Development of a clinical score to estimate pancreatitis-related hospital admissions in patients with a new diagnosis of chronic pancreatitis: the trinity score.

BACKGROUND: The clinical course of chronic pancreatitis is unpredictable and there is no globally accepted score to predict the disease course. We developed a clinical score to estimate pancreatitis-related hospitalisation in patients with newly diagnosed chronic pancreatitis. METHODS: We conducted a retrospective cohort study using two clinical chronic pancreatitis databases held in tertiary referral centres in Dublin, Ireland, and in Tarragona, Spain. Individuals diagnosed with chronic pancreatitis between 2007 and 2014 were eligible for inclusion. Candidate predictors included aetiology, body mass index, exocrine dysfunction, smoking and alcohol history. We used multivariable logistic regression to develop the model. RESULTS: We analysed data from 154 patients with newly diagnosed chronic pancreatitis. Of these, 105 patients (68%) had at least one hospital admission for pancreatitis-related reasons in the 6 years following diagnosis. Aetiology of chronic pancreatitis, body mass index, use of pain medications and gender were found to be predictive of more pancreatic-related hospital admissions. These predictors were used to develop a clinical score which showed acceptable discrimination (area under the ROC curve = 0.70). DISCUSSION: We developed a clinical score based on easily accessible clinical parameters to predict pancreatitis-related hospitalisation in patients with newly diagnosed chronic pancreatitis.

ABCs and 123s: A large birth cohort study examining the role of the home learning environment in early cognitive development.

The aim of this study was to examine the role of different types of home learning activities, such as reading, singing, painting, playing games, and letters and numbers (ABCs and 123 s), in the development of nonverbal reasoning skills in young children. Although much previous research has focused on the role of the home learning environment in the development of language and numeracy skills, few studies have explored other aspects of cognitive development such as nonverbal reasoning. The data were drawn from the Growing Up in Ireland study, a nationally representative longitudinal birth cohort study. We examined whether learning activities were associated with scores on standardized nonverbal reasoning and vocabulary tests of the British Ability Scales in a sample of 9793 3-year-old children. The regression models also controlled for other factors that potentially influence cognitive development such as the parent-child relationship and maternal education. The findings indicate that activities such as reading, games, and painting/drawing have a small but statistically significant association with nonverbal reasoning scores, as well as with vocabulary scores, even after controlling for other factors in the model. Teaching the alphabet or numbers did not make significant contributions to the model. The findings of the study highlight the importance of considering the role of different types of home learning activities, as well as other environmental factors, in different aspects of cognitive development. We consider the implications of the findings for theories of cognitive development and for supporting cognitive development in young children.

Dietary intake in patients with chronic pancreatitis: A systematic review and meta-analysis.

BACKGROUND: A progressive reduction in the secretion of pancreatic enzymes in patients with chronic pancreatitis (CP) results in malabsorption and ultimate malnutrition. However, the pathogenesis of malnutrition is multifactorial and other factors such as chronic inflammation, alcohol excess and poor dietary intake all contribute. Patients may restrict their dietary intake due to poor appetite or to avoid gastrointestinal symptoms and abdominal pain. Whilst up to half of patients with chronic pancreatitis are reportedly malnourished, the dietary intake of patients with CP is relatively understudied and has not been systematically reviewed to date. AIM: To perform a systematic review and meta-analysis of the dietary intakes of patients with CP compared to healthy controls, and to compare the dietary intake of patients with alcohol-related CP and non-alcohol-related CP. METHODS: A systematic literature search was performed using EMBASE, MEDLINE, and Cochrane review on studies published between 1946 and August 30th, 2019. Adult subjects with a diagnosis of CP who had undergone dietary assessment were included in the systematic review (qualitative analysis). Studies on patients with other pancreatic diseases or who had undergone pancreatic surgery were not included. Studies comparing the dietary intake of patients with CP to that of healthy controls were included in the meta-analysis (quantitative analysis). Meta-analysis was performed using Review Manager 5.3. Newcastle Ottawa Scale (NOS) was used to assess quality of studies. RESULTS: Of 6715 studies retrieved in the search, 23 were eligible for qualitative analysis while 12 were eligible for quantitative analysis. In the meta-analysis, the total energy (calorie) intake of patients with CP was similar to that of healthy controls [mean difference (MD): 171.3; 95% confidence interval (CI): -226.01, 568.5; P = 0.4], however patients with CP consumed significantly fewer non-alcohol calories than controls [MD: -694.1; 95%CI: -1256.1, (-132.1); P = 0.02]. CP patients consumed more protein, but carbohydrate and fat intakes did not differ significantly. Those with alcohol-related CP consumed more mean (standard deviation) calories than CP patients with a non-alcohol aetiology [2642 (1090) kcal and 1372 (394) kcal, respectively, P = 0.046], as well as more protein, fat, but not carbohydrate. CONCLUSION: Although patients with CP had similar calorie intake to controls, studies that analysed the contribution of alcohol to energy intake showed that patients with CP consumed fewer non-alcohol calories than healthy controls. A high calorie intake, made up to a large degree by alcohol, may in part contribute to poor nutritional status in CP.

Missing Early Education and Care During the Pandemic: The Socio-Emotional Impact of the COVID-19 Crisis on Young Children.

Worldwide, millions of children have missed out on early childhood education and care (ECEC) due to the closure of their settings during the COVID-19 pandemic. However, little is known about the socio-emotional impact of these closures on young children. This paper draws upon a study of 506 parents of children aged 1-10 years in Ireland who completed the online Play and Learning in the Early Years (PLEY) Survey during lockdown in May and June 2020. Parents responded to a series of questions about their child's play, learning and development during lockdown, and described the impact of the restrictions on their children's lives. The study was approved by the institutional ethics committee. Findings indicate that most children missed their friends, playing with other children, and the routine and structure of ECEC and school settings. Parents described the negative impact of the closure of these settings on their children's social and emotional well-being, which they suggested, resulted in tantrums, anxiety, clinginess, boredom, and under-stimulation. However, some parents did report positive aspects of lockdown for their children and the family, including more time to play with siblings and a break from the usual routine. While the findings of the PLEY study indicate that children's socio-emotional development was severely disrupted during lockdown, with a variety of negative impacts, this experience was not universal. Moreover, the findings suggest that families missed the nurturing environment provided by ECEC programs that supported their children's socio-emotional development, as well as the structure and routine afforded by their children's participation in early childhood programs.

A high prevalence of genetic polymorphisms in idiopathic and alcohol-associated chronic pancreatitis patients in Ireland.

BACKGROUND: Individual genetic architecture is considered central to susceptibility and progression of disease in chronic pancreatitis. The study aimed to evaluate the presence of common pancreatic gene mutations in a defined cohort of idiopathic and alcohol-induced chronic pancreatitis patients in Ireland. METHODS: The study comprised patients with idiopathic and alcohol-induced chronic pancreatitis and historic controls. Variants in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, cationic trypsinogen (PRSS1) gene and serine protease inhibitor kazal type-1 (SPINK1) gene, were assessed by Taqman© genotyping assay. RESULTS: Of n = 126 patients and n = 167 controls, mutations were detected in 23 (20%) and in 10 (6%) respectively (P < 0.001). The majority of mutations found were in the SPINK1 gene variant N34S (13%) which increased disease risk almost six-fold (OR 5.9). Neither CFTR severe mutation (F508del) (P = 0.649) nor mild variant (R117H) (P = 0.327) were over-represented amongst patients compared to control subjects. PRSS1 variants were not detected in either patient or control subjects. CONCLUSION: There was a significant prevalence of chronic pancreatitis-associated gene mutations in this well-phenotyped cohort. In patients with alcohol-related or idiopathic chronic pancreatitis, the possibility of genetic mutations in the SPINK 1 gene should be considered as a contributing aetiology factor.

The Role of Screen Time and Screen Activity in the Nonverbal Reasoning of 5-Year-Olds: Cross-Sectional Findings from a Large Birth Cohort Study.

Family and home environment factors have been outlined in previous literature as important variables that affect early reasoning development. However, little research has focused on the association between screen use in the home environment and nonverbal reasoning ability. The aim of this cross-sectional study is to examine the role of both screen time and various screen activities (e.g., television, video, or educational games) in nonverbal reasoning ability in 9,001 5-year-old children using a large birth cohort study (Growing Up in Ireland). Interviews conducted with parents related to the children's screen use and various family factors, while reasoning ability was measured using a standardized task (Picture Similarities Task, British Ability Scales II). A hierarchical multiple regression examined the role of screen use in nonverbal reasoning, while also statistically controlling for family factors such as parental education and employment status. Screen use variables made a significant contribution to the regression model, even after family factors were accounted for, although the effect sizes were very small. Playing educational games, video games, or engaging in over three hours screen use per day were all significant predictors of nonverbal reasoning scores in the final adjusted model. The results of this study suggest that screen use may play a small role in the development of nonverbal reasoning in young children. The findings highlight the need for further studies in this area and may have implications for current debates in screen time research.

Inferences from counterfactual threats and promises.

We examine how people understand and reason from counterfactual threats, for example, "if you had hit your sister, I would have grounded you" and counterfactual promises, for example, "if you had tidied your room, I would have given you ice-cream." The first experiment shows that people consider counterfactual threats, but not counterfactual promises, to have the illocutionary force of an inducement. They also make the immediate inference that the action mentioned in the "if" part of the counterfactual threat and promise did not occur. The second experiment shows that people make more negative inferences (modus tollens and denial of the antecedent) than affirmative inferences (modus ponens and affirmation of the consequent) from counterfactual threats and promises, unlike indicative threats and promises. We discuss the implications of the results for theories of the mental representations and cognitive processes that underlie conditional inducements.

Indicative and counterfactual 'only if' conditionals.

We report three experiments to test the possibilities reasoners think about when they understand a conditional of the form 'A only if B' compared to 'if A then B'. The experiments examine conditionals in the indicative mood (e.g., A occurred only if B occurred) and counterfactuals in the subjunctive mood (A would have occurred only if B had occurred). The first experiment examines the conjunctions of events that reasoners judge to be consistent with conditionals, e.g., A and B, not-A and not-B. It shows that people think about one possibility to understand 'if' and two possibilities to understand 'only if'; they think about two possibilities to understand counterfactual 'if' and 'only if'. The second experiment shows that the possibilities people think about when they understand 'only if' are in a different temporal order (e.g., B and A) to the possibilities they think about for 'if' (A and B). The third experiment shows that people make different inferences from 'only if' and 'if' conditionals and counterfactuals. The implications of the results for theories of counterfactual conditionals are considered.

Counterfactual and prefactual conditionals.

We consider reasoning about prefactual possibilities in the future, for example, "if I were to win the lottery next year I would buy a yacht" and counterfactual possibilities, for example, "if I had won the lottery last year, I would have bought a yacht." People may reason about indicative conditionals, for example, "if I won the lottery I bought a yacht" by keeping in mind a few true possibilities, for example, "I won the lottery and I bought a yacht." They understand counterfactuals by keeping in mind two possibilities, the conjecture, "I won the lottery and I bought a yacht" and the presupposed facts, "I did not win the lottery and I did not buy a yacht." We report the results of three experiments on prefactuals that examine what people judge them to imply, the possibilities they judge to be consistent with them, and the inferences they judge to follow from them. The results show that reasoners keep a single possibility in mind to understand a prefactual.