Not Quite Meeting the Mark: College Experiences for Patients With Celiac Disease.

Strict adherence to a gluten-free diet (GFD), the current treatment for celiac disease (CD), is socially challenging for adolescents, especially in the college setting. We conducted a survey of factors contributing to GFD adherence during college among patients meeting the ESPGHAN criteria for CD. One-hundred-one young adults (18 years and older) were contacted; 59 completed the survey, of which 47 were enrolled or had attended college. The survey was developed by the study team. Most patients were able to maintain strict adherence to the GFD, whereas at college and reported that GF food was available and consistent with expectations. Nearly all participants reported a lack of resources for students with CD. Strong family support helped, and school stress and lack of peer support impeded diet adherence. Although colleges may meet the basic needs of celiac students, the availability and quality of gluten-free options, and improved campus resources are needed.

Call for Action: High Rates of Depression in the Pediatric Celiac Disease Population Impacts Quality of Life.

To test the impact of celiac disease (CD) and depression symptoms on quality of life in adolescent patients. Methods: We conducted a prospective survey of 12- to 18-year-old celiac patients and their caregivers between January 2015 and November 2016. Enrolled parents and youth completed standard measures of adjustment to celiac disease, depression, and quality of life. Results: We enrolled 105 patients with CD and their parents. Both parents and youth reported high levels of depression symptoms. There were no associations between age, duration of CD, or following a gluten-free diet (GFD) and quality of life. No significant associations were found between adolescent perception of CD state and quality of life; parental report of adolescent's adjustment to CD; and youth report of quality of life were modestly associated (r = 0.19, P ≤ 0.05). Moderate associations were observed between adolescent reports of depression and quality of life (r = 0.59, P < 0.01) and between parental reports of adolescent depression and quality of life (r = 0.41, P = 0.01). Only depressive symptoms by youth and parent report, however, and not adjustment to celiac, explained unique variance in quality of life. Conclusion: Adolescents with CD report levels of depression comparable to those reported by adolescents seeking mental health services. Length of time living with CD, or on GFD, age at diagnosis and perception of disease state do not appear to contribute to depression. High rates of depression may impact CD prognosis, therefore, screening for depression in adolescents with CD appears critical. Identification and intervention of depression may lead to improved adherence to the GFD during emerging adulthood.

Delving Deeper Into Informed Consent: Legal and Ethical Dilemmas of Emergency Consent, Surrogate Consent, and Intraoperative Consultation.

Informed consent is gaining an ever-important place in modern medicine. The practice of patient-centered medicine along with evidence-based medicine requires a balance between the patient's wishes and the physician's oath to do no harm. Surrogate consent, emergency consent, and intraoperative consultation are 3 situations prone to legal and ethical dilemmas in the fulfillment of informed consent. By examining the proposed models and legal precedents that address the challenges in informed consent, discussion of these dilemmas in the context of both law and bioethics may provide a better understanding of how to resolve them. [Orthopedics. 2018; 41(6):e741-e746.].

Individual differences in combat experiences and error-related brain activity in OEF/OIF/OND veterans.

Increased error-related negativity (ERN) has been implicated in the pathophysiology of multiple forms of psychopathology. Although there is increasing evidence that the ERN can be shaped by environment and experience, no studies to date have examined this question in a clinical sample. In the current study, we examined the influence of combat exposure on the ERN using electroencephalogram (EEG) in a sample of military veterans with a high prevalence of psychopathology. Participants included sixty-seven U.S. military veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). The degree of combat exposure was assessed using the Deployment Risk and Resilience Inventory-2 (DRRI-2) and Combat Exposure Scale (CES). A well-validated flanker task was used to elicit the ERN during continuous EEG recording. Results revealed that veterans who reported experiencing greater combat exposure exhibited a more enhanced ERN, even when adjusting for broad anxiety and posttraumatic stress disorder (PTSD) symptoms. The association between combat exposure and ERN was not moderated by PTSD symptom severity. The current study demonstrates that greater combat exposure is associated with a more enhanced ERN among OEF/OIF/OND veterans. This enhanced ERN may be one mechanism that places veterans at greater risk for developing psychiatric disorders following exposure to combat. Future longitudinal studies are needed to directly test whether the ERN mediates the relation between level of combat exposure and the development of internalizing disorders.