Efficacy and findings of a blinded randomized reintroduction phase for the low FODMAP diet in Irritable Bowel Syndrome

BACKGROUND AND AIMS

The efficacy of a low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet in Irritable Bowel Syndrome (IBS) is well established. After the elimination period, a reintroduction phase aims to identify triggers. We studied the impact of a blinded reintroduction using FODMAP-powders to objectively identify triggers and evaluated the effect on symptoms, quality of life (QoL), and psychosocial co-morbidities.

METHODS

Responders to a 6-week low-FODMAP diet, defined by a drop in IBS-symptom severity score (IBS-SSS) compared to baseline, entered a 9-week blinded randomized reintroduction phase with 6 FODMAP powders (fructans, fructose, galacto-oligosaccharides, lactose, mannitol, sorbitol) or control (glucose). A rise in IBS-SSS (≥50 points) defined a FODMAP-trigger. Patients completed daily symptom diaries and questionnaires for QoL and psychosocial co-morbidities.

RESULTS

In 117 recruited IBS patients, IBS-SSS improved significantly after the elimination period compared to baseline (150±116 vs 301±97, P < .0001, 80% responders). Symptom recurrence was triggered in 85% of the FODMAP powders, by an average of 2.5±2 FODMAPs/patient. The most prevalent triggers were fructans (56%) and mannitol (54%), followed by galacto-oligosaccharides, lactose, fructose, sorbitol, and glucose (respectively 35%, 28%, 27%, 23%, and 26%) with a significant increase in abdominal pain at day 1 for sorbitol/mannitol, day 2 for fructans/galacto-oligosaccharides and day 3 for lactose.

CONCLUSION

We confirmed the significant benefit of the low-FODMAP diet in tertiary care IBS. A blinded reintroduction revealed a personalized pattern of symptom recurrence, with fructans and mannitol as the most prevalent, and allows the most objective identification of individual FODMAP-triggers; Clinicaltrial.gov number: NCT04373304.

Validation of a French questionnaire assessing knowledge of suicide

OBJECTIVES

The objective of this study was to develop and validate the Knowledge of Suicide Scale (KSS), elaborated to assess adherence to myths about suicide.

METHODS

The KSS is a self-questionnaire including 22 statements relating to myths about suicide for which the respondent is asked to rate his degree of adherence on a scale ranging from 0 ("strongly disagree") to 10 ("completely agree"). Using the script concordance test scoring method, the respondents' scores were compared with those of experts to obtain, for each item, a score between 0 (maximum deviation with the experts) and 1 (minimum deviation with the experts). One thousand and thirty-five individuals (222 psychiatric interns, 332 medical interns in the first semester excluding psychiatry and 481 journalism students) were included.

RESULTS

According to the exploratory factor analysis, the KSS is a two-dimensional scale: the first subscale includes 15 items and the second seven items. The tool showed excellent face validity, correct convergent and divergent validities (multi-method multi-feature analyzes), and good internal consistency (Cronbach's alpha coefficient between 0.66 and 0.83 for scales and subscales). The KSS is moderately and negatively correlated with the Stigma of Suicide Scale (r=-0.3). It significantly discriminates groups with different expected levels of knowledge regarding suicide (P<0.001).

CONCLUSIONS

The KSS demonstrated good psychometric properties to measure adherence to myths about suicide. This tool could be useful in assessing the effectiveness of suicide prevention literacy improvement programs.

A Short Media Training Session Is Effective in Reinforcing Psychiatrists' Communication Skills About Suicide

Because it has been associated with significant increases [through the Werther Effect (WE)] or decreases [through the Papageno Effect (PE)] of suicide rates, media coverage of suicide-related events is recognized as a prevention leverage. Unfortunately, the recommendations that the World Health Organization (WHO) has published to help journalists reporting on suicide remain poorly applied. The Mini Media Training (MMT) is a short media training session designed to increase psychiatrists’ ability to communicate about suicide during interviews. We aimed at assessing the effect of the MMT on psychiatrists’ ability to help journalists complying with the WHO recommendations. From June 2017 to December 2019, 173 physicians and residents in psychiatry were recruited during French national congresses. At baseline (T0) and 1 and 3 months later (T1), participants received the MMT, which consisted in a simulated interview where they we asked to answer a journalist about a mock suicide. Communication skills were measured with a score summing the number of delivered pieces of advice in relation to the WHO recommendations, with a maximum score of 33. A weighted score was also derived based on the degree of directivity needed for the participant to provide these items, again with a possible maximum of 33. A total of 132 psychiatrists participated in the study at T0 and T1. Both the weighted and unweighted score significantly increased from T0 to T1 (d = +2.08, p < 0.001, and d = +1.24, p < 0.001, respectively). Having a history of contacts with journalists, a short professional experience (<3 years) and prior knowledge of the WE, PE, and WHO recommendations were significantly associated with greater unweighted and weighted scores at baseline. The latter two variables also predicted greater T0–T1 improvement of the weighted score. These results suggest that the MMT could be effective for improving the ability of psychiatrists to guide journalists toward more responsible media coverage of suicide. As a short, easy to implement educational activity, the MMT could therefore be considered in association with other measures to help media professionals mitigating the WE and promoting the PE.

[Suicide prevention after a suicide attempt: how to stay in touch?]

Suicide prevention after a suicide attempt: how to stay in touch? Attempted suicide is a major risk factor of further re-attempts and death. Self-harm behaviors are related to multiple causes, explaining why it is ineffective to have a single and simple strategy to offer after the clinical assessment in reducing morbidity and mortality. Furthermore, treatment adherence is known to be especially poor, in a context where social connection seems compromised and source of pain. Effective interventions can be divided into two categories: intensive intervention programs (care at home, supported by a series of brief psychotherapy interventions) and, case management programs that rely on a "stay in contact" dimension(letters, telephone, sms, mail, etc.). A prevention algorithm was further proposed to routine care in 2015, in the northern departments of France, Nord et Pas-de-Calais (4.3 million people), taking the name of VigilanS. The inclusion consists in sending a form for every patient assessed after a suicide attempt in the two departments to the medical staff of VigilanS, in order to provide information about the patient and the context of his suicide attempt. The algorithm consist in giving crisis card to all the patients; an information letter, explaining the aim of the monitoring is also given to the patient, and to his general practitioner. The calling staff is composed of4 nurses and 4 psychologists, all trained in suicidal crisis management. They use a phone platform located in the Emergency Medical Assistance Service (SAMU) of the Nord department, and manage the incoming calls from the patients, plus the outgoing calls towards the patients, their relatives and their medical contacts. A set of 4 postcards (1 per month) can be sent if needed incase of an inconclusive or a failed phone call. Built on a monitoring philosophy, VigilanS has further developd a real crisis case management dimension, requiring enough time to insure an effective medical supervision, and strong networking abilities. A specific time is also needed to take care of all the technical aspects of the organization. We measured the evolution of the number of suicide attempts before and after implantation of VigilanS: we found an acceleration of the reduction of stay for suicide attempt in Nord et Pas-de-Calais after 2014(-16% instead of -6%), instead of the two Picardy departments the most comparable show a degradation of the phenomenon (+13%). The system is currently being deployed across France.

Leveraging the Web and Social Media to Promote Access to Care Among Suicidal Individuals

After two decades of exponential development, the Internet has become an inseparable component of suicide prevention matters. More specifically, social media has turned out to be a privileged space for suicidal individuals to express their distress and seek support. Although this tendency carries with it specific risks and challenges, it creates unprecedented opportunities to face the challenges of help seeking and access to care. In this paper, we present the empirical, technological, and theoretical evidence supporting the implementation of a digitally augmented prevention policy that would increase its reach. Congruent to the clinical observations and theories on the help-seeking process, we argue that social media can help undertake three main functions of increasing proactivity to bring suffering Web users to care. The gateway function relates to the properties of social media interactions to leverage help-seeking barriers and enable ambivalent individuals to access the mental healthcare system. The communication outreach function aims to broadcast pro-help-seeking messages, while drawing on the functional structure of the social media network to increase its audience. The intervention outreach function consists in using machine learning algorithms to detect social media users with the highest risk of suicidal behaviors and give them a chance to overcome their dysfunctional reluctance to access help. We propose to combine these three functions into a single coherent operational model. This would involve the joint actions of a communication and intervention team on social networks, working in close collaboration with conventional mental health professionals, emergency service, and community resources.

Validation d’une grille d’évaluation qualitative d’articles de presse écrite sur le suicide, dans le cadre du programme Papageno

Contexte

La couverture médiatique d’un fait suicidaire influence le taux de suicide par le biais d’un effet d’incitation, aussi nommé « effet Werther » (EW) ou d’un potentiel rôle préventif via « l’effet Papageno » (EP) . L’objectif du programme national français Papageno est d’améliorer les propriétés qualitatives du contenu médiatique dont dépendent principalement l’EW et l’EP, via l’application des recommandations de l’Organisation mondiale de la Santé (OMS) pour un traitement journalistique plus responsable du suicide. L’évaluation de l’efficacité du programme est donc un enjeu de prévention qui nécessite un outil d’analyse fidèle à ces recommandations.

Objectifs

Élaborer et valider une grille d’analyse qualitative permettant, pour chaque article de presse traitant du suicide, de mesurer le degré de compliance aux recommandations de l’OMS et de quantifier le risque d’EW et le potentiel EP.

Méthode

La grille d’évaluation PReSS (Print media Reporting on Suicide Scale) combine 10 items descriptifs et 19 items qualitatifs issus de l’opérationnalisation des 11 recommandations de l’OMS. La validation de la fiabilité interjuges a été obtenue par séries de double cotation-correction de 25 articles traitant du suicide. Les critères de satisfaction des items ont été affinés après chaque série jusqu’à obtention d’un coefficient de kappa ≥ 0.7 pour chacun. À titre d’illustration, le traitement médiatique du supposé suicide du pilote d’avion A. Lubitz en mars 2015 a été analysé grâce à la PReSS.

Résultats

Trois séries de cotation-correction ont été nécessaires pour valider la grille. L’analyse de la couverture du suicide présumé d’A. Lubitz montre un compliance faible aux recommandations, un score Papageno bas et un score Werther élevé.

Conclusion

La grille d’évaluation PReSS est un outil fiable et utile pour mesurer la compliance aux recommandations de l’OMS concernant la couverture médiatique du suicide.

Le Questionnaire d’évaluation des connaissances sur le suicide (QECS)

L’accès aux soins des personnes à risque constitue un pilier essentiel de la prévention du suicide. Cependant, les idées reçues véhiculées autour des conduites suicidaires y opposent un obstacle significatif. Afin de cibler au mieux les campagnes d’information qui dissiperaient ces mythes, et pour en évaluer l’efficacité, les connaissances sur le suicide devraient pouvoir être quantifiées de façon fiable. À ce jour, seules quelques études anglo-saxonnes dédiées ont été validées. La limite décisive à leur interprétation tient cependant à ce qu’elles ne permettent pas d’approche normative. En effet, l’exactitude de leurs propositions n’est validée par aucun étalon officiel, alors même que certaines relèvent plus de l’expérience clinique que de connaissances issues de la littérature. Notre objectif consiste à palier cette limite en proposant une échelle dont la cotation est adaptée à l’évaluation d’un savoir normé. Le Questionnaire d’Évaluation des Connaissances sur le Suicide (QECS) est un auto-questionnaire qui explore, en 35 items, les principales connaissances relatives à l’épidémiologie et aux mythes communs concernant le suicide. Les réponses y sont recueillies par échelle visuelle analogique. La cotation finale se fait en confrontant ces réponses à celles d’un panel de référence constitué de spécialistes en suicidologie (n = 47). Nous présentons ici les résultats de ce panel, ainsi qu’une illustration des potentialités d’interprétation du QECS, via l’évaluation des connaissances d’un échantillon test d’étudiants en journalisme (n = 111). Les réponses du panel de référence étaient significativement différentes de « ni accord, ni désaccord » pour 27 des 29 items dédiés aux mythes. Pour 25 de ces items, une différence significative était retrouvée entre l’échantillon test et le panel de référence. Ainsi attestée, l’existence d’un avis expertal spécifique a servi d’étalon pour 2 modes de cotation des réponses de l’échantillon test : un score de véracité et un score de concordance aux experts.

A numerical analysis of the influence of tram characteristics and rail profile on railway traffic ground-borne noise and vibration in the Brussels Region

Nowadays, damage potentially caused by passing train in dense cities is of increasing concern and restricts improvement to the interconnection of various public transport offers. Although experimental studies are common to quantify the effects of noise and vibration on buildings and on people, their reach is limited since the causes of vibrations can rarely be deduced from data records. This paper presents the numerical calculations that allow evaluating the main contributions of railway-induced ground vibrations in the vicinity of buildings. The reference case is the Brussels Region and, more particularly, the T2000 tram circulating in Brussels city. Based on a pertinent selection of the vibration assessment indicators and a numerical prediction approach, various results are presented and show that the free-field analysis is often improperly used in this kind of analysis as the interaction of soil and structure is required. Calculated high ground vibrations stem from singular rail surface defects. The use of resilient wheels is recommended in order to reduce the ground-borne noise and vibration to permissible values.

Empirical validation of a real options theory based method for optimizing evacuation decisions within chemical plants

This article empirically assesses and validates a methodology to make evacuation decisions in case of major fire accidents in chemical clusters. In this paper, a number of empirical results are presented, processed and discussed with respect to the implications and management of evacuation decisions in chemical companies. It has been shown in this article that in realistic industrial settings, suboptimal interventions may result in case the prospect to obtain additional information at later stages of the decision process is ignored. Empirical results also show that implications of interventions, as well as the required time and workforce to complete particular shutdown activities, may be very different from one company to another. Therefore, to be optimal from an economic viewpoint, it is essential that precautionary evacuation decisions are tailor-made per company.

Making evacuation decisions by using a discrete-time approximation methodology

This article further elaborates the findings by Reniers et al. in 2007 and 2008. A discrete-time approximation is presented to determine the severity of a major accident threat triggering immediate evacuation and its expected resulting costs. By implementing the proposed mathematical model, precautionary evacuation decision problems can be tackled in a realistic way, i.e., allowing for major accident threats with limited duration. Furthermore, the model is moulded into a working procedure which was used to develop software to solve the suggested algorithms. A case-study is provided and the results obtained by application of the methodology are discussed. Using a (realistic) discrete-time approximation computer simulation, we found that ignoring option characteristics may produce suboptimal intervention decisions in shutdown settings.

A multiple shutdown method for managing evacuation in case of major fire accidents in chemical clusters

This paper may be regarded as the second part of a larger article. The basic decision model developed in the first part of the article by Reniers et al. [G.L.L. Reniers, N. Pauwels, A. Audenaert, B.J.M. Ale, K. Soudan, Management of evacuation in case of fire accidents in chemical industrial areas, J. Hazard. Mater., 147 (2007) 478-487] is extended to determine both the optimal time and the optimal mode to stop the ongoing activities in case of a major fire possibly giving rise to an escalating event. Chemical plants have multiple modes to stop their production processes, differing with respect to the resulting costs, and with respect to the required time and personnel to complete the shutdown operations. The existence of an additional and more economic (but slower) shutdown mode might encourage the decision maker to stop the production processes earlier, in a less intervening manner, whereas the availability of an additional faster (but less economic) shutdown procedure might stimulate the decision maker to stop the production processes later, in a more intervening manner.

Management of evacuation in case of fire accidents in chemical industrial areas

Trade-offs between economic and safety arguments exist in the operation of chemical installations, should knock-on calamities induced by fire accidents occur: a sudden installation shutdown might result in substantial economic losses, but may be needed to ensure safety. Due to the very rare nature of domino effect risks induced decision problems an adequate evacuation decision aid model to be used by plant safety management does, to the best of the authors' knowledge, not exist. This paper develops a tentative approach to calculate the economic gains and/or losses linked to the decision problem whether or not, and when, to evacuate chemical installation(s) threatened by possible domino effect risks. The proposed model is illustrated by a case-study based on empirical data.

Radiological protective measures in highly industrialized areas: do the existing intervention levels apply?

Several international organizations have provided numerical guidance on the intervention levels for protective measures in case of a nuclear accident. The resulting intervention levels, however, are generic in nature and allow for (and even require) adjustment to site-specific conditions. As interventions in highly industrialized areas may result in important economic losses and potential secondary risks for the workers and the environment, we argue that the appropriate intervention levels for evacuating or relocating people from these areas might be higher than those generically derived. Furthermore, the optimal duration of these interventions will in general be shorter when imposed on industrial areas. The same results apply for sheltering, in case it requires a shut-down of the industrial production processes.

The monetary value of the person-Sievert: a practical approach in case of occupational exposures

This paper gives some practical advice on the determination of the value of the person-Sievert, this figure being of primary importance when cost-benefit analysis is used to optimize (ALARA-principle) routine occupational exposures of professionals to external radiation. After a brief introduction on the use of cost-benefit analysis in a radioprotection context, more attention will be paid to the theoretical guidelines that exist on the monetary value of the person-Sievert. By combining these insights with the practical problems that occur in daily task preparations and evaluations, a more workable proposal for the determination of the value of the person-Sievert will be presented.

Activation of thick targets by energetic heavy ions and the resultant radiation levels

This study completes data collected for thick targets exposed to carbon and oxygen ions accelerated at 86 MeV/u. The radioactivity induced in carbon and tungsten targets bombarded by argon projectiles at 95 MeV/u has been studied in order to assess the relative contributions of the incoming heavy ion and the mass number of the bombarded nuclei to the consequent radiation hazards related to the production of radioactive ion beams. Induced radioactivity measurements are only rarely made under controlled irradiation conditions, in order to derive from the measured activities the dose rates after beam bombardment and a prediction of radiation protection constraints.