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Management of children and adolescents with coeliac disease in selected Central European countries
Petra Rižnik, 2021, doctoral dissertation

Abstract: Coeliac disease (CD) is a lifelong systemic autoimmune disorder elicited by gluten and related prolamines in genetically susceptible individuals and is one of the most common chronic diseases, affecting about 1% of the population. It has a very diverse clinical presentation, involving intestinal, extraintestinal and even asymptomatic presentations. Due to its genetic background, CD is more common among family members of affected individuals and is associated with a number of other conditions. The diagnosis of CD is traditionally based on the presence of a specific immune response and characteristic histological changes in the small intestinal mucosa. In the recently published European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guidelines, the initial diagnostic step is determination of CD-specific IgA autoantibodies against type-2 (tissue) transglutaminase. Positive autoantibodies imply a high probability of mucosal atrophy. To confirm the diagnosis, an upper endoscopy with multiple duodenal biopsies should be performed. However, ESPGHAN guidelines for the past eight years allow paediatric gastroenterologists to diagnose the disease without intestinal biopsy when certain criteria are met. The only available treatment for CD is a lifelong strict gluten-free diet, which should only be initiated after firm confirmation of the diagnosis. Patients have to avoid all gluten-containing products, including products from wheat and wheat cultivars, rye, barley, Khorasan wheat, triticale and bulgur. Owing to the high likelihood of cross-contamination, avoidance of oats is also recommended in many regions. Despite being one of the most common lifelong disorders, CD still remains undiagnosed for a long time in many adult and paediatric patients. Diagnostic delays in some regions exceed 10 years, which can have important adverse effects on patients’ health and quality of life. The aims of our study were to analyse the clinical presentation of CD in children and adolescents in selected Central European (CE) countries, to evaluate the compliance with current ESPGHAN guidelines for diagnosing CD in children and adolescents, to assess the diagnostic delays in children and adolescents with CD in selected CE countries, to identify possible regional differences, and to determine whether the clinical presentation or the diagnostic approach influence diagnostic delays. The study was carried out as a part of the Focus IN CD project with twelve project partners from five CE countries (Croatia, Germany, Hungary, Italy, and Slovenia). Paediatric gastroenterologists from the included regions were encouraged by the regional project partners to complete a web-based questionnaire, providing anonymised medical records of children and adolescents below 19 years of age who were diagnosed with CD in 2016. The questionnaire was translated into the languages of all project partners and focused on the onset of the CD-related symptoms, clinical presentation, diagnostic approach, and the results of all performed tests. The medical records of children and adolescents were then analysed, and the results compared regionally. We found that a non-classical clinical presentation and asymptomatic disease are becoming more common, and the classical clinical presentation with malabsorption syndrome less frequent in children and adolescents with CD. Abdominal pain was found to be the most common leading symptom in children older than three years, whereas, in very young children (
Keywords: coeliac disease, children, adolescents, Central Europe, clinical presentation, management, diagnostic delays
Published: 18.03.2021; Views: 157; Downloads: 28
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Increased augmentation index and central systolic arterial pressure are associated with lower school and motor performance in young adolescents
Bernarda Vogrin, Marjan Rupnik, Dušanka Mičetić-Turk, 2017, original scientific article

Abstract: Objective: In adults, improper arterial function has been linked to cognitive impairment. The pulse wave velocity (PWV), augmentation index (AIx) and other vascular parameters are useful indicators of arterial health. In our study, we monitored arterial properties, body constitution, school success, and motor skills in young adolescents. We hypothesize that reduced cognitive and motor abilities have a vascular origin in children. Methods: We analysed 81 healthy school children aged 11-16 years. Anthropometry central systolic arterial pressure, body mass index (BMI), standard deviation scores (SDS) BMI, general school performance grade, and eight motor tests were assessed. PWV, AIx, and central systolic arterial pressure (SBPao) were measured. Results: AIx and SBPao correlated negatively with school performance grades. Extremely high AIx, PWVand SBPao values were observed in 5% of children and these children had average to low school performance. PWV correlated significantly with weight, height, and waist and hip circumference. AIx, PWV, school success, and BMI correlated strongly with certain motor functions. Conclusions: Increased AIx and SBPao are associated with lower school and motor performance in children. PWV is influenced by the body's constitution.
Keywords: augmentation index, pulse wave velocity, school success, motor functions, young adolescents, central systolic arterial pressure, body mass index
Published: 13.07.2017; Views: 531; Downloads: 262
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Clinical utility of serodiagnostic testing in pediatric inflammatory bowel disease
Darja Urlep Žužej, Jernej Dolinšek, 2006, original scientific article

Abstract: Background: Among children and adolescents, the diagnosis of inflammatory bowel disease (IBD) is often missed or delayed because of the nonspecific nature of the clinical symptoms. In such instances noninvasive and accurate diagnostic tests that would accurately distinguish IBD from functional disorders would be most valuable to clinicians. Several serological markers have been used as non-invasive diagnostic tools in IBD pediatric patients. The aim of our study was to determine the prevalence and diagnostic accuracy of perinuclear antineutrophil cytoplasmic antibodies (p-ANCA), anti-Saccharomyces cerevisiae antibodies (ASCA), anti-exocrine pancreatic antibodies (PAB) and anti-goblet cells antibodies (GAB) alone and in combination in children and adolescents with IBD. Patients and methods: Serum specimens were analyzed for p-ANCA, ASCA IgG, ASCA IgA, PAB and GAB antibodies in 49 children and adolescents with confirmed IBD and 53 non-IBD controls. P-ANCA, PAB and GAB antibodies were determined by indirect immunofluorescent test and ASCA by enzyme-linked immunosorbent assay. All patients with Crohn's disease (CD) had genotyping performed using a sequence specific PCR directed against the wild type and the three principal mutations of NOD2/CARD15 gene. Disease location, body mass index (BMI) and disease activity by pediatric Crohn's disease activity index (PCDAI) at the time of diagnosis were determined in CD patients. Results: The prevalence of p-ANCA in patients with UC and ASCA in CD patients was high (82.3 % and 67.9 %, respectively). Positivity for PAB antibodies in CD and GAB in UC was lower (35.7 % and 23.5 %, respectively). Accuracy data (sensitivity, specificity, PPV, NPV, respectively) for differentiating IBD from non-IBD controls were as follows: p-ANCA: 82 %, 100 %, 100 %, 94 %; ASCA IgG: 68 %, 94 %, 86 %, 84 %; ASCA IgA: 54 %, 100 %, 100 %, 80 %; PAB: 36 %, 98 %, 91 %, 74 %; GAB: 23 %, 100 %, 100 %, 80 %. In distinguishing CD from UC we found out the following accuracy data (sensitivity, specificity, PPV, NPV, respectively): p-ANCA: 82 %, 82 %, 74 %, 88 %; ASCA IgG: 68 %, 100 %, 100 %, 65 %; ASCA IgA: 54 %, 100 %, 100 %, 57 %; PAB: 36 %, 100 %, 100 %, 49 %; GAB: 23 %, 100 %, 100 %, 68 %. There were no significant association between ASCA positivity and the three major mutations of NOD2/CARD15 gene, disesase location and family history in CD patients, however an association between BMI and disease activity at the time of diagnosis was found out. Conclusions: Specificity and positive predictive value of serological markers p-ANCA, ASCA IgG, ASCA IgA, PAB and GAB for IBD alone and in combination are high and which make them useful in diagnosis of inflammatory bowel disease in day-to-day clinical practice, particulary in making decision about performing invasive diagnostic procedures. Because of low sensitivity they are less useful as screening tests for inflammatory bowel disease in pediatric population.
Keywords: serological markers, inflammatory bowel disease, children, adolescents, Crohn’s disease, ulcerative colitis, NOD2/CARD15 mutations
Published: 21.12.2015; Views: 921; Downloads: 43
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A test of Self-Control Theory across different socioeconomic strata
Alexander T. Vazsonyi, Rudi Klanjšek, 2008, original scientific article

Abstract: The current investigation examined the relationships between family processes, self-control, and adolescent deviance in a sample of N = 3,764 Swiss male and female youth pursuing an apprenticeship (lower SES) or attending a Gymnasium/teacher's college (higher SES). Participants completed a questionnaire that included measures of family processes, self-control, and deviant behaviors. Results indicated that self-control predicted adolescent deviance in both groups, and that direct and indirect effects existed in the relationships between family processes, self-control, and deviance. Findings provided evidence of comparatively few differences in the observed associations by SES, though the magnitude of the positive effect by low self-control on deviance was more modest in male apprentices as compared to non-apprentices. Findings are discussed in terms of the implications for Self-Control Theory.
Keywords: sociology, adolescents, deviations, family, self-control, self-control theory, socioeconomic strata
Published: 07.06.2012; Views: 907; Downloads: 92
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Possible consequence of student's relationship to parents and to school
Samo Fošnarič, Antonija Milivojević Krajnčič, 2009, original scientific article

Abstract: This research work is dealing with the different behaviour of the young, adolescent people and their perception of the relationship with their parents and their attitude towards school in the time of their early adolescence. Research work is answering the questions connected with the relationship with the parents, attitude towards school as well as the behaviour deviation of adolescents (youth). The research is based on claim that teenager's relationship with his mother and father have an important influence on his/her behavior, especially on the conflicts with the environment. Opačič (1995) argues that the relationship between parents, the environment and the teenagers is not so important. Therefore, we were interested in teenagers' attitudes towards their relationships that they have with their parents. The following dimensions of a relationship were emphasized (observed in greater detail): control, punishment, intimacy and carelessness on the side of the parents. Through those dimensions we could show the teenager's comprehension of the relationship they have with their parents and/or mother and father's comprehension of the relationship in the early phase of adolescence. He stresses (emphasizes) their attitude (perception of) towards such relationships. Some quantity research procedures are used in this research work. There are four different non-standardized questionnaires: The frequency of the behaviour deviation, A relationship with a mother, A relationship with a father, A conflict situations with parents connected with different conversation themes, An attitude towards school. The study relies on descriptive and causal-non-experimental methods of empirical pedagogical research. The research includes an accidental sample of the pupils attending 7th and 9th class of the Primary school in Maribor in the school year 2007 (n=300).
Keywords: education, pedagogy, adolescents, personal development
Published: 07.06.2012; Views: 1188; Downloads: 28
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