Examining the associations between self and body compassion and health related quality of life in people diagnosed with endometriosis

OBJECTIVE

An understanding of the role that self and body compassion may play as protective mechanisms in the context of psychological and physical health conditions is steadily increasing. The availability of research pertaining to their role in mitigating the health-related quality of life (HRQoL) impacts associated with endometriosis is limited. The current study examined the influence of self and body compassion on HRQoL in people diagnosed with endometriosis.

METHODS

Individuals aged 18+ years (n = 318), assigned female at birth, with a self-reported diagnosis of symptomatic endometriosis completed an online cross-sectional survey. Participant demographics and endometriosis-related data was collected in addition to self and body compassion and HRQoL. Standard multiple regression analyses (MRA) were conducted to estimate the proportion of variance in HRQoL that can be accounted for by self and body compassion in endometriosis.

RESULTS

Self and body compassion were both associated with higher HRQoL across all domains. However, when both self and body compassion were entered into a regression, only body compassion was significantly associated with HRQoL domains of physical wellbeing, bodily pain, vitality, social engagement and general HRQoL; self-compassion explained no unique variance. In the domain of emotional wellbeing, when both self and body compassion were entered into a regression, both were significantly associated, and explained unique variance.

CONCLUSIONS

It is suggested that future psychological interventions for individuals living with endometriosis should emphasise building general self-compassionate abilities with a subsequent specific focus on strategies designed to improve body compassion.

Predictors of self-compassion in endometriosis: the role of psychological health and endometriosis symptom burden

STUDY QUESTION

What is the relationship between self-compassion, endometriosis-related symptoms and psychological health in women with symptomatic endometriosis?

SUMMARY ANSWER

Decreased self-compassion is associated with increased psychological distress, extended diagnostic delay and varies according to individual endometriosis-symptom profile.

WHAT IS KNOWN ALREADY

Existing research indicates that endometriosis is associated with reduced psychological health and varied endometriosis-related symptom profiles. Examining the level of self-compassion reported by women with endometriosis is important as greater self-compassion has been found to improve psychological well-being in several chronic health populations.

STUDY DESIGN, SIZE, DURATION

This study utilized a cross-sectional survey design to explore the relationship between self-compassion, psychological health and endometriosis-related symptoms (n = 318).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women with a self-reported diagnosis of endometriosis were recruited via online advertising through social media platforms. Demographic and endometriosis-specific information (e.g. disease stage, diagnostic delay, symptom experience) was collected in addition to psychological health and self-compassion. Psychological health was measured by the PROMIS Emotional Distress and Anxiety short forms and the Patient Health Questionnaire (PHQ-15). Self-compassion was measured by the Self-Compassion Scale (26-item). Independent t-tests, bivariate correlations and linear regression analyses explored the relationship between specific endometriosis-related symptoms, psychological health and self-compassion.

MAIN RESULTS AND THE ROLE OF CHANCE

Hierarchical multiple regression indicated that psychological symptoms accounted for the greatest variance in levels of self-compassion in the current sample. Depression and anxiety were found to be significant negative predictors of self-compassion. Notable symptoms that were significant in the final model were the presence of dysmenorrhea, lower back pain, dyspareunia, pain after sexual intercourse, fatigue and nausea.

LIMITATIONS, REASONS FOR CAUTION

The cross-sectional nature of the findings prevents direct findings of causality. The information pertaining to endometriosis was self-report in nature and was not medically verified.

WIDER IMPLICATIONS OF THE FINDINGS

These preliminary findings indicate the importance of clinical interventions aimed at enhancing self-compassion and the importance of individual case conceptualization and treatment planning based on endometriosis-related symptomatic profiles.

STUDY FUNDING/COMPETING INTEREST(S)

The study was not associated with research funding. Author L.V.N. is a member of the Endometriosis Australia Clinical Advisory Committee.

TRIAL REGISTRATION NUMBER

N/A.

Evidence-based treatment of multicystic dysplastic kidney: a systematic review

OBJECTIVES

There is a lack of a standardised protocol for the investigation and non-operative management of paediatric multicystic dysplastic kidney (MCDK). Institutional protocols for non-operative management remain essentially ad hoc. The primary outcome of this systematic review is to establish the incidence of hypertension associated with an MCDK. The secondary outcome is to determine the malignancy risk associated with an MCDK. The tertiary outcome is to assess the rate of MCDK involution. Subsequent to these, an evidence-based algorithm for follow-up is described.

METHODOLOGY

A systematic review of all relevant studies published between 1968 and April 2017 was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified by specific inclusion and exclusion criteria, all of which included data relevant to the primary, secondary and tertiary outcomes. Hypertension was defined as systolic blood pressure greater than the 95th centile for gender, age and height centile. Subset analysis was performed for hypertension associated with an MCDK.

RESULTS

The primary outcome measure revealed a 3.2% (27/838) risk of developing hypertension associated with an MCDK. The secondary outcome measure noted a 0.07% malignancy risk (2/2820). The tertiary outcome measure established that 53.3% (1502/2820) had evidence of involution of the dysplastic kidney. A total of 44 cohort studies (2820 patients) were analysed.

CONCLUSION

Given the low risk of hypertension and malignancy, which is similar to the general population, the current conservative non-operative pathway is an appropriate management strategy. An algorithm to help support clinicians with ongoing management is proposed.

Nucleotide sequence of Pseudomonas aeruginosa conjugative plasmid pUM505 containing virulence and heavy-metal resistance genes

We determined the complete nucleotide sequence of conjugative plasmid pUM505 isolated from a clinical strain of Pseudomonas aeruginosa. The plasmid had a length of 123,322bp and contained 138 complete coding regions, including 46% open reading frames encoding hypothetical proteins. pUM505 can be considered a hybrid plasmid because it presents two well-defined regions. The first region corresponded to a larger DNA segment with homology to a pathogenicity island from virulent Pseudomonas strains; this island in pUM505 was comprised of genes probably involved in virulence and genes encoding proteins implicated in replication, maintenance and plasmid transfer. Sequence analysis identified pil genes encoding a type IV secretion system, establishing pUM505 as a member of the family of IncI1 plasmids. Plasmid pUM505 also contained virB4/virD4 homologues, which are linked to virulence in other plasmids. The second region, smaller in length, contains inorganic mercury and chromate resistance gene clusters both flanked by putative mobile elements. Although no genes for antibiotic resistance were identified, when pUM505 was transferred to a recipient strain of P. aeruginosa it conferred resistance to the fluoroquinolone ciprofloxacin. pUM505 also conferred resistance to the superoxide radical generator paraquat. pUM505 could provide Pseudomonas strains with a wide variety of adaptive traits such as virulence, heavy-metal and antibiotic resistance and oxidative stress tolerance which can be selective factors for the distribution and prevalence of this plasmid in diverse environments, including hospitals and heavy metal contaminated soils.

Long term treatment with rifampicin for pruritis has implications for warfarin use

Warfarin is an established treatment method for anticoagulating patients following diagnosis of deep vein thrombosis (DVT). We present a patient who was on rifampicin treatment for pruritis, secondary to primary biliary cirrhosis (PBC), who was diagnosed with a DVT post operatively. A therapeutic INR was not obtained following fourteen days of warfarin treatment due to a drug interaction with rifampicin. We review the use of rifampicin for pruritis in PBC and the mechanism of interaction between warfarin and rifampicin.

Use of Electrophysical Agents: Findings and Implications of a Survey of Practice in Metro Toronto

Purposes: (1) To determine the availability, use and factors associated with the use of electrophysical agents (EPAs) in the management of patients with musculoskeletal impairments in physical therapy (PT) outpatient clinics in Metro Toronto and (2) to determine sources of EPA information used by physical therapists (PTs) and their perceived need for continuing EPA education.

Method: Information was collected by a questionnaire distributed to all eligible PTs in the defined area. Data included the characteristics of PTs and clinics, availability and use of EPAs by PTs, treatments received by patients, sources and influence of EPA information, use of support personnel and PTs' past education and future needs.

Results: The response rate was 54.1 per cent. The results were analyzed for 125 eligible PTs. On a typical day, treatment excluded EPAs for 29 per cent of patients. Treatment included one, two and three or more EPAs for 36, 26, and 9 per cent of patients, respectively. On average, PTs used EPAs for more than half of their patients: the most significant factors associated with EPA use were type of patient funding and number of patients treated per hour. Place of entry-level education and years since graduation were associated with the sources and perceived importance of EPA information that PTs used. More than half of the respondents indicated an interest in continuing EPA education.

Conclusions: EPAs are commonly included in PT management of persons with musculoskeletal impairments. Entry-level and continuing education should promote use of EPAs based on scientific evidence.

Macrophages as a major source of oxygen radicals in the hyperoxic newborn rat lung

The lungs of newborn rats exposed to 60% O(2) for 14 d were found to have a greatly increased cyanide-insensitive O(2) consumption, reflecting increased reactive oxygen species (ROS) formation. Exposure of the lung to hyperoxia is known to increase the production of ROS by mitochondria. We hypothesized that macrophages may also be a major contributor to this increase. Newborn rat pups were exposed to either air or 60% O(2) for 14 d and received either intraperitoneal gadolinium chloride (GdCl(3)) to abrogate macrophage influx, or inert vehicle. Lung homogenates were equilibrated in either 21% or 100% O(2) and total and cyanide-insensitive O(2) consumption, as well as nitric oxide accumulation were measured polarographically. Citrate synthase, a marker of mitochondrial mass, and nitrotyrosine, a marker of peroxynitrite formation, were quantified by Western blot. In addition to increased macrophage numbers, the lungs of 60% O(2)-exposed animals had greatly increased cyanide-insensitive O(2) consumption (p <.05 compared to air controls) and immunoreactive nitrotyrosine (p <.05), which were all completely abrogated by treatment with GdCl(3). Exposure to 60% O(2) for 14 d had no effect on peroxynitrite-independent nitric oxide release or mitochondrial mass. We conclude that increased ROS in the lungs of newborn rats exposed to 60% O(2) for 14 d was likely to be caused, in significant part, by the presence of increased numbers of macrophages.

Fibroblast growth factor receptor-1 and neonatal compensatory lung growth after exposure to 95% oxygen

Neonatal rats exposed to 95% oxygen (O2) for 7 days from birth had inhibited lung growth, DNA synthesis, and secondary septation. These parameters were rapidly restored by a period of recovery in air. Northern and Western blot analysis and immunohistochemistry were used to screen for the fibroblast growth factor receptor-1 (FGF-R1) and its high affinity ligand, basic fibroblast growth factor (bFGF), which could have a role in this recovery process. Expression of bFGF in the lung was significantly reduced at the end of the 7-day exposure to 95% O2 and was increased after 3 days of recovery in air. Expression of FGF-R1 was not affected by exposure to 95% O2 or recovery in air. We hypothesized that the increase in bFGF after removal from 95% O2, acting through the FGF-R1, would be critical for compensatory growth. Intraperitoneal injection of soluble truncated FGF-R1 at the onset of the recovery phase arrested compensatory lung DNA synthesis and secondary septation seen in control animals after 3 days of recovery, confirming a role for FGF-R1 in this model of compensatory neonatal lung growth.

A role for platelet-derived growth factor-BB in rat postpneumonectomy compensatory lung growth

Unilateral pneumonectomy leads to compensatory growth in the residual lung, the mediators of which are largely unknown. We hypothesized, based on its other known roles in lung cell growth, that platelet-derived growth factor (PDGF)-BB would be an essential mediator of postpneumonectomy compensatory lung growth. Left-sided pneumonectomies were performed on 21-d-old rats, for comparison with sham-operated or unoperated control animals. Body weights were not different between groups. Right lung weights and DNA content were significantly increased (p < 0.05), compared with controls, by 10 d after pneumonectomy. The rate of DNA synthesis was maximal on d 5 postpneumonectomy. Total right lung PDGF-B mRNA and PDGF-BB protein increased after pneumonectomy, but were apparently tightly regulated, relative to total right lung beta-actin mRNA and protein content, respectively. However, PDGF-BB expression after pneumonectomy was apparently not purely constitutive, in that daily i.p. injections of a truncated soluble PDGF beta-receptor both reduced activation of the native PDGF beta-receptor, and attenuated increased lung DNA synthesis on d 3 after pneumonectomy. These findings are consistent with a critical role for PDGF-BB in postpneumonectomy lung growth.

Control of oxygen free radical formation from mitochondrial complex I: roles for protein kinase A and pyruvate dehydrogenase kinase

Human NADH CoQ oxidoreductase is composed of a total of 43 subunits and has been demonstrated to be a major site for the production of superoxide by mitochondria. Incubation of rat heart mitochondria with ATP resulted in the phosphorylation of two mitochondrial membrane proteins, one with a M(r) of 6 kDa consistent with the NDUFA1 (MWFE), and one at 18kDa consistent with either NDUFS4 (AQDQ) or NDUFB7 (B18). Phosphorylation of both subunits was enhanced by cAMP derivatives and protein kinase A (PKA) and was inhibited by PKA inhibitors (PKAi). When mitochondrial membranes were incubated with pyruvate dehydrogenase kinase, phosphorylation of an 18kDa protein but not a 6kDa protein was observed. NADH cytochrome c reductase activity was decreased and superoxide production rates with NADH as substrate were increased. On the other hand, with protein kinase A-driven phosphorylation, NADH cytochrome c reductase was increased and superoxide production decreased. Overall there was a 4-fold variation in electron transport rates observable at the extremes of these phosphorylation events. This suggests that electron flow through complex I and the production of oxygen free radicals can be regulated by phosphorylation events. In light of these observations we discuss a potential model for the dual regulation of complex I and the production of oxygen free radicals by both PKA and PDH kinase.

Reducing high-risk interventions for managing aggression in psychiatric settings

Seclusion and restraints have traditionally been major interventions for controlling patient aggression. The implementation of less restrictive measures may or may not be an option in managing individual cases of psychiatric emergencies. Improvement in patients, knowledge of alternatives and the need to reduce the use of restraints have led to the development of new tools to enhance prevention of high-risk interventions. At one institution, an anger management assessment tool and "Triangle of Choices" have assisted patients in identifying and managing feelings of frustration and anger. Since their inception 1 year ago, the implementation of documented alternatives to restraints has increased, and use of most restrictive measures has decreased.

Medication self-administration: an outcome-oriented, consumer-driven program

The ability to understand medication and consistently follow a prescribed medical regimen varies among the general population. The Department of Nursing at Mohawk Valley Psychiatric Center developed a medication self-administration program to help consumers gain knowledge and/or improve their ability to participate in medication and symptoms management. Results have demonstrated that consumers can learn at least one more piece of information about their illness and/or medication despite their level of cognitive functioning, can learn to self-administer medications with minimal supervision before leaving the hospital, and can make an easier transition into the community setting.

Triple immunosuppression with subsequent prednisolone withdrawal: 6 years' experience in paediatric renal allograft recipients

Thirty-four children (< or = 15 years of age) with end-stage renal failure received 39 renal allografts between 1985 and 1991 and were treated with cyclosporin A (CyA), azathioprine and low-dose prednisolone (PNL). We aimed to withdraw PNL by 6 months after transplantation. Median duration of follow-up was 2 years 4 months (range 0.1 month to 6 years 4 months). There were no deaths. Crude graft survival for living-related grafts (n = 9) was 100%, although only 1 patient has been followed for > 2 years. For cadaveric grafts (n = 30), 1- and 5-year actuarial graft survivals were 90% and 79% respectively. At 12 months posttransplant, the median (range) glomerular filtration rate for all patients was 63 (19-109) ml/min per 1.73 m2 (n = 25) and at 5 years was 48 (17-64) ml/min per 1.73 m2 (n = 9). Complications observed included rejection episodes which occurred after discontinuation of PNL. Long-term (after 12 months), 28% of patients remain on PNL. Hypertension was present in more than 50% of patients. Severe CyA nephrotoxicity was not seen. Catch-up growth as determined by the change (delta) in mean height standard deviation score (Ht-SDS) was noted at 1 year [delta SDS/year = +0.60; P < 0.001 (n = 18)] and at 2 years [delta SDS/year = +0.27; P < 0.01 (n = 16)] in pre-pubertal patients. The median Ht-SDS at 2 years for pre-pubertal children was -0.71 SD and growth velocity did not improve thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)

Pathogenesis of vertebral metastasis and epidural spinal cord compression

The authors have studied the sequential events in the process of vertebral metastasis that result in spinal cord compression. Different tumor cell lines were injected into the systemic arterial circulation of syngeneic or nude mice, and they were killed at timed intervals after injection or when they became paraplegic. The following observations were made. The tumor cells lodged and grew in the hematopoietic bone marrow of the vertebrae. Cancer cells in the vertebral marrow cavity invaded into the spinal canal through the foramina of the vertebral veins rather than destroying the cortical bone. Tumor cell lines that grew in an infiltrative fashion migrated toward a posterior location in the spinal canal, and compressed the spinal cord from a posterior direction. Tumor cell lines that grew as compact tumors formed a tumor mass at the same location from which the cells emerged from the vertebra, and compressed the cord predominantly from an anterior direction. Radiographic evidence of vertebral metastasis was a late event, and commonly associated with significant compression of the cord and extraosseous tumor. These experimental findings may help to establish better diagnostic and treatment strategies for patients with metastatic disease of the spine.