The Effects of an Equine-Assisted Therapeutic Intervention on Well-Being in Persons Diagnosed with Schizophrenia. A Pilot Study.

The process of personal recovery among persons diagnosed with schizophrenia may be facilitated through innovative health promotion interventions targeting multidimensional aspects of subjective well-being. The current pilot study aims to test the use of self-rated questionnaires as a means of evaluation of the effects of an equine-assisted intervention for persons diagnosed with schizophrenia. Twenty adults diagnosed with schizophrenia were offered a 12-week EAT intervention performed six times once every 14 days by a licensed mental health nurse. Two validated self-rated questionnaires, HSCL-25 and SHIS were used as outcome measurements at baseline and at post-treatment, additionally the self-rated questionnaire PANAS was completed twice a week starting 1 week before the 12 week-EAT intervention. Only six of the 20 participants managed to complete the validated questionnaires. Despite the low response rate of approximately 30%, a significant difference was found between pre and post scores for positive affect and well-being. Effect sizes, ranging from small to large for pre-to-post treatment scores indicated less depression and anxiety, more positive affect, less negative affect, and reinforced well-being. Results suggest that EAT interventions may have beneficial effects among persons diagnosed with schizophrenia and that a varied range of research methods are needed to create a solid evidence base for EAT interventions intended for the target group.

Investigating the influence of intraindividual changes in perceived stress symptoms on injury risk in soccer.

Research has shown that high levels of stress and stress responsivity can increase the risk of injuries. However, most of the research that has supported this notion has focused on between-person relationships, ignoring the relationships at the within-person level. As a result, the objective of this study was to investigate if within-person changes in perceived stress symptoms over a 1-month time period could predict injury rates during the subsequent 3 months. A prospective design with two measurement points (Time 1-at the beginning of the season and Time 2-1 month into the season) was utilized. A total of 121 competitive soccer players (85 males and 36 females; Mage  = 18.39, SD = 3.08) from Sweden and the United States completed the Kessler Psychological Distress Scale (KPDS) and a demographic sheet at Time 1. The KPDS was also completed at Time 2, and all acute injuries that occurred during the subsequent 3-month period were recorded. A Bayesian latent change scores model was used to determine whether within-person changes in stress symptoms could predict the risk of injury. Results revealed that there was a credible positive effect of changes in stress symptoms on injury rates, indicating that an increase in reported stress symptoms was related to an increased risk for injury. This finding highlights the importance of creating caring and supportive sporting environments and relationships and teaching stress management techniques, especially during the earlier portion of competitive seasons, to possibly reduce the occurrence of injuries.

The temporal relations across burnout dimensions in athletes.

Burnout is a construct that has garnered considerable attention in sport psychology within recent years. Several hypothesized models regarding how the three dimensions (exhaustion, devaluation, and reduced sense of accomplishment) temporally relate to each other have been advanced. One proposal outlined by Maslach and Leiter suggests that exhaustion predicts devaluation which predicts reduced sense of accomplishment. However, there is no consensus among researchers as it has been argued that exhaustion predicts devaluation and reduced accomplishment separately. The aim of this study was to test multiple alternative hypotheses regarding the relationships of the burnout dimensions in athletes. Two samples of Swedish youth elite athletes with differing time spans between measurements were used. Specifically, one sample involved time-intensive measures collected every week over an eight-week period, and the other sample included four measurement points across an 18-month period. Results showed that none of the previously proposed models outlining the temporal relations of burnout dimensions were supported. Statistical analysis of the models including the cross-lagged predictions of dimensions did not have any statistically significant impact except when exhaustion negatively predicted devaluation between time 1 (month 0) and time 2 (month 6) in the 18-month sample; this relation faded in the following time points. Further, issues regarding the stability of devaluation and reduced sense of accomplishment emerged as their autocorrelation were very weak in the time-intensive sample. These findings raise a number of points for further theoretical and practical discussions about the athlete burnout construct.

Nutrient intake in adolescent girls and boys diagnosed with coeliac disease at an early age is mostly comparable to their non-coeliac contemporaries.

BACKGROUND: Food habits, nutrient needs and intakes differ between males and females, although few nutritional studies on patients with coeliac disease (CD) have reported results stratified by gender. OBJECTIVES: To compare energy and nutrient intakes among 13-year olds diagnosed with CD in early childhood with those of a non-coeliac (NC) age- and gender-matched control group, and also with estimated average requirements (EAR). METHODS: A case-control study was conducted in Sweden 2006-2007 within the coeliac screening study ETICS (Exploring The Iceberg of Coeliacs in Sweden). Dietary intake was assessed among 37 adolescents (23 girls) diagnosed with CD at median age 1.7 years (CD group) and 805 (430 girls) NC controls (NC group) using a food-frequency questionnaire covering 4 weeks. Reported energy intake was validated by comparison with the calculated physical activity level (PAL). RESULTS: Regardless of CD status, most adolescents reported an intake above EAR for most nutrients. However, both groups had a low intake of vitamin C, with 13% in the CD-group and 25% in the NC-group below EAR, and 21% of boys in the CD-group below EAR for thiamine. The intake of fatty acids was unbalanced, with a high intake of saturated and a low intake of unsaturated fats. Girls and boys in the CD-group had an overall lower nutrient density in reported food intake compared to girls and boys in the NC-group. CONCLUSIONS: Nutrient intake of adolescent girls and boys with CD was mostly comparable to intakes of NC controls. Dietitians should take the opportunity to reinforce a generally healthy diet when providing information about the gluten-free diet.

Sleep interventions for children with attention deficit hyperactivity disorder (ADHD): A systematic literature review.

OBJECTIVE/BACKGROUND: Healthy sleep is particularly important for children with attention deficit hyperactivity disorder (ADHD), as sleep disturbances might aggravate disease symptoms. This review aims to synthesize and report evidence on the effectiveness of sleep interventions in increasing sleep, quality of life (QoL), and ADHD symptoms among children with ADHD. PATIENTS/METHODS: The systematic literature review follows the Cochrane Collaboration methodology recommendations for literature reviews. Four databases were used based on the population, intervention, control and outcome (PICO) framework. Controlled trials with minimum 20 children in each group, aged 6-18, and published from 2005 and onwards were included. Results from the studies were reported in forest plots and three of the seven review outcomes were synthesized in meta-analyses. RESULTS: The search identified 7710 records; of which 4808 abstracts were screened. After fulltext-screening of 99 papers, eight papers from five studies were included. The studies included behavioral sleep interventions and pharmacological interventions using melatonin and eszopiclone. For six of the seven outcomes, the effect sizes were small to moderate and the certainty of the evidence was low. For one outcome, sleep disturbances, the effect size was a moderate -0.49 standardized mean differences (95% confidence interval -0.65;-0.33), with a moderate certainty of evidence for the behavioral interventions for children aged 5-13 years with ADHD. CONCLUSIONS: This review identified few and heterogeneous studies. A moderate certainty of evidence for a moderate effect size was only obtained for sleep disturbances from the behavioral interventions. A low certainty of the evidence for a moderate effect size was found for the total sleep time from the pharmacological intervention using melatonin and one behavioral intervention, which indicates that these sleep interventions impact sleep quantity and quality among children with ADHD.

Psychological predictors of sport injuries among junior soccer players.

Previous researches have established models that specify psychological factors that could predict sport injuries. One example is Williams and Andersen's stress-injury model stressing factors such as anxiety, negative life stress and few coping resources. The purpose of the current study was to find psychological factors that could lead to an increased injury risk among junior soccer players, in addition to construct an empirical model of injury risk factors for soccer players. The participants were 108 male and female soccer players (m=17, 6) studying at soccer high schools in southwest Sweden. Five questionnaires were used, State Trait Anxiety Inventory, Sport Anxiety Scale, Life Events Survey for Collegiate Athletes, Athletic Coping Skills Inventory-28 and Swedish universities Scales of Personality. Injury record was collected by athletic trainers at the schools during a period of 8 months. The result suggested four significant predictors that together could explain 23% of injury occurrence. The main factors are life event stress, somatic trait anxiety, mistrust and ineffective coping. These findings partly support Williams and Andersen's stress-injury model and are organized into an empirical model. Recommendations are given to sport medicine teams and coaches concerning issues in sport injury prevention.

Children with screening-detected coeliac disease show increased levels of nitric oxide products in urine.

AIM: Increased concentration of nitric oxide (NO) metabolites, nitrite and nitrate, in the urine is a strong indication of ongoing small intestinal inflammation, which is a hallmark of the enteropathy of coeliac disease (CD). It has previously been shown that children with symptomatic, untreated CD have increased levels of NO oxidation products in their urine. The aim of this study was to investigate whether screening-detected, asymptomatic coeliac children display the same urinary nitrite/nitrate pattern. METHODS: In a multicenter screening study, serum samples were collected from 7208 12-year-old children without previously diagnosed CD. Sera were analysed for anti-human tissue transglutaminase (tTG) of isotype IgA. Small bowel biopsy was performed in antibody-positive children, yielding 153 new cases of CD. In the screening-detected individuals, the sum of nitrite and nitrate concentrations in the urine was analysed and used as an indicator of NO production. For comparison, 73 children with untreated, symptomatic CD were studied. RESULTS: The nitrite/nitrate levels in children with screening-detected CD and those with untreated symptomatic CD did not differ significantly. Both groups had significantly increased urinary nitrite/nitrate concentrations compared to the children with normal small bowel biopsy (p < 0.001). CONCLUSION: Children with screening-detected CD have increased production of NO just as children with untreated symptomatic CD. High NO metabolite levels in the urine may indicate a pathogenetic feature of CD and be a marker of major clinical importance.

The everyday life of adolescent coeliacs: issues of importance for compliance with the gluten-free diet.

BACKGROUND: Noncompliance with the gluten-free diet is often reported among adolescents with coeliac disease. However, knowledge is limited regarding their own perspectives and experiences of managing the disease and the prescription of a gluten-free diet. The aim of this study was to explore how adolescents with coeliac disease perceive and manage their everyday lives in relation to a gluten-free diet. METHODS: In total, 47 adolescents with coeliac disease, divided into 10 focus groups, were interviewed. In the qualitative analysis, themes emerged to illustrate and explain the adolescents' own perspectives on life with a gluten-free diet. RESULTS: The probability of compliance with the gluten-free diet was comprised by insufficient knowledge of significant others, problems with the availability and sensory acceptance of gluten-free food, insufficient social support and their perceived dietary deviance. Three different approaches to the gluten-free diet emerged: compliers, occasional noncompliers, and noncompliers. Each approach, as a coping strategy, was rational in the sense that it represented the adolescents' differing views of everyday life with coeliac disease and a prescription of a gluten-free diet. CONCLUSIONS: dolescents with coeliac disease experience various dilemmas related to the gluten-free diet. The study demonstrated unmet needs and implies empowerment strategies for optimum clinical outcomes.

Systematic review with meta-analysis: early infant feeding and coeliac disease--update 2015.

BACKGROUND: New evidence emerged on early feeding practices and the risk of coeliac disease. AIM: To systematically update evidence on these practices to find out whether there is a need to revise current recommendations. METHODS: MEDLINE, EMBASE and the Cochrane Library were searched from July 2012 (end of last search) to February 2015 for studies of any design that assessed the effect of gluten consumption and breastfeeding on the development of coeliac disease and/or coeliac disease-related autoimmunity. RESULTS: We identified 21 publications, including two, new, large, randomised controlled trials performed in high-risk infants. Exclusive or any breastfeeding, as well as breastfeeding at the time of gluten introduction, did not reduce the risk of developing coeliac disease during childhood. For infants at high risk of developing coeliac disease, gluten introduction at 4 months of age in very small amounts, or at 6 or 12 months of age, resulted in similar rates of coeliac disease diagnosis in early childhood. Later gluten introduction was associated with later development of coeliac specific autoimmunity and coeliac disease during childhood, but not total risk reduction. Observational studies indicate that consumption of a higher amount of gluten at weaning may increase the risk for coeliac disease development. CONCLUSIONS: Infant feeding practices (breastfeeding, time of gluten introduction) have no effect on the risk of developing coeliac disease during childhood (at least at specific timeframes evaluated in the included studies), necessitating an update of current European recommendations.

Children born in the summer have increased risk for coeliac disease.

STUDY OBJECTIVE: Coeliac disease, also called permanent gluten sensitive enteropathy, is being recognised as a widespread health problem. Defining the possible role of environmental factors in its aetiology might open doors to primary prevention. This study therefore analysed if the risk for coeliac disease varies with month of birth as a proxy for a seasonal pattern for possible causal environmental exposure(s). DESIGN: A population based incidence register of coeliac disease in children below 15 years of age covering the period from 1973 to 1997. Incidence rates were calculated by month of birth, stratified for age at diagnosis. Poisson regression analyses were used to estimate the relative risk for coeliac disease for children below 2 years of age by season of birth, also taking into account gender and time period of diagnosis. SETTING: Sweden. PARTICIPANTS: All 2151 children in the study base with verified coeliac disease. MAIN RESULTS: The risk for coeliac disease was significantly higher if born during the summer as compared with the winter (RR=1.4, 95% CI 1.2 to 1.7), but only in children below 2 years of age at diagnosis. This relative seasonal risk pattern prevailed during a 10 year epidemic of coeliac disease, although incidence rates varied threefold. The incidence was constantly higher among girls as compared with boys, but boys showed a more pronounced seasonal variation in risk than girls. CONCLUSIONS: An increased coeliac disease risk in children born in the summer compared with the winter reflects causal environmental exposure(s) with a seasonal pattern. Infections might be the exposure of importance, either by means of a direct causal role and/or through interaction with other exposures, for example, gluten intake. However, non-infectious exposures should also be explored as possible contributing causal factors.

Coeliac disease: effect of early feeding on the incidence of the disease.

Coeliac disease, also called permanent gluten sensitive enteropathy, has recently been recognised as constituting a widespread health problem. Effective treatment involves the strict exclusion of wheat, rye, barley and possibly also oats from the diet. Genetic susceptibility and the presence of gluten in the diet are prerequisites for developing the disease. Sweden has recently experienced an epidemic of coeliac disease in children below 2 years of age. Previously, considerable changes in incidence over time have also been reported from England, Scotland and Ireland. Such obvious changes in incidence over rather short time periods, in genetically stable populations, emphasise the importance of environmental factors in the aetiology. Thus, most likely, the aetiology of coeliac disease is multifactorial. However, further conclusive evidence is required to settle if environmental factors, beyond presence of gluten in the diet, really influence the immunological process resulting in the coeliac small intestinal lesion, or merely influence the clinical expression of the disease. The search for contributing exposures has thus far focused on early feeding, suggesting that breast-feeding duration and the amount of gluten consumed are of importance, and possibly also the age for introducing gluten into the diet of infants. The pattern of causation may vary over time and between countries, however, which may obscure the search for risk factors. Nevertheless, a challenging possibility that needs to be explored is if coeliac disease can be delayed, or possibly even prevented for an entire life span, by favourable dietary habits.

Does breast-feeding affect the risk for coeliac disease?

Coeliac disease, or permanent gluten sensitive enteropathy, has emerged as a widespread health problem. It is considered an immunological disease, possibly of autoimmune type, albeit strictly dependent on the presence in the diet of wheat gluten and similar proteins from rye and barley. There are reasons to believe that the aetiology of coeliac disease is multifactorial, i.e. that other environmental exposures than the mere presence in the diet of gluten affect the disease process. Our studies have shown that prolonged breast-feeding, or perhaps even more important, ongoing breast-feeding during the period when gluten-containing foods are introduced into the diet, reduce the risk for coeliac disease. The amount of gluten consumed is also of importance in as much as larger amounts of gluten-containing foods increase the risk for coeliac disease, while it still is uncertain if the age for introducing gluten into the diet of infants is important. Thus, a challenging possibility, that need to be further explored, is if the coeliac enteropathy can be postponed, or possibly even prevented for the entire life span, by favourable dietary habits early in life.

Current status of pressure chamber treatment.

Forty-five patients with unilateral and one patient with bilateral Meniere's disease were exposed to underpressure in a pressure chamber during an acute attack that was primary in 24 and recurrent in 23. The patients were instructed to avoid active equilibration during reduction of the pressure, in order to induce an overpressure in the middle ear. Treatment was promptly followed by improvement of hearing in 20 patients (21 ears) and by a remission for more than three years in seven cases. No side effects were observed. We therefore believe that this procedure may be useful in the prevention of damage to the cochlear hair cells with secondary permanent loss of hearing.

Immediate relief of symptoms during acute attacks of Meniere's disease, using a pressure chamber.

Five patients with Meniere's disease were exposed to underpressure in a pressure chamber while suffering from acute attacks with vertigo, nausea, tinnitus and fullness of the ear. Spontaneous nystagmus was the objective criterion for the selection of suitable cases. Subjective as well as objective symptoms subsided much faster than they do with other kinds of treatment. Four patients were free from symptoms within 40 minutes, while the fifth case still complained of vertigo, tinnitus and fullness of the ear after the treatment. However, the symptoms were less severe. A mechanism is discussed by means of which an ambient pressure decrease might cause a reduction of the endolymphatic volume, thus relieving acute symptoms of Meniere's disease.

On tubal function in presence of central perforation of drum in chronic otitis media. Clinical methods and preoperative analyses - 132 cases.

Opinions differ on the value of preoperative testing of tubal function. The results vary widely, but so far no comparative investigation between different tubal function tests seems to have been published. On 132 ears with central tympanic perforation, 9 of which were traumatic and the remaining following chronic otitis media, tubal function was studied with a closed manometric method and open flow volume method which measures the tubal volume passage. The results of the closed and open techniques agreed in 96%. The open method is more sensitive, but the closed method is easier. 70% of the total material had aspiration capacity, i.e. could neutralise middle ear pressures, which is better than earlier results. Toynbee's test is a good screening test and when positive, it means good tubal function. A close correlation was found between tubal function and the volume of the air cell system as an effect of the systemic mucosal damage.

Volume-pressure properties of round and oval windows. A quantitative study on human temporal bone.

A model study was carried out on human temporal bones to assess quantitatively the displacement of the round and oval windows when different pressure levels were applied to the external ear canal and inside the middle ear. It was found that the major displacements of the window membranes occurred in the pressure range of +/- 20 cm H2O in the intact middle ear. An additional increase in the middle ear pressure up to +/- 70 cm H2O caused a minor displacement of the window membranes.

Pressure opening and closing functions of the eustachian tube in children and adults with normal ears.

Eustachian tube function was studied with the impedance technique and a pressure chamber in 58 children, aged 3-12 years, and 61 adults, aged 17-73 years, all otologically healthy. The pressure opening and closing functions were measured, i.e. the relative overpressure in the middle ear required to force open the tube, and the residual overpressure in the middle ear after pressure opening, respectively. These "passive" functions of the tube, assumed to reflect the closing factors, did not differ significantly between normal children and adults. The muscular opening function, i.e. "active" pressure equilibration capacity, on the other hand, was significantly poorer in children than in adults and poorer in younger children than in older ones. The results can be used as a reference material in investigations of the Eustachian tube in children with middle ear disease.

Reliability in tests of the eustachian tube function.

With the aid of a quantitative impedance method and a pressure chamber, the capacity of the Eustachian tube to equilibrate pressure differences across the tympanic membrane was repeatedly determined in 20 otologically healthy men. The test-retest reliability was calculated from five determinations of static pressure equilibration of over- and underpressures of 10 cmH2O and 10 determinations of equilibration of dynamic pressure changes. The pressure opening level of the tube during pressure increase in the middle ear was significantly lowered in the initial determinations. The residual pressure in the middle ear after maximum equilibrating efforts during pressure increase in the chamber was also significantly lowered. For the rest, the test-retest reliability was good. Ears with perfect tubal function had better test-retest reliability for all parameters tested than ears with poorer function. The significance of repeated measurements and the value of reliability determinations are discussed.

Pressure opening and closing functions of the Eustachian tube by inflation and deflation in children and adults with normal ears.

Different inflationary (e.g. Valsalva's) and deflationary (e.g. sniffing) manoeuvres were studied in 58 children and 61 adults, all otologically healthy, in order to evaluate qualitatively and quantitatively the pressure opening and closing functions of the Eustachian tube. Only 71% of the normal children could voluntarily increase the middle ear pressure compared with 100% of the adults. The corresponding figures for evacuating the middle ear by deflation were 24% and 34%, respectively. The rhinopharyngeal pressure levels during the manoeuvres were age-dependent and decided the response rate in children. Tubal factors also determined the response rate since low pressure opening and closing levels were related to successful deflation. Negative middle ear pressures found in the normal children were due to poor muscular opening function of the tube rather than successful deflation. The pressure closing level seems to be a reliable tool in grading tubal closing ability.