Being active or flexible? Role of control coping on quality of life among patients with gastrointestinal cancer

Objectives: This study examined the link between coping and quality of life among patients with gastrointestinal (GI) cancer. Two hypotheses were tested. The active‐personality hypothesis states that quality of life is associated with the predominant use of primary control coping (PCC) in general. The situational‐flexibility hypothesis states that quality of life is related to flexible deployment of PCC and secondary control coping (SCC) according to situational controllability. Methods: Participants were 180 Chinese adult patients diagnosed with colon or liver cancer. Their perceived controllability of stressors, coping, and quality of life were compared with those of a sex‐and age‐matched community sample. Results: Three groups with distinct coping patterns were identified: (a) a flexible group characterized by the use of PCC in controllable situations but SCC in uncontrollable situations, (b) an active group characterized by predominant use of PCC in most situations, and (c) a passive group characterized by predominant use of SCC or avoidant coping in most situations. Patients in the active and the flexible groups had higher perceived controllability and psychological well‐being scores than those in the passive group. Conclusions: Our results provide support for both the active‐personality and the situational‐flexibility hypotheses among GI cancer patients. Clinical and research implications of the findings are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

The effects of regular consumption of short-chain fructo-oligosaccharides on digestive comfort of subjects with minor functional bowel disorders

A comparative, randomised, double-blind trial was performed in the medical departments of five hospitals to study the effects of regular consumption of short-chain fructo-oligosaccharides (sc-FOS) on the digestive comfort of subjects with minor functional bowel disorders (FBD). In step 1, 2235 subjects were questioned to assess the incidence and intensity of digestive disorders. In step 2, 105 of these patients diagnosed with minor FBD were randomised into two groups to receive either 5 g sc-FOS or 5 g placebo (sucrose and maltodextrins) per d over a 6-week period. The incidence and intensity of digestive disorders were assessed at the end of the treatment period (day 43) using the step 1 questionnaires. A quality-of-life questionnaire was also completed at the start and end of the treatment period to assess potential effects on well-being and social performance. In step 1, 44 % of the subjects questioned presented FBD, of whom 57.1 % suffered from minor FBD. In step 2, on day 43, the intensity of digestive disorders decreased by 43.6 % in the sc-FOS group v. a 13.8 % increase in the placebo group (P = 0.026). Symptoms were experienced less frequently by 75.0 % of subjects in the sc-FOS group, while 53.8 % of controls experienced no change (P = 0.064). Using the functional digestive disorders quality of life questionnaire, the discomfort item scores increased in the sc-FOS group (P = 0.031). However, expressed as change in quality of life (improvement, worsening or unchanged), daily activities were significantly improved in the sc-FOS group (P = 0.022). Regular consumption of sc-FOS may improve digestive comfort in a working population not undergoing medical treatment.     

Pectus deformities: a review of open surgery in the modern era

Pectus deformities represent a spectrum of relatively common congenital chest malformations. The adoption of less invasive techniques has renewed interest in surgical repair by both patients and clinicians. The aim of this review is to identify current management, outcomes, and controversy in the treatment of pectus excavatum and pectus carinatum.     

Inherited renal tubular dysgenesis: the first patients surviving the neonatal period

Renal tubular dysgenesis (RTD) is a clinical disorder either acquired during fetal development or inherited as an autosomal recessive condition. Inherited RTD is caused by mutations in the genes encoding the components of the renin-angiotensin system angiotensinogen, renin, angiotensin-converting enzyme and angiotensin II receptor type 1. Inherited RTD is characterized by early onset oligohydramnios, skull ossification defects, preterm birth and neonatal pulmonary and renal failure. The histological hallmark is the absence or poor development of proximal tubules. So far, all patients died either in utero or shortly after birth. We report the first patients with inherited RTD surviving the neonatal period and still being alive. Genetic and functional analysis of the renin-angiotensin system contributes to the diagnosis of RTD. In conclusion, the clinical diagnosis of inherited RTD is easily missed after birth without renal biopsy or information on affected family members. Genetic and functional analysis of the renin-angiotensin system contributes to correct diagnosis.     

Disentangling the effects of racial and weight discrimination on body mass index and obesity among Asian Americans

Objectives. We examined whether racial discrimination is associated with increased body mass index (BMI) and obesity among Asian Americans. Further, we explored whether this association strengthens with increasing time in the United States.Methods. We analyzed data from the 2002 to 2003 National Latino and Asian American Study (n=1956). Regression models tested whether reports of racial discrimination were associated with BMI and obesity, after accounting for weight discrimination, age, gender, marital status, ethnicity, generation, employment, health status, and social desirability bias (the tendency to seek approval by providing the most socially desirable response to a question).Results. We found that (1) racial discrimination was associated with increased BMI and obesity after we controlled for weight discrimination, social desirability bias, and other factors and (2) the association between racial discrimination and BMI strengthened with increasing time in the United States.Conclusions. Racial discrimination may be an important factor related to weight gain among ethnic minorities.Stress caused by disadvantaged social status may be related to obesity. Two elements provide the foundation for this observation. First, stress may have adverse physiological consequences, including increased risk for obesity and allostatic load, the “wear and tear” on organ systems that contributes to health problems.1 Stressors activate the hypothalamic–pituitary–adrenal axis system, releasing cortisol and other glucocorticoids. Glucocorticoids may stimulate appetite and blunt the satiety system.2 Cortisol increases fat retention, particularly in the abdominal region.3 Moreover, stressors may selectively increase the intake of “comfort foods” over other foods among humans and other animals.4^,5Stress may also be related to abdominal and general obesity. Daily stress,6 anxiety,7 and depressed mood8^,9 are related to visceral obesity. Among monozygotic twins, stress-induced hormonal changes result in greater intra-abdominal fat deposits in the twin with higher stress.10 Further, obesity, indicated by a high body mass index (BMI), has been associated with work stress11^,12 and early childhood trauma.13 In a prospective study of British civil servants, job stress was associated with metabolic syndrome (a group of risk factors that includes abdominal obesity, elevated blood pressure, and atherogenic dyslipidemia)8 and general and visceral obesity.12Second, social disadvantage, such as experiences with racial discrimination, may produce stress.14 Self-reported discrimination appears to be related to several stress-related and obesity-related outcomes, including high blood pressure,15 depression and anxiety,16 sleep problems,17 and coronary calcification.18 Individuals may also use alcohol to cope with discrimination,19^–21 and alcohol can contribute to obesity.22 Hence, discrimination may directly produce weight gain by activating the stress system and by influencing behavior change. Discrimination also may act indirectly by hindering socioeconomic advancement23^,24 and by segregating individuals into communities with fewer healthy food options25^,26 and fewer safe places for physical activity.27^,28Consistent with these observations, several studies have suggested that discrimination is associated with weight gain and metabolic problems. Tull et al. found that reports of internalized racism were associated with greater obesity among women in Barbados.29 Similarly, Chambers et al. found associations between internalized racism and insulin resistance among girls in Barbados.30 Butler et al. found associations between internalized racism and greater waist circumference and higher fasting glucose among Dominica women.31We tested the first hypothesis that reports of discrimination are associated with higher BMI and the risk of obesity and build on previous research in 3 primary ways. First, overweight people may encounter weight discrimination,32 and associations between racial discrimination and weight might therefore be confounded by weight discrimination. To reduce the chance of spurious findings, we controlled for weight discrimination and other factors.Second, we examined whether findings from Black populations generalize to Asian Americans. Among Asian Americans, discrimination is associated with outcomes related to obesity, including cardiovascular conditions,33^,34 depression,35^–37 and substance use,19 but no study has directly examined whether discrimination is associated with BMI and obesity in this population.Third, we tested the main effects of discrimination and investigated whether discrimination is moderated by time spent in the United States. US-born Asians appear to have higher rates of obesity than their foreign-born counterparts, but the rates of obesity among the foreign born increase with years in the United States.38^–40 Additionally, immigrants often report less racial discrimination than do nonimmigrants, but reports of discrimination increase with years spent in the United States, perhaps because immigrants are more likely to encounter and recognize discrimination over time.41^–43 A recent study found that among African and Latino immigrants, the association between racial discrimination and mental health strengthened with increasing time in the United States.44 These observations motivate the second hypothesis that time spent in the United States will interact with the association between racial discrimination, such that the association between racial discrimination and BMI among immigrant Asians will strengthen with increasing time spent in the United States.