Brain imaging of visceral functions in healthy volunteers and IBS patients

From experience, most people know about a link between psychological processes and gastrointestinal sensory and motor functions. Cognitive processes (e.g., attention) as well as affective processes (e.g., fear) play a role in gastrointestinal sensations in healthy controls and patients with irritable bowel syndrome (IBS) alike. However, the exact nature of this relationship has not been completely understood yet. Brain imaging techniques allow for the study of brain-gut interactions in vivo. Accordingly, positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) have been widely used to study neural mechanisms underlying visceral sensations. This article will summarize the results of functional brain imaging studies in healthy controls and selected studies assessing the influence of psychological processes on gastrointestinal functions. Subsequently, this article will deal with those brain areas activated by visceral stimulation in IBS patients. Special attention will be paid to recently published studies concerning psychological factors and novel research questions.     

糖尿病前期患者焦虑现状调查及影响因素分析

背景　中国目前可能有多达1.139亿成年人糖尿病患者,近5亿糖尿病前期患者,而糖尿病患者伴发焦虑的患病率为40%,远高于健康人群。但是,目前关于糖尿病前期患者焦虑的研究较少。目的　通过对糖尿病前期患者焦虑情绪的调查分析,明确糖尿病前期患者焦虑现状,分析其影响因素,为糖尿病前期患者的心理干预提供科学依据。方法　选取2015年3—9月于江西省人民医院内分泌科门诊或体检科体检行口服葡萄糖耐量试验（OGTT）检查并筛查出的糖尿病前期患者100例为研究对象,使用自编一般情况调查表及焦虑自评量表（SAS）对其进行问卷调查,并进行临床指标检测。按照SAS评分结果将其分为非焦虑组与焦虑组,比较两组间的差异,采用多因素Logistic回归分析糖尿病前期患者焦虑的影响因素。结果　共发放问卷100份,回收有效问卷100份,有效回收率为100.0%。100例糖尿病前期患者中,焦虑组22例（22.0%）,其中轻度焦虑20例（90.9%）,中度焦虑2例（9.1%）,非焦虑组78例（78.0%）。两组患者家庭月收入、体质指数（BMI）比较,差异均有统计学意义（P<0.05）。糖尿病前期患者焦虑与家庭月收入（rs=-0.256）呈负相关（P<0.05）,与性别（rs=0.026）、年龄（rs=-0.160）、文化程度（rs=0.100）、医疗保险类型（rs=0.140）、BMI（rs=0.142）、吸烟（rs=0.095）、饮酒（rs=0.027）、颈动脉硬化（rs=0.167）、下肢动脉硬化（rs=0.077）、糖尿病家族史（rs=0.049）、高血压（rs=0.061）、高脂血症（rs=0.032）、空腹血糖（FPG）（rs=0.122）、餐后2 h血糖（2 hPG）（rs=0.034）、糖化血红蛋白（HbA1c）（rs=0.121）无直线相关关系（P>0.05）。多因素Logistic回归分析结果显示,家庭月收入〔OR=1.636,95%CI（1.010,2.648）〕是糖尿病前期患者焦虑的影响因素（P=0.045）。结论　糖尿病前期患者普遍存在焦虑情绪,家庭月收入是影响其情绪的主要因素。因此,临床工作中应重视经济条件相对较差的患者群体,加强早期筛查并尽早行干预措施。     

Emotional Vitality: Concept of Importance for Rehabilitation

Objectives

To (1) provide a framework for the conceptualization of emotional vitality as an important construct for rehabilitation professionals; (2) outline the existing scope and breadth of knowledge currently available regarding the definition and measurement of emotional vitality in persons with chronic health conditions; and (3) identify the extent to which the components can be mapped to the International Classification of Functioning, Disability and Health (ICF).

Design

Activities included a scoping review of the literature, and a Delphi mapping exercise using the ICF.

Setting

Not applicable.

Participants

Not applicable.

Intervention

Not applicable.

Main Outcome Measure

Not applicable.

Results

The results of this study suggest that emotional vitality is a complex latent construct that includes (1) physical energy and well-being, (2) regulation of mood, (3) mastery, and (4) engagement and interest in life. Existing literature supported the presence of all 4 components of the construct. The mapping exercise showed that 3 of these components could be readily mapped to the Body Function chapter of the ICF (energy, mood, mastery).

Conclusions

Emotional vitality may influence both the physical and emotional adaptation to living with a chronic illness or disability and should be included in both assessment and treatment planning to optimize rehabilitation outcomes. Future research is needed to refine the definition and identify optimal methods of measuring this construct.     

Emotional modulation of muscle pain is associated with polymorphisms in the serotonin transporter gene

The perception of pain is determined by a combination of genetic, neurobiological, cultural, and emotional factors. Recent studies have demonstrated an association between specific genotypes and pain perception. Particular focus has been given to the triallelic polymorphism in the promoter region of the serotonin transporter gene in relation to pain perception. The aim of this study was to investigate whether the modulatory effect of emotions mediated by visual stimuli on muscular pain perception is genotype dependent. A total of 150 healthy subjects were selected on the basis of their polymorphism in the serotonin transporter gene. First, visual conditioning was performed with positive, negative, and neutral pictures from the International Affective Picture System, and the unpleasantness/pleasantness of the pictures was rated. Second, visual conditioning stimuli were presented while experimental jaw muscle pain was evoked by injection of hypertonic saline into the masseter muscle, and participants continuously rated pain intensity on an electronic visual analogue scale. The pictures induced similar changes in emotions across the 3 genotype groups, and hypertonic saline evoked moderate pain levels in all participants. However, in participants with a high expression of the serotonin transporter protein, conditioning with negative pictures increased pain intensity and positive pictures decreased pain intensity when compared with neutral pictures. In contrast, there were no significant effects of the pictures on pain perception in participants with either intermediate or low expression of the protein. These results suggest that polymorphisms in the serotonin transporter gene play an important role in emotions modulation of muscle pain.     

The effect of challenge and threat states on performance: An examination of potential mechanisms

Challenge and threat states predict future performance; however, no research has examined their immediate effect on motor task performance. The present study examined the effect of challenge and threat states on golf putting performance and several possible mechanisms. One hundred twenty‐seven participants were assigned to a challenge or threat group and performed six putts during which emotions, gaze, putting kinematics, muscle activity, and performance were recorded. Challenge and threat states were successively manipulated via task instructions. The challenge group performed more accurately, reported more favorable emotions, and displayed more effective gaze, putting kinematics, and muscle activity than the threat group. Multiple putting kinematic variables mediated the relationship between group and performance, suggesting that challenge and threat states impact performance at a predominately kinematic level.     

Antenatal counselling for parents facing an extremely preterm birth: limitations of the medical evidence

When physicians are asked for a consult for women in premature labour, they face a complex set of challenges. Policy statements recommend that women be given detailed information about the risks of various outcomes, including death, long-term disability and various specific neonatal problems. Both personal narratives and studies suggest that parents also base their decisions on factors other than the probabilistic facts about expected outcomes. Statistics are difficult to understand at any time. Rational decision-making may be difficult when taking life-and-death decisions. Furthermore, the role of emotions is not discussed in peri-viability guidelines. CONCLUSION: We argue against trying to tell parents every fact that we think might be relevant to their decision. This may be overwhelming for many parents. Instead, doctors should try to discern, on a case-by-case basis, what particular parents want and need. Information and delivery of information should be personalized. Unfortunately, evidence in this area is limited.     

The emotional and cognitive impact of the unexpected death in the simulation lab

IntroductionThe impact of animal death on surgeons during training in laparoscopic techniques is unknown.MethodsEmotions and cognitive load were assessed depending on animal survival.ResultsThose exposed to animal death (n = 14) had higher levels of sadness (1.3) and anxiety (2.4), and lower levels of happiness (6.1) on a one-to-ten scale, compared to the 56 that were non-exposed (1.0/2.0/7.5). Mean cognitive load was 68.21 ± 12.865 in the exposed and 64.74 ± 14.632 in the non-exposed (p > 0.05).ConclusionsEmotions and cognitive load among surgeons training in laparoscopic techniques were similar, regardless animal survival after the surgical procedure.     

Cancer patients' expressions of emotional cues and concerns and oncology nurses' responses, in an online patient-nurse communication service

Objective

To (1) investigate emotional cues and concerns (C&;C) of cancer patients expressed in e-mail communication with oncology nurses in an online patient–nurse communication service (OPNC), and (2) explore how nurses responded to patients’ C&;C.

Methods

283 e-messages sent from 38 breast and 22 prostate cancer patients and 286 e-responses from five oncology nurses were coded with the Verona Coding Definitions of Emotional Sequences.

Results

We identified 102 cues and 33 concerns expressed in patients’ messages. Cues indicating expression of uncertainty or hope, occurred most frequently (in 38.5% of messages), followed by concerns (in 24.4% of messages). Nurses responded to 85.2% of patients’ C&;Cs; more than half of patients’ C&;Cs were met with a mixture of information giving and empathic responses.

Conclusion

Patients with breast and prostate cancer express many C&;C in e-mail communications with oncology nurses, who demonstrated satisfactory sensitivity to patients’ emotions in their responses to patients.

Practice implications

Offering e-communication with oncology nurses to cancer patients is a promising and feasible supplement to usual care to address and relieve patients’ concerns and emotional distress during illness and recovery.