Support for Students Exposed to Trauma (SSET) Program: An Approach for Building Resilience and Social Support Among Flood-Impacted Children

School Mental Health - The present study is a pilot study to examine the initial effectiveness of the Support for Students Exposed to Trauma (SSET) program (Jaycox et al. in Support for Students...     

Effectiveness of metronidazole gel and mobile telephone short-message service reminders on gingivitis in orthodontic patients:: A double-blind randomized controlled trial

ObjectivesTo compare the effectiveness of metronidazole gel and mobile telephone short-message service (SMS) reminders on gingivitis in patients undergoing fixed orthodontic treatment.Materials and MethodsThe trial was double blinded (patient and investigator), and only the clinical trial unit pharmacist was unblinded. Data were collected from patients undergoing fixed orthodontic treatment for at least 6 months. A total of 66 patients were randomly assigned to either 0.8% metronidazole gel (n = 22), SMS reminder and placebo gel (n = 22), or placebo (control) group only (n = 22). Gingival index (GI), bleeding index (BI), and orthodontic plaque index (OPI) were evaluated on several teeth at baseline (T₀) and after 4 weeks (T₁). Paired-sample t-tests were used to compare mean differences of indexes at T₀ and T₁ in the groups, and independent-sample t-tests were used to determine the effects of interventions compared with the controls.ResultsData from 64 patients were analyzed; there were 2 dropouts. There were statistically significant (P < .05) reductions in GI, BI, and OPI scores from T₀ to T₁ for each intervention. However, there were no significant differences between each intervention and the control group. There were no adverse effects.ConclusionsThe null hypothesis could not be rejected. There is no difference between interventions (application of 0.8% metronidazole gel and SMS reminder for reinforcing oral hygiene) in reducing gingival inflammation in orthodontic patients.     

Is non-traditional therapy for multiple sclerosis overwhelming in Saudi Arabia

Objectives:To describe the prevalence, knowledge and attitudes about complementary and alternative medicine (CAM) use and the proportion that seek advice from their physician about CAM use.Methods:This cross-sectional observational study was performed in multiple sclerosis (MS) clinic of King Fahd Hospital of Universityin Alkhobar, Kingdom of Saudi Arabia from January-June 2017. A total of 133 patients have completed the survey.Results:The mean age of patients was 32.3±7.6 years and 84 (63.2 %) were female. Approximately 83.5% of the patients reported the use of CAM. Among all the reported forms of CAM, vitamins were the most prevalent form, followed by cupping, special prayers and meditation. The majority of patients (62%) obtained knowledge of CAM through social media. A significant number of patients (75.6%) did not disclose the use of CAM to their physician. There was a trend for using CAM more in highly educated, older age, and female patients. The most commonly reported rationale to use CAM was overall improvement in health status.Conclusion:The use of CAM among Saudi patients with MS is highly prevalent, without disclosure of its use to physicians. These factors should be taken into account in the doctor-patient consultation to avoid adverse events.

Multiple sclerosis (MS) is a chronic neurological disorder, typified by a relapsing and progressive course of symptoms, resulting in long-term severe disability. Multiple sclerosis was thought to be uncommon in Kingdom of Saudi Arabia, but the prevalence of MS is increasing in the Gulf region, particularly in Kingdom of Saudi Arabia, and the latest prevalence estimates are 40/100,000 in 2008.1,2 These increasing numbers of MS patients represent a challenge to provide treatment, health promotion, employment, and rehabilitation for severely disabled patients.3 The etiology of MS is still unknown. Multiple sclerosis patients face many challenges in their daily routine life, like other patients suffering from chronic diseases. Treatment for MS is not curative, though many disease modifying drugs (DMDs) are available with United States of America’s Food and Drug Administration (FDA) approval; the available treatment options for MS often have several adverse side effects and a very high cost. Therefore, MS patients turn to CAM with the hope to cure their MS, minimizing the relapses and treating their symptoms, even though the efficacy may not be established. Complementary and alternative medicine is defined as “a group of diverse medical and health-care systems, practices and products that are not presently considered to be part of conventional modern medicine”.1There is a worldwide interest in CAM. Its use ranges from 9-70% of the total population, despite insufficient scientific evidence for its use.4 Complementary and alternative medicine is popular among patients as well as healthy individuals.4 There are variations in CAM practices between countries, which depend on their traditions and the prevalence of diseases. Also, the methods that are used in different studies differ.4,5Patients suffering from MS are significant users of CAM.6 The prevalence of CAM use among MS patients has been reported in several studies, with a wide range of prevalence between 33-70%.6 Knowledge about CAM practices and the prevalence in MS patients in Arab countries is limited. To document the influence of psychosocial, religious and cultural factors on health beliefs and behaviors in Kingdom of Saudi Arabia, having a religious background, studying CAM is of utmost importance.4,7 Health care facilities are free for the nationals in Kingdom of Saudi Arabia and provided by The Ministry of Health, but the ministry does not cover CAM. However, a center for CAM was established by a ministerial decree (No. 236) on 10/8/1429 H (12/8/2008 G). This center, being a reference center for CAM and related issues, has the objectives to monitor the CAM practices among different health care services and to regulate them using evidence-based support.8 In a 2015 publication, Kingdom of Saudi Arabia was ranked very high in scientific research related to CAM among all Arab countries.9 This highlights the importance of CAM-related research in Kingdom of Saudi Arabia to document how their different psychosocial, cultural and religious background can influence the use of CAM and to see the effects on their health beliefs and attitudes.10We aimed to determine the prevalence of CAM use among MS patients in Kingdom of Saudi Arabia, as well as to document their knowledge and behaviors concerning CAM, the used types and the reasons behind them and the frequency of the patients disclosing the use of CAM to their physician. We also wanted to determine any association of demographic characteristics, health behaviors and health status with CAM use and disclosure.     

Who Gets Care? Mental Health Service Use Following a School-Based Suicide Prevention Program

OBJECTIVE: To examine symptomatology and mental health service use following students' contact with a large urban school district's suicide prevention program. METHOD: In 2001 school district staff conducted telephone interviews with 95 randomly selected parents approximately 5 months following their child's contact with the district's suicide prevention program, a School Gatekeeper Training model. Parents provided information regarding service use, their child's depressive symptoms (using the Diagnostic Interview Schedule for Children Predictive Scale, Depression module), and their perceptions of their child's need for services. Information about the crisis intervention was abstracted from a standardized assessment form. RESULTS: More than two thirds of students received school or community mental health services following contact with the suicide prevention program. Depressive symptoms, but not past year suicide attempt, predicted community mental health service use. Latino students had lower rates of community mental health service use than non-Latinos. School-based service use did not differ by student characteristics including race/ethnicity. CONCLUSIONS: Most students identified by a school-based suicide prevention program received follow-up care, although Latinos were less likely to access services outside the school. School-based mental health services may be an important way in which underserved populations at risk of suicide can receive care.     

Magnetic resonance elastography SE-EPI vs GRE sequences at 3T in a pediatric population with liver disease

Purpose

The goal of our study is to compare hepatic stiffness measures using gradient-recalled echo (GRE) versus spin-echo echo planar imaging (SE-EPI)-based MR Elastography (MRE) at 3T used to measure hepatic stiffness in a patients with suspected liver diseases.

Materials and methods

This retrospective study included 52 patients with liver disease who underwent a 3T MRE exam including both an investigational SE-EPI-based technique and a product GRE-based technique. Regions of interest (ROI) were placed on the elastograms to measure elastography-derived liver stiffness as well as the area included within the ROIs. The mean liver stiffness values and area of ROIs were compared.

Results

The mean liver stiffness was 3.72 kilopascal (kPa) ± 1.29 using GRE MRE and 3.78 kPa ± 1.13 using SE-EPI MRE. Measurement of liver stiffness showed excellent agreement between the two pulse sequences with a mean bias of − 0.1 kPa (range − 1.8 to 1.7 kPa) between sequences. The mean measurable ROI area was higher with SE-EPI (313.8 cm² ± 213.8) than with the GRE technique (208.6 cm² ± 114.8), and the difference was statistically significant (P < 0.05).

Conclusions

Our data shows excellent agreement of measured liver stiffness between GRE and SE-EPI-based sequences at 3T. Our results show the advantage of a SE-EPI MRE sequence in terms of image quality, ROI size and acquisition time with equivalent liver stiffness measurements as compared to GRE-MRE sequence.

     

Consultation as an Implementation Strategy for Evidence-Based Practices Across Multiple Contexts: Unpacking the Black Box

There is great interest in the dissemination and implementation of evidence-based treatments and practices for children across schools and community mental health settings. A growing body of literature suggests that the use of one-time workshops as a training tool is ineffective in influencing therapist behavior and patient outcomes and that ongoing expert consultation and coaching is critical to actual uptake and quality implementation. Yet, we have very limited understanding of how expert consultation fits into the larger implementation support system, or the most effective consultation strategies. This commentary reviews the literature on consultation in child mental health, and proposes a set of core consultation functions, processes, and outcomes that should be further studied in the implementation of evidence-based practices for children.     

The Role of Consultation Calls for Clinic Supervisors in Supporting Large-Scale Dissemination of Evidence-Based Treatments for Children

This study explores the content of consultation provided to clinic supervisors within the context of a statewide training program in an evidence-based practice. Minute-to-minute live coding of consultation calls with clinic supervisors was conducted in order to identify the content and distribution of call topics. Results indicated that approximately half of the total speaking time was spent on a range of clinically relevant topics (e.g., cognitive-behavioral therapy techniques, fidelity to the treatment protocols). The remaining time was spent on program administration and CBT-related supervisory issues. This pilot study has broad implications for structuring the content of consultation process in large-scale dissemination efforts involving multiple portions of the clinical workforce.     

Neurocognition in children with autosomal recessive polycystic kidney disease in the CKiD cohort study

Background

Autosomal recessive polycystic kidney disease (ARPKD) is an inherited disorder characterized by enlarged, cystic kidneys with progressive chronic kidney disease (CKD), systemic hypertension, and congenital hepatic fibrosis. Children with ARPKD can have early onset CKD and severe hypertension, both of which are known to have adverse neurocognitive effects. The objectives of this study were (1) to determine whether ARPKD patients have greater neurocognitive deficits compared to that of children with other causes of CKD, and (2) to examine the relative prevalence of hypertension in ARPKD, a known risk factor for neurocognitive dysfunction.

Methods

We performed a cross-sectional, control-matched analysis of 22 ARPKD patients with mild-to-moderate CKD in the Chronic Kidney Disease in Children (CKiD) cohort study, compared with a control group of 44 children with other causes of CKD, matched based on glomerular filtration rate, age at study entry, and age at diagnosis.

Results

Children with ARPKD in this cohort had neurocognitive functioning comparable to children with other causes of CKD in domains of intellectual functioning, academic achievement, attention regulation, executive functioning, and behavior. Blood pressure parameters were similar between the two groups; however, ARPKD patients required a significantly greater number of antihypertensive medications to achieve similar BP levels.

Conclusions

ARPKD patients are potentially at risk for neurocognitive dysfunction due to early onset CKD and more severe hypertension. However, this study of children with mild-to-moderate CKD in the CKiD cohort did not demonstrate increased risk in children with ARPKD compared to children with other causes of CKD. Further studies are needed to determine if these findings are applicable to children with more severe manifestations of ARPKD.