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Long MD, Schreiber S, Hibi T, Gibble TH, Fisher DA, Park G, Moses RE, Higgins PDR, Lindsay JO, Lee SD, Escobar R, Jairath V. Association of Bowel Urgency With Quality-of-Life Measures in Patients With Moderately-to-Severely Active Ulcerative Colitis: Results From Phase 3 LUCENT-1 (Induction) and LUCENT-2 (Maintenance) Studies. CROHN'S & COLITIS 360 2024; 6:otae001. [PMID: 38313767 PMCID: PMC10838132 DOI: 10.1093/crocol/otae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Indexed: 02/06/2024] Open
Abstract
Background Improvement in bowel urgency (BU) was associated with better clinical outcomes in phase 3 LUCENT-1 (induction) and LUCENT-2 (maintenance) studies in moderately-to-severely active ulcerative colitis (UC). We assessed association of BU with quality-of-life (QoL) outcomes. Methods LUCENT-1: 1162 patients randomized 3:1 to intravenous mirikizumab 300 mg or placebo every 4 weeks (Q4W) for 12 weeks. LUCENT-2: 544 mirikizumab induction responders re-randomized 2:1 to subcutaneous mirikizumab 200 mg or placebo Q4W through Week (W) 40 (W52 of continuous treatment). Patients reported BU severity in the past 24 hours using a validated Urgency Numeric Rating Scale (NRS). In patients with baseline Urgency NRS ≥3, the association between BU Clinically Meaningful Improvement (CMI; ≥3-point decrease) and remission (score 0 or 1) with patient-reported outcomes was assessed at W12 and W52. Results A significantly greater proportion of patients with versus without BU Remission achieved IBDQ remission (W12: 87.3% vs 42.7%, P < .0001; W52: 91.4% vs 45.5%, p < .0001). Similarly, BU Remission was associated with more patients achieving CMI in SF-36 Physical Component Summary (W12: 69.0% vs 44.4%, P < .0001; W52: 77.5% vs 42.1%, P < .0001) and Mental Component Summary (W12: 53.5% vs 41.0%, P = .0019; W52: 62.0% vs 38.3%, P < .0001) scores. At W12 and W52, patients with BU CMI or Remission showed significant improvements in EQ-5D-5L and Work Productivity and Activity Impairment:UC scores. Significant improvements were also seen in fatigue, abdominal pain, and nocturnal stool. Conclusions In patients with moderately-to-severely active UC, improvement in BU was associated with improved QoL in phase 3 LUCENT-1 and LUCENT-2 studies. Clinical Studies LUCENT-1: NCT03518086; LUCENT-2: NCT03524092.
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Affiliation(s)
- Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Stefan Schreiber
- Department Internal Medicine I, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Toshifumi Hibi
- Kitasato Institute Hospital, Minato-ku, Center for Advanced IBD Research and Treatment, Tokyo, Japan
| | | | | | - Gina Park
- Techdata Services Company LLC, King of Prussia, PA, USA
| | | | - Peter D R Higgins
- Department of Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | | | - Scott D Lee
- Division of Gastroenterology, University of Washington Medical Center, Seattle, WA, USA
| | | | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
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Panés J, Loftus EV, Higgins PDR, Lindsay JO, Zhou W, Yao, X, Ilo D, Phillips C, Tran J, Sanchez Gonzalez Y, Vermeire S. Induction and Maintenance Treatment With Upadacitinib Improves Health-Related Quality of Life in Patients With Moderately to Severely Active Ulcerative Colitis: Phase 3 Study Results. Inflamm Bowel Dis 2023; 29:1421-1430. [PMID: 36645051 PMCID: PMC10472742 DOI: 10.1093/ibd/izac260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND We evaluated the health-related quality of life (HRQoL) benefits of upadacitinib (UPA) induction and maintenance treatment in a phase 3 study of patients with ulcerative colitis (UC) across a broad range of patient-centered outcomes. METHODS Patients received UPA 45 mg once daily or placebo as induction treatment for 8 weeks. Patients who achieved clinical response were rerandomized to receive once daily UPA 15 mg, 30 mg, or placebo as maintenance treatment for 52 weeks. The percentages of patients reporting a clinically meaningful within-person change from baseline in the Ulcerative Colitis Symptoms Questionnaire, Inflammatory Bowel Disease Questionnaire, Work Productivity and Impairment Questionnaire, 36-Item Short Form Survey, and European Quality of Life-5 Dimension 5 Levels were evaluated at weeks 2 and 8 of induction and at weeks 0 and 52 of maintenance. RESULTS Significant improvements from baseline in all HRQoL measures except the Work Productivity and Impairment Questionnaire-absenteeism were achieved with UPA (P < .001) vs placebo as early as week 2 of induction. These improvements were sustained at week 52 with significantly more patients treated with either 15 mg or 30 mg UPA vs placebo achieving meaningful within-person change in the Ulcerative Colitis Symptoms Questionnaire; Inflammatory Bowel Disease Questionnaire; overall work impairment, presenteeism, and activity impairment; both 36-Item Short Form Survey Physical and Mental Component Summaries; and European Quality of Life-5 Dimension 5 Levels (P < .001). CONCLUSIONS Induction treatment with UPA 45 mg significantly improved HRQoL measures. A significantly higher percentage of patients who responded to induction treatment with UPA maintained clinically meaningful improvements consistently across a wide range of HRQoL outcomes after 52 weeks of maintenance therapy with UPA (15 mg and 30 mg) compared with placebo. (ClinicalTrials.gov, Numbers: NCT02819635, NCT03653026).
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Affiliation(s)
- Julian Panés
- Inflammatory Bowel Disease Unit, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - James O Lindsay
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Wen Zhou
- AbbVie Inc, North Chicago, IL, USA
| | | | - Dapo Ilo
- AbbVie Inc, North Chicago, IL, USA
| | | | - Jacinda Tran
- AbbVie and the Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, WA, USA
| | | | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
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Fujii K, Hashimoto H. Socio-psychological factors associated with anticipated stigma toward COVID-19: a cross-sectional study in Japan. BMC Public Health 2023; 23:1245. [PMID: 37370015 DOI: 10.1186/s12889-023-16159-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The stigmatization against COVID-19 has become a public issue. However, it remains unknown which individual factor contributes to anticipated stigma formation. This study explored socio-psychological factors associated with anticipated stigma toward coronavirus disease 2019 (COVID-19). METHODS We obtained cross-sectional data regarding 1,638 middle-aged community residents (mean age, 48.5 years) from a population-based survey in metropolitan Tokyo, Japan during the third wave of the COVID-19 pandemic, when a regional public health emergency had been declared in December 2020 and January 2021. We hypothesized that perceived risk of infection, normative beliefs about preventive behaviors, and past experiences of stigmatization unrelated to COVID-19 would be associated with anticipated stigma. Modified Poisson regression was conducted to examine associations after adjustments for demographic and socioeconomic statuses. RESULTS Higher perceived risk (adjusted prevalence ratio [APR] = 1.17; 95% confidence interval [CI, 1.08-1.27]), past experiences of stigmatization (APR = 1.09; 95% CI [1.00-1.19]), and higher normative beliefs about preventive behaviors (APR = 1.18; 95% CI [1.11-1.26]) were independently associated with anticipated stigma. CONCLUSIONS These results suggest that intervention messages to increase risk perception and normative beliefs to enhance protective behaviors may have the unintended effect of increasing anticipated stigma in the context of the COVID-19 pandemic.
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Affiliation(s)
- Kana Fujii
- Department of Health and Social Behavior, The University of Tokyo School of Public Health, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Hideki Hashimoto
- Department of Health and Social Behavior, The University of Tokyo School of Public Health, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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4
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Simeone S, Mercuri C, Cosco C, Bosco V, Pagliuso C, Doldo P. Enacted Stigma in Inflammatory Bowel Disease: An Italian Phenomenological Study. Healthcare (Basel) 2023; 11:healthcare11040474. [PMID: 36833009 PMCID: PMC9956300 DOI: 10.3390/healthcare11040474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/28/2023] [Accepted: 02/05/2023] [Indexed: 02/09/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic disease of the gastrointestinal tract that has a profound impact on the quality of life of those afflicted with it. The scientific literature shows how the quality of life of people with IBD influences and is influenced by the clinical manifestations of the disease. Strongly connected with excretory functions, which have always been taboo in society, these clinical manifestations can lead to stigmatizing behaviours. The purpose of this study was to understand the lived experiences of the enacted stigma of people with IBD through Cohen's phenomenological method. Two main themes (stigma in the workplace and stigma in social life) and one subtheme (stigma in love life) emerged from the data analysis. The data analysis revealed that stigma is associated with a multitude of negative health outcomes for the people targeted by it and can add to the already complex physical, psychological and social burdens endured by people with IBD. Having a better understanding of the stigma attached to IBD will facilitate the development of care and training interventions that can improve the quality of life of people suffering from IBD.
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Glynn H, Knowles SR. A Phenomenological Investigation of Trauma in 18 Adults Living With Inflammatory Bowel Disease. Clin Nurs Res 2023; 32:159-170. [PMID: 35156407 DOI: 10.1177/10547738221075649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
While trauma is recognized as being common in Inflammatory Bowel Disease (IBD) cohorts, limited research has explored how trauma impacts the lived experience of IBD. The aim of this study was to develop an understanding of how trauma impacts the experience of living with IBD and its subsequent management. An interpretative phenomenological analysis with thematic analysis was conducted. Eighteen adults with IBD participated in this qualitative research study. Key themes identified included: (1) Trauma was associated with the journey of IBD; (2) the impact of IBD and trauma, and (3) coping strategies. Pre-existing non-IBD trauma was prevalent, with several participants reporting links between traumatic events and their IBD diagnosis. Experiences of IBD trauma were described by participants across all stages of their illness journey. The study can assist healthcare professionals to better understand the experience of living with IBD and trauma and the factors that can contribute to traumatic responses.
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Affiliation(s)
- Heidi Glynn
- Swinburne University of Technology, Melbourne, Australia
| | - Simon R Knowles
- Swinburne University of Technology, Melbourne, Australia.,St Vincent's Hospital, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Australia
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Lenti MV, Scribano ML, Biancone L, Ciccocioppo R, Pugliese D, Pastorelli L, Fiorino G, Savarino E, Caprioli FA, Ardizzone S, Fantini MC, Tontini GE, Orlando A, Sampietro GM, Sturniolo GC, Monteleone G, Vecchi M, Kohn A, Daperno M, D’Incà R, Corazza GR, Di Sabatino A. Personalize, participate, predict, and prevent: 4Ps in inflammatory bowel disease. Front Med (Lausanne) 2023; 10:1031998. [PMID: 37113615 PMCID: PMC10126747 DOI: 10.3389/fmed.2023.1031998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/14/2023] [Indexed: 04/29/2023] Open
Abstract
Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a complex, immune-mediated, disorder which leads to several gastrointestinal and systemic manifestations determining a poor quality of life, disability, and other negative health outcomes. Our knowledge of this condition has greatly improved over the last few decades, and a comprehensive management should take into account both biological (i.e., disease-related, patient-related) and non-biological (i.e., socioeconomic, cultural, environmental, behavioral) factors which contribute to the disease phenotype. From this point of view, the so called 4P medicine framework, including personalization, prediction, prevention, and participation could be useful for tailoring ad hoc interventions in IBD patients. In this review, we discuss the cutting-edge issues regarding personalization in special settings (i.e., pregnancy, oncology, infectious diseases), patient participation (i.e., how to communicate, disability, tackling stigma and resilience, quality of care), disease prediction (i.e., faecal markers, response to treatments), and prevention (i.e., dysplasia through endoscopy, infections through vaccinations, and post-surgical recurrence). Finally, we provide an outlook discussing the unmet needs for implementing this conceptual framework in clinical practice.
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Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | | | - Livia Biancone
- Unit of Gastroenterology, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Rachele Ciccocioppo
- Gastroenterology Unit, Department of Medicine, A.O.U.I. Policlinico G.B. Rossi and University of Verona, Verona, Italy
| | - Daniela Pugliese
- CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Pastorelli
- Liver and Gastroenterology Unit, ASST Santi Paolo e Carlo, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Gionata Fiorino
- IBD Unit, Ospedale San Camillo-Forlanini, Rome, Italy
- Department of Gastroenterology, San Raffaele Hospital and Vita-Salute San Raffaele University,, Milan, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Flavio Andrea Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Sandro Ardizzone
- Gastroenterology and Digestive Endoscopy Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Massimo Claudio Fantini
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria (AOU) di Cagliari, Cagliari, Italy
| | - Gian Eugenio Tontini
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, Azienda Ospedaliera Ospedali Riuniti "Villa Sofia-Cervello" Palermo, Palermo, Italy
| | | | - Giacomo Carlo Sturniolo
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Giovanni Monteleone
- Unit of Gastroenterology, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Anna Kohn
- Gastroenterology Operative Unit, Azienda Ospedaliera San Camillo-Forlanini FR, Rome, Italy
| | - Marco Daperno
- Division of Gastroenterology, Ospedale Ordine Mauriziano di Torino, Turin, Italy
| | - Renata D’Incà
- Department of Gastroenterology, San Raffaele Hospital and Vita-Salute San Raffaele University,, Milan, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
- Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
- *Correspondence: Antonio Di Sabatino,
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Philippou A, Birhanu B, Biello A, Keefer L, Gorbenko K. A Mixed-methods Assessment of the Impact of Insurance Issues on the Emotional and Physical Health of Patients With Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:1851-1858. [PMID: 35191977 DOI: 10.1093/ibd/izac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND In patients with inflammatory bowel disease (IBD), failure to adhere to treatment regimens due to insurance issues can lead to disease complications. Our aim was to examine patients' perceptions of the impact of insurance issues on their health. METHODS Twenty-nine patients with IBD at a large US academic center and an insurance issue participated in a mixed-methods study. Retrospective chart review and an online questionnaire were completed to collect demographic information, IBD characteristics, and validated resilience scores. Semistructured interviews were completed for insurance experiences, which were coded independently by 2 coders for themes. RESULTS Twenty-nine patients completed the interview, and 24 completed the online survey. Sixteen had Crohn's disease, 13 had ulcerative colitis, and 66% were female. The most common insurance issue was lapsed insurance. Many experienced physical consequences, with 58% having flares, 14% undergoing surgery, and 14% developing antibodies. All emotional responses were negative, with the majority feeling stressed (38%). Providers were uninformed of insurance issues in 28% of cases. When asked about perceived resilience, 41% felt incapable of managing the situation, and 45% gave up trying to solve the problem. When asked how to improve going forward, 38% requested an easily accessible advocate to guide them. CONCLUSIONS A large proportion of our cohort chose not to inform their provider, felt incapable of managing on their own, and gave up on resolving their insurance issue. This highlights the need to consider restructuring the insurance system, to identify those at risk for insurance issues, and to make advocates available to avoid devastating consequences.
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Affiliation(s)
- Alicia Philippou
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Beselot Birhanu
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anthony Biello
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laurie Keefer
- The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ksenia Gorbenko
- Institute for Health Care Delivery Science, Mount Sinai Health System, New York, New York, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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8
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Keefer L, Gorbenko K, Siganporia T, Manning L, Tse S, Biello A, Ungaro R, Cohen LJ, Cohen BL, Dubinsky MC. Resilience-based Integrated IBD Care Is Associated With Reductions in Health Care Use and Opioids. Clin Gastroenterol Hepatol 2022; 20:1831-1838. [PMID: 34798332 DOI: 10.1016/j.cgh.2021.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/21/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Integrated inflammatory bowel disease (IBD) care is effective but not routinely implemented. Validated methods that simultaneously address mind and body targets such as resilience may improve access and outcomes. We describe the development and implementation of the GRITT method and its impact on resilience, health care utilization (HCU), and opioid use in IBD. METHODS Consecutive patients from an academic IBD center were evaluated for low resilience on the basis of provider referral. Low resilience patients were invited to participate in the GRITT program. Primary outcome was % reduction in HCU. Secondary outcomes were change in resilience and corticosteroid and opioid use. Patients were allocated into 2 groups for analysis: GRITT participants (GP) and non-participants (NP). Clinical data and HCU in the year before enrollment were collected at baseline and 12 months. One-way repeated measures multivariate analysis of covariance evaluated group × time interactions for the primary outcome. Effect size was calculated for changes in resilience over time. RESULTS Of 456 screened IBD patients 394 were eligible, 184 GP and 210 NP. GP had greater reduction in HCU than NP: 71% reduction in emergency department visits, 94% reduction in unplanned hospitalizations. There was 49% reduction in opioid use and 73% reduction in corticosteroid use in GP. Resilience increased by 27.3 points (59%), yielding a large effect size (d = 2.4). CONCLUSIONS Mind-body care that focuses on building resilience in the context of IBD care may be a novel approach to reduce unplanned HCU and opioid use, but large, multicenter, randomized controlled trials are needed.
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Affiliation(s)
- Laurie Keefer
- Division of Gastroenterology and Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Ksenia Gorbenko
- Division of Gastroenterology and Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tina Siganporia
- Division of Gastroenterology and Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laura Manning
- Division of Gastroenterology and Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stacy Tse
- Division of Gastroenterology and Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anthony Biello
- Division of Gastroenterology and Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan Ungaro
- Division of Gastroenterology and Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Louis J Cohen
- Division of Gastroenterology and Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Benjamin L Cohen
- Cleveland Clinic, Department of Gastroenterology, Hepatology and Nutrition, Cleveland, Ohio
| | - Marla C Dubinsky
- Division of Gastroenterology and Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
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Lenti MV, Brera AS, Ballesio A, Croce G, Padovini L, Bertolino G, Di Sabatino A, Klersy C, Corazza GR. Resilience is associated with frailty and older age in hospitalised patients. BMC Geriatr 2022; 22:569. [PMID: 35818046 PMCID: PMC9275243 DOI: 10.1186/s12877-022-03251-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Little is known about resilience in an internal medicine setting. We aimed to assess the relationship between resilience and frailty and other clinical and sociodemographic characteristics in a cohort of prospectively enrolled hospitalised patients. Methods In 2017–2019, we consecutively enrolled patients in our internal medicine wards. We selected all patients who filled in the 25-item Connor-Davidson resilience scale (CD-RISC). Mean resilience was evaluated according to baseline demographic (i.e., age, sex, marital and socioeconomic status) and clinical (i.e., Cumulative Illness Rating Scale [CIRS], Edmonton Frail Scale [EFS], Barthel index, Short Blessed test, length of stay [LOS]) data. A multivariable analysis for assessing factors affecting resilience was fitted. Results Overall, 143 patients (median age 69 years, interquartile range 52–79, 74 females) were included. Resilience was significantly lower in frail (p = 0.010), elderly (p = 0.021), dependent (p = 0.032), and more clinically (p = 0.028) and cognitively compromised patients (p = 0.028), and in those with a low educational status (p = 0.032). No relation between resilience and LOS was noticed (p = 0.597). Frail patients were significantly older (p < 0.001), had a greater disease burden as measured by CIRS comorbidity (p < 0.001) and severity indexes (p < 0.001), were more dependent (p < 0.001), more cognitively impaired (p < 0.001), and displayed a lower educational level (p = 0.011) compared to non-frail patients. At multivariable analysis, frailty (p = 0.022) and dependency (p = 0.031; according to the Barthel index) were associated with lower resilience in the age groups 18–64 and ≥ 65 years, respectively. Conclusions Low resilience was associated with frailty and dependency with an age-dependent fashion. Studies assessing the impact of this finding on important health outcomes are needed. Trial registration Clinical Complexity in Internal Medicine Wards. San MAtteo Complexity Study (SMAC); NCT03439410. Registered 01/11/2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03251-9.
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Affiliation(s)
| | | | - Alessia Ballesio
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Gabriele Croce
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Lucia Padovini
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | | | | | - Catherine Klersy
- Clinical Epidemiology & Biometry, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, University of Pavia, Pavia, Italy. .,Department of Internal Medicine, Clinica Medica, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
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10
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Adams C, Kiruki M, Karuga R, Otiso L, Graham SM, Beima-Sofie KM. "Your status cannot hinder you": the importance of resilience among adolescents engaged in HIV care in Kenya. BMC Public Health 2022; 22:1272. [PMID: 35773690 PMCID: PMC9245269 DOI: 10.1186/s12889-022-13677-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Approximately 40% of the 110,000 adolescents living with HIV (ALHIV) in Kenya have not achieved viral suppression. Despite the increasing availability of adolescent-friendly services, adolescents face barriers that impact ART adherence. This study aimed to identify key stigma-related barriers to ART adherence and strategies used by adolescents in overcoming these barriers. METHODS Data were collected by LVCT Health, a Kenyan organization with a programmatic focus on HIV testing, prevention, and care. 122 participants were recruited from 3 clinical sites affiliated with LVCT Health in Nairobi, Kisumu, and Mombasa. In-depth interviews were conducted with ALHIV (n = 12). Focus group discussions were conducted with ALHIV (n = 5), peer leaders (n = 3), and adolescents receiving HIV services in community settings (AIC) irrespective of HIV status (n = 3). Interviews and focus groups were audio recorded, translated, and transcribed. Data were analyzed thematically, with a focus on stigma and resilience. RESULTS While AIC primarily focused on adherence barriers and stigma, ALHIV and, to some extent, peer leaders, also identified resilience factors that helped overcome stigma. Four major themes emerged: 1) knowledge and future-oriented goals can drive motivation for ALHIV to remain healthy; 2) disclosure to others strengthens support systems for ALHIV; 3) medication-taking strategies and strategic disclosure can overcome adherence challenges in school; and 4) a supportive clinic environment promotes continuous adolescent engagement in HIV care. These concepts were used to develop a conceptual stigma/resilience model depicting how resilience moderates negative effects of stigma among ALHIV. CONCLUSIONS This study demonstrates the positive effects of ALHIV resilience on ART adherence and illuminates how stigma impacts ALHIV differently depending on their resilience. Strengths-based interventions, focused on increasing resilience among ALHIV in Kenya, and more formal involvement of adolescent peers to bolster adolescent support, have the potential to improve ART adherence among ALHIV.
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Affiliation(s)
- Casey Adams
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Social Work, University of Washington, Seattle, WA USA
| | - Millicent Kiruki
- grid.463443.20000 0004 0372 7280Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Robinson Karuga
- grid.463443.20000 0004 0372 7280Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Lilian Otiso
- grid.463443.20000 0004 0372 7280Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Susan M. Graham
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Medicine, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Epidemiology, University of Washington, Seattle, WA USA
| | - Kristin M. Beima-Sofie
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
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11
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Taft TH, Craven MR, Adler EP, Simons M, Nguyen L. Stigma experiences of patients living with gastroparesis. Neurogastroenterol Motil 2022; 34:e14223. [PMID: 34337831 DOI: 10.1111/nmo.14223] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/17/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stigmatization toward chronic digestive diseases is well documented. Patients perceive others hold negative stereotypes toward their disease and may internalize these beliefs as true. Because of this, stigmatization is associated with poor outcomes across disease-related and psychosocial domains. No study to date evaluates stigmatization toward patients living with gastroparesis (GP), a poorly understood disease affecting gastric motility. We aimed to gain deep understanding of stigma in patients living with gastroparesis. METHODS Patients with GP were recruited from two university-based gastroenterology practices as well as patient advocacy support groups. Participants underwent a semi-structured qualitative interview about their experiences with stigma related to their GP diagnosis, which were audio-recorded and transcribed to text for analysis using a grounded theory approach. Major themes with representative quotations were documented. RESULTS Twenty-three patients participated. The majority were White, female, with idiopathic GP under the care of a gastroenterologist. All patients reported stigma related to GP. Seven major themes were found: stigma from healthcare providers, stigma within interpersonal relationships, GP as an invisible disease, blame, unsolicited suggestions on how to manage disease, disclosure, and stigma resistance. CONCLUSIONS This is the first study to describe stigma experiences in patients with GP. The results suggest patients experience considerable stigmatization toward their condition from multiple sources. Patients also demonstrated resistance to negative beliefs, which can serve as a protective factor for the negative effects of disease stigma. Clinicians should be aware of stigma in GP patients, including their own potential internal biases and behaviors.
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Affiliation(s)
- Tiffany H Taft
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Meredith R Craven
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emerald P Adler
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Gastroenterology, Stanford University, Palo Alto, CA, USA
| | - Madison Simons
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Linda Nguyen
- Division of Gastroenterology, Stanford University, Palo Alto, CA, USA
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12
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Lenti MV, Dolby V, Clark T, Hall V, Tattersall S, Fairhurst F, Kenneth C, Walker R, Kemp K, Borg‐Bartolo S, Limdi JK, Taylor J, Townsend T, Subramanian S, Storey D, Assadsangabi A, Stansfield C, Smith P, Byrne D, De Silvestri A, Selinger C. A propensity score-matched, real-world comparison of ustekinumab vs vedolizumab as a second-line treatment for Crohn's disease. The Cross Pennine study II. Aliment Pharmacol Ther 2022; 55:856-866. [PMID: 34935160 PMCID: PMC9305775 DOI: 10.1111/apt.16742] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/06/2021] [Accepted: 12/09/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The optimal choice of biological agents after failure of anti-tumour-necrosis-factor-(TNF)α agent in Crohn's disease (CD) is yet to be defined. AIMS To assess the effectiveness and safety of ustekinumab compared to vedolizumab as second-line treatment in CD patients who failed anti-TNFα therapy. METHODS Retrospective analysis of clinical response and remission at 14 and 52 weeks to ustekinumab by physician global assessment (PGA). A propensity score-matched analysis with a cohort treated with vedolizumab was performed. RESULTS Of 282 patients (mean age 40 ± 15, F:M ratio 1.7:1) treated with ustekinumab, clinical response or remission was reached by 200/282 patients (70.9%) at 14 weeks, and 162/259 patients (62.5%) at 52 weeks. Overall, 74 adverse events occurred, of which 26 were labelled as serious (8.3 per 100 person-year). After exclusion of patients without prior anti-TNFα exposure and patients previously exposed to vedolizumab or ustekinumab, we analysed 275/282 patients (97.5%) on ustekinumab and 118/135 patients (87.4%) on vedolizumab. Propensity score analysis revealed that at 14 weeks, patients treated with ustekinumab were 38% (95% CI 25%-50%; P < 0.001) more likely to achieve clinical remission, while at 52 weeks, the difference of 9% (95% CI -15% to 33%; P = 0.462) was not significant. CONCLUSIONS Ustekinumab was effective and well tolerated in this real-world cohort. While ustekinumab proved more effective at 14-weeks, we found no statistically significant differences at 52 weeks compared to vedolizumab.
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13
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Keefer L, Bedell A, Norton C, Hart AL. How Should Pain, Fatigue, and Emotional Wellness Be Incorporated Into Treatment Goals for Optimal Management of Inflammatory Bowel Disease? Gastroenterology 2022; 162:1439-1451. [PMID: 34995528 DOI: 10.1053/j.gastro.2021.08.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/10/2021] [Accepted: 08/14/2021] [Indexed: 12/16/2022]
Abstract
Early diagnosis and the optimal control of inflammation, with a continuous cycle of assessment, treatment, monitoring, and adjustment of therapy, is best practice for the management of inflammatory bowel disease. However, patients express frustration with ongoing challenging symptoms, often discordant with inflammation, including abdominal pain, fatigue, depression, anxiety, and emotional wellness; these are often not optimally addressed by inflammatory bowel disease clinicians due to lack of time or resources. This review will highlight the burden of these symptoms and issues, suggest ways of assessing these in clinical practice, highlight the importance of acknowledging and validating the symptoms and issues with patients, reassuring them that they are being heard, and discuss different possible models of service delivery for psychosocial support, from fully integrated gastropsychology models to referral pathways that optimize community support. We suggest the importance of the treat-to-target concept, where the target is not only control of inflammation but also emotional wellness.
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Affiliation(s)
- Laurie Keefer
- Department of Medicine-Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Alyse Bedell
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
| | - Christine Norton
- Florence Nightingale School of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Ailsa L Hart
- IBD Unit, St Mark's, The National Bowel Hospital, London, United Kingdom
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14
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Cococcia S, Lenti MV, Mengoli C, Klersy C, Borrelli de Andreis F, Secco M, Ghorayeb J, Delliponti M, Corazza GR, Di Sabatino A. Validation of the Italian translation of the perceived stigma scale and resilience assessment in inflammatory bowel disease patients. World J Gastroenterol 2021; 27:6647-6658. [PMID: 34754158 PMCID: PMC8554395 DOI: 10.3748/wjg.v27.i39.6647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/21/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stigmatization is the separation of an individual from a group due to aspects that make them different. Resilience may in turn influence the perception of stigma. Patients with inflammatory bowel disease (IBD) are susceptible to stigma, although data are very limited.
AIM To validate an Italian translation of the IBD perceived stigma scale (PSS) in relation to patients’ resilience.
METHODS Consecutive IBD outpatients were prospectively enrolled (December 2018-September 2019) in an Italian, tertiary referral, IBD center. Clinical and demographic data were collected. Stigma and resilience were evaluated through the IBD-PSS and the 25-item Connor-Davidson Resilience Scale, respectively. The International Quality of Life Assessment Project approach was followed to translate the IBD-PSS into Italian and to establish data quality. Higher scores represent greater perceived stigma and resilience. Multivariable analysis for factors associated with greater stigma was computed.
RESULTS Overall, 126 IBD patients (mean age 46.1 ± 16.9) were enrolled. The International Quality of Life Assessment criteria for acceptable psychometric properties of the scale were satisfied, with optimal data completeness. There was no ceiling effect, whilst floor effect was present (7.1%). The discriminant validity and the internal consistency reliability were good (Cronbach alpha = 0.87). The overall internal consistency was 95%, and the test-retest reliability was excellent 0.996. The median PSS score was 0.45 (0.20-0.85). Resilience negatively correlated with perceived stigma (Spearman’s correlation = -0.18, 95% confidence intervals: -0.42-0.08, P = 0.03).
CONCLUSION We herein validated the Italian translation of the PSS scale, also demonstrating that resilience negatively impacts perceived stigma.
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Affiliation(s)
- Sara Cococcia
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Caterina Mengoli
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Catherine Klersy
- Service of Biometry & Statistics, Foundation IRCCS Policlinico San Matteo, Pavia 27100, Lombardia, Italy
| | - Federica Borrelli de Andreis
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Matteo Secco
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Jihane Ghorayeb
- Psychology, Zayed University, Dubai 00000, United Arab Emirates
| | - Mariangela Delliponti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Gino Roberto Corazza
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia 27100, Lombardia, Italy
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Tempchin J, Storch B, Reigada LC. Systematic review: Psychosocial factors of resilience in young people with inflammatory bowel disease. J Psychosom Res 2021; 148:110558. [PMID: 34280678 DOI: 10.1016/j.jpsychores.2021.110558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 06/10/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Inflammatory bowel disease (IBD) affects a growing number of young people. While factors associated with poor disease experience in pediatric IBD have garnered much attention in the literature, less attention has focused on the factors associated with the resilient outcomes seen in the majority of young people with IBD. This review seeks to contribute to the literature by synthesizing research on the psychosocial factors that promote resilience in pediatric IBD and by offering future directions for the field. METHODS Systematic searches of the MEDLINE, Embase, PsychInfo, and CINAHL databases were performed for quantitative English-language studies with keywords for IBD, resilience or factors of resilience, and pediatric populations, with no date restrictions. Reference lists of all included articles were searched. Quality assessments were performed using an NIH tool. RESULTS Of 3315 articles identified, 17 were included. Studies were heterogeneous, with 19 psychosocial factors identified and analyzed for associations with over two dozen indicators of resilience. A narrative synthesis of included studies was performed. Study details were organized into three domains-individual, social, and family. Preliminary data indicate that resilience in pediatric IBD may be associated with positive body image, increased mindfulness, and improved social functioning, among other potential factors. CONCLUSIONS Resilience in pediatric IBD is largely unstudied. Only one study pursued an understanding of resilience as an aim, and no studies incorporated validated measures of resilience. Future prospective, theory-driven research is needed to elucidate the network of factors and mechanisms that can foster resilience in children and adolescents with IBD.
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Affiliation(s)
- Jacob Tempchin
- Quantitative Methods in the Social Sciences, The Graduate Center, City University of New York, New York, NY, USA.
| | - Barbara Storch
- Health Psychology and Clinical Science Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA.
| | - Laura C Reigada
- Health Psychology and Clinical Science Program in Psychology, The Graduate Center, City University of New York, New York, NY, USA; Psychology Department, Brooklyn College, City University of New York, Brooklyn, NY, USA.
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16
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Muse K, Johnson E, David AL. A Feeling of Otherness: A Qualitative Research Synthesis Exploring the Lived Experiences of Stigma in Individuals with Inflammatory Bowel Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158038. [PMID: 34360327 PMCID: PMC8345596 DOI: 10.3390/ijerph18158038] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/18/2022]
Abstract
Inflammatory bowel disease (IBD) consists of Crohn’s disease and ulcerative colitis, chronic conditions involving inflammation and ulceration of the gastrointestinal tract. Individuals with IBD may be susceptible to experiencing health-related stigma: experienced, perceived, or internalised social exclusion, rejection, blame, or devaluation resulting from negative social judgements based on the disease. This qualitative research synthesis draws together findings from 38 studies describing lived experiences to develop a unified interpretative account of the experience of stigma in IBD. Analysis developed two categories: ‘The IBD journey’ explores the dynamic ways in which having IBD impacted on individuals’ self-identity and ‘a need to be understood’ examines the tension between wanting to be understood whilst feeling their true experiences needed to be hidden from or were misjudged by the social sphere. The overarching concept ‘feeling of otherness’ highlights that, rather than a static, binary experience, individuals moved across a continuum ranging from the excluding experience of feeling stigmatised and othered, to the inclusive experience of integration. Individuals fluctuated along this continuum across different physical, social, and health contexts. Psychological adjustment to IBD, drawing on experience of adaptive coping, and reconnecting with valued others through illness disclosure strengthened stigma resistance during more challenging times.
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Affiliation(s)
- Kate Muse
- School of Psychology, University of Worcester, Worcester WR2 6AJ, UK
- Correspondence:
| | - Emma Johnson
- Children’s Psychological Medicine, Oxford Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; (E.J.); (A.L.D.)
| | - Annabel L. David
- Children’s Psychological Medicine, Oxford Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; (E.J.); (A.L.D.)
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Armuzzi A, Liguori G. Quality of life in patients with moderate to severe ulcerative colitis and the impact of treatment: A narrative review. Dig Liver Dis 2021; 53:803-808. [PMID: 33744172 DOI: 10.1016/j.dld.2021.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023]
Abstract
As a chronic inflammatory disease, ulcerative colitis has significant negative impact on the quality of life (QoL) of patients. Since the disease affects many aspects of QoL, comprising multiple domains, treatments that induce and maintain remission can provide benefits beyond hard clinical endpoints. Effective treatment of ulcerative colitis can restore QoL and return it to normal or near normal levels. Biological therapies have shown consistent improvement in the QoL of patients with ulcerative colitis during the induction phase, with benefits that are generally maintained in the long-term. Current medical treatment options broadly comprise aminosalicylates, corticosteroids, thiopurines, and calcineurin inhibitors, as well as biologic therapies. Conventional therapies do not always adequately control disease in a sizeable portion of patients, while anti-TNF antibodies are associated with several issues such as contraindications, intolerance, primary non-response, and loss of response in some patients. JAK inhibitors have been associated with clinical improvements in disease manifestations and long-term improvement in QoL outcomes. However, additional studies are needed to better understand the comparative effects of different treatments on QoL and patient preferences for therapy. Herein, the available evidence is reviewed regarding the impact of various treatments on QoL in patients with moderate to severe ulcerative colitis.
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Affiliation(s)
- Alessandro Armuzzi
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, Rome 00168, Italy; Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
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18
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Luo D, Zhou M, Sun L, Lin Z, Bian Q, Liu M, Ren S. Resilience as a Mediator of the Association Between Perceived Stigma and Quality of Life Among People With Inflammatory Bowel Disease. Front Psychiatry 2021; 12:709295. [PMID: 34421685 PMCID: PMC8377363 DOI: 10.3389/fpsyt.2021.709295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Improving Quality of Life (QOL) is an essential objective in the management of inflammatory bowel disease. An accumulating body of research has been conducted to explore the association between perceived stigma and QOL among patients with chronic illness. Still, underlying mechanisms behind this pathway have not been thoroughly examined. Objective: To investigate (a) the effect of perceived stigma on QOL among patients with inflammatory bowel disease; and (b) the mediating role of resilience in the association between perceived stigma and QOL. Methods: This cross-sectional study included a convenient sample of patients diagnosed with inflammatory bowel disease from four tertiary hospitals in Jiangsu Province, China. Patients completed the Perceived Stigma Scale in Inflammatory Bowel Disease (PSS-IBD), the Resilience Scale for Patients with Inflammatory Bowel Disease (RS-IBD), and the Inflammatory Bowel Disease Questionnaire (IBDQ). A bootstrapping analysis was implemented using the SPSS macro PROCESS. Results: A total of 311 patients with Cohn's disease and ulcerative colitis participated in this study, and 57.6% were men. The mean disease duration was 3.51 ± 1.04 years. Approximately 40% of the sample exceeded the criterion score for moderate stigma. Patients who perceived moderate or severe stigma reported lower QOL compared with those with mild stigma. After controlling for sociodemographic and clinical variables, we observed that perceived stigma was negatively associated with resilience. Moreover, resilience was found to mediate the relationship between perceived stigma and all aspects of QOL. Conclusions: These findings suggested that QOL of patients with inflammatory bowel disease was associated with perceived stigma and resilience and identified the mediating effects of resilience in the relationship between perceived stigma and QOL. Furthermore, this suggests that integrating intervention techniques to target resilience into the QOL improvement program of individuals with perceived stigma is possible.
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Affiliation(s)
- Dan Luo
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Meijing Zhou
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lifu Sun
- School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Zheng Lin
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,School of Nursing, Nanjing Medical University, Nanjing, China
| | - Qiugui Bian
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meihong Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shurong Ren
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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