Nonspecific Factors Research Articles

Alcohol Use Disorder Is Differently Associated With Psychotic Symptoms According To Underlying Psychiatric Disorders: A General Population Study.

Psychotic symptoms can occur in the general population, and alcohol use disorder (AUD) is an identified vulnerability factor. However, it remains unclear how AUD is associated with psychotic symptoms, depending on the underlying psychiatric condition.We aimed to compare the prevalence of psychotic symptoms among subjects with different types of psychiatric disorders, i.e. unipolar or bipolar disorders, anxiety disorders, psychotic disorders or no psychiatric disorder, depending on whether or not there was an underlying AUD. In a 38,694-subject general population study, we compared the likelihood of occurrence of seven types of psychotic symptoms, depending on the AUD status and the underlying psychiatric disorders, after adjustment for age, sex, marital status, education and income levels. In unipolar depression and anxiety disorders, almost all types of psychotic symptoms were found associated with AUD (odds ratios (ORs) between 1.98 and 2.19). In contrast, in bipolar disorder, only auditory hallucinations were associated with AUD (OR=2.50). In psychotic disorders, only thought broadcasting was more frequent among subjects with AUD (OR=1.78). Our findings in depression and anxiety disorders are in line with the 'dual diagnosis' concept, which posits that comorbid psychiatric/addictive disorders form distinctive entities that are more frequently associated with non-specific severity factors, here psychotic symptoms. The co-occurrence of AUD in bipolar/psychotic disorders was not associated with a generalized increased occurrence of psychotic symptoms but altered their manifestations with an increased risk of auditory hallucinations for bipolar disorder and thought broadcasting for psychotic disorders.

CURRENTLY UNKNOWN ASPECTS OF POULTRY NECROTIC ENTERITIS PATHOGENESIS

Necrotic enteritis (NE) or poultry clostridiosis is a disease which poses enormous health problems and makes tremendous economic losses to intensive poultry production worldwide. Despite having been targeted in extensive research for decades, a number of aspects of its pathogenesis remain unknown. For more than 30 years alfa-toxin has been considered to be the main virulence factor of the causative agent, but experimental research using a mutant Clostridium perfringens strain lacking the gene coding for this confirmed that alpha-toxin is not necessary for pathogenesis. Since the 1980s, NetB toxin has been the main suspected virulence factor. However, recently it has been discovered that the large clostridial cytotoxin named TpeL also contributes to the pathogenesis of NE. In spite of that, the prevalence of the genes which code for these toxins vary between the isolates of C. perfringens from the intestines of diseased poultry, which made clear that further investigation into their roles is necessary. It has been agreed that specific intestinal environmental conditions, which favour the growth and multiplication of C. perfringens, are key factors to the emergence of disease. Given that a battery of non-specific factors contributes to pathogenesis, as well as that it is impossible to eliminate them in intensive poultry production, not much hope remains that NE can be controlled. In this short review, the current knowledge on the pathogenesis of NE has been summarized.

Effective climate change mitigation through cover cropping and integrated fertilization: A global warming potential assessment from a 10-year field experiment

Abstract In this study, field-specific data was collected from a 10-year experiment in central Spain in which vetch (Vicia sp. L.) and barley (Hordeum vulgare L.) were established as cover crops and compared to the traditional fall-winter fallow between two irrigated cash crops, maize (Zea mays L.) and sunflower (Helianthus annuus L.). The global warming potential (GWP) balance included direct and indirect (nitrous oxide (N2O) resulting from the deposition of ammonia (NH3) or from leached nitrate (NO3−)) soil greenhouse gas (GHG) emissions, changes in soil organic carbon (SOC) and albedo, and carbon dioxide equivalent (CO2eq) emissions from inputs, irrigation and farm operations. Several scenarios involving i) changes in the termination method of the cover crops, ii) consideration of the application of a distinct nitrogen (N) source (urea, slurry or manure instead of ammonium nitrate) or nitrification inhibitors, iii) employing the same N rate for all treatments (i.e., conventional instead of integrated fertilization), iv) modelling SOC accumulation over a 100-year horizon, and v) using default emission factors, were also analysed. Under the conditions of our experiment, cover crops mitigated yield-scaled emissions by 77.4% (barley) and 91.9% (vetch). Synthetic N fertilization (particularly the industrial production of fertilizer) contributed 38% to the balance of the cover cropping treatments, followed by SOC (22.5%), irrigation (14.7%) and albedo (14.5%). All scenarios led to notable mitigation efficacies, ranging from 39% mitigation (in barley when considering default or non-specific emission factors) to a net CO2eq sink (i.e., >100% mitigation) in the scenario consisting of the replacement of ammonium nitrate by urea or organic fertilizers although with side effects on NH3 volatilization and/or yields. Based on these results, the combined use of cover cropping and integrated soil fertility management could lead to the design of C-neutral irrigated cropping systems in semi-arid regions.

Effects of different acupuncture treatment methods on mild cognitive impairment: a study protocol for a randomized controlled trial

BackgroundMild cognitive impairment (MCI) is an intermediate state between normal aging and Alzheimer’s disease, which is the world’s most common form of dementia. It is important to identify early and easily available interventions to delay the progression of MCI to Alzheimer’s disease. Acupuncture has been reported to improve the clinical outcomes of MCI treatment. Acupuncture is a complex intervention, involving both specific and non-specific factors associated with therapeutic benefits. Therefore, we intend to obtain basic data for developing an optimal acupuncture treatment for MCI by comparing the effects of different acupuncture treatment methods on cognitive function in MCI patients.MethodsThis study will be a prospective, outcome-assessor-blinded, parallel-arm, single-center (DongShin University Gwangju Korean Medicine Hospital, Republic of Korea), randomized controlled clinical trial. Thirty-two participants with MCI will be randomized in equal numbers to four groups (basic acupuncture (BA), acupoint specificity (AS), needle duration (ND), or electroacupuncture (EA)) and receive acupuncture treatment once per day, 3 days/week for 8 weeks. The BA and ND groups will receive acupuncture treatment for 30 and 20 min, respectively, at Baihui (GV20), Sishencong (EX-HN1), Fengchi (GB20), and Shenting (GV24). The EA group will receive electroacupuncture treatment at the same acupoints for 30 min. The AS group will receive acupuncture treatment at GV20, EX-HN1, GB20, GV24, and Taixi (KI3) for 30 min. The outcome measured will be scores on the Korean version of the Alzheimer’s Disease Assessment Scale—cognitive subscale, the Korean version of the Montreal Cognitive Assessment, the Center for Epidemiological Studies Depression scale, the Korean Activities of Daily Living scale, the Korean Instrumental Activities of Daily Living scale, and the European Quality of Life Five Dimension Five Level scale. All scores will be recorded before intervention, 8 weeks after the first intervention, and 12 weeks after completing the intervention.DiscussionFour acupuncture protocols will be assessed and compared as potential MCI treatments. This study is expected to provide data to be used in developing an optimal acupuncture method for MCI treatment.Trial registrationClinical Research Information Service, KCT0003430. Registered on 16 January 2019.http://cris.nih.go.kr).

Factors affecting the composition of the gut microbiota, and its modulation.

Gut microbiota have important functions in the body, and imbalances in the composition and diversity of those microbiota can cause several diseases. The host fosters favorable microbiota by releasing specific factors, such as microRNAs, and nonspecific factors, such as antimicrobial peptides, mucus and immunoglobulin A that encourage the growth of specific types of bacteria and inhibit the growth of others. Diet, antibiotics, and age can change gut microbiota, and many studies have shown the relationship between disorders of the microbiota and several diseases and reported some ways to modulate that balance. In this review, we highlight how the host shapes its gut microbiota via specific and nonspecific factors, how environmental and nutritional factors affect it, and how to modulate it using prebiotics, probiotics, and fecal microbiota transplantation.

Binge-Eating Symptoms, Emotional-Behavioral Problems and Gender Differences among Adolescents: A Brief Report

We investigated relationships between binge-eating symptoms and emotional-behavioral problems in 382 community-adolescents (aged 13‑18 years, M = 15, SD = 1; 61% girls), analyzing gender differences. Few studies have investigated binge eating in community-adolescents and none have explored gender differences in Italy. Participants completed the Binge Eating Scale (BES) and the Youth Self Report (YSR 11/18), which measures internalizing, externalizing and other problems (e.g. binge-drinking, substance abuse). 6% of adolescents (99% girls) were at-risk of binge-eating symptoms. In both gender, binge-eating symptoms were correlated with internalizing and other problems (all p < .001), but unexpectedly they were correlated with externalizing problems only in girls. The set of internalizing, externalizing and other problems predicted 23% of variance in BES among girls; only other problems predicted 12% of variance in BES among boys . Results identified gender-specific and non-specific risk factors for binge eating in Italian community-adolescents, that should be further investigated.

СТРУКТУРНЫЕ ОСОБЕННОСТИ МЯГКИХ ТАКНЕЙ, ОКРУЖАЮЩИХ ИМПЛАНТАТ, И ФАКТОРЫ, ВЛИЯЮЩИЕ НА РАЗВИТИЕ ВОСПАЛЕНИЯ В ПЕРИИМПЛАНТАЦИОННОМ ПРОСТРАНСТВЕ

Introduction. The tissues surrounding the implant, which have common features with periodontal tissues, but still possessing a certain specificity are the actual topic of the study. A considerable amount of textbooks has been written on this topic, but so far it has remained little studied.&#x0D; Purpose ― to summarize all knowledge of the structural features of the tissues surrounding the implant, etiology, pathogenesis, clinical picture, differential diagnosis of the pathologies of these tissues.&#x0D; Results. This review is devoted to the analysis of the modern understanding of the influence of the structural features of the soft tissues surrounding the implant and the nonspecific protection factors of the oral mucosa on the potentiation of inflammatory processes and their relationship with the biodegradation of the material. The work of scientists on the criteria for choosing an implantable material depending on the resistance to aggressive environments of the oral cavity, as well as biocompatibility with the tissues of the oral cavity. The risks of complications are considered depending on the implantable material. The etiopathogenesis of such diseases as implantation mucositis and dental periimplantitis is also considered. The clinical picture of these diseases is described, a correlation is made with the materials used for the manufacture of suprastructures. The prevention of complications arising from prosthetics on dental implants is considered.

Serum and Urinary NGAL and Cystatin C Levels as Diagnostic Tools for Acute Kidney Injury and Chronic Kidney Disease: A Histobiochemical Comparative Study.

High global incidence of acute kidney injury (AKI) is an observable complication in critically ill patients. Long-term disease and medication complexity contribute to devastating chronic kidney disease (CKD), diminishing quality of life. To establish new biomarkers to guide patient care and facilitate novel therapeutics development. Serum and urinary levels of creatinine, CysC, and NGAL were estimated in 86 renal patients and compared with healthy controls for AKI and CKD categorization. Creatinine and CysC measurements were used to estimate GFR. Kidney biopsies were prepared for light microscopy for further characterization. Patients' demographic data were used in group association studies. Thirty-six patients met the criteria for AKI and 50 for CKD. Both mean serum and urine creatinine levels were significantly elevated by 2.8 and 2.6, respectively, from baseline in 48 h in the AKI group but not CKD group. Mean serum Cystatin C (CysC) values were higher than controls but similar in both disease states, while urine levels were slightly higher in CKD patients, and remained steady by the end of the follow-up (EF-Up). Further, a significant 2.9-fold and 5.5-fold (p=0.001) increase in serum NGAL in AKI and CKD, respectively, and a dramatic 7.1-factor reduction in AKI group, but no appreciable change in the CKD group from admission to EF-Up were observed. Similarly, urine NGAL level for AKI and CKD increased 3.2-fold and 6-fold respectively, on admission, which decreased moderately with the AKI group (2.5-fold) but increased by a factor of 1-8 (10.7- fold; p=0.001) at EF-Up. ROC assessment curve revealed relatively higher NGAL performance at good predictive values than CysC (p < 0.009). Our data demonstrated creatinine elevation by a factor > 2 in 48 h in AKI group but not CKD group, which returned close to normal levels by the EF-Up, an indication of abrupt renal injury in AKI, compared with a persistent effect in the CKD group. Both serum and urine NGAL sensitivity and specificity provided powerful discriminative tool between AKI and CKD by reduction in the AKI group and an increase in the CKD group by the EF-UP, thus, contributing in establishing the basis for AKI and CKD classification. CysC, however, displayed less sensitivity than NGAL, indicating effects by enigmatic non-specific factors.

The Role of Heart Rate Variability in Mindfulness-Based Pain Relief

Mindfulness meditation is a self-regulatory practice premised on sustaining nonreactive awareness of arising sensory events that reliably reduces pain. Yet, the specific analgesic mechanisms supporting mindfulness have not been comprehensively disentangled from the potential nonspecific factors supporting this technique. Increased parasympathetic nervous system (PNS) activity is associated with pain relief corresponding to a number of cognitive manipulations. However, the relationship between the PNS and mindfulness-based pain attenuation remains unknown. The primary objective of the present study was to determine the role of high-frequency heart rate variability (HF HRV), a marker of PNS activity, during mindfulness-based pain relief as compared to a validated, sham-mindfulness meditation technique that served as a breathing-based control. Sixty-two healthy volunteers (31 females; 31 males) were randomized to a 4-session (25 min/session) mindfulness or sham-mindfulness training regimen. Before and after each group's respective training, participants were administered noxious (49°C) and innocuous (35°C) heat to the right calf. HF HRV and respiration rate were recorded during thermal stimulation and pain intensity and unpleasantness ratings were collected after each stimulation series. The primary analysis revealed that during mindfulness meditation, higher HF HRV was more strongly associated with lower pain unpleasantness ratings when compared to sham-mindfulness meditation (B = −.82, P = .04). This finding is in line with the prediction that mindfulness-based meditation engages distinct mechanisms from sham-mindfulness meditation to reduce pain. However, the same prediction was not confirmed for pain intensity ratings (B = −.41). Secondary analyses determined that mindfulness and sham-mindfulness meditation similarly reduced pain ratings, decreased respiration rate, and increased HF HRV (between group ps < .05). More mechanistic work is needed to reliably determine the role of parasympathetic activation in mindfulness-based pain relief as compared to other meditative techniques.Perspective: Mindfulness has been shown to engage multiple mechanisms to reduce pain. The present study extends on this work to show that higher HRV is associated with mindfulness-induced reductions in pain unpleasantness, but not pain intensity ratings, when compared to sham-mindfulness meditation. These findings warrant further investigation into the mechanisms engaged by mindfulness as compared to placebo.

The flip side of collaborative alliance: a single-case study.

The present single case study explored whether a positive collaboration may conceal some of the patient’s dysfunctional interpersonal schemas, hence reflecting a non-authentic collaboration. In particular, we reasoned that conceiving collaborations only as adaptive relations may prevent a comprehensive insight of the therapeutic relationship itself. To explore this possibility, we used an intersubjective approach that emphasizes the integration of specific and non-specific factors in an interdependent way. In particular, we assessed different constructs (i.e. therapeutic alliance, technical interventions, defense mechanism, therapeutic relationship) of the therapeutic process and combined them through statistical methods able to investigate the micro- and macro-analytic processes that define each interaction. Results of a single case study (Sara) showed that the collaborative functioning may hold back many critical aspects, that hardly conciliate with the classic positive definition of collaboration. These findings, therefore, indicate that Sara’s collaborative alliance works mainly as a pseudo-alliance.

The Hyperfocusing Hypothesis: A New Account of Cognitive Dysfunction in Schizophrenia.

Impairments in basic cognitive processes such as attention and working memory are commonly observed in people with schizophrenia and are predictive of long-term outcome. In this review, we describe a new theory-the hyperfocusing hypothesis-which provides a unified account of many aspects of impaired cognition in schizophrenia. This hypothesis proposes that schizophrenia involves an abnormally narrow but intense focusing of processing resources. This hyperfocusing impairs the ability of people with schizophrenia to distribute attention among multiple locations, decreases the number of representations that can simultaneously be maintained in working memory, and causes attention to be abnormally captured by irrelevant inputs that share features with active representations. Evidence supporting the hyperfocusing hypothesis comes from a variety of laboratory tasks and from both behavioral and electrophysiological measures of processing. In many of these tasks, people with schizophrenia exhibit supranormal effects of task manipulations, which cannot be explained by a generalized cognitive deficit or by nonspecific factors such as reduced motivation or poor task comprehension. In addition, the degree of hyperfocusing in these tasks is often correlated with the degree of impairment in measures of broad cognitive function, which are known to be related to long-term outcome. Thus, the mechanisms underlying hyperfocusing may be a good target for new treatments targeting cognitive deficits in schizophrenia.

Changing Host Plants Causes Structural Differences in the Parasitoid Complex of the Monophagous Moth Yponomeuta evonymella, but Does Not Improve Survival Rate.

Recently in Poland, cases of host expansion have frequently been observed in the typically monophagous bird-cherry ermine moth (Yponomeuta evonymella), which has moved from its native host plant, bird cherry (Prunus padus), to a new, widely distributed plant that is invasive in Europe, black cherry (P. serotina). We attempted to verify the reasons behind this host change in the context of the enemy-free space hypothesis by focusing on parasitoids attacking larval Y. evonymella on one of three host plant variants: The primary host, P. padus; initially P. padus and later P. serotina (P. padus/P. serotina); or the new host, P. serotina. This experiment investigated if changing the host plant could be beneficial to Y. evonymella in terms of escaping from harmful parasitoids and improving survival rate. We identified nine species of parasitoids that attack larval Y. evonymella, and we found that the number of parasitoid species showed a downward trend from the primary host plant to the P. padus/P. serotina combination to the new host plant alone. We observed a significant difference among variants in relation to the percentage of cocoons killed by specific parasitoids, but no effects of non-specific parasitoids or other factors. Total mortality did not significantly differ (ca. 37%) among larval rearing variants. Changing the host plant caused differences in the structure of the parasitoid complex of Y. evonymella but did not improve its survival rate. This study does not indicate that the host expansion of Y. evonymella is associated with the enemy-free space hypothesis; we therefore discuss alternative scenarios that may be more likely.

Placebo Effects in Psychotherapy: A Framework.

The issue of placebo response and the extent of its effect on psychotherapy is complex for two specific reasons: i) Current standards for drug trials, e.g., true placebo interventions, double-blinding, cannot be applied to most psychotherapy techniques, and ii) some of the “nonspecific effects” in drug therapy have very specific effects in psychotherapy, such as the frequency and intensity of patient–therapist interaction. In addition, different psychotherapy approaches share many such specific effects (the “dodo bird verdict”) and lack specificity with respect to therapy outcome. Here, we discuss the placebo effect in psychotherapy under four aspects: a) nonspecific factors shared with drug therapy (context factors); b) nonspecific factors shared among all psychotherapy traditions (common factors); c) specific placebo-controlled options with different psychotherapy modalities; and d) nonspecific control options for the specific placebo effect in psychotherapy. The resulting framework proposes that the exploration and enumeration of context factors, common factors, and specific factors contributes to the placebo effects in psychotherapy.

Harnessing Progress in Psychiatric Genetics to Advance Population Mental Health.

Advances in genomics and neuroscience have ushered in unprecedented opportunities to increase our understanding of the biological underpinnings of mental disorders, yet there has been limited progress in translating knowledge on genetic risk factors to reduce the burden of these conditions in the population. We describe the challenges and opportunities afforded by the growth of large-scale population health databases, progress in genomics, and collaborative efforts in epidemiology and neuroscience to develop informed population-wide interventions for mental disorders. Future progress is likely to benefit from the following efforts: expansion of large collaborative studies of mental disorders to include more systematically ascertained multiethnic samples from biobanks and registries, harmonization of phenotypic characterization in registry and population samples to extend clinical diagnosis to transdiagnostic concepts, systematic investigation of the influences of both specific and nonspecific environmental factors that may combine with genetic susceptibility to confer increased risk of specific mental disorders, and implementation of study designs that can inform gene-environment interactions. Such data can ultimately be combined to develop comprehensive models of risks of, interventions for, and outcomes of mental disorders. With its focus on phenotypic characterization, sampling, study designs, and analytic methods, epidemiology will be central to progress in translating genomics to public health.

Sex differences in the etiology of disgust sensitivity: A preliminary behavioral genetic analysis

Evidence suggests that Disgust Sensitivity (DS) is a personality trait that may confer risk for the development of some anxiety-related disorders. To examine the origins of this trait we administered the DS subscale of the Disgust Propensity and Sensitivity Scale-Revised to 90 monozygotic and 90 dizygotic twin pairs, of which 55% were women. The DS subscale consists of two dimensions; Somatic Disgust and Ruminative Disgust. Biometrical modeling techniques were used to estimate heritability of the DS dimensions by sex. For women, each dimension was influenced by a combination of genetic and environmental factors. More specifically, 40.1% of the variance in DS was observed to be due to additive genetic factors and the remaining variance due to non-shared environment. Correlations among DS dimensions for women could be explained by genetic and environmental factors influencing the two dimensions. For men, the two dimensions were influenced by environmental but not genetic factors. These findings suggest that the etiology of DS is complex and arises as a function of dimension-specific and non-specific etiologic factors that vary as a function of sex. The implication of these findings for the sex differences in the etiology of some anxiety-related disorders are discussed.

187. Developing Approaches to Identify and Modulate Components of Altered Resting State Default Mode Connectivity in Suicidal Individuals

Neural signatures of suicidal risk may reflect a combination of suicide-specific and non-specific illness related factors, and successful identification of a marker may assist the development of treatments. We examined whether default mode network (DMN) connectivity can be decomposed into components reflecting familial risk for depression and suicidal ideation (SI), and whether DMN connectivity can be modulated using transcranial direct current stimulation (tDCS) via the left ventrolateral prefrontal cortex (VLPFC).

Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial

ObjectiveThis study compared the efficacy of a technician-assisted single-session virtual reality exposure therapy (VRET) for the treatment of spider phobia featuring low-cost consumer-available hardware and novel automated software to gold-standard in-vivo one-session treatment (OST), using a parallel group randomized non-inferiority design. Method Participants (N = 100) were randomized to VRET and OST arms. Assessors blinded to treatment allocation evaluated participants at pre- and post-treatment as well follow-up (3 and 12 months) using a behavioral approach test (BAT) and self-rated fear of spider, anxiety, depression and quality-of-life scales. A maximum post-treatment difference of 2-points on the BAT qualified as non-inferiority margin. Results Linear mixed models noted large, significant reductions in behavioral avoidance and self-reported fear in both groups at post-treatment, with VRET approaching the strong treatment benefits of OST over time. Non-inferiority was identified at 3- and 12- months follow-up but was significantly worse until 12-months. There was no significant difference on a questionnaire measuring negative effects. Conclusions Automated VRET efficaciously reduced spider phobia symptoms in the short-term and was non-inferior to in-vivo exposure therapy in the long-term. VRET effectiveness trials are warranted to evaluate real-world benefits and non-specific therapeutic factors accruing from the presence of a technician during treatment. ClinicalTrials.gov (NCT02533310).

OPTIMIZATION OF DETECTION OF BRONCHIAL ASTHMA OF EARLY BEGINNING IN CHILDREN

Resume. Bronchial asthma (BA) is the most frequent chronic pathology in children, and untimely verification of a diagnosis in children in the future determines an unfavorable prognosis of its course with the formation of severe forms of the disease and early disability of patients.Objective - to establish the indicators of the clinical and epidemiological risk of early onset phenotype in patients with a wheezing syndrome based on the histochemical results of the test of eosinophilic granulocytes in order to improve individualized recommendations for the treatment of asthma in young children.Materials and methods. 50 children with persistent BA of different age were examined. Two clinical observation groups were formed by the age of the debut of the disease. In particular, the first clinical group (I) consisted of 25 children with an early onset phenotype (up to 3 years), and in the second (II) observation group were 25 children with late-debut phenotype of BA (in 6 years and later). Conducted a comprehensive clinical and paraclinical examination of children, which included anamnestic indicators, allergic anamnesis, activity of the oxygen-dependent metabolism of eosinophilic granulocytes of peripheral blood.Results. In I group children, the tendency towards a decrease in the results of the stimulated NBT- test of granulocyte data was observed, which probably indicated an exhaustion of their oxygen-dependent functional activity as a result of active involvement in the inflammatory response of the organism. Thus, in patients of Group I, the minimum and maximum values of the stimulated NBT-test for cytochemical factors were respectively 0.06 conventional units (CU) and 0.72 CU, in the comparison group - 0.08 CU, and 0.8 CU respectively. At the same time, the proportion of children with the value of stimulated NBT-test of eosinophils of peripheral blood, which did not exceed 0.08 CU were registered in 12.2% patients with early onset phenotypes and 4.5% in patients with late-onset asthma (Рφ &lt;0,05).Conclusions. The following characteristics of phenotype of early onset BA are (1) birth from the third and subsequent parities of births; (2) greater trigger role of non-specific factors, in particular, ARI; (3) less severe illness and worse control of disease symptoms; (4) high demand for facilitating fast-acting drugs. In the presence of signs of exhaustion of processes of oxygen dependent microbicide eosinophilic granulocytes, the chances of having an early-onset asthma-phenotype increase in triple, which allows the appointment of basic anti-inflammatory therapy for children with a wheezing syndrome.

CLINICAL APPROACHES TO THE PREVENTION OF ATOPIC DERMATITIS CHILDREN: EUROPEAN GUIDELINES 2018

The article presents an overview of data from the European guidelines (2018) on the prevention of atopic dermatitis in children.This guideline was developed as a joint interdisciplinary European project, including physicians from all relevant disciplines as well as patients. It is a consensus‐based guideline, taking available evidence from other guidelines, systematic reviews and published studies into account.According to the European recommendations (2018), prevention and exacerbation of atopic dermatitis in infants and children is impossible without the successive stages of identifying specific and non-specific risk factors, avoiding contact with allergens, appropriate clothing for the child, adherence to dietary recommendations, hygiene in the home and basic skin care and therapy of impaired barrier functions of the epidermis, non-drug mitigating therapy, cleaning and bathing a child.Using Penaten cream optimally fits into modern international rules for skin care in children with atopic dermatitis. The current skin care for these children is very important, since the usual means of external non-drug therapy are mainly aimed at stopping the acute manifestations of the disease. It is during the period between exacerbations that the child has strong dry skin, peeling, a feeling of tightening and cracking of the skin. Therefore, the elimination of these manifestations (according to European recommendations, 2018) is an important component in the prevention and treatment of blood pressure in children, which Penaten of Johnson & Johnson helps to cope with.

The Case of "Daniel": Flexibly Delivering an Inherently Challenging Treatment in the Face of a Complex Presentation

In this article, I respond to commentaries by Martin Franklin (2019) and by Liza Pincus and Andrea Quinn (2019) about my case study of "Daniel" (Tice, 2019), a 14-year-old young man presenting to therapy with Obsessive Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD). I treated Daniel with a manual-based, 25-session treatment centered around the cognitive-behavioral approach of Exposure and Response Prevention (E/RP). A major theme running through my case study and the two commentaries is the need for flexibility in adapting the manual to be responsive to a variety of factors associated with Daniel’s disorder, such as his personality, interests, life situation, attitude towards his symptoms, and his way of relating to the therapist. In the context of the commentaries, I review a variety of the specific ways in which I learned to be flexible. Some of these included (a) focusing on nonspecific factors in developing a strong therapeutic alliance and rapport; (b) paying particular attention to how I communicated relevant psychoeducational concepts to Daniel, particularly by the use of metaphors, in preparing him for the E/RP procedures and in encouraging his participation; and (c) focusing on the process of making decisions at important clinical choice points.