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Dietary intervention represents a promising strategy for managing post-surgical patients with Crohn’s disease (CD). This study aims to evaluate the effects of modified Mediterranean diet (MMD) supplemented with partial enteral nutrition (PEN) for 4-5 weeks on quality of life in post-surgical CD patients, compared to exclusive enteral nutrition (EEN). The study was conducted at The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU). The primary outcome was quality of life, measured using the IBD quality-of-life questionnaire (IBDQOL-22) at the end of the intervention. Secondary outcomes included nutritional status and disease-related characteristics. Among 115 screened patients, 46 were randomized to either the EEN group (n=24) or the MMD supplemented with PEN group (n=22). Twenty-three patients in the EEN group and 22 in the MMD supplemented with PEN group completed the study and were included for analysis. At the end of the intervention, both groups achieved similar 22-item inflammatory bowel disease quality-of-life questionnaire (IBDQOL-22) scores (EEN vs. MMD supplemented with PEN: 88.43±9.17 vs. 87.57±7.38, p=0.734). In addition, both groups exhibited comparable nutritional status and disease-related characteristics (all p>0.05). These results suggest that MMD supplemented with PEN provides comparable clinical benefits to EEN in post-surgical CD patients and may serve as an alternative nutritional strategy.
ThinkER equips emergency medicine residents with the tools they need to succeed where it matters most-at the bedside. Interactive and practical, the book is structured in two parts: the first section imparts the essential skills needed to excel in the Emergency Department, while the second section provides immersive case-based learning. Through realistic scenarios, readers are challenged to think critically, communicate clearly, and document effectively, with examples provided for review. The book trains readers in the cognitive framework unique to emergency care, where uncertainty, urgency, and limited information are commonplace. It also delves into the 'hidden curriculum' of Emergency Medicine: how to deliver bad news, collaborate with consultants, manage difficult nurses, and avoid communication breakdowns that lead to burnout. Helping to build the mindset and communication skills that distinguish great physicians early in their careers, this book is ideal for first-year residents, EMPA students, and medical students.
A 6-year-old male with a concordant criss-cross heart after Fontan surgery was referred for fast-slow atrioventricular nodal reentrant tachycardia. Verapamil was useful in preventing haemodynamic collapse in this case, requiring mapping during tachycardia.
This review paper provides an overview of the Scientific Advisory Committee on Nutrition’s (SACN’s) report ‘Feeding young children aged 1 to 5 years’. The purpose of the report was to 1) review the scientific basis of current recommendations for feeding children aged 1 to 5 years 2) consider evidence on developmental stages and other factors that influence eating behaviour and diversification of the diet in the early years and 3) make recommendations for policy, practice and research. This report was based on a comprehensive assessment of the systematic review literature and also evidence provided by the Diet and Nutrition Survey of Infants and Young Children and National Diet Nutrition Survey. Dietary survey data indicated that the diets of children aged 1 to 5 years in the UK did not meet current dietary recommendations for several nutrients. Intakes of energy, free sugars and protein exceeded recommendations while dietary fibre intakes were below the recommended level for this age group. Children from lower socioeconomic status households or from certain ethnic groups may be at risk of inadequate intakes of iron, zinc, vitamin A and vitamin D. Systematic review evidence indicated that in children aged 1 to 5 years: higher free sugars intake is associated with increased dental caries; higher consumption of sugar-sweetened beverages is associated with increased risk of overweight/obesity; and higher child body mass index is associated with higher risk of adult overweight/obesity. Based on the evidence, SACN has made recommendations to improve the diets of young children in the UK.
People suffering from common mental disorders (CMDs), such as depression and anxiety, are more likely to be inactive in the labor market. Psychological therapies are highly effective at treating CMDs, but less is known about their impact on long-term labor market outcomes.
Methods
Using national treatment program data in England, NHS Talking Therapies (NHSTT), with unique linkage to administration data on employment and census records, we estimated the effects of NHSTT on employment and earnings. We used an event study approach using individual fixed effects to capture time-invariant confounders and natural recovery.
Results
Overall, completing treatment led to a maximum average increase of £17 in monthly earnings (year 2) and a likelihood of paid employment by 1.5 percentage points (year 7). Those ‘Not working, seeking work’ saw a maximum average increase in pay of £63 per month (year 7) and a likelihood of paid employment by 3.1 percentage points (year 4). Patients in the younger age groups (25–34 years) saw the largest effect on the likelihood of paid employment by 2.3 percentage points (year 7), followed by those aged 35–44 years with 2.0 percentage points (year 5).
Conclusions
Completion of psychological treatment for CMDs through the national NHSTT program leads to sustained increases in both employment and earnings up to 7 years after the start of treatment. Our findings demonstrate the economic benefits of treating CMDs and how investing in mental health can impact labor market participation.
Patients with advanced liver disease (ALD) may benefit from the early integration of supportive care toward the end of life. Engagement with supportive and palliative care could decrease disease-related distress and alleviate pressure on the health system. This trial evaluated whether a transdisciplinary supportive care model, aligned with standard care and guided by patient- and carer-identified needs, could optimize health service utilization and outcomes for patients and carers living with ALD.
Methods
A 90-day multicenter, mixed-methods pilot randomized controlled trial, “Liver Life,” was conducted at 1 regional tertiary and 1 rural referral hospital in NSW, Australia. The intervention group received patient- and carer-centered supportive care interventions during 5 scheduled allied health-led outpatient visits, alongside ongoing standard care. This paper reports health service utilization and associated costs, and participant-reported measures.
Results
Over 90 days, emergency department presentations were reduced by 66% (incidence rate ratio: 0.34 [0.13–0.80]), and hospital admissions by 64% (incidence rate ratio: 0.36 [0.12–0.98]). Intervention patients were 5 times more likely to have more days “alive and out of hospital” than those receiving standard care alone (odds ratio: 5.34 [1.43–22.1]). As a result, the overall cost of health service use per intervention patient was less than half that of standard care alone.
Significance of results
The Liver Life trial demonstrated the feasibility, acceptability, efficacy, and potential cost savings of a transdisciplinary supportive care model for ALD patients and their caregivers. Future research should investigate the sustainability and transferability of this approach to other populations and other chronic diseases.
Functional magnetic resonance imaging (fMRI) has revealed inconsistent neural activity patterns in major depressive disorder (MDD) across cognitive and affective domains, and this study used an activation likelihood estimation (ALE) meta-analysis to examine brain function abnormalities in working memory, reward processing, and emotion processing.
Methods
A systematic search was conducted in PubMed, Embase, Web of Science, ScienceDirect, and CNKI for fMRI studies comparing MDD patients with healthy controls (HCs), including data up to 3 December 2024. ALE meta-analysis was performed to examine activation patterns. Jackknife sensitivity analysis, risk of bias, and Newcastle–Ottawa scale were used to assess robustness and publication bias. Meta-regression analyses were conducted to explore the impact of covariates on the results.
Results
Sixty-nine studies (2,073 MDD individuals and 2,009 HCs) were included. MDD individuals showed hyperactivation in the bilateral parahippocampal gyrus, subcallosal gyrus, lentiform nucleus, left claustrum, insula, and anterior cingulate cortex, alongside hypoactivation in the right lentiform nucleus, parahippocampal gyrus, fusiform gyrus, and other regions. Domain-specific analyses revealed working memory-related hyperactivation in the right middle and superior frontal gyrus, reward-related hyperactivation in the bilateral lentiform nucleus, right claustrum, and left caudate, and emotion-related hyperactivation in the bilateral parahippocampal gyrus, bilateral lentiform nucleus, right subcallosal gyrus, right anterior cingulate cortex, and left claustrum. Jackknife sensitivity analysis confirmed robustness, with no significant publication bias or covariate impact.
Conclusions
Aberrant activation in the lentiform and caudate nuclei across reward and emotion tasks suggests striatal dysfunction plays a key role in emotion-motivation interplay, highlighting the striatum as a potential target for future therapies.
To examine the relationships between patient activation, depressive symptoms, and quality of life among older adults receiving palliative oncology care.
Methods
A cross-sectional correlational study was conducted among 145 adults aged ≥60 years receiving palliative oncology care at King Khalid Hospital, Saudi Arabia, using stratified random sampling. Data were collected via a demographic and clinical questionnaire, the Patient Activation Measure-13 (PAM-13), the Patient Health Questionnaire-9 (PHQ-9), and the McGill Quality of Life Questionnaire–Revised (MQOL-R). Descriptive statistics, Pearson correlation, independent t-tests, one-way ANOVA, and multiple linear regression were performed using SPSS version 26.
Results
All participants demonstrated Level 2 patient activation, with a mean PAM-13 score of 50.83 (SD = 1.04). Moderate depressive symptoms were prevalent (mean PHQ-9 = 13.56, SD = 3.48), and overall quality of life was moderate (mean MQOL-R = 55.21, SD = 10.14). Patient activation was weakly but significantly inversely correlated with depressive symptoms (r = −0.179, p < 0.05). No significant associations were found between patient activation and quality of life, or between depressive symptoms and quality of life. Regression analysis showed that patient activation, depressive symptoms, and demographics accounted for only 3.2% of the variance in quality of life (R2 = 0.032, p = 0.714).
Significance of results
Patient activation may modestly reduce depressive symptoms but is not sufficient to improve quality of life in older adults receiving palliative oncology care. Quality of life appears influenced by broader multidimensional factors beyond activation and mood, highlighting the need for comprehensive interventions in palliative care settings.
Across school and community-based contexts, nutritional education interventions are often associated with improvements in a range of food-related and health-related outcomes. The aim of this study was to investigate whether the nutritional education component of the Holiday Activities and Food (HAF) programme, in England, was similarly associated with changes in these outcomes for children who attend.
Design:
A quasi-experimental, mixed-factorial 3 (School) x 3 (Group) x 2 (Time) design was employed. Outcome variables were liking and frequency of trying new foods, perceived cooking competence and health-related quality of life.
Setting:
Pre-post data were collected at three primary schools in one local authority in the North East of England, at two time points (before and after the summer holidays).
Participants:
A non-probability, purposive sample of 169 children (Mean age = 9.4 years, SD = 0.54), self-selected into groups of children who did not attend HAF over the summer holidays (No HAF; n = 123), attended their school-based HAF club (HAF; n = 29) or attended their school-based HAF club alongside a bespoke nutritional education programme (HAF NEP; n = 17).
Results:
Kruskal-Wallis and Mann-Whitney U analyses found no significant between-group differences for any outcome, apart from perceived cooking competence. HAF NEP was associated with improved perceived cooking competence.
Conclusions:
Standard HAF was not associated with improved outcomes related to nutritional education. The HAF NEP group was associated with improved cooking competence only. The lack of significant findings in the intervention groups suggests further research into HAF nutritional education is required.
Law and healing is a colourful and critical account of the longstanding ‘marriage’ between two fundamental pillars of human society, law and medicine. The book addresses medico-legal history, exploring aspects of English law’s fascinating and sometimes acrimonious relationship with healing and healers. It challenges assumptions that medical law is new and that when law engaged with medicine, judges deferred to the ‘medical man’. It traces the regulation of healing from the dominance of the Church, and goes on to examine how the battles between different groups of lay ‘doctors’, physicians, surgeons and apothecaries were fought out in the law courts, the Royal Court and Parliament. Malpractice litigation and predictions of malpractice crises are shown to date back to the fourteenth century. Evidence of judicial deference is scant until late in the nineteenth century. Medical law today addresses moral dilemmas arising in medical practice and biomedical science. Considering historical perceptions of the human body from the womb to the grave, this work identifies themes persisting through medico-legal history and how history repeats itself. The book assesses both how English law responded to changes in ‘scientific’ understanding of bodies and how ‘science’, or what was thought to be science, influenced law. Bizarre theories about biology are seen to buttress laws of primogeniture and legal incapacities imposed on married women. The book considers how in the nineteenth century medical practitioners gradually acquired a strong voice in law-making on morals as much as medical practice.
This study aimed to evaluate the independent effect of parental smoking on early markers of atherosclerosis in children, specifically carotid intima-media thickness and epicardial adipose tissue thickness.
Methods:
A total of 106 healthy children aged 6–16 years were enrolled, including 53 with parental smoking exposure and 53 unexposed controls. Participants underwent clinical evaluation, laboratory assessment, transthoracic echocardiography, and carotid ultrasonography. Data on parental smoking habits, sociodemographic characteristics, and children’s daily sleep duration were collected. Multivariable analyses were performed to assess the independent association between parental smoking and subclinical atherosclerotic markers.
Results:
Children exposed to parental smoking demonstrated significantly greater epicardial adipose tissue thickness and carotid intima-media thickness compared with controls (p = 0.014 and p = 0.001, respectively). Lipid parameters did not differ significantly between groups. Daily sleep duration was negatively correlated with epicardial adipose tissue thickness (r = –0.325, p = 0.018) and carotid intima-media thickness (r = –0.484, p < 0.001). Parental smoking remained independently associated with both markers after adjustment for relevant covariates.
Conclusions:
Parental smoking is associated with early atherosclerotic changes in children, demonstrated by increased carotid intima-media thickness and epicardial adipose tissue thickness, independent of traditional cardiovascular risk factors.
Vasovagal syncope is the most common cause of syncope in children, and there is no satisfactory treatment currently. We evaluated the response to midodrine treatment in patients with vasovagal syncope who failed to benefit from conventional, non-pharmacologic treatments.
Materials and methods:
The study was a single-centre retrospective study. The data of 44 children between the ages of 6 and 18 years, who were diagnosed with recurrent vasovagal syncope, did not benefit from non- pharmacological treatments, and received midodrine treatment from 2015 to 2022 were enrolled in the study.
Results:
In total, 44 patients, 38 (86.4%) were girls, and 6 (13.6%) were boys. The primary outcome measure was the change in frequency of vasovagal syncope episodes from baseline to 6 months after treatment with midodrine. Patients received a midodrine treatment at an average of 2.5–5 mg/day and were followed for a median of 23.07 (8–72) months. The median number of syncope was 4.2 (3–9.8)/year prior to treatment and 1.2 (1–5)/year (p = 0.01) following the treatment. There was a significant improvement in syncope episodes in all patients.
Conclusion:
Vasovagal syncope is the common cause of syncope in children, and its treatment has not yet been found satisfactory. Midodrine treatment was found to be effective and safe in paediatric patients with recurrent vasovagal syncope. However, further research is needed to determine the most effective treatment for this condition.