Pediatric patients with eosinophilic esophagitis: an 8-year follow-up

BACKGROUND: Eosinophilic esophagitis (EE) is a gastrointestinal disorder that is increasingly diagnosed in pediatric patients. OBJECTIVE: We aimed to define, in pediatric patients with EE, their demographic and atopic characteristics, the histopathology of all segments of the gastrointestinal tract, and the effect of therapeutic interventions on the natural history. METHODS: We conducted a retrospective analysis of a database of pediatric patients with EE followed over a period of 8 years. RESULTS: In 89 pediatric patients with EE, male sex (78.6%), white race (94.4%), young age at diagnosis, mean +/- SD, 6.2 +/- 4.8 years, and atopy with sensitization to environmental and food allergens in 79% and 75%, respectively, were prevalent. Patients had EE of the proximal and distal esophagus, and 77% had in addition either mucosal eosinophilia or noneosinophilic histopathology in the stomach, duodenum, and colon. EE was chronic, with a duration of mean +/- SD, 0.91 +/- 0.84 years, until first resolution, and was recurrent; of 66% of the patients who had resolution, 79% later relapsed. CONCLUSION: Eosinophilic esophagitis in the pediatric population is a chronic and relapsing condition, associated with atopy and sometimes with subsequent histopathology in segments of the gastrointestinal tract other than the esophagus. CLINICAL IMPLICATIONS: Physicians evaluating pediatric patients with chronic gastrointestinal symptoms should consider the diagnosis of EE, particularly in young white male patients with atopy. Once diagnosed and treated, the physicians should follow the patients over a period of several years because the course of the disease is protracted, other gastrointestinal segments may be affected, and relapses are common.     

Early prenatal stress impact on coping strategies and learning performance is sex dependent

Diseases involving cognitive disorders and maladaptive stress-coping behaviors including autism and schizophrenia are present in children born to mothers exposed to stress during pregnancy. To determine the gestational time window when stress exposure produces the greatest impact on cognition, dams were exposed to chronic variable stress (CVS) early, mid-, or late in gestation and offspring learning performance and navigation strategies assessed. These studies utilized a modified version of the Barnes maze to allow investigation of coping responses to stress stimuli. In our study, males exposed to early gestational stress showed significantly impaired learning performance, requiring twice as long to locate the target following training. In stark contrast, early prenatal stress enhanced female performance, where these females located the target in a quarter of the time required by controls. Differences in search strategies whether cued, random, or serial accounted for divergent performances between sex and CVS groups. While control males' behavior expectedly evolved to a cued strategy, the early stressed offspring continued to rely on serial and random searching. Surprisingly, in a long-term memory recall test 6 weeks following previous maze exposure, these early stressed offspring now located the target significantly faster than controls suggesting gestational effects of stress on memory retention that were specific to prenatal time window of stress exposure. Overall, these results provide important insight into the temporal specificity of the effects of prenatal CVS revealing a remarkable vulnerability during early development and a sexually dichotomous influence on cognitive abilities and stress-coping strategies.     

Digital Promotion of Energy Drinks to Young Adults Is More Strongly Linked to Consumption Than Other Media

Objective

To examine whether digital marketing strategies are more strongly associated with energy drink use than other marketing and whether Theory of Planned Behavior (TPB) constructs mediated the effects of digital marketing on energy drink use.

Efficient Screening for Impairments in Peer Functioning Among Mid-to-Late Adolescents Receiving Clinical Assessments for Social Anxiety

Background

Impairments in peer relations comprise a core feature of social anxiety, particularly among adolescents. Yet, these impairments may also stem from concerns that commonly co-occur with social anxiety, namely depressive symptoms and attention-deficit/hyperactivity disorder (ADHD) symptoms.

Objective

Although peer-related impairments spike during adolescence, we know relatively little about efficiently screening for peer-related impairments that specifically index those impairments relevant to adolescent social anxiety.

Method

We recruited 89 adolescents (M?=?14.5 years, 64% female, 65.1% African American) who varied on evaluation-seeking status (30 evaluation-seeking; 59 community control). On a preliminary phone screen, parents provided reports on three peer-related impairment items identified in prior work as particularly discriminative: number of friends, trouble making friends, and trouble keeping friends. Parents and adolescents completed survey measures of social anxiety and mental health concerns commonly linked to social anxiety (i.e., depressive symptoms, ADHD symptoms).

Results

Increased peer-related impairments were uniquely related to increased social anxiety, controlling for depressive symptoms and ADHD symptoms. Increased peer-related impairments also predicted increased risk for being above the clinical cut score on measures of social anxiety, depressive symptoms, and ADHD symptoms. The number of peer-related impairments significantly distinguished adolescents on evaluation-seeking status.

Conclusions

Using a short list of three items assessing peer-related impairments (number of friends, trouble making friends, and trouble keeping friends) one can efficiently screen for peer-related impairments of specific relevance to adolescent social anxiety. These findings have important implications for leveraging efficient, evidence-based screening devices when clinically assessing adolescent social anxiety, particularly in low-resource mental health settings.