Behavioral gastroenterology: An emerging system and new frontier of action

Behavioral gastroenterology is a new interdisciplinary science that explores the influence of unhealthy lifestyles and psychological factors on the digestive system and addresses the prevention, diagnosis, treatment, and rehabilitation of digestive diseases. Moreover, the concept of whole-course intervention with a focus on disease prevention and a new model of integrated therapy based on alterations of lifestyle and psychology are being gradually established. This paradigm may substantively impact the prevention and treatment of digestive diseases.

Whats 'App-ening': the help of new technologies in nutrition in digestive diseases

PURPOSE OF REVIEW

The aim of this study is to review the basic concepts of electronic health (eHealth), with a focus on its nutritional applications and its usefulness for digestive diseases.

RECENT FINDINGS

eHealth applications for the treatment and monitoring of digestive disease are growing in number. ehealth helps patients in coping with their disease by promoting self-management, which increases adherence to medical treatment and diets, and leads to an improved quality of life. For irritable bowel syndrome (IBS), there are multiple applications that provide dietary advice, for example, a low FODMAP (Fermentable Oligo, Mono, Disaccharides And Polyols) diet. However, many applications lack a symptom scoring function and do not include a module for assisting the essential reintroduction of high FODMAP foods. In general, there are very few applications that enable direct patient communication with healthcare professionals. A more holistic approach that educates patients and enables them to communicate directly with eCare provider through a web application is one of the functions most requested by patients.

SUMMARY

eHealth solutions for digestive diseases have a supportive function and a positive impact on patients. However, there is a need to increase patient education and further develop the possibility for care team-patient communication within eHealth solutions.

People with dyslexia and heart, chest, skin, digestive, musculoskeletal, vision, learning, speech and mental disorders were more dissatisfied with neighbourhoods: Scottish Household Survey, 2007-2008

Rarely do we know the perception toward neighbourhoods in people specifically with health conditions. Therefore, the aim of the present study was to understand the perception toward neighbourhoods among adults with a series of the existing health conditions in a country-wide and population-based setting. Data were retrieved from and analysed in Scottish Household Survey, 2007-2008. Information on demographics, self-reported health conditions and perception toward neighbourhoods and the surrounding facilities was obtained by household interview. Analysis including chi-square test, t test and logistic regression modelling were performed. Of 19,150 Scottish adults (aged 16-80) included in the study cohort, 1079 (7.7 %) people were dissatisfied with their living areas; particularly for those who experienced harassment (15.4 %), did not recycle or with dyslexia, chest, digestive, mental and musculoskeletal problems. Twenty to forty per cent reported common neighbourhood problems including noise, rubbish, disputes, graffiti, harassment and drug misuse. People with heart or digestive problems were more dissatisfied with the existing parks and open space. People with arthritis, chest or hearing problems were more dissatisfied with the waste management condition. People with dyslexia were more dissatisfied with the existing public transportation. People with heart problems were more dissatisfied with the current street cleaning condition. People with hearing, vision, speech, learning problems or dyslexia were also more dissatisfied with sports and recreational facilities. People with heart, chest, skin, digestive, musculoskeletal, vision, learning, speech and mental disorders and dyslexia were more dissatisfied with their current neighbourhood environments. Upgrading neighbourhood planning to tackle social environment injustice and put pleasant life experience as priorty would be suggested. Graphical abstract interrelations of individual health and neighbourhood health.

Prevalence of depression and anxiety in patients with chronic digestive system diseases: A multicenter epidemiological study

AIM

To investigate the prevalence of depression and anxiety in patients with chronic digestive system diseases.

METHODS

A total of 1736 patients with chronic digestive system diseases were included in this cross-sectional study, including 871 outpatients and 865 in-patients. A self-designed General Information for Patients of the Department of Gastroenterology of General Hospitals questionnaire was used to collect each patient’s general information, which included demographic data (including age, sex, marital status, and education) and disease characteristics (including major diseases, disease duration, principal symptoms, chronic pain, sleep disorder, and limited daily activities).

RESULTS

The overall detection rate was 31.11% (540/1736) for depression symptoms alone, 27.02% (469/1736) for anxiety symptoms alone, 20.68% (359/1736) for both depression and anxiety symptoms, and 37.44% (650/1736) for either depression or anxiety symptoms. Subjects aged 70 years or above had the highest detection rate of depression (44.06%) and anxiety symptoms (33.33%). χ² trend test showed: the higher the body mass index (BMI), the lower the detection rate of depression and anxiety symptoms (χ²_trend = 13.697, P < 0.001; χ²_trend = 9.082, P = 0.003); the more severe the limited daily activities, the higher the detection rate of depression and anxiety symptoms (χ²_trend = 130.455, P < 0.001, χ²_trend = 108.528, P < 0.001); and the poorer the sleep quality, the higher the detection rate of depression and anxiety symptoms (χ²_trend = 85.759, P < 0.001; χ²_trend = 51.969, P < 0.001). Patients with digestive system tumors had the highest detection rate of depression (57.55%) and anxiety (55.19%), followed by patients with liver cirrhosis (41.35% and 48.08%). Depression and anxiety symptoms were also high in subjects with comorbid hypertension and coronary heart disease.

CONCLUSION

Depression and anxiety occur in patients with tumors, liver cirrhosis, functional dyspepsia, and chronic viral hepatitis. Elderly, divorced/widowed, poor sleep quality, and lower BMI are associated with higher risk of depression and anxiety.

[The Study of Psychological Characteristics of Children and Adolescents with Digestive Diseases]

OBJECTIVE

The present study was aimed at the psychological characteristics of children with different chronic diseases of the digestive system and the identification of key factors influencing the formation of their personality.

METHODS

The continuous prospective study of psychological peculiarities of 125 patients (7-17 y.o.) with diseases of the digestive system who have been monitored at Scientific Centre of Children's Health (Moscow) was performed. As research methods were used: analysis of medical and pedagogical documentation, participant observation, educational experiment, interview, questionnaires and projective methods.

RESULTS

The study involved 125 patients aged 7-17 years (12.4 averagely) with diseases of the digestive system including teens--68 (54%), primary school pupil--57 (46%). The number of boys significantly prevailed over the number of girls (2:1). The study confirmed the existence of a close relationship and mutual influence of three factors: the physical condition, social situation of development, and individual psychological characteristics of children. According to the psychological characteristics the children can be combined in three groups: Group I (47 of 125 people; 37.6%) - children with bad psychological status. This is most typicalfor children with active form of chronic diseases requiring intensive medical assistance (37 of 47people; 78.7%). Group II (59 of 125 people; 47.2%)--children with instable psychological condition, with risk of neurotization. This group mainly comprises patients with chronic diseases at the stage of unstable clinical remission with preserved or compensated functions of organism bodies and systems or with incomplete compensation of functions requiring long term supportive treatment (45 of 59 people; 76.3%). Group III--patients with rather stable psychological condition (19 of 125 people; 15.2%). It comprises patients with rather stable psychological condition, anyway, with expressed psychological vulnerability in stress situation. Most children suffer from chronic diseases of different etiology at the stage of clinical remission with rare aggravations, with preserved or compensated functions, provided there are no aggravations of the basic disease (17of 19 people; 89.5%).

CONCLUSION

Most children with diseases of the digestive system have the psychological difficulties, while their identity is often formed in the distorted social conditions. Therefore, these children need psychological and pedagogical support, as well the special psychological and pedagogical conditions for the realization of their mental and cognitive capacities. To put together a program of psychological and educational assistance we should take into account the child's age at the moment of occurrence of the disease, etiology, duration and severity of the illness, the nature and degree of non-compliance of social environmental.

Translation and psychometric evaluation of the Chinese version of functional digestive disorders quality of life questionnaire

BACKGROUND

Few useful patient-reported outcomes scales for functional dyspepsia exist in China.

AIMS

The purpose of this work was to translate and cross-culturally adapt the Functional Digestive Disorders Quality of Life Questionnaire (FDDQL) from the English version to Chinese (in Mandarin).

METHODS

The following steps were performed: forward translations, synthesis of the translations, backward translations, pre-testing and field testing of FDDQL. Reliability, validity, responsiveness, confirmatory factor analysis, item response theory and differential item functioning of the scale were analyzed.

RESULTS

A total of 300 functional dyspepsia patients and 100 healthy people were included. The total Cronbach's alpha was 0.932, and split-half reliability coefficient was 0.823 with all test-retest coefficients greater than 0.9 except Coping With Disease domain. In construct validity analysis, every item correlated higher with its own domain than others. The comparative fit index of FDDQL was 0.902 and root mean square error of approximation was 0.076. Functional dyspepsia patients and healthy people had significant differences in all domains. After treatment, all domains had significant improvements except diet. Item response theory analysis showed the Person separation index of 0.920 and the threshold estimator of items was normally distributed with a mean of 0 and standard deviation of 1.27. The residuals of each item were between -2.5 and 2.5, without statistical significance. Differential item functioning analysis found that items had neither uniform nor non-uniform differential item functioning in different genders and age groups.

CONCLUSIONS

The Chinese version of FDDQL has good psychometric properties and is suitable for measuring the health status of Chinese patients with functional dyspepsia.

[The impact of health personnel at the cohesion of military units]

It is shown that in military units sociometric status of troops largely determined by the frequency of diseases in the following classes of diseases: mental and behavioral disorders (grade 7), diseases of the eye (grade 7), diseases of the ear and mastoid process (grade 8) and diseases of the digestive system (grade 11). Therefore, prevention efforts on these types of diseases will help to create cohesive military units, but it rebuet presence in the military link of the medical service of specialists.

[The prevalence of depression and anxiety in gastrointestinal out-patients of tertiary general hospitals in Beijing]

OBJECTIVE

To explore the prevalence and physician's recognition of depression and anxiety disorder in gastrointestinal out-patients of three tertiary general hospitals in Beijing.

METHODS

A hospital-based cross-sectional survey was conducted in the gastrointestinal out-patient departments of three tertiary general hospitals in Beijing from May to June 2007. Total 517 subjects were recruited consecutively within a one month period. All the subjects were screened with Hospital Anxiety Depression Scale (HADS). The subjects with HADS score of 8 and over were interviewed and diagnosed by psychiatrists using Mini International Neuropsychiatric Interview (MINI). The physicians made the diagnosis and management without knowing the results of MINI and HADS score.

RESULTS

Among the 517 cases, 301 had a HADS score of 8 and above and 244 were interviewed by psychiatrists; the response rate was 81.1%. The prevalence according to Diagnostic and Statistical Manual of Mental Disorders Fourth edition of depressive disorders and anxiety disorders in gastrointestinal outpatients were 15.3%, depressive disorders were 12.0%, anxiety disorders were 6.4%, depression combined anxiety disorder was 3.0%. The prevalence of depression, anxiety, depression combined anxiety were not different between genders (chi2=0.874, chi2=1.797, chi2=0.518, P>0.05) and among different age group (18-34, 35-54, >or=55 years old) (chi2=1.084, chi2=2.735, chi2=0.350, P>0.05). Gastritis and gastrointestinal dysfunction were the major diagnoses in patients with depression and/or anxiety disorders, the rates were 30.6% and 26.4% respectively. The rate of identification of depression and anxiety disorder by physicians was 2.8%.

CONCLUSION

Gastrointestinal out-patients have a high prevalence of depression and anxiety disorder and the rate of identification by physicians was very low.

[Role of physical, psychological and sexual abuse in functional digestive disorders. A case-controls trial.]

INTRODUCTION

Abuse has been considered a significant factor on the development of functional gastrointestinal disorders (FGID), especially for severe and treatment-refractory patients. The aim of our study was to evaluate the presence of all FGID according to Rome II criteria, in a group of women with history of physical, psychological and/or sexual abuse.

MATERIAL AND METHODS

A cross sectional study was performed in 96 women (37 +/- 12 years of age) with history of physical, psychological and/or sexual abuse (cases); and 96 open population women (36 +/- 14 years of age) (controls). The following evaluations were administered: Rome II questionnaire, a self-administered instrument to evaluate history of physical (beating), psychological(insults, public humiliation) and/or sexual abuse (rape, coercion), and HAD questionnaire.

RESULTS

Among 96 women with history of abuse,91 (95%) reported to have suffered psychological abuse, 72 (75%) physical abuse, and 24 (25%)sexual abuse. Women with history of abuse had a higher prevalence of rumination (6% vs. 0%, p= 0.02), functional heartburn (26% vs. 13%, p =0.04), aerofagia (17% vs. 5%, p = 0.019), irritable bowel syndrome (38% vs. 18%, p = 0.002), fecalin continence (16% vs. 4%, p = 0.01), elevator anisyndrome (5% vs. 0%, p = 0.05), and proctalgia fugax (29% vs. 15%, p = 0.02) compared to controls. There was a positive correlation between anxiety (r = 0.5, p = 0.001) and depression scores(r = 0.45, p = 0.001), and the number of FGID.

CONCLUSION

We demonstrated a high prevalence of FGID among women with history of physical,psychological, and/or sexual abuse. In this association,concomitant anxiety and depression play a significant role.

[Impact of several illnesses on health related quality of life on workers]

FOUNDATION AND OBJECTIVE: To make a comparative study of the degree of impact of different diseases in the health related quality of life (HRQoL) of workers.

MATERIAL AND METHODS

A questionnaire including the measure of HRQoL SF-36, was sent by mail and fulfilled by employees of the Pfizer company in Spain. Differences in the impact in HRQoL between subjects with and without several characteristics, with less or more degree of work productivity and with and without antecedents of several diseases and current treatment, were assessed by means of statistical tests of U Mann-Whitney and Kruskal-Wallis.

RESULTS

In a sample of 399 valuable subjects, 35.8+/-6.5 years (mean+/-standard deviation), with a 63.7% of men, worst HRQoL scores in the Physical Summary Component of SF-36 were observed among subjects with history of some disease (52.6+/-5.9 days versus 55.9+/-2.6), migraine (46.2+/-5.9 versus 54.7+/-4.1), musculoskeletal (49.7+/-7.2 versus 53.9+/-5.1) and digestive diseases (51.5+/-6.6 versus 54.1+/-4.9), and/or taking some current treatment (50.2+/-6.4 versus 55.0+/-4.4); p <0.05 for all comparisons. In the Physical Summary Component of SF-36 worst HRQoL scores were observed among subjects with history of some disease (51.4+/-7.1 versus 53.4+/-5.9), digestive (49.9+/-8.3 versus 52.5+/-6.3) and mental disorders (46.0+/-8.8 versus 52.4+/-6.4); p <0.05 for all comparisons.

CONCLUSIONS

The impact of the disease in the HRQoL was associated to the type of pathological antecedents, being migraine that hit more negatively in the Physical Health, and mental disorders in the Mental Health.

[Depressive syndrome in gastroenterology: diagnosis and treatment]

The article presents modern data on depressive syndrome, its prevalence and possible reasons for its growth, the role of psychoemotional stress in the development of anxiety depression (AD), as well as psychosomatic diseases and syndromes and modern views on the mechanisms of their formation. The authors discuss methods of revealing and diagnostic criteria of AD and psychosomatic diseases, including those that develop against the background of masked depression. Associations between depressive syndrome and the development of gastroenterological diseases and psychosomatic syndromes such as peptic ulcer, functional dyspepsia, irritated bowel syndromes, chronic cholecystitis, and chronic duodenal obstruction syndrome are discussed in detail. Special attention is paid to treatment of AD in gastroenterological patients using psycho- and hypnotherapy as well as psychotropic drugs such as antidepressives, anxiolytics, neuroleptics, and nootropic agents.

Signalment factors, comorbidity, and trends in behavior diagnoses in cats: 736 cases (1991–2001)

OBJECTIVE

To describe trends in behavior diagnoses from 1991 to 2001; assess the relationship between diagnoses and age, sex, reproductive status, and breed; and evaluate associations between diagnoses within the same cat (comorbidity).

DESIGN

Retrospective case series.

ANIMALS

736 cats.

PROCEDURES

Medical records were reviewed for species, breed, sex, reproductive status, consultation year, birth date, and diagnoses.

RESULTS

The caseload decreased over the course of the study. Aggression toward people increased, and spraying decreased. Cases involving Siamese cats decreased over time. Siamese cats were evaluated more often than expected in general and specifically for aggression and ingestive behavior problems, whereas Persian cats were evaluated more often than expected for elimination outside of the litter box. Domestic shorthair cats were evaluated less often than expected in general and specifically for aggression, ingestive behavior problems, and house soiling. Male cats were overrepresented. Cats with ingestive behavior problems were evaluated at a median age of 1.5 years, compared with cats with other problems (median age, 5.5 years). Certain diagnoses were clustered, with a mean of 1.2 diagnoses/cat.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that in cats, behavior problems changed over the course of the study, age and breed distributions varied among diagnoses, and certain diagnoses were likely to occur together.

Digestive symptoms and their psychosocial impact: validation of a questionnaire

OBJECTIVE

Questionnaires evaluating digestive symptoms and their psychosocial impact have not been extensively validated in Norwegian populations. In this study a self-administered questionnaire developed in Norway is evaluated for this purpose.

MATERIAL AND METHODS

The questionnaire, the Digestive Symptoms and Impact Questionnaire, DSIQ, was developed by a cooperative group of general practitioners and gastroenterologists. The DSIQ contains 18 similarly structured global-type questions focusing on the patient's own judgement. The validation was based on 567 patients with dyspeptic symptoms or reflux symptoms referred to gastroscopy from general practice.

RESULTS

Eighty percent of the patients responded to all the questions. All response categories were used for all questions. Factor analysis revealed 4 subscales: abdominal pain and bowel symptoms; gastric dysfunction; health impairment and impairment of everyday life. A question about reflux symptoms was retained as a subscale on its own. Overall score was established by calculating the mean of all question responses. Test-retest reliability in stable patients (intraclass correlation coefficient, range 0.80- 0.91) and internal consistency reliability (Cronbach's alpha, range 0.65-0.91) were satisfactory. Criterion validity was supported by significant correlations to patients' globally estimated quality of life and the General Health Questionnaire (GHQ-30). Responsiveness in spontaneously improved patients or patients given effective treatment ranged from moderate to highly responsive (responsiveness statistic range from 0.54 to 2.83).

CONCLUSIONS

The DSIQ is a self-administered, simple and well-validated method for evaluating digestive symptoms and their psychosocial impact. The DSIQ shows satisfactory internal consistency reliability, test-retest reliability, responsiveness and criterion validity.

[Internet use to obtain health information among patients attending a digestive diseases office]

INTRODUCTION

The use of the Internet to gain health information has increased in Spain. This is changing the way patients access medical information and, in turn, the physician-patient relationship.

OBJECTIVES

To analyze the use of the Internet for medical purposes by patients attending a digestive diseases office and to determine the profile of patients seeking this information.

MATERIAL AND METHODS

A questionnaire was administered to consecutive patients attending a general digestive diseases office for the first time.

RESULTS

Four hundred twenty-three patients completed the questionnaire (56% women, 44% men, mean age 42.63 [15.994] years). A total of 2.4% had only not completed basic education, 14% had completed basic education, 32.8% had completed high school, 50.6% had university degrees, and 0.2% did not answer. More than three-quarters (76.4%) had a computer at home and 72% had internet access. Forty-two percent looked for health information on the internet. Seventeen percent had searched for specific information on their illnesses before consulting and 66% believed the internet is a good resource for obtaining medical information. Seventy percent would be interested in a specific web page on digestive disease topics and 75% would use e-mail to consult with their physicians. The group that most frequently looked for medical information consisted of patients aged 45 years or younger with secondary school or university education.

CONCLUSIONS

In our environment, patients with digestive diseases routinely use the Internet to search for medical information. These patients have a high degree of confidence in the information obtained and would be interested in a specific website devoted to diseases of the digestive system. The patients that most frequently searched for health information were aged less than 45 years old and had secondary school education or university degrees.

School and leisure activities in adolescents and young adults with chronic digestive disorders: Impact of burden of disease

First, we compared the nature of burden of disease (i.e., manifestations of the disease in daily life) in adolescents and young adults with various chronic digestive disorders with controls. After that, we investigated whether burden of disease is associated with difficulties in school and leisure activities of adolescents and young adults with various digestive disorders. For this purpose, we performed a multicenter study in 5 diagnostic groups (total N = 758; ages 12 to 25 years) including inflammatory bowel diseases (IBD), chronic liver diseases, congenital disorders, celiac disease, and food allergy and a population based control group (N = 306) using a self-report questionnaire. Especially adolescents and young adults with a chronic liver disease, IBD, and food allergy were found to experience daily manifestations of their disease. Several disease burden characteristics, of which especially depression, could be identified as important contributors to difficulties in school performance and leisure activities.

Improving the quality of life of patients with prostate carcinoma

BACKGROUND

Treatments for clinically localized prostate carcinoma are accompanied by sexual, urinary, and bowel dysfunction and other sequelae that can result in significant distress and reduced well being. Methods capable of improving quality of life are needed that can be integrated into clinical practice. To address this need, a nurse-driven, cancer care intervention was developed and tested.

METHODS

Within 6 weeks after completing treatment, 99 patients, along with their partners, were enrolled into a prospective, controlled trial and were randomized to receive the cancer care intervention or to receive standard care. Participants in the intervention arm met once each month for 6 months with an oncology nurse intervenor, who helped patients identify their quality-of-life needs using an interactive computer program. The intervener then provided education and support tailored to participants' needs. Primary outcome variables included 1) disease-specific quality of life, including sexual, urinary, and bowel outcomes and cancer worry; 2) depression; 3) dyadic adjustment; and 4) general quality of life. Outcomes data were collected prior to randomization and again at 4 months, 7 months, and 12 months posttreatment.

RESULTS

Patients in the intervention arm experienced long-term improvements in quality-of-life outcomes related to sexual functioning and cancer worry compared with patients who received standard care. Baseline depression moderated the impact of the intervention on several other quality-of-life outcomes.

CONCLUSIONS

The findings of the current study indicated that a computer-assisted, nurse-driven intervention was capable of providing durable improvements in the quality of life of men who underwent treatment for clinically localized prostate carcinoma.

Perioperative music therapy with a key-lighting keyboard system in elderly patients undergoing digestive tract surgery

BACKGROUND/AIMS

It is important to minimize the perioperative mental dysfunction of elderly patients undergoing surgery and to avoid lowering their coping skills postoperatively. Music therapy for digestive tract surgery has yet not been explored.

METHODOLOGY

We evaluated perioperative music therapy using a simple key-lighting keyboard system in 37 elderly patients who underwent digestive tract surgery (Group A) compared with 13 patients who were not applied music therapy (Group B).

RESULTS

On the first day after surgery there were no general hemodynamic changes after music therapy. There were no significant changes in the Philadelphia Geriatric Center morale scale and the Yesavage depression scale between the day before surgery and 7 POD in both groups. The self-assessed visual analogue health scale and the number connection test worsened significantly from 58.9+/-14.6 and 159+/-47 to 42.3+/-14.6 and 199+/-51 (p<0.05), respectively, over this time in Group B, but it did not worsen significantly in Group A. The happiness score increased significantly from 3.9+/-1.1 to 4.6+/-1.2 (P<0.05) over this time in Group A, but it did not increase significantly in Group B.

CONCLUSIONS

We conclude that the music therapy with a key-lighting keyboard system in elderly patients does not change postoperative hemodynamics and helps to maintain perioperative mental functioning.

[Using psychotropic phytotherapy in gastroenterology]

This review contains up-to-date information about the use of adaptogenic, tonic, sedative, antidepressant phytopreparations in case of personal and vegetative dysfunctions in patients with functional disorders and organic pathologies of the digestive system.

Social position of adolescents with chronic digestive disorders

OBJECTIVE

To investigate the consequences of having a chronic digestive disorder on the social position of adolescents.

METHODS

Five diagnostic groups, including inflammatory bowel disease (IBD), chronic liver diseases, congenital digestive disorders, coeliac disease and food allergy (total n = 758, ages 12-25 years), were each compared with a population-based control group in a multicentre study using a cross-sectional design. Social position was assessed by a mailed questionnaire measuring 24 aspects, categorized as education, leisure activities, friendship, labour participation, financial situation, partnership and sexuality.

RESULTS

Eight aspects of social position were found to be affected negatively by one or more chronic digestive diseases: absence from school due to illness, going out, having a paid job, needing re-education in order to get a job, getting benefits as main income source, encountering bottlenecks in establishing financial commitments, having self-confidence in making a pass at someone, and restrictions in making love. Adolescents with chronic liver disease and IBD were found to experience more restrictions in social position. Adolescents with food allergy and congenital digestive disorders appear to experience some restrictions, but to a lesser degree, and adolescents with coeliac disease do not appear to have any problems regarding social position compared with controls.

CONCLUSION

The social position of adolescents is affected negatively by having a chronic digestive disease, in particular chronic liver disease and IBD. Negative consequences occur in education, leisure activities, labour participation, financial situation, partnership and sexuality.

Comorbid depressive symptomatology: isolating the effects of chronic medical conditions on self-reported depressive symptoms among community-dwelling older adults

Advances in medical technology and surgical knowledge have greatly extended the life expectancy of older individuals with chronic disabilities. Among the older adult population the prevalence of comorbid chronic illness and depressive symptoms has often been investigated. Yet there continues to be a lack of understanding about the consequences of specific chronic illnesses on depressive symptoms. Using cross-sectional data while simultaneously controlling the effects of various socioenvironmental, demographic, and other factors, this study analyzed the prevalence of self-reported depressive symptoms in relation to chronic illness. The cumulative effect of medical comorbidity and the specific effect of individual chronic illnesses were examined. The sample consisted of 359 older white Americans aged 55-93. Overall, the findings show that self-reports of depressive symptoms were greater among those individuals who also reported digestive disorders, respiratory ailments, and heart problems. These results suggest that for older white Americans these three chronic conditions may present a greater mental health burden than other chronic illnesses.

[Psychosomatics in gastroenterology]

Never before has the correlation between psychosocial factors and digestive diseases or disorders been studied more intensively than in the past decade. The following article will provide you with a survey of the major studies, functional gastrointestinal disorders, gastroesophageal reflux disease, peptic ulcer and chronic inflammatory bowel diseases taking into account psychosocial factors. The biopsychosocial model is a remarkable step forward in the process of learning more about these diseases, The integrated way of looking at biological, psychological and social factors has become an absolute must for those who want to fully understand the development and the severity of symptoms as well as diagnostics and therapy of these disorders.

[The characteristics of the clinical picture and of the psychotherapy of somatogenically induced neurosis-like disorders in people subjected to ionizing radiation exposure as a result of the accident at the Chernobyl Atomic Electric Power Station]

In a 10-year follow-up the time-related course was studied of neurosis-like disorders in those subjects presenting with digestive abnormalities. The group of examinees was 108 patients--liquidators of the Chernobyl accident who had come to be exposed to the doses of irradiation of the order of 0.7 Gy and higher, persons who had suffered acute radiation sickness. Rise in morbidity is shown. Some principles are suggested of devising rehabilitation measures together with therapeutic ones aimed to correct somatic disorders presenting with concurrent psychoneuronal type problems.

[Acute gastroduodenal lesions and stress]

Haemorrhagic gastroduodenitis together with complicated peptic ulcer, are--after trauma--the most common causes of urgent admission in hospital for young people. In the present paper the Authors deal with the role of emotional disturbances, generated by environmental stress, in the pathogenesis of many gastrointestinal diseases in the young. They observed a rise in the incidence of gastroduodenal pathology (especially of the erosive-haemorrhagic form) in young males during military service. So they hypothesized that such high incidence of acute GDD during military service, could be attributed to abrupt changes in lifestyle, generating a significant environmental stress. The results of a clinical study on 65 young conscripts out of 483 who underwent EGDS for acute digestive symptoms also tested for psychological evaluation to stress response, are reported. In the 60.7% of all patients, MMPI (Minnesota Multiphasic Personality Inventory) test showed pathological alterations. Correlating the pathological findings with MMPI results, the Authors found that the 25% of patients suffering from oesophagitis, the 36.3% of those with peptic ulcers, the 68% of aspecific gastroduodenitis and the 75% of erosive-haemorrhagic gastroduodenitis, had psychological disturbances. The study shows that GDD in the young is a very frequent pathology, which may be triggered off by abrupt changes in life style, especially in those patients who are unable to react positively to changes in the outer world. GD pathology arises most frequently during the first five months of military service, especially within the third and the fourth month. The Authors conclude that a correct management of GDD in the young needs a versatile approach based on EGDS to establish the correct diagnosis, and on psychopathological investigations.

Sexual abuse is more frequently reported by IBS patients than by patients with organic digestive diseases or controls. Results of a multicentre inquiry. French Club of Digestive Motility

OBJECTIVES

The aim of this multicentre inquiry was to evaluate the prevalence of sexual abuse among IBS patients consulting a gastroenterologist, in comparison to healthy controls and patients with organic digestive diseases.

PATIENTS AND METHODS

Patients with irritable bowel syndrome (IBS; Rome Criteria) were included by eight university hospitals (n = 196; 41.2 +/- 20.6 years; sex ratio (M/F) = 0.23). Control groups were: (i) patients consulting for the follow-up of non-neoplastic organic digestive diseases (n = 135; 41.5 +/- 17.0 years; 1.21); (ii) patients attending ophthalmology units (n = 200; 43.8 +/- 20.7 years; 0.81); (iii) healthy subjects seen in centres of the National Health System (n = 172; 40.3 +/- 16.3 years; 0.83). Each patient filled in an anonymous questionnaire, without help. Prevalence of sexual abuse in the various groups was compared by the chi 2 test.

RESULTS

Sixty-two instance of sexual abuse (55 females, 7 males) were recorded among the 196 IBS patients (31.6%); 8 cases of verbal aggression, 4 of exhibitionism, 11 of sexual harassment, 22 sexual touches, 17 rapes. The prevalence of sexual abuse was 14.0% for the patients with organic digestive diseases (P = 0.0005 vs. IBS), 12.5% among ophthalmology patients (P < 0.0001) and 7.6% in healthy controls (P < 0.0001). Sexual abuse was accompanied by physical abuse in 23 IBS patients and 19 patients from control groups (not significant). Twenty-six IBS patients reported isolated physical abuse (14.7%) versus 40 from control groups (8.8%; P = 0.041). There was a significant trend towards more severe attacks of abuse among IBS patients than in others.

CONCLUSION

This study confirms the high prevalence of sexual abuse among IBS patients consulting in Gastroenterology. Some of these patients would benefit from appropriate therapy. (In the majority of cases, this will be psychotherapy.)

[The characteristics of the psychoautonomic status of patients with chronic combined diseases of the digestive organs]

Studied with the aid of the variational pulsimetry, adapted Lüscher's [correction of Leucher's] colour test, were the functional state of the vegetative nervous system, vegetative homeostasis, psycho-emotional state during both exacerbation and clinical remission of associated digestive diseases. Overall forty six children aged 11-14 were examined. The children were found out to be unlike in respect of the vegetative homeostasis. A contingent was identified with their compensatory and adaptive mechanisms failing to work adequately, and showing inability to react in an operative manner, high level of anxiety, emotional stress, psychic fatigue. Note is taken of the fact that in clinical remission the above parameters fail to return to normal whereupon an approach tailored to the individual is warranted toward treatment of the primary disorder to prevent relapse and chronization of the morbid process.

[Functional diseases of the digestive organs]

In this lecture the authors analyze so-called functional disease of the digestive organs, namely disorders of these organs where modern means are unable to reveal organic changes. The role of emotional and psychic factors on functions of the digestive tract and its blood supply is stressed. From 30 to 50% of gastroenterological patients suffer of functional diseases of the digestive organs. Women prevailed (3:1, 2:1). The etiology, diagnosis and treatment of this condition is described in detail.

An Inventory of Positive Psychological Attitudes with potential relevance to health outcomes: validation and preliminary testing

This article describes the validation of an Inventory of Positive Psychological Attitudes that has potential relevance to health outcomes and its preliminary testing with chronic pain patients. The inventory taps two attitudinal domains: (1) life purpose and satisfaction and (2) self-confidence during potentially stressful situations. It also provides a total score. The inventory scales, developed using factor analysis, were found to have a strong degree of internal reliability and concurrent validity. Preliminary testing suggested that positive change on these scales correlates with positive changes in the health status of chronic pain patients. Multiple regression analyses suggested that the interactions of these positive psychological attitudes with health status are not fully accounted for by the interactions of negative psychological attitudes with health status.

[Sulpiride (Eglonyl Alkaloid) in the treatment of functional disorders of the digestive tract]

Sulpirid was administered in an open clinical trial--150 mg/day for 4 weeks--to 31 patients (15 man and 16 women, mean age 31.5 years, mean duration of complaints 1 month to 6 years) suffering from functional disorders of the digestive system. Their health status was evaluated by a specialist in internal medicine, by a psychiatrist and a self-administered SCL-90 questionnaire before the onset of treatment and after four weeks. In 29 patients the complaints disappeared or improved markedly and this improvement persisted also after discontinuation of the drugs. In the entire group a significant drop of the mean initial intensity of psychopathological feature in all dimensions of the questionnaire occurred; the improvement was more marked in men where the mean baseline values of psychopathology were higher. There was also a significant decline of the mean numbers of positively evaluated items in 9 of 10 dimensions of the questionnaire. The drug was well tolerated by the patients with the exception of one transient allergic skin reaction. So far the exact ratio of improvement of psychopathology as a therapeutic response to sulpirid administration and the placebo effect on the patient's complaints cannot be exactly evaluated. Sulpirid has some advantages, as compared with other psychopharmaceutic preparations used in this indication (e.g. amitriptyline, dosulepine).

[The role of mental and social factors in the development of digestive organ diseases in young people]

An epidemiological examination carried out in 586 persons (age: 14-20 years) with consideration of psychosocial factors allowed to distinguish a group of social risk (385 (persons). Prophylactic and therapeutic measures in 84 persons during the prodromal stage of digestive diseases allowed to prevent or delay in most cases development of this pathology.

[Acute surgical diseases and injuries of the abdominal organs in mentally ill patients]

The work analyses the results of treatment of acute surgical diseases and traumas of the abdominal organs in 84 patients 18 to 81 years of age suffering from various mental disorders. Schizophrenia was encountered in 47 patients, the manic-depressive syndrome in 16, epilepsy in 8, reactive psychosis in 8, and senile psychosis in 5 patients. Among 66 patients who were admitted for suspected acute surgical disease of the abdominal organs, in 54 the diagnosis was confirmed. Operation was conducted on 59 of them. Eighteen patients had an abdominal trauma. Fourteen patients were operated on for closed (2) and open (12) abdominal injury. All in all 73 patients were treated by operation. Eight patients died. The causes of death were peritonitis and intoxication (4), thromboembolism of the pulmonary artery (1), acute cardiovascular insufficiency (2), and pulmonary edema (1). The peculiarities of the diagnosis and postoperative management of these patients are discussed.

Anamnestic and psychological features in diagnosis and prognosis of functional abdominal complaints: a prospective study

Psychological and anamnestic data from 308 patients were collected to investigate whether patients with abdominal complaints from organic causes could be distinguished psychologically or by their case histories from patients with functional abdominal complaints. Two years later the same patients took part in a follow up study. Only 9% of the patients with functional abdominal complaints became symptom free. Most variables showed no significant difference between the organic and the functional group. The most important variables with predictive value were psychological factors, factors associated with the severity and factors associated with the duration of the complaints.

[Psychological aspects of diet therapy of children and adolescents suffering from digestive system diseases]

Clinicopsychological investigations of 361 patients, aged from 6 to 17 years, suffering from diseases of the gastrointestinal tract, have revealed in 60.7% of them negative psychological attitude to the dietotherapy they received. Among children and adolescents with concomitant neurotic disorders such attitude was noted in 79.6%. A system of special measures has been developed including three main elements: 1) psychotherapeutic mediation of dietotherapy before its administration and in the process of the therapy; 2) creation of the psychologic attitude to the diet adherence; 3) alteration of the patient's taste stereotype. Realization of such measures has been conducive to higher effectiveness of the dietotherapy.