Language, Social Problems, Recognize Need for Change, Cognitive Differences, Constant Anxiety, Improvement Takes Time, Family Background and Depression, Sensory Problems, Aggressive and Self-Injurious Behavior.