Decrease In Symptom Severity Research Articles

Ideal Parent Figure method in the treatment of complex posttraumatic stress disorder related to childhood trauma: a pilot study

ABSTRACTBackground: There is a consensus within the trauma field for the necessity of a three-phase treatment programme for complex posttraumatic stress disorder (CPTSD). This pilot study focuses on the stabilisation phase, the goal of which is the development of psychological resources and the reduction of disabling symptoms.Objective: To test the efficacy of the Ideal Parent Figure (IPF) method as a stabilization treatment for CPTSD patients with a history of childhood trauma.Method: The sample was comprised of 17 adults with a history of childhood trauma concomitant with CPTSD symptoms consulting at a clinic in France. Participants enrolled in a 5-week psychotherapy programme based on the IPF method, a semi-structured visualization programme designed to treat attachment disturbances. Measures of DESNOS symptoms, psychological symptoms, quality of life, and adult attachment were administered pre- and posttreatment as well as at 8-month follow-up.Results: A significant decrease in symptom severity and attachment traumatization and a significant increase in quality of life were found, both with medium-to-large effect sizes. The 8-month follow-up assessment showed outcome stability.Conclusions: These results suggest that treating attachment disturbances directly with an approach akin to the Ideal Parent Figure method may lead to fast and stable improvement for individuals with CPTSD.

A randomised, placebo-controlled trial of transcranial pulsed electromagnetic fields in patients with multiple chemical sensitivity.

To evaluate the efficacy of transcranially applied pulsed electromagnetic fields (PEMF) on functional impairments and symptom severity in multiple chemical sensitivity (MCS) patients. The study was conducted as a nationwide trial in Denmark using a randomised, parallel-group, double-blind and placebo-controlled design. Sample size was estimated at 40 participants. Eligibility criteria were age 18-75 years and fulfilment of the MCS case criteria. Participants received either PEMF or placebo PEMF (no stimulation) applied transcranially for 6 weeks. The primary outcome was the Life Impact Scale (LIS) of the Quick Environmental Exposure and Sensitivity Inventory (QEESI). Secondary outcomes were the Symptom Severity Scale (SSS) and the Chemical Intolerance Scale of QEESI. A total of 39 participants were randomised to PEMF or placebo treatment. No significant difference was observed on QEESI LIS between groups with a mean change score of -5.9 in the PEMF group compared with -1.5 in the placebo group (p=0.35, effect size=-0.31). However, a significant decrease was detected on QEESI SSS within and between groups with a mean change score of -11.3 in the PEMF group compared with -3.2 in the placebo group (p=0.03, effect size=-0.60). PEMF treatment of 6 weeks showed no effect on functional impairments in MCS. However, a significant decrease in symptom severity was observed.

The Emerging Role of Mindfulness Meditation as Effective Self-Management Strategy, Part 1: Clinical Implications for Depression, Post-Traumatic Stress Disorder, and Anxiety.

Mindfulness-based interventions (MBIs) have been increasingly utilized in the management of mental health conditions. This first review of a two-part series evaluates the efficacy, mechanism, and safety of mindfulness meditation for mental health conditions frequently seen after return from deployment. Standard databases were searched until August 4, 2015. 52 systematic reviews and randomized clinical trials were included. The Strength of Recommendation (SOR) Taxonomy was used to assess the quality of individual studies and to rate the strength of evidence for each clinical condition. Adjunctive mindfulness-based cognitive therapy is effective for decreasing symptom severity during current depressive episode, and for reducing relapse rate in recovered patients during maintenance phase of depression management (SOR moderate [SOR B]). Adjunctive mindfulness-based stress reduction is effective for improving symptoms, mental health-related quality of life, and mindfulness in veterans with combat post-traumatic stress disorder (PTSD) (SOR B). Currently, there is no sufficient data to recommend MBIs for generalized anxiety disorder (SOR B). MBIs are safe, portable, cost-effective, and can be recommended as an adjunct to standard care or self-management strategy for major depressive disorder and PTSD. Future large, well-designed randomized clinical trials in service members and veterans can help plan for the anticipated increase in demand for behavioral health services.

Lisdexamfetamine Effects on Executive Activation and Neurochemistry in Menopausal Women with Executive Function Difficulties.

Many women with no history of executive dysfunction report difficulties in this domain during the menopause transition. Lisdexamfetamine (LDX) has been suggested to be a safe and effective treatment option for these women. However, the mechanism by which LDX improves executive functioning in these women is not known. Here we investigated the effects of LDX on brain activation and neurochemistry, hypothesizing that LDX would be associated with increased activation and decreased glutamate in executive regions. Fourteen women underwent multimodal neuroimaging at 7T at three time points in this baseline-corrected, double-blind, placebo-controlled, crossover study. Effects of LDX on symptom severity, blood-oxygen-level-dependent (BOLD) signal, and dorsolateral prefrontal cortex (DLPFC) glutamate+glutamine (Glx) were measured using a clinician-administered questionnaire, fMRI during performance of a fractal n-back task, and 1H-MRS, respectively. The effect of treatment (LDX minus baseline vs placebo minus baseline) on these behavioral and neural markers of executive function was examined using repeated measures mixed effects models. LDX treatment was associated with decreased symptom severity, increased activation in the insula and DLPFC, and decreased DLPFC Glx. In addition, the magnitude of LDX-induced improvement in symptom severity predicted both direction and magnitude of LDX-induced change in insular and DLPFC activation. Moreover, symptom severity was positively correlated with Glx concentration in the left DLPFC at baseline. These findings provide novel evidence that the neural mechanisms by which LDX acts to improve self-reported executive functioning in healthy menopausal women with midlife onset of executive difficulties include modulation of insular and DLPFC recruitment as well as decrease in DLPFC Glx concentration.

The Effect of a New Therapy for Children with Tics Targeting Underlying Cognitive, Behavioral, and Physiological Processes.

Tourette disorder (TD) is characterized by motor and vocal tics, and children with TD tend to present a lower quality of life than neurotypical children. This study applied a manualized treatment for childhood tics disorder, Facotik, to a consecutive case series of children aged 8–12 years. The Facotik therapy was adapted from the adult cognitive and psychophysiological program validated on a range of subtypes of tics. This approach aims to modify the cognitive–behavioral and physiological processes against which the tic occurs, rather than only addressing the tic behavior. The Facotik therapy lasted 12–14 weeks. Each week 90-min session contained 20 min of parental training. The therapy for children followed 10 stages including: awareness training; improving motor control; modifying style of planning; cognitive and behavioral restructuring; and relapse prevention. Thirteen children were recruited as consecutive referrals from the general population, and seven cases completed therapy and posttreatment measures. Overall results showed a significant decrease in symptom severity as measured by the YGTSS and the TSGS. However, there was a discrepancy between parent and child rating, with some children perceiving an increase in tics, possibly due to improvement of awareness along therapy. They were also individual changes on adaptive aspects of behavior as measured with the BASC-2, and there was variability among children. All children maintained or improved self-esteem posttreatment. The results confirm the conclusion of a previous pilot study, which contributed to the adaptation of the adult therapy. In summary, the Facotik therapy reduced tics in children. These results underline that addressing processes underlying tics may complement approaches that target tics specifically.

The predictive value of early treatment response in antipsychotic-naive patients with first-episode psychosis: Haloperidol versus olanzapine

Early antipsychotic response predicts outcomes for psychotic patients, but recent evidence suggests that this may not be true for patients treated with olanzapine. In this study, we assessed the predictive value of early response to olanzapine or haloperidol in 75 antipsychotic-naive, first-episode psychosis inpatients. Patients were assessed weekly using the Brief Psychiatric Rating Scale (BPRS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Young Mania Rating Scale (YMRS). Regression analyses were used to determine whether improvement at week 2 or week 3 predicted improvement at hospital discharge. The majority of patients in both groups experienced a decrease in symptom severity of ≥50% at week 2. In the haloperidol group, week 2 improvement predicted improvement at discharge for all measures except the HAM-A. In the olanzapine group, week 2 improvement only predicted improvement at discharge for HAM-D scores. However, week 3 improvement in the olanzapine group predicted improvement at discharge for all measures except the HAM-A. Olanzapine non-responders at week 3 (but not week 2) benefited from having olanzapine switched to another antipsychotic. These results suggest that a 2 week trial of haloperidol is sufficient to predict treatment outcomes, while a 3 week trial is required for olanzapine.

Clinical correlates and predictors of perceived coercion among psychiatric inpatients: A prospective pilot study.

The current Mental Health Care Bill (MHCB) -2013 in India advocates least restrictive alternatives (LRA) in psychiatric treatment. However, we have little evidence on patient's perspectives of coercion and LRA. This was a hospital-based prospective pilot study. 170 subjects chosen by computer-generated random number sampling were screened. In 83 eligible subjects, all assessments including coercion assessment were completed within 3 days of admission and in 75 subjects reassessment was done within 3 days of discharge. Perceived coercion as measured by the MacArthur Perceived Coercion Scale (MPCS) decreased significantly from 3.72±1.98 at admission to 1.77±1.8 (<0.001) at discharge. This was accompanied by significant increase in global functioning, insight score (from 1.5±1.0 to 3.8±1.1; p<0.001) and as well as decrease in symptom severity (CGI-S) (from 5.9±1.1 to 1.8±1.9; p<0.001). Coercion is predicted by family type, employment status, socio economic status, severity of illness and level of insight. 87% patients reported that their admission was justified even though many felt coerced during hospital stay. Coercion is a dynamic state and changes with treatment and care. Clinical care may result in an improvement in global functioning, insight as well as in reduction in severity of illness consequently leading to less coercion. During the time of discharge, majority of patients reported that their admission was justified, even though they felt coerced during hospital stay and agreed for treatment against their will within a safe, standardised coercive practice.

Insight in bipolar disorder through the course of manic episode and its clinical correlates

IntroductionInsight is a well-documented phenomenon for psychotic disorders. It has been studied extensively in schizophrenia and its association with clinical outcomes has drawn increased attention. Although less is known for affective disorders, recent studies point out that impaired insight in bipolar disorder may take part in patients’ overall well-being.AimsExploring the main components of insight in psychiatry, particularly in bipolar disorder.ObjectivesWith this study, we wanted to examine how clinical and cognitive insights change in patients with bipolar disorder through their hospitalization period and how they correlate with symptom severity and neuropsychological functioning.MethodsIn this prospective study, inpatients with bipolar I disorder who were presented by manic episode with psychotic features were included. The patients were assessed with Young Mania Rating Scale, Beck Cognitive Insight Scale, Schedule for the Assessment of Insight-Expanded Version (SAI-E) and a neuropsychological test battery both at the time of admission and discharge.ResultsAs of October 2015, a total number of 20 patients with bipolar I disorder participated in the study. Preliminary results revealed a significant improvement in the total score of clinical insight, which was measured with SAI-E by the time of discharge (P = 0.001). This transition was strongly correlated with the decrease in symptom severity (P = 0.006, r = −0.61). Improved clinical insight exhibited significant correlation with the increase in patients’ memory span (P = 0.007, r = −0.596).ConclusionThe preliminary results suggest that changes in symptom severity and working memory might be the determinants of improvement in clinical insight of inpatients with bipolar disorder through manic episode.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Hospitalization durations and remission rates of patients in a psychiatry clinic

ObjectiveThe duration of hospitalization is related to many well-documented factors in literature. However, little is known about psychiatric patients and psychiatric service delivery in non-Western developing countries. It is supposed that major contributing factors in discharge are remission rates and functional levels. Therefore, this naturalistic preliminary study aimed at analyzing and describing the hospitalization duration and remission rates of a psychiatric population treated in the mental health inpatient facility.MethodsA total of 88 male patients, who were hospitalized in a psychiatry clinic were included in the study. They were evaluated at admission and before discharge using the Brief Psychiatric Rating Scale (BPRS) and the Clinic Global Impression Scale (CGI). Other variables, including length of stay, number of previous admissions, demographic characteristics, and diagnosis were also assessed.ResultsMean of the total scores on BPRS were declined from 24.95 to 13, and the mean CGI scores were declined from 3.85 to 2.04 during hospitalization period. Mean length of hospitalization was 7.91 days.ConclusionOur study shows that patients are discharged from the hospital with approximately 50% decrease in symptom severity. Such research can contribute to understand better, the needs of psychiatric patients, and help to develop continuously improved service delivery and optimize therapeutic options.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The impact of clinical, psychological, behavioral, social, and environmental factors on self-perceived symptom severity in a male cohort with intermittent claudication

To understand the relationship between self-perceived severity of intermittent claudication and various associated nonclinical factors, we examined how correlates in domains of physical activity (ie, clinical, psychological, behavioral, social, and environmental factors) relate to exertional limb symptoms. A survey was administered to individuals with intermittent claudication during their initial outpatient assessment. The subjects' self-reported exertional limb symptom severity and classic-versus-atypical claudication classification was based on the Walking Impairment Questionnaire (WIQ) and San Diego Claudication Questionnaire (SDCQ), respectively. We evaluated psychosocial and environmental factors, osteoarthritis symptoms, health, behaviors, and beliefs. Logistic and linear regressions identified factors with a strong independent association with total WIQ scores and the SDCQs. A cohort of 102 subjects (99.0% male) was enrolled in the study. The median age was 65years with a median ankle-brachial index of 0.69. Forty-three subjects (43%) had "typical" claudication per SDCQs. Individuals with atypical claudication were more likely to report higher Aberdeen Clinical Back Pain Questionnaire scores (odds ratio, 1.04; P= .04) and no depressive symptoms (odds ratio, 8.30; P= .03). Exertional limb symptom severity among the entire cohort was significantly associated with increasing osteoarthritis symptoms (P<.001), age (P= .02), a reserved personality (P= .008), and the belief that an exercise regimen would not improve symptoms (P= .005), self-perceived levels of boredom (P= .002), and the belief that exercise (P= .002) was the best way to improve symptoms were associated with decreased symptom severity. When restricted to those with atypical pain, significant factors associated with increasing exertional symptom severity included age greater than 60years (P= .005), osteoarthritis (P=.02), alcohol use (P= .01), belief that exercise would not improve walking (P= .03), and difficulty walking around the neighborhood (P= .02). When restricted to those with classic claudication, significant factors associated with increasing exertional limb symptom severity included frequent pain or aching in the calves while walking or sitting (P=.03 [walking]; P= .01 [sitting]) and occasional morning joint stiffness (P= .007). Exertional limb symptom severity was also associated with high limitations at home (P= .003) and a belief that exercise would not improve walking (P= .005) among those with classic claudication. Symptom severity and type of pain are associated with a number of nonclinical factors. A multidomain approach, as indicated by the models above, would benefit the continuum of care for intermittent claudication, where management is integrated and coordinated among multiple lines of care.

The suppressive effect of compost amendments on Fusarium oxysporum f.sp. radicis-cucumerinum in cucumber and Verticillium dahliae in eggplant

The suppressive effect of six different compost amendments (A, B, C, D, E and Z) against Fusarium oxysporum f.sp. radicis-cucumerinum (Forc) in cucumber and Verticillium dahliae in eggplant was tested. The evaluation of composts in each pathosystem was carried out by recording external symptoms, isolations and plant growth. The concentration of total phenols was determined in the root and stem tissues of eggplant as well as in pure composts and in potting mixtures (soil amended with 20% of compost) at the beginning and the end of eggplant – V. dahliae bioassays. It was shown that composts A, B, C and D were effective against Forc, and composts C, D, E and Z were effective against V. dahliae. The decreased symptom severity and V. dahliae isolation ratio in eggplant was associated with significantly lower accumulation of phenols in stem tissues; whereas the concentration of total phenols in stem tissues of V. dahliae-infested eggplants was significantly higher compared to the non infested. In addition, total phenols content in the pure V. dahliae-suppressive composts was significantly higher than in the non-suppressive ones. Moreover, total phenols content in soil substrate and in potting mixture A decreased, whereas in mixtures B, C, D, E and Z was significantly increased during the time of bioassays process. Interestingly, total phenols content in the V. dahliae-suppressive potting mixtures C, D, E and Z was 3.8-, 3.7-, 3.7- and 4.4-fold higher compared with the non-suppressive control (100% soil), at the end of bioassays process (68 days post inoculation). This is the first insight in the role of phenols in the suppressive effect of composts against soil-borne pathogens, in planta.

Clustering symptoms of non-severe malaria in semi-immune Amazonian patients.

Malaria is a disease that generates a broad spectrum of clinical features. The purpose of this study was to evaluate the clinical spectrum of malaria in semi-immune populations. Patients were recruited in Mâncio Lima, a city situated in the Brazilian Amazon region. The study included 171 malaria cases, which were diagnosed via the use of a thick blood smear and confirmed by molecular methods. A questionnaire addressing 19 common symptoms was administered to all patients. Multiple correspondence analysis and hierarchical cluster analysis were performed to identify clusters of symptoms, and logistic regression was used to identify factors associated with the occurrence of symptoms. The cluster analysis revealed five groups of symptoms: the first cluster, which included algic- and fever-related symptoms, occurred in up to 95.3% of the cases. The second cluster, which comprised gastric symptoms (nausea, abdominal pain, inappetence, and bitter mouth), occurred in frequencies that ranged between 35.1% and 42.7%, and at least one of these symptoms was observed in 71.9% of the subjects. All respiratory symptoms were clustered and occurred in 42.7% of the malaria cases, and diarrhea occurred in 9.9% of the cases. Symptoms constituting the fifth cluster were vomiting and pallor, with a 14.6% and 11.7% of prevalence, respectively. A higher parasitemia count (more than 300 parasites/mm3) was associated with the presence of fever, vomiting, dizziness, and weakness (P < 0.05). Arthralgia and myalgia were associated with patients over the age of 14 years (P < 0.001). Having experienced at least eight malaria episodes prior to the study was associated with a decreased risk of chills and fever and an increased risk of sore throat (P < 0.05). None of the symptoms showed an association with gender or with species of Plasmodium. The clinical spectrum of malaria in semi-immune individuals can have a broad range of symptoms, the frequency and intensity of which are associated with age, past exposure to malaria, and parasitemia. Understanding the full spectrum of nonsevere malaria is important in endemic areas to guide both passive and active case detection, for the diagnosis of malaria in travelers returning to non-endemic areas, and for the development of vaccines aimed to decrease symptom severity.

Adolescents', mothers', and fathers' gendered coping strategies during conflict: Youth and parent influences on conflict resolution and psychopathology.

We observed gendered coping strategies and conflict resolution outcomes used by adolescents and parents during a conflict discussion task to evaluate associations with current and later adolescent psychopathology. We studied 137 middle- to upper-middle-class, predominantly Caucasian families of adolescents (aged 11-16 years, 65 males) who represented a range of psychological functioning, including normative, subclinical, and clinical levels of problems. Adolescent coping strategies played key roles both in the extent to which parent-adolescent dyads resolved conflict and in the trajectory of psychopathology symptom severity over a 2-year period. Gender-prototypic adaptive coping strategies were observed in parents but not youth, (i.e., more problem solving by fathers than mothers and more regulated emotion-focused coping by mothers than fathers). Youth-mother dyads more often achieved full resolution of conflict than youth-father dyads. There were generally not bidirectional effects among youth and parents' coping across the discussion except boys' initial use of angry/hostile coping predicted fathers' angry/hostile coping. The child was more influential than the parent on conflict resolution. This extended to exacerbation/alleviation of psychopathology over 2 years: higher conflict resolution mediated the association of adolescents' use of problem-focused coping with decreases in symptom severity over time. Lower conflict resolution mediated the association of adolescents' use of angry/hostile emotion coping with increases in symptom severity over time. Implications of findings are considered within a broadened context of the nature of coping and conflict resolution in youth-parent interactions, as well as on how these processes impact youth well-being and dysfunction over time.

Distress and symptom development in relation to plasma cytokines and secretion of DAMPs during remission induction treatment for acute myeloid leukemia

The objective of the study was to assess the relation between development of cancer- and cancer therapy-induced symptoms, distress, plasma levels of cytokines, and damage-associated molecular patterns (DAMPs) in patients with acute myeloid leukemia (AML; n = 45) receiving remission induction chemotherapy. Patients were monitored for somatic symptoms (MDASI-core) and distress. Blood samples were obtained prior to chemotherapy (baseline) and weekly during the first 3 weeks of therapy. Symptom severity and distress were high at baseline, decreased during therapy, and were related on all time-points (r’s = .45–71). High baseline distress was related to a stronger decrease in symptom severity during chemotherapy ( r = −.34).The pro-inflammatory cytokines IL-6, TNF-alpha, IL-7, and IL-15 increased and the DAMPs HMGB1 and HSP70 decreased during chemotherapy. Higher baseline symptom severity was related to larger increases in IL-7 ( r = .38). Higher baseline distress predicted less decrease in HMGB1 ( r = .32) and was correlated with plasma concentrations of HSP70 at all time-points ( r = .35–.42). In conclusion, most patients with AML suffer from severe somatic symptoms together with high distress prior to chemotherapy. Although chemotherapy was associated with increases in cytokine production, somatic symptom scores did not increase during therapy. High distress at baseline was related to higher levels of DAMPs during treatment, which are associated with poorer prognosis. These data suggest that it would be interesting to investigate the benefit of early stress reduction during diagnosis of AML.

Evidence for the Implementation of the Early Start Denver Model for Young Children With Autism Spectrum Disorder.

The Early Start Denver Model (ESDM) is a manualized comprehensive therapy for toddlers with autism spectrum disorder. It emphasizes interpersonal engagement through synchrony, rhythms, and reciprocity to decrease symptom severity and accelerate cognitive, social-emotional, and language development. To systematically review evidence regarding the use of the ESDM as an intervention for young children with autism spectrum disorder. PubMed, Scopus, Web of Science, Embase, and CINAHL were searched from 2010-2015 using predetermined inclusion criteria. Study methodology, participant characteristics, and outcomes were evaluated and quality of evidence was assigned. Eight articles met inclusion criteria and consisted of two randomized controlled trials, four controlled trials, and two observational cohort studies. Evidence quality ranged from low to high. The ESDM is an effective intervention that improves cognition, language, and adaptive behavior. ESDM strategies delivered in community group settings and in the home by parents have potential to be efficacious and feasible.

Symptoms of myasthenia gravis in a patient with a history of thymectomy for invasive thymoma

Myasthenia gravis is an antibody-mediated autoimmune disease. Approximately 10-15% of patients present with a thymoma, the presence of which is associated with greater severity of symptoms, myasthenic crisis, and irresponsiveness to front-line therapy. A thymectomy is recommended in young patients with generalized myasthenia gravis and in all patients presenting with thymoma. The patient was a 43-year-old woman, who first showed symptoms of myasthenic crisis in 2005 and presented with invasive thymoma managed with thymectomy and radiotherapy. In the subsequent three years, the patient presented with severe symptoms and two myasthenic crises that required mechanical ventilation and immunoglobulin treatment. Contrast chest computed tomography examinations showed no recurrence. Between 2009 and 2012, the patient experienced decreased symptom severity. In 2013, the patient presented with an exacerbation of symptoms; a contrast chest magnetic resonance scan showed a lesion in the anterior mediastinum, previously observed in 2011, suggestive of residual tissue as opposed to fibrosis. Regular management was started with immunoglobulins; a positron emission tomography scan was inconclusive, requiring a new resection, which showed no evidence of tumor recurrence. Patients with myasthenia gravis and those with myasthenia-related thymoma both share thymectomy as an element of treatment. However, following the procedure, exacerbation or reappearance of symptoms does not necessarily represent new alterations in the thymus.

Toward a Definition of Quality Care for Patients with Restless Legs Syndrome.

Health care systems and payers are placing increasing emphasis on the measurement and improvement of quality. The process of quality improvement is complex but can be supported by professional organizations such as the American Academy of Sleep Medicine (AASM). In 2013, the AASM commissioned a series of restless legs syndrome (RLS)-specific quality measures, consisting of process and outcome measures. This article provides an overview of the measure development process and discusses the individual RLS quality measures. These measures were designed to support the goals of improved diagnostic accuracy, decreased symptom severity, and reduced treatment complications.

Penetration and translocation of Erwinia amylovora-specific bacteriophages in apple - a possibility of enhanced control of fire blight

We have investigated the uptake and delivery of Erwinia amylovora-specific bacteriophages in apple plants. The main aim of this study was to assess the potential of phage application as a means for improving phage persistence and thereby the control of fire blight, the disease caused by E. amylovora. Both phage strains tested (ΦEa104 and H5K) were able to translocate in apple seedlings and were detectable by a modified Adams’ drop test and real-time qPCR in plant parts above ground level following their application to the roots. Conversely, phages were detectable in roots after spraying them onto the stem and leaves. A water suspension of phages effectively decreased symptom severity of E. amylovora infection in apple seedlings following treatment of roots or aerial plant parts and application to the cotyledon, as judged by symptom bonitation. A similar effect was achieved by spraying a phage suspension onto flowering firethorn shoots. Interestingly no significant differences in controlling E. amylovora infection were found among the two phage strains tested. It seems that phages specific to E. amylovora can penetrate plants and exhibit a decrease in severity of symptoms caused by the phytopathogen. Demonstrating in planta translocation of E. amylovora-specific bacteriophages and their effect of reducing fire blight symptoms may significantly contribute to a better control of E. amylovora and promote further investigations on penetration and translocation of phages into plants.

Clinical effectiveness and economic costs of group versus one-to-one education for short-chain fermentable carbohydrate restriction (low FODMAP diet) in the management of irritable bowel syndrome.

Restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) is an effective dietary treatment for irritable bowel syndrome (IBS). Patient dietary education is essential but labour intensive. Group FODMAP education may alleviate this somewhat but has not previously been investigated. The present study aimed to investigate the clinical effectiveness of low FODMAP group education in patients with IBS and to explore the cost of a group pathway. Patients with IBS (n = 364) were assessed for their suitability to attend dietitian-led group education or traditional one-to-one education in a novel group pathway. Clinical effectiveness (global symptom question, symptom prevalence, stool output) were compared at baseline and follow-up using the chi-squared test. The costs of the novel group pathway were assessed using a decision model. The global symptom question indicated more patients were satisfied with their symptoms following dietary advice, in both group education [baseline 48/263 (18%) versus follow-up 142/263 (54%), P < 0.001] and one-to-one education [baseline 5/101 (5%) versus follow-up 61/101 (60%), P < 0.001], with no difference between group and one-to-one education at follow-up (P = 0.271). Overall, there was a significant decrease in symptom severity from baseline to follow-up (P < 0.001 for both groups) but no difference in symptom response between group and one-to-one education. The cost for the group education pathway for all 364 patients was £31 713.36. The present study shows that dietitian-led FODMAP group education is clinically effective and the costs associated with a FODMAP group pathway are worthy of further consideration for routine clinical care.

Biological control of Verticillium wilt of olive by Paenibacillus alvei, strain K165

In the present study, the efficiency of the biocontrol agent Paenibacillus alvei (strain K165) to suppress Verticillium wilt of olive tree was evaluated in greenhouse and field experiments. In planta bioassays were conducted under greenhouse conditions and revealed that K165 significantly decreased symptoms on the susceptible cultivar ‘Amfissis’ by 44.5 and 51.6 % of the final disease severity index and relative area under disease progress curve (AUDPC), respectively. Thereafter, the suppressive effect of K165 against Verticillium dahliae was studied for two consecutive years (2007 and 2008) in a newly established olive orchard of the susceptible cv Amfissis and the resistant cv Kalamon, naturally infested with V. dahliae. The evaluation of K165 was carried out by recording symptoms, isolations and qPCR quantification of the pathogen in olive tissues. In both years, ‘Amfissis’ trees treated with K165 showed significantly lower final disease severity and relative AUDPC values compared to the non treated controls, whereas, in 2008 decreased symptom severity was associated with significantly lower V. dahliae DNA levels in plant tissues, indicating the suppressive effect of the biocontrol agent. However, no significant suppression was observed in ‘Kalamon’. Pathogen isolations along with qPCR quantification revealed a seasonal fluctuation of V. dahliae biomass in olive tissues with higher amounts occurring in May, and lower amounts in February, August and November. This is the first report of biological control of Verticillium wilt of olive tree under field conditions, associated with reduced pathogen levels inside the xylem tissues.