Beyond Helicobacter: dealing with other variants of gastritis—an algorithmic approach

In daily practice, the presence of inflammation in gastric biopsies prompts a mental algorithm, an early question being whether the lesion present is Helicobacter‐associated. If Helicobacter organisms are not found, then there is a further algorithm, governed by the predominant type of inflammatory cells present, and the presence of other features such as intraepithelial lymphocytosis, a subepithelial collagen band, granulomas, coexisting chronic inflammation, focality, and superimposed reactive changes including erosions and ulcers. Each of these generates its own differential diagnosis. If no inflammation is present, then the two major changes specifically looked for are the changes associated with hypergastrinaemia, by far the most common cause of which is treatment with proton pump inhibitors, and reactive changes. These may be present with and without accompanying inflammation, and, when the epithelial changes dominate, the term gastropathy is preferred. In this article, we present an approach to non‐Helicobacter inflammation and gastropathies.     

Trends in adolescent alcohol use in the Netherlands, 1992–2015: Differences across sociodemographic groups and links with strict parental rule-setting

BackgroundFrom an international perspective, studying trends in adolescent alcohol use in the Netherlands is an important case study. Whereas Dutch adolescents topped the international rankings of alcohol consumption in the beginning of this century, they are nowadays found more toward the bottom of these rankings. This study examines time trends in adolescent alcohol use between 1992 and 2015, and tests whether these trends differ according to gender, age group, and educational track. Moreover, it examines to what extent the strictness of parental rule-setting can explain the identified trends.MethodsUsing data from ten waves of two nationally representative studies with a repeated cross-sectional design, trends were examined for eight different alcohol measures. Interaction analyses were conducted to test for subgroup differences. All analyses were controlled for educational track, family structure, and ethnicity. For the period 2007–2015, trends in parental alcohol-specific rule-setting were included as a predictor of the trends in adolescent alcohol use.ResultsAdolescent alcohol use increased substantially between 1992 and 2003, and decreased sharply thereafter. Trends were stronger for 12- to 15-year olds, compared to the 16-year olds, and for adolescents attending higher educational tracks, compared to adolescents attending lower educational tracks. Overall, gender differences remained constant over time. Between 2007 and 2015, strict parental alcohol-specific rule-setting increased substantially, and this (partly) explained the strong decline in adolescent alcohol use during this period.ConclusionThis study shows clear time trend changes in alcohol use among Dutch adolescents. The phenomenal decrease in adolescent alcohol use since 2003 appears to be closely related to a radical change in parenting behaviours surrounding the alcohol use of their children. While national prevention programs may have encouraged stricter parenting behaviours, the decline in alcohol use should be interpreted in a broader context of internationally changing sociocultural norms regarding adolescent alcohol use.     

以游戏形式开展的健康宣教对甲亢患儿服药依从性的影响

目的：探讨以游戏形式开展的健康宣教对甲亢患儿服药依从性的影响。方法：选取2012年1月至2017年1月期间本院儿科住院部甲亢患儿150例，采用随机数字表法将患儿分为观察组与对照组，各75例，对照组采用常规健康宣教，观察组在对照组基础上采用以游戏形式开展的健康宣教，比较两组服药依从性的差异。结果：入院时，两组甲亢相关知识掌握率比较差异无统计学意义（P>0.05）。出院时，两组甲亢相关知识掌握率明显高于同组入院时，观察组甲亢相关知识掌握率明显高于对照组（P<0.01）。观察组治疗依从率明显高于对照组，两组比较差异具有统计学意义（P<0.01）。入院时，两组精神健康、情感职能、社会功能、活力、躯体疼痛、生理职能、生理功能与总体健康共8个项目的SF-36评分比较差异无统计学意义（P>0.05）。出院后6个月，两组上述评分明显高于出院时（P<0.01），观察组社会功能、活力、生理职能、总体健康4个项目的SF-36评分明显高于对照组（P<0.01）。结论：以游戏形式开展的健康宣教有助于改善甲亢患儿知识掌握程度，提高服药依从性与生活质量，值得临床推广应用。