Psychosocial Complications Research Articles

Activity-Based Anorexia Reduces Body Weight without Inducing a Separate Food Intake Microstructure or Activity Phenotype in Female Rats-Mediation via an Activation of Distinct Brain Nuclei.

Anorexia nervosa (AN) is accompanied by severe somatic and psychosocial complications. However, the underlying pathogenesis is poorly understood, treatment is challenging and often hampered by high relapse. Therefore, more basic research is needed to better understand the disease. Since hyperactivity often plays a role in AN, we characterized an animal model to mimic AN using restricted feeding and hyperactivity. Female Sprague-Dawley rats were divided into four groups: no activity/ad libitum feeding (ad libitum, AL, n = 9), activity/ad libitum feeding (activity, AC, n = 9), no activity/restricted feeding (RF, n = 12) and activity/restricted feeding (activity-based anorexia, ABA, n = 11). During the first week all rats were fed ad libitum, ABA and AC had access to a running wheel for 24 h/day. From week two ABA and RF only had access to food from 9:00 to 10:30 a.m. Body weight was assessed daily, activity and food intake monitored electronically, brain activation assessed using Fos immunohistochemistry at the end of the experiment. While during the first week no body weight differences were observed (p > 0.05), after food restriction RF rats showed a body weight decrease: −13% vs. day eight (p < 0.001) and vs. AC (−22%, p < 0.001) and AL (−26%, p < 0.001) that gained body weight (+10% and +13%, respectively; p < 0.001). ABA showed an additional body weight loss (−9%) compared to RF (p < 0.001) reaching a body weight loss of −22% during the 2-week restricted feeding period (p < 0.001). Food intake was greatly reduced in RF (−38%) and ABA (−41%) compared to AL (p < 0.001). Interestingly, no difference in 1.5-h food intake microstructure was observed between RF and ABA (p > 0.05). Similarly, the daily physical activity was not different between AC and ABA (p > 0.05). The investigation of Fos expression in the brain showed neuronal activation in several brain nuclei such as the supraoptic nucleus, arcuate nucleus, locus coeruleus and nucleus of the solitary tract of ABA compared to AL rats. In conclusion, ABA combining physical activity and restricted feeding likely represents a suited animal model for AN to study pathophysiological alterations and pharmacological treatment options. Nonetheless, cautious interpretation of the data is necessary since rats do not voluntarily reduce their body weight as observed in human AN.

Patient-reported distress in adults with myelodysplastic syndromes (MDS).

80 Background: MDS are hematopoietic malignancies that are incurable in most patients. The National Comprehensive Cancer Network (NCCN) defines distress as an unpleasant emotional experience associated with the psychosocial complications of cancer that may interfere with quality of life. Distress is not well described in MDS and may be useful to screen for palliative care needs. Methods: We conducted a retrospective review of distress in ambulatory adult MDS patients visiting our clinics from July 2013 to September 2015. We abstracted demographic, diagnostic, and comorbidity data from records along with the 10-point ordinal NCCN Distress Thermometer (DT) and its 39-item Problem List (PL). NCCN guidelines suggest DT scores ≥ 4 be evaluated for referral to psychosocial resources. Results: We included 119 patients (median age = 68, range = 30-88 years; 73.9% White; 67.2% male; 29.4% with prior cancer). Half were low-risk and 5 progressed to AML. Twenty-three (19.3%) had ≥ 1 hospitalization and 10.9% had &gt; = 1 emergency department visit. Ten patients died; 1 was referred to counseling and 1 used hospice. Three others were referred to counseling and no patients had a palliative care consult. There were 366 DT (median distress = 1, range = 0-10) across 580 visits and 106 patients (median = 2 DT/patient, range = 1-16). Fifty-two patients had at least 1 DT ≥ 4 and 19 had 2 or more DT ≥ 4. With patients classified by their maximum DT (median = 3, interquartile range = 1-7) ever-use of therapy (hypomethylating agents/lenalidomide/growth factors/transfusions/chelation) was associated with greater maximum DT (median = 4, range = 0-10, N = 73) compared with no therapy (median = 2, range = 0-9, N = 33; P = 0.03, 2-sample Wilcoxon test). Ninety-five patients reported 1,335 problems during 22,846 person-days of follow-up (median = 4 problems/patient/visit, range = 1-23). The 5 most frequent problems were fatigue (176 times; 76 patients), pain (92 times; 44 patients), worry (77 times; 43 patients), sleep (75 times; 39 patients), and tingling hands/feet (68 times; 33 patients). Conclusions: MDS patients experience frequent and substantial distress yet referrals to counseling and use of palliative care are rare. These findings point to unmet palliative care needs in MDS.

Detection of Optic Neuropathy and 3-month Follow-up of an Adolescent Inhalant User: Are we Paying Enough Attention?

Byline: Prashant. Gupta, Piyali. Mandal, Digvijay. Singh, Raman. Pattanayak, Rachna. Bhargava, Anju. Dhawan Sir, Very few centers provide specialty treatment services for adolescent drug users in India. When an adolescent presents with chronic drug use, often the resultant psychosocial complications are assessed in detail, however the physical complications (unless gross or with overt manifestation) are often overlooked in general clinical settings. Inhalant abuse is known to be especially more prevalent among children and adolescents. Toluene, present in many inhaled products, has lipophilic propensity and neurotoxic effects, leading to multifocal brain damage [sup][1] and peripheral neuropathies. However, very few cases of optic neuropathy have been reported.[sup][2],[3],[4],[5] Adolescent inhalant/drug users often have co-occurring nutritional deficiencies, which may cause or enhance their vulnerability to optic neuropathies. We discuss the case of an adolescent inhalant user, who presented to the specialty clinic at the NDDTC, AIIMS, New Delhi, and though did not have any subjective visual complaints, he was detected to have optic neuropathy, which could later be partially reversed over 3-month follow-up. A 14-year-old male, school drop-out, from lower socioeconomic status, presented with regular use of inhalants for 2 years. Inhalant use continued largely uninterrupted (1–2 tubes/day adhesive glue) with no abstinence and was associated with significant psychosocial dysfunction. He also smoked tobacco (10–15 beedis/day) regularly with an occasional use of cannabis for 5 years. There is no significant past or family history. On examination, the patient was thinly built (BMI= 17 kg/sq.m), and pallor was noticed. In routine physical examination, constriction of visual fields was detected on confrontation visual field examination (no subjective complaints). The patient was admitted for further assessment and management with an International Classification of Diseases-10 diagnosis of tobacco dependence syndrome (F17.2) and volatile solvent dependence syndrome (F18.2). Hemogram and biochemistry tests were within normal limits (except hemoglobin: 9.2 g/dl). Urinalysis did not reveal any opioids, benzodiazepines or cannabis. Intelligence quotient (IQ) assessment yielded a score of 84. Referrals were sought from an ophthalmologist, otorhinolaryngologist, and neurologist. Ophthalmological examination revealed mildly sluggish pupillary reactions (visual acuity: right: 6/6, left: 6/9). Fundus showed bilateral (B/L) temporal optic disc pallor. Visual function assessment revealed normal color vision and contrast sensitivity. Humphrey's visual field testing revealed B/L global depression of sensitivity and constricted visual fields [Figure 1]. Findings were indicative of optic neuropathy. No abnormality was detected in otorhinolarygological examination (including pure tone audiometry) and neurological examination. Patient was prescribed an iron supplement, Vitamin B complex, Vitamin C, and coenzyme Q10. …

Cognitive and Affective Symptoms Experienced by Cancer Patients Receiving High-Dose Intravenous Interleukin 2 Therapy: An Integrative Literature Review.

Alterations in cognitive/affective functioning are among the most challenging adverse effects experienced by 80% of patients with metastatic melanoma and metastatic renal cell carcinoma undergoing high-dose interleukin 2 (IL-2) therapy. The purpose of this literature review is to describe what is known about IL-2-induced cognitive/affective symptoms, their prevalence, and level of severity and synthesize findings to determine areas for future research to address symptom management challenges. This review describes the IL-2 patient experience and the pathophysiology leading to these changes. An online electronic search using PubMed was performed to identify relevant literature published between 1992 and 2015. Of the original 113 articles, information was extracted from 9 articles regarding cognitive symptoms, affective symptoms, sample size, research design, reliability, and validity. Our review suggests that the trajectories, breadth, and depth of cognitive/affective symptoms have yet to be described. Despite intervention studies designed to address the psychosocial complications of IL-2, an understanding of the level of altered cognitive/affective symptoms experienced by IL-2 patients remains unclear. Our literature review reveals a lack of standardization when assessing, reporting, and managing cognitive/affective symptoms. Patients/family members have reported cognitive/affective symptoms to be the most alarming and difficult symptoms, yet these symptoms are not adequately screened for, and patients were not informed about potential changes. Assessing patients for cognitive/affective alterations is important to reduce anxiety while improving outcomes. Education about the illness trajectory (what to expect during/after treatment) can help care partners/patients set realistic shared expectations and increase coping.

Antipsychotic medications for cocaine dependence.

Cocaine dependence is a public health problem characterised by recidivism and a host of medical and psychosocial complications. Cocaine dependence remains a disorder for which no pharmacological treatment of proven efficacy exists. To evaluate the efficacy and the acceptability of antipsychotic medications for cocaine dependence. This review is an update of a previous Cochrane review published in 2007. We searched up to 15 July 2015 in Cochrane Drugs and Alcohol Group Specialised Register (searched in CRSLive); the Cochrane Library (including the Cochrane Central Register of Controlled Trials (CENTRAL); the Database of Abstracts of Reviews of Effects (DARE)); PubMed; EMBASE; CINAHL and Web of Science. All searches included non-English language literature. All randomised controlled trials and controlled clinical trials with focus on the use of any antipsychotic medication for the treatment of cocaine dependence. We used standard methodological procedures expected by Cochrane. We included 14 studies (719 participants). The antipsychotic drugs studied were risperidone, olanzapine, quetiapine, lamotrigine, aripiprazol, haloperidol and reserpine. Comparing any antipsychotic drugs versus placebo, we found that antipsychotics reduced dropout: eight studies, 397 participants, risk ratio (RR) 0.75 (95% confidence interval (CI) 0.57 to 0.97), moderate quality of evidence. We found no significant differences for any of the other primary outcomes considered: number of participants using cocaine during the treatment, two studies, 91 participants: RR 1.02 (95% CI 0.65 to 1.62); continuous abstinence, three studies, 139 participants: RR 1.30 (95% CI 0.73 to 2.32); side effects, six studies, 291 participants: RR 1.01 (95% CI 0.93 to 1.10); and craving, four studies, 240 participants: RR 0.13 (-1.08 to 1.35). For all of these comparisons we rated the quality of evidence as low.Comparisons of single drug versus placebo or versus another drug are conducted in few trials with small sample sizes, limiting the reliability of the results. Among these comparisons, only quetiapine seemed to outperform placebo in reducing cocaine use, measured by grams per week: mean difference (MD) -0.54 (95% CI -0.92 to -0.16), by US dollars spent per week: MD -53.80 (95% CI -97.85 to -9.75), and by craving: MD -1.23 (95% CI -2.19 to -0.27), but results came from one study with 60 participants.The major limitations of the studies were the high risk of attrition bias (40% of the included studies) and low quality of reporting, mainly for the risk of selection bias, performance and detection bias, that we rated as being at unclear risk for 75% to 80% of the studies. Furthermore, most of the included studies did not report results on important outcomes such as side effects, or use of cocaine during treatment and craving, which prevented the possibility of including them in statistical synthesis. At present, there is no evidence supporting the clinical use of antipsychotic medications in the treatment of cocaine dependence, although results come from only 14 trials, with small sample sizes and moderate to low quality of evidence.

Conversion disorder in adolescents: A review and case report

IntroductionConversion disorder (CD) is an uncommon but highly disabling condition. Affected children and adolescents are often severely impaired and at risk of serious long-term physical and psychosocial complications. Despite the enormous personal suffering and health resource implications of CD, little research has been done.ObjectivesTo update our knowledge about CD in adolescents, with a comprehensive review of the literature with special focus in prevalence, psychosocial factors, diagnosis, treatment and outcome.AimsTo present the most relevant data of our review with a clinical illustration that provides a practical vision of this disorder.MethodsA systematic literature review was performed in MEDLINE, with particular interest in papers published in the last 10 years. Clinical illustration is provided by a case selected from an outpatient child and adolescent mental health service.ResultsFew reliable prevalence data are available; the range goes from 0.2 in a German study to 31% in non-western clinical settings. Diagnosis is based on a constellation of features and treatment should involve several heath care professionals. CD has a favourable outcome in children and adolescents. However, mood and/or anxiety disorders are encountered at a considerable rate even after recovery from conversion symptoms. Long clinical follow-up seems appropriate.ConclusionsThe expression of emotional distress in the form of physical complaints is common in children. Nevertheless, the most severe presentation of physical symptoms is not a common topic in literature. More research should be done to improve our understanding of this disabling disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Pulsed dye laser treatment of capillary malformations in infants at 2-weekly versus 3-monthly intervals, reducing the need for general anaesthesia.

Capillary malformations (CM) cause significant psychosocial complications. Pulsed dye laser (PDL) treatment at 6-12-weekly intervals under general anaesthesia (GA) commencing in infants at 6 months of age remains the standard of care in order to achieve maximal improvement prior to school age. The safety of repeated GA in children is controversial. Shortening the time between treatments increases the number that can be delivered prior to 6 months of age, thus reducing the number of subsequent treatments needed under GA. We investigated the safety and effectiveness of more frequent PDL treatment of CM in infancy via a pilot, prospective patient-controlled study of 10 patients. Using 595 nm (Vbeam) PDL, the entire CM was treated initially, then half the CM randomly allocated to 2-weekly and half to 3-monthly intervals for two further treatments. Photographs of the CM taken 3 months after treatment completion were evaluated by an independent, blinded dermatologist. Nine infants completed the study. Three infants (33%) had more improvement on the 2-weekly treated side and four (44%) had more improvement on the 3-monthly treated side. Two patients (22%) showed no difference between sides. Treatments were well tolerated without complications. We conclude that 2-weekly PDL treatments of CM in infants aged under 6 months is effective and well tolerated without adverse effects. Our preliminary data suggest a possible superior efficacy with 3-monthly treatment intervals; however, larger studies are warranted for stronger evidence. More frequent non-GA treatment of CM in infants should be further investigated to decrease the risk of repeated GA exposure in young children.

A survey of burn professionals regarding the mental health services available to burn survivors in the United States and United Kingdom

This investigation surveyed burn health professionals in the UK and US to investigate the psychosocial issues facing burn survivors and the psychological services available to them through their burns service. MethodsOne hundred and sixty six burn care professionals (132 from the United States and 34 from the United Kingdom) from 76 different hospitals (60 in the US and 16 in the UK) completed an online survey. Mental health practitioners (MHPs) answered questions regarding their psychotherapy practice with burn survivors. ResultsRespondents reported that psychosocial issues are common among burn survivors. Burn teams in the UK were more likely than those in the US to include psychologists, but social workers were more common in the US. Participants reported that routine screening for psychosocial issues was more common in the UK than the US, and indicated it was easier for burn survivors to access mental health care after discharge in the UK. Burn services in both countries routinely referred burn survivors to support organizations such as the Phoenix Society or Changing Faces. The preferred mental health treatment modality in the UK was psychotherapy without medications. Reported psychotropic medications use was more common in the US. MHPs had two primary orientations – eclectic and cognitive behavioral therapy. Among MHPs there was a modest tendency to favor evidence-based interventions. DiscussionThe provision of mental health services varies between these two countries. Creating international standards for assessing and treating psychosocial complications of burns could facilitate the improvement of burn mental health services.

Protect the Player, Protect the Game: Subconcussion and Chronic Traumatic Encephalopathy

Chronic traumatic encephalopathy (CTE), formerly known as “punch drunk” or dementia pugilistica, is a progressive neurodegenerative disease. Repetitive exposure to head insults may cause insidious effects in the brain parenchyma, including tau protein dissociation and abnormal phosphorylation, encompassing the cerebrovasculature without being cleared. Concomitantly, various psychosocial complications (e.g. headache, difficulty concentrating, depression, dementia) are notable in CTE (Gardner, 2014., McKee, 2013). However, because the bulk of evidence originates from post-mortem case reports, there is a substantial knowledge gap in causality among tau accumulation, head impact exposure, and behavioural alteration.

Obstetric and psychosocial risk factors for Australian-born and non-Australian born women and associated pregnancy and birth outcomes: a population based cohort study.

BackgroundOne in four Australians is born overseas and 47 % are either born overseas or have a parent who was. Obstetric and psychosocial risk factors for these women may differ.MethodData from one Sydney hospital (2012–2013) of all births recorded in the ObstetriX™ database were analysed (n = 3,092). Demographics, obstetric and psychosocial risk profile, obstetric interventions and complications and selected maternal and neonatal outcomes were examined for women born in Australia and overseas.ResultsWomen born in Australia were younger, more likely to be primiparous (28.6 v 27.5 %), be obese (32.0 % v 21.4 %), smoke (19.7 % v 3.0 %), have an epidural (26.2 % v 20.2 %) and were less likely to have gestational diabetes mellitus (GDM) (6.8 % v 13.7 % when compared to non-Australian born women. The highest rates of GDM, Gestational Hypertension (GH) and maternal anaemia were seen in women born in China, the Philippines and Pakistan respectively. Differences were also seen in psychosocial screening between Australian and non-Australian women with Australian-born women more likely to smoke and report a mental health disorder. There was an association between having an Edinburgh Postnatal Depression Scale (EPDS) ≥ 13 and other psychosocial issues, such as thoughts of self-harm, domestic violence, childhood abuse etc. These women were also less likely to breastfeed. Women with an EPDS ≥ 13 at booking compared to women with EPDS ≤12 had a higher chance of being diagnosed with GDM (AOR 1.85 95 % CI 1.14–3.0).ConclusionsThere are significant differences in obstetric and psychosocial risk profiles and maternal and neonatal outcomes between Australian-born and non-Australian born women. In particular there appears to be an association between an EPDS of ≥13 and developing GDM, which warrants further investigation.

Topical and systemic interventions for the treatment of rosacea

Rosacea is a well-recognised chronic inflammatory skin disease of poorly understood aetiology. It is one of the most common skin diseases in adulthood, predominantly occurring in people who are middle-aged and fair-skinned. In the UK, about 4000–5000 new cases are diagnosed each year. Rosacea can significantly affect people's quality of life, often causing considerable psychological distress. Supporting patients with symptom-specific treatments can improve their physiological and psychological wellbeing. Aesthetic practitioners are well placed to either initiate or complement rosacea management, and are often able to offer treatments with limited or no availability on the NHS. This article will look at the pathogenesis, clinical features, diagnosis, triggers and psychosocial complications of rosacea; reflect on an aesthetic patient case study; discuss some effective oral/topical antibiotic therapies and routine skin care; and aim to encourage aesthetic nurses to incorporate the management of rosacea into their portfolio of knowledge and experience, thus effectively including this specialist area of dermatology in their services. Photographs and tables are provided as reference points to aid patient assessment and diagnosis.

Ambulatory Medical Assistance--After Cancer (AMA-AC): A model for an early trajectory survivorship survey of lymphoma patients treated with anthracycline-based chemotherapy.

BackgroundCancer survivorship has emerged as an important aspect of oncology due to the possibility of physical and psychosocial complications. The purpose of this study was to assess the feasibility of the Ambulatory Medical Assistance for After Cancer (AMA-AC) procedure for monitoring lymphoma survivorship during the first year after chemotherapy.MethodsAMA-AC is based on systematic general practitioner (GP) consultations and telephone interventions conducted by a nurse coordinator (NC) affiliated to the oncology unit, while an oncologist acts only on demand. Patients are regularly monitored for physical, psychological and social events, as well as their health-related quality of life (HRQoL). Inclusion criteria were patients newly diagnosed with non-Hodgkin or Hodgkin lymphomas, who had been treated with anthracycline-based chemotherapy and were in complete remission after treatment.ResultsAll 115 patients and 113 collaborating GPs agreed to participate in the study. For patients who achieved one year of disease-free survival (n = 104) their assessments (438 in total) were fully completed. Eleven were excluded from analysis (9 relapses and 2 deaths). The most frequent complications when taking into account all grades were arthralgia (64.3 %) and infections (41.7 %). About one third of patients developed new diseases with cardiovascular complications as the most common. Psychological disorders such as anxiety, depression and post-traumatic stress disorder were diagnosed in 42.6 % of patients. The data collected showed that Hodgkin lymphoma patients, females, and patients with lower HRQoL (mental component) at study entry were at greater risk for developing at least one psychological disorder.ConclusionThis study showed that AMA-AC is a feasible and efficient procedure for monitoring lymphoma survivorship in terms of GP and patient participation rates and adherence, and provides a high quality of operable data. Hence, the AMA-AC procedure may be transferable into clinical daily practice as an alternative to standard oncologist-based follow-up.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1815-7) contains supplementary material, which is available to authorized users.

Physical Exercise Training versus Relaxation in Allogeneic stem cell transplantation (PETRA Study) – Rationale and design of a randomized trial to evaluate a yearlong exercise intervention on overall survival and side-effects after allogeneic stem cell transplantation

BackgroundAllogeneic stem cell transplantation (allo-HCT) is associated with high treatment-related mortality and innumerable physical and psychosocial complications and side-effects, such as high fatigue levels, loss of physical performance, infections, graft-versus-host disease (GvHD) and distress. This leads to a reduced quality of life, not only during and after transplantation, but also in the long term. Exercise interventions have been shown to be beneficial in allo-HCT patients. However, to date, no study has focused on long-term effects and survival. Previous exercise studies used ‘usual care’ control groups, leaving it unclear to what extent the observed effects are based on the physical effects of exercise itself, or rather on psychosocial factors such as personal attention. Furthermore, effects of exercise on and severity of GvHD have not been examined so far. We therefore aim to investigate the effects and biological mechanisms of exercise on side-effects, complications and survival in allo-HCT patients during and after transplantation.Methods/designThe PETRA study is a randomized, controlled intervention trial investigating the effects of a yearlong partly supervised mixed exercise intervention (endurance and resistance exercises, 3–5 times per week) in 256 patients during and after allogeneic stem cell transplantation. Patients in the control group perform progressive muscle relaxation training (Jacobsen method) with the same frequency. Main inclusion criterion is planned allo-HCT. Main exclusion criteria are increased fracture risk, no walking capability or severe cardiorespiratory problems. Primary endpoint is overall survival after two years; secondary endpoints are non-relapse mortality, median survival, patient reported outcomes including cancer related fatigue and quality of life, physical performance, body composition, haematological/immunological reconstitution, inflammatory parameters, severity of complications and side-effects (e.g. GvHD and infections), and cognitive capacity.DiscussionThe PETRA study will contribute to a better understanding of the physiological and psychological effects of exercise training and their biological mechanisms in cancer patients after allo-HCT. The ultimate goal is the implementation of optimized intervention programs to reduce side-effects and improve quality of life and potentially prognosis after allogeneic stem cell transplantation.Trial registrationClinicalTrials.gov Identifier: NCT01374399.

First-time admissions for opioid treatment: cross-sectional and descriptive study of new opioid users seeking treatment.

BackgroundThe purpose of this study was to gain an understanding of the profiles of the new treatment demands posed by opioid addicts between 2005 and 2010 at the addictive disorders assistance units in Galicia, Spain.MethodsA cluster analysis was performed using data from 1,655 treatment entrants. Clusters were constructed using sociodemographic and medicolegal variables. A cluster analysis was also conducted according to age. Once clusters were defined, their association with the following variables was analyzed: age at first use of opioids, years of use, frequency of opioid use in the previous month, psychiatric treatment, cocaine use, existence of a drug-dependent partner, and source of referral.ResultsFour clusters were obtained in the main analysis. Cluster 1 (34.01%) consisted of young males, cluster 2 (16.19%) consisted of not-so-young males, cluster 3 (32.62%) consisted mainly of older males and a small group of females, and cluster 4 (17.18%) was made up entirely of women. With regard to age-related clusters, two clusters were obtained in those under the age of 30 years: cluster 1 (73%) without medicolegal complications and cluster 2 (27%) with medicolegal complications. For those over the age of 30 years, two clusters were obtained: cluster 1 (53.92%) with hardly any medicolegal complications and cluster 2 (46.08%) with medicolegal complications.ConclusionCluster analysis suggests that there have been no substantial changes in variables indicating greater severity in this new group of patients. Women are likely to seek help earlier, which reduces their duration of opioid use. The younger the patient, the shorter the duration of opioid use and the greater the likelihood of cessation of intravenous use. Public health systems should use a two-pronged treatment strategy of short but intense cessation therapies for women and younger treatment entrants and longer maintenance and replacement therapies for older treatment entrants with more psychosocial and medical complications.

Anticonvulsants for cocaine dependence.

Cocaine dependence is a major public health problem that is characterised by recidivism and a host of medical and psychosocial complications. Although effective pharmacotherapy is available for alcohol and heroin dependence, none is currently available for cocaine dependence, despite two decades of clinical trials primarily involving antidepressant, anticonvulsivant and dopaminergic medications. Extensive consideration has been given to optimal pharmacological approaches to the treatment of individuals with cocaine dependence, and both dopamine antagonists and agonists have been considered. Anticonvulsants have been candidates for use in the treatment of addiction based on the hypothesis that seizure kindling-like mechanisms contribute to addiction. To evaluate the efficacy and safety of anticonvulsants for individuals with cocaine dependence. We searched the Cochrane Drugs and Alcohol Group Trials Register (June 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 6), MEDLINE (1966 to June 2014), EMBASE (1988 to June 2014), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to June 2014), Web of Science (1991 to June 2014) and the reference lists of eligible articles. All randomised controlled trials and controlled clinical trials that focus on the use of anticonvulsant medications to treat individuals with cocaine dependence. We used the standard methodological procedures expected by The Cochrane Collaboration. We included a total of 20 studies with 2068 participants. We studied the anticonvulsant drugs carbamazepine, gabapentin, lamotrigine, phenytoin, tiagabine, topiramate and vigabatrin. All studies compared anticonvulsants versus placebo. Only one study had one arm by which the anticonvulsant was compared with the antidepressant desipramine. Upon comparison of anticonvulsant versus placebo, we found no significant differences for any of the efficacy and safety measures. Dropouts: risk ratio (RR) 0.95, 95% confidence interval (CI) 0.86 to 1.05, 17 studies, 20 arms, 1695 participants, moderate quality of evidence. Use of cocaine: RR 0.92, 95% CI 0.84 to 1.02, nine studies, 11 arms, 867 participants, moderate quality of evidence; side effects: RR 1.39, 95% CI 1.01 to 1.90, eight studies, 775 participants; craving: standardised mean difference (SMD) -0.25, 95% CI -0.59 to 0.09, seven studies, eight arms, 428 participants, low quality of evidence. Although caution is needed when results from a limited number of small clinical trials are assessed, no current evidence supports the clinical use of anticonvulsant medications in the treatment of patients with cocaine dependence. Although the findings of new trials will improve the quality of study results, especially in relation to specific medications, anticonvulsants as a category cannot be considered first-, second- or third-line treatment for cocaine dependence.

G195 What are the long term clinical outcomes of spinal dysraphias in children?

Background Spinal dysraphia is a non-fatal foetal anomaly comprising a range of spinal canal fusion abnormalities. There have been recent advances in the diagnosis, treatment and prevention of this condition. The longer term outcomes currently vary within the literature and are based historic cohorts prior to more recent advances in care. Aims Review the long term outcomes and symptomatology in a current cohort of children with spinal dysraphia. Methods Retrospective review of medical records of patients with diagnosis of spinal dysraphias. Children were excluded if there was other genetic abnormality or syndrome. Results We identified 70 children (mean age 10.7, SD 7.1, 41% male). There was 100% survival at 1 year of age and 68 (97%) children were still alive at time of the review. Mortality in both children was secondary to meningitis. Diagnosis was made antenatally in 37%, and postnatally in 63% with 3 children (5.7%) being diagnosed at school age. 51 (73%) were symptomatic and 22 (31%) had evidence of neuropathic bladder and bowel. Antenatal diagnosis (p = 0.047), higher level of lesion (p = 0.044) or shunts in situ (p Conclusions Spinal dysraphia is associated with high rates of morbidity (73%) with a significantly lower mortality (3%) and incidence of mental health issues (6%) when compared to previous studies. The current follow-up of patients with spinal dyraphias varies, therefore further studies are needed to develop appropriate follow-up strategies for this high risk patient group; including the evaluation for comorbidities and psychosocial complications.

Iron Nutrition following Bariatric Surgery

Bariatric weight loss surgery is growing in popularity as a treatment for moderate and severe obesity (body mass index ≥35 kg/m2). Although bariatric surgery induces significant weight loss and ameliorates cardiometabolic, mechanical, and psychosocial complications of obesity, evidence shows increased incidence of various nutrient deficiencies following surgery, including iron deficiency. Iron deficiency is the most common and widespread nutritional disorder in the world, known for its multifactorial etiology and its difficulty to treat. Iron deficiency is prevalent in obese candidates for bariatric surgery and appears to be exacerbated after surgery. Symptomatic manifestations of iron deficiency following bariatric surgery include disorders such as chronic anemia, fatigue, and even pica, a disorder characterized by the eating of nonfoods such as ice. The aim of this review is to explore the mechanisms associated with impaired iron status in obesity before and following bariatric surgery in order to understand the effects of bariatric surgery on iron nutriture. Understanding the underlying mechanisms that cause impairment of iron status may serve as a foundation for developing methods to prevent the common occurrence of iron deficiency following bariatric surgery.

Health services research in psycho-oncology

Given the increasing incidence of cancer and improved diagnostics and cancer treatments, the number of cancer patients in industrialized nations is increasing worldwide. Multimodal treatment regimens, which contribute to a tumor-free survival or extend patients life expectancy can, however, alone or in combination increase the risk of physical and psychosocial long-term problems or late complications. For many patients cancer has become a chronic disease and is associated with significant physical and psychosocial problems that affect the quality of life in the medium and longer-term perspective. Common problems of cancer patients in the longer course of the disease include chronic and post-cancer pain, cancer-specific fatigue, psychosocial distress and impairment in self-management and activities of daily living, work participation and quality of life. Current developments with respect to both curative and palliative oncological care have various implications for health services research in psycho-oncology. These questions relate to issues of care needs, service provision and the appropriateness of care, issues of development, implementation and scientific evaluation of patient-centered and affordable support programs for different groups of cancer patients with different supportive care needs, issues of access and utilization of supportive care services, as well as questions of appropriate outcome criteria of health services research.

Midwives' experiences of caring for women with female genital mutilation: Insights and ways forward for practice in Australia.

Female genital mutilation (FGM) has serious health consequences, including adverse obstetric outcomes and significant physical, sexual and psychosocial complications for girls and women. Migration to Australia of women with FGM from high-prevalence countries requires relevant expertise to provide women and girls with FGM with specialised health care. Midwives, as the primary providers of women during pregnancy and childbirth, are critical to the provision of this high quality care. To provide insight into midwives' views of, and experiences working with, women affected by FGM. A descriptive qualitative study was undertaken using focus group discussions with midwives from four purposively selected antenatal clinics and birthing units in three hospitals in urban New South Wales. The transcripts were analysed thematically. Midwives demonstrated knowledge and recalled skills in caring for women with FGM. However, many lacked confidence in these areas. Participants expressed fear and a lack of experience caring for women with FGM. Midwives described practice issues, including the development of rapport with women, working with interpreters, misunderstandings about the culture of women, inexperience with associated clinical procedures and a lack of knowledge about FGM types and data collection. Midwives require education, training and supportive supervision to improve their skills and confidence when caring for women with FGM. Community outreach through improved antenatal and postnatal home visitation can improve the continuity of care provided to women with FGM.

41. Assessing Feasibility and Strategies for Clinicians to Communicate Via Social Media With Adolescent Patients About HPV Vaccination

Purpose: Sexting is becoming a more prevalent practice among today’s youth. (1) Studies have shown a link between sexting and other high-risk sexual behavior. (2) The purpose of this study was to investigate the prevalence of sexting of select youth in the Los Angeles area as well as discover the opinions of youth themselves as to why they engage in sexting behavior. Methods: Fifty-five youth presenting for care at the Teen Health Center at Children’s Hospital Los Angeles were surveyed to evaluate sexting prevalence and specific sexting behaviors such as forwarding sexts, reasons for sending sexts, and youth’s concerns regarding sexting. Chi-square analysis was used to compare answers to sexting behavior questions between genders. Results: More than half the youth in our sample (48.5% of girls, 63.6% of boys) had sent a sext, and the majority (70% of girls, 82% of boys) had received a sext. There were no significant gender differences in sending, receiving, or forwarding sexts. Girls expressed significantly more concern than boys about how sexting could affect their reputation, including getting caught by an adult with a sext (c2(1)1⁄46.246, p1⁄4.012) and how others would think of them (c2(1)1⁄413.38, p<.001). 52% of respondents said they would be comfortable talking with their doctor about sexting. Conclusions: Sexting is becoming more prevalent in today’s youth dating culture. In regards to sexting, youth seem to be worried that sexting may damage their reputations and that there may be personal or legal repercussions for getting caught with a sext. Youth, who need to be made aware of the possible psychosocial complications of sexting, may be receptive to physicians discussing the implications of sexting with them. Sources of Support: 1. Temple JR., Paul JA., van den Berg, P., Le VD., McElhany A., Temple BW. Teen Sexting and Its Association With Sexual Behaviors. Arch Pediatr Adolesc Med. 2012.166 (9): 828-833. 2. Rice, E., Rhoades, H.,Winetrobe, H., Sanchez,M., Montoya, J., Plant, A., Kordic, T. Sexually Explicit Cell Phone Messaging Associated with Sexual Risk Among Adolescents. Pediatrics. 2012: 130; 4: 667-673.