The relationship between body image disturbance and distress in colorectal cancer patients with and without stomas

Objective

This study aimed to investigate the effect of having a stoma on body image in patients with colorectal cancer and to determine whether disturbances in body image predicted distress.

Methods

A prospective analysis of 79 colorectal cancer patients. Patients were assessed within 9 weeks of surgery and followed up at the end of adjuvant treatment. Body image disturbance, depressive symptoms, anxiety, and general distress were measured at baseline and follow-up.

Results

Patients who received stomas had poorer body image, which worsened over time. Although there were no differences between stoma groups on anxiety or depressive symptoms, those with a late stoma were most depressed. Body image was a strong predictor of initial levels of anxiety, depression, and distress and subsequent anxiety and distress.

Conclusions

These results confirm that stomas negatively impact on the body image of patients with colorectal cancer. Importantly, those whose body image is most disturbed are at risk for experiencing more anxiety and depression. These results underscore the importance of assessing and treating body image disturbance in colorectal patients who receive a stoma.     

莫沙必利分散片治疗餐后不适综合征的近期疗效观察

背景：餐后不适综合征（PDS）是临床常见的功能性胃肠病,胃肠动力障碍为其重要病理生理机制之一。莫沙必利是一种胃肠促动力药．已用于胃肠动力障碍的治疗。目的：观察莫沙必利分散片治疗PDS的近期疗效。方法：60例符合罗马mPDS诊断标准的患者随机分成M组（接受铝碳酸镁1000mg加莫沙必利分散片5mg tid治疗）和P组（接受铝碳酸镁1000mg加安慰剂tid治疗）。疗程均为2周。于治疗前后行患者总体PDS症状评分并检测胃排空功能。结果：两组治疗后总体PDS症状评分较治疗前均显著降低（P〈0．001）,其中M组评分又显著低于P组（P〈0．01）。M组治疗有效率为83．3％,显著高于P组（40．0％）（P〈0．001）。两组治疗前胃3h排空钡条数无明显差异,均显著少于正常对照组（P〈0．001）。M组治疗后胃排空钡条数较治疗前和P组治疗后显著增多（P〈0．001）,P组治疗后与治疗前相比则无明显差异。结论：莫沙必利分散片能明显改善PDS患者的胃排空功能,对缓解餐后饱胀和早饱症状近期疗效满意。     

Symptom perception in CHF: (why mind matters)

Symptoms utilized in the clinical care of heart failure as markers of disease severity include, dyspnea, insomnia, low energy, fatigue, poor appetite, and diminished memory. This is despite the fact that physiologic variables such as cardiac ejection fraction and oxygen consumption do not accurately predict functional state in individuals with congestive heart failure (CHF). Distress (anxiety and depression) may amplify symptom complaints without associated physiologic aberration. Personality traits and psychiatric illness, such as mood, anxiety, and psychotic illnesses may also alter perception of somatic symptoms that are associated with this chronic illness. The impact of distress and its treatment on functional performance and CHF symptom reporting deserve additional attention. The need to screen for distress in all with serious symptomatic heart failure is certain.

Cell mediated immunity to meet the avian influenza A (H5N1) challenge

Avian influenza A subtype H5N1 virus with its recombination potential with the human influenza viruses presents a threat of producing a pandemic. The consensus is that the occurrence of such a pandemic is only a matter of time. This is of great concern, since no effective vaccine is available or can be made before the occurrence of the event. We present arguments for the use of cell mediated immunity for the prevention of the infection as well as for the treatment of infected patients. Transfer factor (TF), an immunomodulator of low molecular weight capable of transferring antigen-specific cell mediated immune information to T-lymphocytes, has been used successfully over the past quarter of a century for treating viral, parasitic, and fungal infections, as well as immunodeficiencies, neoplasias, allergies and autoimmune diseases. Moreover, several observations suggest that it can be utilised for prevention, transferring immunity prior to infection. Because it is derived from lymphocytes of immune donors, it has the potential to answer the challenge of unknown or ill-defined pathogens. Indeed, it is possible to obtain an antigen-specific TF preparation to a new pathogen before its identification. Thus, a specific TF to a new influenza virus can be made swiftly and used for prevention as well as for the treatment of infected patients.     

Parental catastrophizing about their child's pain. The parent version of the Pain Catastrophizing Scale (PCS-P): a preliminary validation

Numerous studies have found evidence for the role of catastrophizing about pain in adjustment to pain in both adults and children. However, the social context influencing pain and pain behaviour has been largely ignored. Especially in understanding the complexities of childhood pain, family processes may be of major importance. In line with the crucial role of pain catastrophizing in explaining adjustment and disability in adults and children, this study investigates the role of parental catastrophic thinking about their child's pain in explaining child disability and parental distress. To study parental catastrophizing, a parent version of the Pain Catastrophizing Scale (PCS-P) was developed. An oblique three-factor structure emerged to best fit the data in both a sample of parents of schoolchildren (N=205) and in a sample of parents of children with chronic pain (N=107). Moreover, this three-factor structure was found to be invariant across both parent samples. Further, in the clinical sample, parents' catastrophic thinking about their child's pain had a significant contribution in explaining (a) childhood illness-related parenting stress, parental depression and anxiety, and (b) the child's disability and school attendance, beyond the child's pain intensity.     

Psychological assessment of patients with temporomandibular disorders: confirmatory analysis of the dimensional structure of the Brief Symptoms Inventory 18

OBJECTIVE: This article analyzes the psychometric and structural properties of the Brief Symptoms Inventory 18 in a sample of patients with temporomandibular disorders (TMDs), given the convenience of a brief evaluation of distress in these patients. METHODS: Confirmatory factor analysis was carried out in a sample of 114 patients with TMDs. Two models were tested: the theoretical model with the original structure proposed--which considers three dimensions--and the empirical model obtained through the exploratory factor analysis initially carried out by Leonard R. Derogatis--which consists of the four-factor structure. RESULTS: Both models reached satisfactory indexes in confirmatory factor analysis. Empirical and theoretical reasons led us to prefer the original proposal of three dimensions: somatization, depression and anxiety, and general distress. CONCLUSION: The Brief Symptoms Inventory 18 has been demonstrated to be a reliable and valid tool for the assessment of distress in patients with TMDs, with the advantage of its simplicity and ease of application.     

A dose-response relationship between types of physical activity and distress

This study aimed to examine whether a dose-response relationship exists between psychological distress and types of physical activity (total, occupational, and leisure-time). The study subjects (233 men and 313 women) were recruited for a study on cardiovascular disease in the Yangpyeong community located in South Korea. The type and characteristics of physical activity were measured with a modified version of the Stanford 5 city project's questionnaire by well-trained interviewers using a standard protocol. The Psychological Well-being Index-Short Form was used to assess psychological distress. Both the intensity and duration of time in either total physical activity or occupational physical activity (OPA) were not related to the distress score. However, a long duration of time (1 hr/day) in severely intensive (> or =6 metabolic equivalent) OPA was related to a high distress score in men (14.1 for none vs. 19.7, p-for-trend=0.005), even after the adjustment for leisure-time physical activity (LTPA). A long duration in time (1 hr/day) in LTPA was related to a lower distress score in men independent of their OPA (16.7 for none vs. 13.1, p-for-trend=0.02). In conclusion, the dose-response relationship of physical activity on psychological distress appeared to differ among the different types of activities. The type of activity may be an important determinant of whether physical activity produces psychological benefits.     

The clinical efficacy of GOCA scoring system in patients with acute respiratory distress syndrome

To explore the following hypotheses: 1) Gas exchange, Organ failure, Cause, Associated disease (GOCA) score, which reflects both general health and the severity of lung injury, would be a better mortality predictor of acute respiratory distress syndrome (ARDS) than acute physiology and chronic health evaluation (APACHE II) or simplified acute physiology score (SAPS II), which are not specific to lung injury, and lung injury score (LIS) that focuses on the lung injury; 2) the performance of APACHE II and SAPS II will be improved when reinforced by LIS, we retrospectively analyzed ARDS patients (N=158) admitted to a medical intensive care unit for five years. The overall mortality of the ARDS patients was 53.2%. Calibrations for all models were good. The area under the curve of (AUC) of LIS (0.622) was significantly less than those of APACHE II (0.743) and SAPS II (0.753). The AUC of GOCA (0.703) was not better than those of APACHE II and SAPS II. The AUCs of APACHE II and SAPS II tended to further increase when reinforced by LIS. In conclusion, GOCA was not superior to APACHE II or SAPS II. The performance of the APACHE II or SAPS II tended to improve when combining a general scoring system with a scoring system that focused on the severity of lung injury.     

产前应用地塞米松预防早产儿发生呼吸窘迫综合征的临床疗效

目的 探讨产前应用地塞米松预防早产儿发生呼吸窘迫综合征(RDS)的临床疗效.方法 分析自2008年10月至2010年1月收治的早产儿92例,根据孕妇产前是否给予地塞米松分为:观察组即给予地塞米松组42例,对照组未给予地塞米松组50例,比较两组临床总体疗效,早产儿RDS发生情况,持续呼吸道正压通气(CPAP)使用率及时间和死亡情况.结果 地塞米松组与对照组比较,RDS发生率、CPAP应用率及应用时间均下降,P＜0.05.地塞米松组总有效率为100.0％,对照组总有效率为79.0％,地塞米松组总有效率明显高于对照组(P＜0.05).结论 产前应用地塞米松是预防早产儿发生RDS的有效方法,且能降低CPAP的临床应用及早产儿病死率,值得临床推广使用.     

Nationwide outcomes of newborns with rectosigmoid versus long-segment Hirschsprung disease

PurposeHirschsprung Disease (HD) is a common congenital intestinal disorder. While aganglionosis most commonly affects the rectosigmoid colon (rectosigmoid HD), outcomes for patients in which aganglionosis extends to more proximal segments (long-segment HD) remain understudied. This study sought to compare postoperative outcomes among newborns with rectosigmoid and long-segment HD.MethodsThe Nationwide Readmission Database was queried from 2016 to 2018 for newborns with HD. Newborns were stratified into those with rectosigmoid or long-segment HD. Those who received no rectal biopsy or pull-through procedure during their newborn hospitalization were excluded. A propensity score-matched analysis (PSMA) of newborns with either type of HD was constructed utilizing 17 covariates including demographics, comorbidities, and congenital-perinatal conditions.ResultsThere were 1280 newborns identified with HD (82% rectosigmoid HD, 18% long-segment HD). Patients with rectosigmoid HD had higher rates of laparoscopic resections (35% vs. 12%) and less frequently received a concomitant ostomy (14% vs. 84%), both p < 0.001. Patients with long-segment HD were more likely to have a delayed diagnosis (12% vs. 5%) and require multiple bowel operations (19% vs. 4%), both p < 0.001. They experienced higher rates of complications, including small bowel obstructions (10% vs. 1%), infections (45% vs. 20%), and Hirschsprung-associated enterocolitis (11% vs. 5%), all p < 0.001. After PSMA, newborns with long-segment HD were found to have a longer length of stay and higher hospitalization costs.ConclusionNewborns with long-segment HD experience significant delays in diagnosis, surgery, and complications compared to those with rectosigmoid HD. This information should be utilized to improve healthcare delivery for this patient population.Type of StudyRetrospective comparative study.Level of EvidenceIII.