ORCID Profile
0000-0003-0565-4938
Current Organisation
Macquarie University
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Public Health and Health Services | Health Care Administration | Primary Health Care | Aboriginal and Torres Strait Islander Health | Mental Health | Psychology | Learning, Memory, Cognition And Language | Health, Clinical And Counselling Psychology |
Aboriginal and Torres Strait Islander Health - Health System Performance (incl. Effectiveness of Interventions) | Health Inequalities | Rural Health | Behavioural and cognitive sciences | Mental health
Publisher: Springer Science and Business Media LLC
Date: 10-1992
DOI: 10.1007/BF01296500
Abstract: 1. Watery vacuolation in the acinar cells of the rat submandibular gland is described. The vacuoles are cytoplasmic, membrane-walled, and 2-20 mu in diameter. They are visible in living cells and appear to contain a watery fluid.2. Vacuolation occurred regularly in the following experimental situations: (1) in vitro-under anoxic conditions (2) post mortem-in animals killed by anoxia, and (3) in vivo-during secretion.3. By in vitro experiments it was shown that vacuolation occurs only when the cells are both anoxic and exposed to an excess of extracellular fluid containing calcium and bicarbonate. It was further shown that vacuolation is reversible in oxygen and that both its development and recovery are temperature dependent.4. Evidence is presented that the vacuolation is not a degenerative or necrotic change, that it is accompanied by the entry of fluid into the cells, and that it is not caused by simple osmosis.5. The mechanism of vacuolation and its possible relation to secretion are discussed. It is suggested that vacuolation represents an imbalance between the ingestion and secretion of water and salts.6. Similar vacuoles, apparently produced by the same mechanism, were observed in the acinar cells of the parotid gland and the pancreas of the rat.7. The close similarity of this vacuolation to that previously described in rat liver cells was noted.
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/AH17262
Abstract: Objectives The aim of this study was to estimate the costs of providing primary care and quantify the cost impact of high staff turnover in Northern Territory (NT) remote communities. Methods This cost impact assessment used administrative data from NT Department of Health datasets, including the government accounting system and personnel information and payroll systems between 2004 and 2015, and the primary care information system from 2007 to 2015. Data related to 54 government-managed clinics providing primary care for approximately 27200 Aboriginal and non-Aboriginal people. Main outcome measures were average costs per consultation and per capita, cost differentials by clinic, year and levels of staff turnover. Linear regression and dominance analysis were used to assess the effect of staff turnover on primary care costs, after adjusting for remoteness and weighting analysis by service population. Both current and constant prices were used. Results On average, in constant prices, there was a nearly 10% annual increase in remote clinic expenditure between 2004 and 2015 and an almost 15% annual increase in consultation numbers since 2007. In real terms, the average costs per consultation decreased markedly from A$273 in 2007 to A$197 in 2015, a figure still well above the Medicare bulk-billing rate. The cost differentials between clinics were proportional to staff turnover and remoteness (both P& .001). A 10% higher annual turnover rate pertains to an A$6.12 increase in costs per consultation. Conclusions High staff turnover exacerbates the already high costs of providing primary care in remote areas, costing approximately A$50 extra per consultation. This equates to an extra A$400000 per clinic per year on average, or A$21million annually for the NT government. Over time, sustained investments in developing a more stable primary care workforce should not only improve primary care in remote areas, but also reduce the costs of excessive turnover and overall service delivery costs. What is known about the topic? Population size and geographical remoteness are important cost drivers in remote clinics, whereas elsewhere in Australia the high use of short-term staff to fill positions has been identified as a major contributor to higher nurse turnover costs and to overall health service costs. Nursing staff expenditure accounts for a large proportion (46%) of total expenditure in NT remote health services, whereas expenditure on Aboriginal Health Practitioners (AHPs) comprises only 6%. Annual nurse turnover rates in remote NT clinics average approximately 150%, whereas levels of 40% in other contexts are considered high. What does this paper add? Annual expenditure for NT remote clinics has increased, on average, by 10% per annum between 2004 and 2015, but small declines in real expenditure have been observed from a maximum in 2012. Expenditure on nursing staff comprises 40% of overall expenditure in remote clinics, whereas expenditure on AHPs comprises less than 5%. The cost impact of every 10% increase in remote nurse and AHP annual turnover has been quantified as an extra A$6.12 per primary care consultation, which equates, on average, to an extra A$400000 per remote clinic, and an extra A$21million overall for the NT Department of Health each year. The average real expenditure per primary care consultation has decreased from A$273 in 2007 to A$197 in 2015, representing a statistically significant linear trend reduction of A$7.71 per consultation annually. What are the implications for practitioners (and other decision-makers)? Adjusting policy settings away from the high use of short-term staff to investment in appropriate training ‘pipelines’ for the remote primary care workforce may, in the medium and longer term, result in reduced turnover of resident staff and associated cost savings. Targeted recruitment and retention strategies that ensure in idual primary care workers are an optimal fit with the remote communities in which they work, together with improved professional and personal support for staff residing in remote communities, may also help reduce turnover, improve workforce stability and lead to stronger therapeutic relationships and better health outcomes.
Publisher: American Medical Association (AMA)
Date: 05-05-2004
Publisher: BMJ
Date: 02-2020
DOI: 10.1136/BMJOPEN-2019-030613
Abstract: To investigate if socioeconomic status (SES) is predictive of cardiovascular risk factors among Swedish adolescents. Identify the most important SES variable for the development of each cardiovascular risk factor. Investigate at what age SES inequality in overweight and obesity occurs. Longitudinal follow-up of a prospective birth cohort. All Babies in Southeast Sweden (ABIS) study includes data from children born between October 1997 and October 1999 in five counties of south east Sweden. A regional ABIS-study subs le from three major cities of the region n=298 adolescents aged 16–18 years, and prospective data from the whole ABIS cohort for overweight and obesity status at the ages 2, 5, 8 and 12 years (n=2998–7925). Blood pressure above the hypertension limit, overweight/obesity according to the International Obesity Task Force definition, low high-density lipoproteins (HDL) or borderline-high low-density lipoproteins according to National Cholesterol Education Program expert panel on cholesterol levels in children. For three out of four cardiovascular risk outcomes (elevated blood pressure, low HDL and overweight/obesity), there were increased risk in one or more of the low SES groups (p .05). The best predictor was parental occupational class (Swedish socioeconomic classification index) for elevated blood pressure (area under the receiver operating characteristic (ROC) curve 0.623), maternal educational level for overweight (area under the ROC curve 0.641) and blue-collar city of residence for low HDL (area under the ROC curve 0.641). SES-related differences in overweight/obesity were found at age 2, 5 and 12 and for obesity at age 2, 5, 8 and 12 years (all p .05). Even in a welfare state like Sweden, SES inequalities in cardiovascular risks are evident already in childhood and adolescence. Intervention programmes to reduce cardiovascular risk based on social inequality should start early in life.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2008
Publisher: Wiley
Date: 29-01-2021
DOI: 10.1111/NMO.14091
Abstract: Patients presenting with gastrointestinal symptoms can be challenging in terms of determining etiology and management strategies. Identifying likely organic pathology is important since it can be treated and may result in further, long‐term harm to the patient if not treated. Currently, organic pathology is often identified via invasive procedures such as endoscopy or referral to a medical imaging service. We report on an approach that offers a first step at identifying patients with an organic gastrointestinal disease based on the SAGIS, a validated symptom questionnaire. 8,922 patients referred to a tertiary care hospital were classified as having either functional gastrointestinal disease or an organic gastrointestinal disease. A model was developed to distinguish organic from functional symptoms on one random split half of the s le and validated on the other half. The incremental benefit of including psychological conditions and extra‐gastrointestinal conditions was also evaluated. Functional gastrointestinal patients scored higher on average than organic patients on all dimensions of the SAGIS and reported higher rates of psychological and extra‐gastrointestinal conditions. All five dimensions of the SAGIS provided statistically independent discrimination of organic from functional diagnoses with good overall discrimination (AUC = 0.75). However, there was no noticeable incremental benefit of adding either psychological or extra‐gastrointestinal conditions. Model performance was highly reproducible. The proposed algorithm for identifying likely organic gastrointestinal disease applied to symptoms as recorded in the SAGIS questionnaire provides a useful tool for the clinician in deciding what or if further diagnostic testing is required.
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1053/J.GASTRO.2009.02.039
Abstract: Tests of gastric neuromuscular function are used to evaluate patients with symptoms referable to the upper digestive tract. These symptoms can be associated with alterations in the rates of gastric emptying, impaired accommodation, heightened gastric sensation, or alterations in gastric myoelectrical function and contractility. Management of gastric neuromuscular disorders requires an understanding of pathophysiology and treatment options as well as the appropriate use and interpretation of diagnostic tests. These tests include measures of gastric emptying contractility electrical activity regional gastric motility of the fundus, antrum, and pylorus and tests of sensation and compliance. Tests are also being developed to improve our understanding of the afferent sensory pathways from the stomach to the central nervous system that mediate gastric sensation in health and gastric disorders. This article reviews tests of gastric function and provides a basic description of the tests, the methodologies behind them, descriptions of the physiology that they assess, and their clinical utility.
Publisher: American Psychological Association (APA)
Date: 08-2019
DOI: 10.1037/BUL0000202
Abstract: Speech and gesture are two vital components of communication. Gesture itself provides an external support to speech, potentially promoting comprehension of a spoken message. The question of whether gesture promotes comprehension is not new, with research dating back to the 1970s. However,
Publisher: Wiley
Date: 17-01-2012
DOI: 10.1111/J.1440-1584.2011.01242.X
Abstract: Evidence indicates that medical graduates with a rural background are more likely to become rural doctors than those with an urban background (the rural background effect (RBE)). Exactly why this is so has rarely been studied. This study sought to identify the role of social, environmental and economic factors in addition to isolation characterising rural environments that either explain or modify the association between rural background and becoming a rural doctorrural practice intention. Secondary analysis of linked databases from the Medical Schools Outcomes Database (MSOD), Australian Bureau of Statistics and other government sources. Seven thousand four hundred twenty-two commencing medical students who took part in the MSOD survey and for whom external data could be linked. No social, environmental or economic factor studied or isolation significantly contributed to explaining the RBE, although there is some evidence that areas of more attractive climate strengthen the RBE. However, even when the RBE is at its weakest, it remains a strong, positive predictor of attraction to rural practice. Why the RBE occurs remains unexplained. Evidence was found of a reduced RBE under certain climatic conditions and personal circumstances, but further work is required to better understand why rural background is so strongly related with rural medical intention and practice.
Publisher: Wiley
Date: 05-07-2017
DOI: 10.1111/AJR.12311
Abstract: To investigate the factors eligible applicants consider in electing for a rural pathway into specialty training. Cohort study. Australia. Applicants to the Australian General Practice Training program. Applicants' initial preference of either a general or rural pathway to undertake specialty training. Of the 2,221 applicants, 45% were Australian Medical Graduates (AMGs), 27% Foreign Graduates of Accredited Medical Schools (FGAMS) and 29% International Medical Graduates (IMGs). Through government regulation, two thirds (70%) were eligible to train on both general and rural pathways and a third (30%) were required to train rurally. For applicants eligible for general pathway (n = 1552), those with rural background [Odds Ratio (OR) = 3.7, 95% CI 2.7-5.2] and rural clinical school experience (OR = 2.0, 95% CI 1.5-2.8) were more likely to choose the rural pathway. In addition, FGAMS who were eligible for the general pathway were less likely to choose a rural pathway when compared with IMGs (OR = 0.33, 95%CI 0.1 = 0.7). In applicants who changed their training pathway from their initial to revised preference, lower Multiple-Mini-Interview (OR = 0.54, 95% CI 0.43-0.66) and Situational Judgement Test z-scores (OR = 0.68, 95% CI 0.56-0.83) were associated with a higher probability of changing from a general to rural pathway preference. For those eligible for a general or rural pathway, rural background and rural clinical school experience are associated with the decision to elect for rural training. Targeted support for international and foreign graduates of Australia/New Zealand schools may influence them to train rurally.
Publisher: Elsevier BV
Date: 10-1991
DOI: 10.1016/0020-7519(91)90081-H
Abstract: The common anthelmintics, oxantel, mebendazole, albendazole and pyrantel were assessed for their comparative activity against Trichuris muris in mice. Mice were infected with T. muris and the infection was maintained by a brief cortisone administration during the second week of infection. Mice carrying the infection with different life cycle stages, viz. fourth stage larvae (L4), pre-adult and adult stages were dosed with anthelminitics. The worm burdens in control infection groups varied although infection dose and other conditions were uniformly followed. With various dose regimens tested, oxantel was highly potent it eliminated completely pre-adult and adult stages, respectively at 25 and 12.5 mg kg-1 dose levels with significant activity also against adult worms at a 1.56 mg kg-1 dose level and against pre-adults at a 6.25 mg kg-1 level. Pre-adults required twice the dose given to that of adults for complete (100%) activity. Mebendazole was the next most active a dosage of 37.5 mg kg-1 was completely active against pre-adults whereas a dosage of 2 x 50 mg kg-1 was required for complete elimination of adult worms. In addition, about 90% of the worms were eliminated with a single dose of 150 mg kg-1. However, a significant activity was seen against adults at a 25 mg kg-1 level and pre-adults at 37.5 mg kg-1, the lowest level tested. In comparison, albendazole did not induce complete clearance of pre-adult and adult stages even when tested at dose levels as high as 150 and 2 x 75 mg kg-1, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Publisher: Society of Economic Geologists
Date: 04-11-2013
Publisher: BMJ
Date: 07-07-2019
Publisher: Springer Science and Business Media LLC
Date: 12-1993
DOI: 10.1007/BF01299904
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.BBI.2019.10.020
Abstract: Inflammation is believed to be a central mechanism in the pathophysiology of fatigue. While it is likely that dynamic of the fatigue response after an immune challenge relates to the corresponding cytokine release, this lacks evidence. Although both fatigue and sleepiness are strong signals to rest, they constitute distinct symptoms which are not necessarily associated, and sleepiness in relation to inflammation has been rarely investigated. Here, we have assessed the effect of an experimental immune challenge (administration of lipopolysaccharide, LPS) on the development of both fatigue and sleepiness, and the associations between increases in cytokine concentrations, fatigue and sleepiness, in healthy volunteers. In addition, because chronic-low grade inflammation may represent a risk factor for fatigue, we tested whether higher baseline levels of inflammation result in a more pronounced development of cytokine-induced fatigue and sleepiness. Data from four experimental studies was combined, giving a total of 120 subjects (LPS N = 79, 18 (23%) women Placebo N = 69, 12 (17%) women). Administration of LPS resulted in a stronger increase in fatigue and sleepiness compared to the placebo condition, and the development of both fatigue and sleepiness closely paralleled the cytokine responses. In iduals with stronger increases in cytokine concentrations after LPS administration also suffered more from fatigue and sleepiness (N = 75), independent of gender. However, there was no support for the hypothesis that higher baseline inflammatory markers moderated the responses in fatigue or sleepiness after an inflammatory challenge. The results demonstrate a tight connection between the acute inflammatory response and development of both fatigue and sleepiness, and motivates further investigation of the involvement of inflammation in the pathophysiology of central fatigue.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-12-2023
Publisher: Wiley
Date: 02-01-2023
DOI: 10.1111/NMO.14527
Abstract: Placebo responses to an apparently inactive intervention are of interest from a scientific perspective as they suggest possible mechanism(s) at work beyond the intervention itself. They are also of interest from a clinical trials perspective since high rates of placebo response limit the potential to demonstrate worthwhile efficacy of a new intervention. This mini‐review was motivated by the work of Bosman and colleagues(Neurogastroenterol Motil, 2022, and e14474) that is published in this issue of the journal in which they report on a systematic review and meta‐analysis of placebo response in functional dyspepsia clinical trials. The review sets the scene for their work by putting it in the context of other disorders of brain–gut interaction and extra‐gastrointestinal disorders. The review canvasses potential mechanisms of placebo response.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2003
Publisher: Wiley
Date: 28-12-2023
DOI: 10.1111/NMO.14524
Abstract: Recent community‐based studies have demonstrated that experiencing multiple concurrent functional gastrointestinal disorders (FGIDs) is associated with increased somatization, worse quality of life (QoL), and greater health care utilization. However, the presence of multiple overlapping FGIDs is unstudied specifically in chronic constipation and functional defecation disorders (FDD). We investigated the prevalence and impact of additional nonconstipation FGIDs on constipation severity, anorectal physiology, anxiety and depression, and QoL, in patients with chronic constipation and FDD. One‐hundred and forty‐six consecutive patients with functional constipation or irritable bowel syndrome (IBS‐C/IBS‐M) presenting to a tertiary referral Neurogastroenterology Clinic were studied. In addition, 90/146 (62%) qualified for FDD due to abnormal defecatory physiology. Patients underwent comprehensive baseline assessment comprising anorectal physiology, Bristol Stool Chart, Rome questionnaire, Knowles‐Eccersley‐Scott‐Symptom (KESS) constipation score, Hospital Anxiety, and Depression Scale, and modified 36‐Item Short Form Health Survey (SF‐36) for QoL. Additional FGIDs were diagnosed using Rome III criteria. Additional nonconstipation FGIDs occurred in 85% of patients, with a mean of 2.1 (SD 1.6) additional FGIDs. Patients with four or more additional FGIDs experienced greater constipation severity compared to those with no additional FGIDs ( p = 0.004). Comorbid FGIDs were associated with worse SF‐36 scores for physical functioning ( p 0.001), role‐physical ( p = 0.005), bodily pain ( p 0.001), vitality ( p = 0.008), social functioning ( p = 0.004), and mental health index ( p = 0.031). Functional gastrointestinal disorders comorbidity is highly prevalent in chronic constipation and defecatory disorders, and this is associated with greater symptom severity and worse QoL. Multimodal treatments targeting comorbid FGIDs may lead to superior outcomes.
Publisher: Wiley
Date: 04-03-2015
DOI: 10.1111/APT.13149
Abstract: While the Rome III classification recognises functional constipation (FC) and constipation predominant IBS (IBS-C) as distinct disorders, recent evidence has suggested that these disorders are difficult to separate in clinical practice. To identify whether clinical and lifestyle factors differentiate Rome III-defined IBS-C from FC based on gastrointestinal symptoms and lifestyle characteristics. 3260 people randomly selected from the Australian population returned a postal survey. FC and IBS-C were defined according to Rome III. The first model used logistic regression to differentiate IBS-C from FC based on lifestyle, quality-of-life and psychological characteristics. The second approach was data-driven employing latent class analysis (LCA) to identify naturally occurring clusters in the data considering all symptoms involved in the Rome III criteria for IBS-C and FC. We found n = 206 (6.5% 95% CI 5.7-7.4%) people met strict Rome III FC whereas n = 109 (3.5% 95% CI 2.8-4.1%) met strict Rome III IBS-C. The case-control approach indicated that FC patients reported an older age at onset of constipation, were less likely to exercise, had higher mental QoL and less health care seeking than IBS-C. LCA yielded one latent class that was predominantly (75%) FC, while the other class was approximately half IBS-C and half FC. The FC-dominated latent class had clearly lower levels of symptoms used to classify IBS (pain-related symptoms) and was more likely to be male (P = 0.046) but was otherwise similar in distribution of lifestyle factors to the mixed class. The latent class analysis approach suggests a differentiation based more on symptom severity rather than the Rome III view.
Publisher: Wiley
Date: 31-01-2019
DOI: 10.1111/NMO.13552
Abstract: Anorectal manometry (ARM) and balloon expulsion test (BET) are pivotal in investigation of anorectal disorders. There is controversy, however, about normal values and optimum methodology for performing these tests. Our aims were to compare BET using three different balloons and to establish normal values for ARM and BET in health. Forty-four female healthy subjects (mean age 56 ± 12 years) underwent ARM, followed by BET which was performed in a private toilet using three different catheters (party balloon, Foley catheter and a commercially available catheter) in a single-blinded randomized order. Outcome measures were time to balloon expulsion and comprehensive measures of anal sphincter function, the push maneuver and rectal sensation. The Foley catheter took longer to expel compared to both party and commercial balloons (both pairwise P < 0.001) with a wider distribution of results (P < 0.001). Ten of 40 healthy subjects could not expel the Foley catheter within 120 seconds. On ARM, older age was associated with lower resting anal sphincter pressure (ρ = -0.3, P = 0.05) and lower anal squeeze pressure (ρ = -0.3, P = 0.05). Having at least one vaginal delivery (compared to none) was associated with lower anal squeeze pressures (P = 0.03) and a smaller difference between cough and squeeze pressures (P = 0.03). A commercial balloon exhibited superior results in vivo compared to the Foley catheter without the concerns of latex allergy and quality control present with the use of a party balloon. Normal values for high-resolution water-perfused manometry have been established and an effect seen for age and parity.
Publisher: Wiley
Date: 19-10-2021
DOI: 10.1111/APT.16651
Abstract: An in idual’s drive to seek medical help remains a complex behavioural process, incorporating psychological, social and symptom‐specific factors. Within irritable bowel syndrome (IBS), gastrointestinal symptoms only predict a small portion of the high healthcare‐seeking experienced. To examine the moderating role of quality of life (QoL) domains on this relationship to help explain the variance observed. This is an analysis of a Swedish population‐based prospective study of healthcare use over a 12‐year period. At baseline, gastrointestinal symptoms were measured with the valid Gastrointestinal Symptom Rating Scale, and QoL via the SF‐36. 1159 subjects (57% female mean age 48.6 years) had their health records matched with the initial survey. 164 were classified as IBS by Rome II criteria. Negative binomial or logistic models were fit to evaluate the moderating effect of particular QoL domains on the relationship between gastrointestinal symptoms and prospective healthcare utilisation. Gastrointestinal symptoms were associated with prospective healthcare use, but moderation in this relationship by particular QoL domains was not supported most models did not reach statistical significance. Furthermore, the impact of IBS status did not alter the moderation hypotheses. Particular QoL domains did not impact the relationship between gastrointestinal symptoms on prospective healthcare seeking. Future research should continue to examine other psychological, social and symptom variables to identify predictors of high healthcare consumers in IBS.
Publisher: Springer Science and Business Media LLC
Date: 10-11-2011
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.CGH.2019.07.019
Abstract: There is controversy about whether psychological factors (anxiety and depression) increase health care seeking by patients with irritable bowel syndrome (IBS). We investigated whether psychological factors increase health care seeking by patients with IBS and the effects of extragastrointestinal (extra-GI) symptoms. We performed a population-based prospective study of health care use over a 12-year period in Sweden. From 2002 through 2006, 1244 subjects were selected randomly for an examination by a gastroenterologist and to complete questionnaires, including the Rome II modular questionnaire. Psychological factors were measured with the valid Hospital Anxiety and Depression scale and extra-GI symptoms were measured with a symptom checklist. Responses from 1159 subjects (57% female mean age, 48.65 y) were matched with health records in 2016 (164 were classified as having IBS based on Rome II criteria). The overall association between depression or anxiety and health care use varied in subjects with and without IBS at baseline. The presence of extra-GI symptoms strengthened the relationship between anxiety and depression and prospective psychiatric visits for subjects with IBS and without IBS (incidence rate ratio, 1.14-1.26). Extra-GI symptoms did not alter the association of anxiety or depression with use of GI or extra-GI health care. In a population-based study in Sweden, we found that in iduals with high baseline anxiety or depression were more likely to seek psychiatric health care, but not GI or extra-GI health care, in the presence of extra-GI symptoms at baseline. Patients with IBS might benefit from more thorough assessments that examine extra-GI and psychological symptoms, to reduce health care utilization.
Publisher: Hindawi Limited
Date: 10-03-2015
DOI: 10.1002/DA.22356
Abstract: For exposure therapy to be successful, it is essential that fear extinction learning extends beyond the treatment setting. D-cycloserine (DCS) may facilitate treatment gains by increasing generalization of extinction learning, however, its effects have not been tested in children. We examined whether DCS enhanced generalization of fear extinction learning across different stimuli and contexts among children with specific phobias. The study was a double-blind placebo-controlled randomized controlled trial among dog or spider phobic children aged 6-14. Participants ingested either 50 mg of DCS (n = 18) or placebo (n = 17) before receiving a single prolonged exposure session to their feared stimulus. Return of fear was examined 1 week later to a different stimulus (a different dog or spider), presented in both the original treatment context and an alternate context. Avoidance and fear were measured with Behavior Approach Tests (BATs), where the child was asked to increase proximity to the stimulus while reporting their fear level. There were no differences in BAT performance between groups during the exposure session or when a new stimulus was later presented in the treatment context. However, when the new stimulus was presented in a different context, relative to placebo, the DCS group showed less avoidance (P = .03) and less increase in fear (P = .04) with moderate effect sizes. DCS enabled children to better retain their fear extinction learning. This new learning generalized to different stimuli and contexts.
Publisher: AMPCo
Date: 08-2017
DOI: 10.5694/MJA16.00697
Publisher: BMJ
Date: 07-2001
DOI: 10.1136/GUT.49.1.66
Abstract: The association of social class with health has been extensively studied, yet relationships between social class and gastrointestinal symptoms remain almost unexplored. To examine relationships between social class and gastrointestinal symptoms in a population s le. The prevalence of 16 troublesome gastrointestinal symptoms was determined by a postal questionnaire sent to 15 000 subjects (response rate 60%) and compared with a validated composite measure of socioeconomic status (index of relative socioeconomic disadvantage). Comparisons across social class were explored for five symptom categories (oesophageal symptoms upper dysmotility symptoms bowel symptoms diarrhoea and constipation). Results are reported as age standardised rate ratios with the most advantaged social class as the reference category. There were clear trends for the prevalence rates of all gastrointestinal symptoms to increase with decreasing social class. These trends were particularly strong for the five symptom categories. Lower social class was associated with a significantly (p<0.0001) higher number of symptoms reported overall and with a higher proportion of in iduals reporting 1-2 symptoms and more than five symptoms. In both sexes, the most pronounced effects for subjects in the lowest social class were found for constipation (males: rate ratio 1.83 (95% confidence intervals (CI) 1.16-2.51) females: rate ratio 1.68 (95% CI 1.31-2.04)) and upper dysmotility symptoms (males: rate ratio 1.45 (95% CI 1.02-1.88) females: rate ratio 1.35 (95% CI 1.07-1.63)). Oesophageal symptoms and diarrhoea were not associated with social class. Troublesome gastrointestinal symptoms are linked to socioeconomic status with more symptoms reported by subjects in low socioeconomic classes. Low socioeconomic class should be considered a risk factor for both upper and lower gastrointestinal symptoms.
Publisher: American Public Health Association
Date: 07-2008
Abstract: Objectives. We sought to determine whether an elevated burden of chronic kidney disease is found among disadvantaged groups living in the United States, Australia, and Thailand. Methods. We used data on participants 35 years or older for whom a valid serum creatinine measurement was available from studies in the United States, Thailand, and Australia. We used logistic regression to analyze the association of income, education, and employment with the prevalence of chronic kidney disease (estimated glomerular filtration rate mL/min/1.73 m 2 ). Results. Age- and gender-adjusted odds of having chronic kidney disease were increased 86% for US Whites in the lowest income quartile versus the highest quartile (odds ratio [OR] = 1.86 95% confidence interval [CI] = 1.27, 2.72). Odds were increased 2 times and 6 times, respectively, among unemployed (not retired) versus employed non-Hispanic Black and Mexican American participants (OR=2.89 95% CI=1.53, 5.46 OR=6.62 95% CI=1.94, 22.64. respectively). Similar associations were not evident for the Australian or Thai populations. Conclusions. Higher kidney disease prevalence among financially disadvantaged groups in the United States should be considered when chronic kidney disease prevention and management strategies are created. This approach is less likely to be of benefit to the Australian and Thai populations.
Publisher: Elsevier BV
Date: 07-1993
DOI: 10.1016/0022-3999(93)90004-Y
Abstract: The association between mood state and treatment outcome after In Vitro Fertilization/Embryo Transfer (IVF/ET) was assessed in a prospective s le of 330 women, of whom 113 were first time participants (inductees) and 217 were repeat cycle women (veterans). Initial evaluation of mood state indicated a significantly higher level of depression amongst veterans than inductees and a significantly greater proportion of veterans (25%) with clinically elevated depression scores compared with inductees (15%) and community norms (approx. 12%). Up to 12 months after initial assessment and after controlling for the number of treatment cycles, a significant difference was observed in the course of pregnancy over time between depressed and non-depressed women. Depressed women exhibited a lower pregnancy rate for the first treatment cycles than non-depressed women. The results and their implications are discussed.
Publisher: Wiley
Date: 08-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 14-04-2020
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.JPSYCHORES.2018.02.015
Abstract: Many people with functional gastrointestinal disorders (FGIDs) face significant barriers in accessing psychological treatments that are known to reduce symptoms and their psychological sequelae. This study examined the feasibility and initial outcomes of a transdiagnostic and internet-delivered cognitive behaviour therapy (iCBT) intervention, the Chronic Conditions Course, for adults with functional gastrointestinal disorders (FGIDs). A single-group feasibility open trial design was employed and administered to twenty seven participants. The course ran for 8 weeks and was provided with weekly contact from a Clinical Psychologist. Seventy percent of participants completed the course within the 8 weeks and 81.5% provided data at post-treatment. High levels of satisfaction were observed and relatively little clinician time (M = 42.70 min per participant SD = 46.25 min) was required. Evidence of clinical improvements in FGID symptoms (ds ≥ 0.46 avg. improvement ≥21%), anxiety symptoms (ds ≥ 0.99 avg. improvement ≥42%), and depression symptoms (ds ≥ 0.75 avg. improvement ≥35%) were observed, which either maintained or continued to improve to 3-month follow-up. Evidence of improvement was also observed in pain catastrophising and mental-health related quality of life, but not physical-health related quality of life. These findings highlight the potential value of transdiagnostic internet-delivered programs for adults with FGIDs and support for the conduct of larger-scale controlled studies.
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.HUMPATH.2014.10.026
Abstract: Irritable bowel syndrome (IBS) is a functional disorder defined by symptoms in the absence of overt pathology. Colonic spirochetosis (CS), defined by histologic observation of spirochetal strains of Brachyspira in colonic biopsies, is uncommon and considered of doubtful significance. We aimed to determine the prevalence of CS in the general population, identify subtle colon pathologies, and evaluate a link with symptoms of IBS. Colonoscopy was performed in 745 subjects (aged 19-70 years, mean age 51 years, 43% male) with biopsies (ileum and 4 colonic sites) from a random population s le, Stockholm, Sweden, who completed a validated questionnaire of gastrointestinal symptoms IBS was identified by Rome III criteria. CS was identified by histology and immunohistochemistry. In a general population, 17 in iduals (2.28% 95% confidence interval, 1.2%-3.5%) were diagnosed as having CS by histology 6 (35%) had IBS. CS was always present in the sigmoid colon, but only 14 rectal biopsies. Eosinophils were increased in colon biopsies in CS cases versus controls, in the transverse (P = .02), sigmoid colon (P = .001), and rectum (P = .0005) with subepithelial eosinophil clusters (P = .053). Lymphoid follicles (at any site) were present in 13 CS (P = .0003). There was a 3-fold increased risk of IBS in CS (odds ratio, 3.59 95% confidence interval, 1.27-10.11 P = .015). Polyps and erticular disease were similar in CS cases and controls. The prevalence of CS in a general population is 2% and associated with nonconstipating IBS. Colonic eosinophilia with lymphoid follicles may signify the presence of CS.
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.CGH.2019.04.036
Abstract: Functional gastrointestinal disorders are highly prevalent, cause significant suffering, and are costly to society. Pain is a central feature of 2 of the most common functional gastrointestinal disorders: irritable bowel syndrome and functional dyspepsia. Although these disorders have been well studied in adults, their etiology is poorly understood. We sought to identify early life factors associated with the development of abdominal pain in children (age, 2-12 y). We collected data from the All Babies in Southeast Sweden study of 1781 children, born from October 1, 1997, through October 31, 1999, whose families answered questions about abdominal pain and risk factors at birth, 1 year, 2.5 years, 5 years, 8 years, and 10 to 12 years. We used latent growth curve models to evaluate risk factors for development of abdominal pain. The primary outcomes were prevalence of abdominal pain and associated factors. The prevalence of abdominal pain increased linearly with age in the study cohort, increasing by approximately 6% per year. Psychosocial variables associated with slope of the growth curve included lower emotional control at age 2 years (P = .005), parental concern for the child at age 2 years (P = .02), and measures of parental stress (P = .004). Nonvaginal birth was associated with a reduced slope of the growth curve (P = .03). In a study of children in Sweden, we found early psychosocial environment and mode of delivery at birth was associated with development of childhood abdominal pain. Factors associated with development of the early immune system, identified in previous recall-based research, were not supported by data from this study. These findings have important implications for the prevention of abdominal pain in children and later in life.
Publisher: Informa UK Limited
Date: 13-06-2020
Publisher: Informa UK Limited
Date: 1987
Publisher: Informa UK Limited
Date: 1992
DOI: 10.3109/00365529209011167
Abstract: Psychologic stress may be a provoking factor in the alterations in phase-2 motor activity of the migrating motor complex (MMC) which have been recorded in patients with the irritable bowel syndrome (IBS). To test this, changes in phase-2 duodenojejunal motor activity during 20 min of psychologic stress in 10 patients with IBS were compared with those shown by 10 healthy subjects. Autonomic arousal in response to the stressor was assessed by cardiovascular responses and self-reported levels of anxiety and tension. IBS and controls showed a significant cardiovascular and subjective response to stress which was comparable in the two groups. In general, duodenal phase-2 motor activity was suppressed during stress in both IBS and controls. Jejunal motor activity showed a similar inhibitory response in both groups, but the change in motility index was significant for controls only. Qualitatively, stress did not cause clustered contractions in either the IBS or the control group. However, in IBS patients with clustered contractions in the basal period there was inhibition of this pattern during stress. These findings suggest that acute psychologic stress profoundly suppresses, rather than enhances, duodenojejunal MMC phase-2 motility in healthy subjects. IBS patients, irrespective of their underlying phase-2 motor pattern show similar, although less marked, changes in motility.
Publisher: Springer Science and Business Media LLC
Date: 14-08-2022
DOI: 10.1007/S10620-021-07149-1
Abstract: Antimicrobial therapy improves symptoms in patients with irritable bowel syndrome (IBS), but the efficacy in functional dyspepsia (FD) is largely unknown. While FD and IBS frequently overlap, it is unknown if concomitant IBS in FD alters the response to antimicrobial therapy in FD. Thus, we aimed to assess and compare the effect of antimicrobial therapy on visceral sensory function and symptom improvement in FD patients with and without IBS. Adult patients with FD with or without IBS received rifaximin 550 mg BD for 10 days, followed by a 6-week follow-up period. The total gastrointestinal symptom score as measured by the SAGIS (Structured Assessment of Gastrointestinal Symptoms) questionnaire and subscores (dyspepsia, diarrhea, and constipation), symptom response to a standardized nutrient challenge and normalization of the glucose breath tests were measured. Twenty-one consecutive adult patients with FD and 14/21 with concomitant IBS were recruited. Treatment with rifaximin resulted in a significant (p = 0.017) improvement in the total SAGIS score from 34.7 (± 15.4) at baseline to 26.0 (± 16.8) at 2 weeks and 25.6 (± 17.8) at 6 weeks post-treatment. Similarly, compared to baseline there was a statistically significant improvement in SAGIS subscores for dyspepsia and diarrhea (all p < 0.05) and effects persisted for 6 weeks post-treatment. Similarly, the symptom score (and subscores) following a standardized nutrient challenge improved significantly (p 0.5). In FD patients, the response to antimicrobial therapy with rifaximin is not influenced by concomitant IBS symptoms.
Publisher: Elsevier BV
Date: 05-2010
Publisher: Springer Science and Business Media LLC
Date: 27-10-2019
DOI: 10.1007/S10620-018-5343-6
Abstract: According to Rome IV criteria, functional dyspepsia (FD) and irritable bowel syndrome (IBS) are distinct functional gastrointestinal disorders (FGID) however, overlap of these conditions is common in population-based studies, but clinical data are lacking. To determine the overlap of FD and IBS in the clinical setting and define risk factors for the overlap of FD/IBS. A total of 1127 consecutive gastroenterology outpatients of a tertiary center were recruited and symptoms assessed with a standardized validated questionnaire. Patients without evidence for structural or biochemical abnormalities as a cause of symptoms were then categorized based upon the symptom pattern as having FD, IBS or FD/IBS overlap. Additionally, this categorization was compared with the clinical diagnosis documented in the integrated electronic medical records system. A total of 120 patients had a clinical diagnosis of a FGID. Based upon standardized assessment with a questionnaire, 64% of patients had FD/IBS overlap as compared to 23% based upon the routine clinical documentation. In patients with severe IBS or FD symptoms (defined as symptoms affecting quality of life), the likelihood of FD/IBS overlap was substantially increased (OR = 3.1 95%CI 1.9-5.0) and (OR = 9.0 95%CI 3.5-22.7), respectively. Thus, symptom severity for IBS- or FD symptoms were significantly higher for patients with FD/IBS overlap as compared to patients with FD or IBS alone (p all < 0.01). Age, gender and IBS-subtype were not associated with overlap. In the clinical setting, overlap of FD and IBS is the norm rather than the exception. FD/IBS overlap is associated with a more severe manifestation of a FGID.
Publisher: Wiley
Date: 07-09-2017
DOI: 10.1111/APT.14260
Publisher: Wiley
Date: 14-09-2008
DOI: 10.1111/J.1440-1754.2007.01207.X
Abstract: Aims: To identify the prevalence of constipation in children with nocturnal enuresis presenting to a tertiary paediatric outpatient service and to assess parental and clinician recognition of constipation. Methods: A prospective cross‐sectional study of children with nocturnal enuresis at presentation to a continence service. Data relating to the child’s bowel habits, pattern of enuresis and other history items were obtained from parental questionnaires and paediatrician assessments. Presence and severity of constipation was assessed independently by parents and clinicians. Kappa was used to compare agreement between parental reporting and clinician assessment of constipation. Results: Of the 277 participants aged 4.8–17.5 years (median 8.6 years), 36.1% ( n = 95) were identified as constipated by the clinician‐based scoring method (‘Constipation Score’) compared with 14.1% from parental reporting (Kappa = 0.155, P = 0.003). Despite the poor overall recognition of constipation by parents, parental and clinician assessment of frequency of bowel motions (Kappa = 0.804) and soiling (Kappa = 0.384) were similar. Major factors influencing parental reporting of constipation were frequency of bowel motions and soiling with less emphasis on straining and stool consistency. Conclusions: Prevalence of constipation was high among children with nocturnal enuresis as assessed by clinicians despite poor identification by parents. This may limit optimal diagnosis and management.
Publisher: Wiley
Date: 10-09-2013
DOI: 10.1111/JGH.12365_7
Publisher: BMJ
Date: 28-09-2020
Publisher: Wiley
Date: 10-09-2013
DOI: 10.1111/JGH.12365_8
Publisher: Informa UK Limited
Date: 1992
DOI: 10.3109/00365529209000156
Abstract: Psychologic distress and gastric motor dysfunction have both been implicated in the pathogenesis of functional (non-ulcer) dyspepsia (FD). This study assesses the association between psychologic factors and gastric emptying in 28 FD patients. Subjects completed an extensive range of psychologic questionnaires and underwent dual-isotope scintigraphic assessment of solid and liquid gastric emptying. Attempts to resist, control, suppress, and hold in anger, to adopt a fighting spirit whilst dealing with chronic stressors, and manifest unhappiness were predictors of prolonged gastric emptying. These findings suggest that psychologic factors may be important in the aetiology of gastric stasis and subsequent upper gastrointestinal symptoms in patients with functional dyspepsia.
Publisher: SAGE Publications
Date: 06-1999
DOI: 10.1046/J.1440-1614.1999.00578.X
Abstract: Objective: A model of intermittent psychiatric service provision to rural and remote New South Wales communities by metropolitan psychiatrists and mental health professionals has been evaluated. The services provided included peer support to lone mental health and generic health workers, direct psychiatric care to clients in their own environment and skills development education sessions to general health staff and other professionals affiliated with health care (e.g. police and ambulance officers). Method: There were 10 visits of teams made up of a psychiatrist and another mental health professional to six rural and remote locations. Outcomes of the services delivered were examined including clinical services and teaching skills training sessions. Indirect outcome measures included changes to Pharmaceutical Benefits Scheme prescription patterns in areas serviced and data regarding transfer of clients for psychiatric care in regional centres. Difficulties in evaluation are discussed. Results: The feasibility of intermittent service provision was demonstrated. Education packages were well received and a positive change in workers' attitudes toward mental health practice was found. Conclusion: Intermittent psychiatric services in remote settings add value to health care delivery particularly when dovetailed with skills-based education sessions.
Publisher: Elsevier BV
Date: 07-1990
Publisher: Wiley
Date: 05-1988
DOI: 10.1111/J.1479-828X.1988.TB01635.X
Abstract: We assessed the relationship between maternal hypertension during pregnancy and the incidence of respiratory distress syndrome (RDS) in 263 infants born at 32 weeks' gestation or less. Two-hundred and twenty-three mothers were normotensive and 40 were hypertensive. RDS occurred significantly more commonly in infants of hypertensive mothers than in controls (60% vs 33% p = 0.001). The association between maternal hypertension and an increased rate of RDS remained after adjustment for differences between groups with respect to gestational age, mode of delivery, administration of antenatal steroids and other complications of pregnancy, except for delivery in the absence of labour. The increased rate of RDS related to the severity of hypertension but did not relate to the duration of hypertension or to maternal treatment with beta-blockers. In those infants who developed RDS there was no significant difference in the severity of the illness between the hypertensive group and the controls.
Publisher: Wiley
Date: 22-07-2016
DOI: 10.1111/APT.13738
Abstract: Traditionally, functional gastrointestinal disorders (FGIDs) are conceptualised as originating in the brain via stress pathways (brain-to-gut). It is uncertain how many with irritable bowel syndrome (IBS) and functional dyspepsia (FD) have a gut origin of symptoms (gut-to-brain pathway). To determine if there is a distinct brain-to-gut FGID (where psychological symptoms begin first) and separately a distinct gut-to-brain FGID (where gut symptoms start first). A prospective random population s le from Newcastle, Australia who responded to a validated survey in 2012 and completed a 1-year follow-up survey (n = 1900). The surveys contained questions on Rome III IBS and FD and the Hospital Anxiety and Depression Scale. We found that higher levels of anxiety and depression at baseline were significant predictors of developing IBS (OR = 1.31 95% CI 1.06-1.61, P = 0.01 OR = 1.54 95% CI 1.29-1.83, P < 0.001) and FD (OR = 1.28 95% CI 1.05-1.55, P = 0.01 OR = 1.55, 95% CI 1.32-1.83, P < 0.001), respectively, at the 1-year follow-up. Among those people who did not have elevated levels of anxiety and depression at baseline, subjects at baseline with documented IBS (mean difference 0.34 95% CI 0.13-0.55, P = 0.002 0.81 95% CI 0.47-1.15, P < 0.001) and FD (0.38 95% CI 0.14-0.63, P = 0.002 0.92 95% CI 0.57-1.27, P < 0.001), reported significantly higher levels of anxiety and depression at the 1-year follow-up. We calculated in one-third of in iduals a mood disorder precedes FGID but in two-thirds an FGID precedes the mood disorder. While brain-gut pathways are bidirectional, a major subset begin with gut symptoms first and only then psychological distress develops, implicating primary gut mechanisms as drivers of the gut and extra-intestinal features in many cases.
Publisher: Elsevier BV
Date: 09-2007
DOI: 10.1111/J.1600-6143.2007.01908.X
Abstract: Transplant recipients have increased cancer risk, but data on risk variation across different patient groups are sparse. Rates and standardized rate ratios (SRR) of cancer (all sites, excluding nonmelanocytic skin and lip cancer) compared to the general population were calculated, using Australia and New Zealand Dialysis and Transplant Registry data. Within the transplant population, risk factors were identified (hazard ratios: HR 95% CI) and absolute risk estimated for recipient groups. A total of 1642 (10.8%) of 15 183 recipients developed cancer. Risk was inversely related to age (SRR 15-30 children, 2 if >65 years). Females aged 25-29 had rates equivalent to women aged 55-59 from the general population. Age trend for lymphoma, colorectal and breast risk was similar melanoma showed less variability across ages, prostate showed no risk increase. Within the transplanted population, risk was affected by age differently for each sex (p = 0.007), elevated by prior malignancy (HR 1.40 1.03-1.89), white race (HR 1.36 1.12-1.89), but reduced by diabetic end-stage kidney disease (ESKD) (HR 0.67 0.50-0.89). Cancer rates in kidney recipients are similar to nontransplanted people 20-30 years older, but absolute risk differs across patient groups. Men aged 45-54 surviving 10 years have cancer risks varying from 1 in 13 (non-white, no prior cancer, diabetic ESKD) to 1 in 5 (white, prior cancer, other ESKD).
Publisher: Springer Science and Business Media LLC
Date: 1998
Publisher: BMJ
Date: 02-2019
DOI: 10.1136/BMJOPEN-2018-023906
Abstract: To compare the costs and effects of higher turnover of resident nurses and Aboriginal health practitioners and higher use of agency-employed nurses in remote primary care (PC) services and quantify associations between staffing patterns and health outcomes in remote PC clinics in the Northern Territory (NT) of Australia. Observational cohort study, using hospital admission, financial and payroll data for the period 2013–2015. 53 NT Government run PC clinics in remote communities. Incremental cost-effectiveness ratios were calculated for higher compared with lower turnover and higher compared with lower use of agency-employed nurses. Costs comprised PC, travel and hospitalisation costs. Effect measures were total hospitalisations and years of life lost per 1000 person-months. Multiple regression was performed to investigate associations between overall health costs and turnover rates and use of agency-employed nurses, after adjusting for key confounders. Higher turnover was associated with significantly higher hospitalisation rates (p .001) and higher average health costs (p=0.002) than lower turnover. Lower turnover was always more cost-effective. Average costs were significantly (p .001) higher when higher proportions of agency-employed nurses were employed. The probability that lower use of agency-employed nurses was more cost-effective was 0.84. Halving turnover and reducing use of a short-term workforce have the potential to save $32 million annually in the NT. High turnover of health staff is costly and associated with poorer health outcomes for Aboriginal peoples living in remote communities. High reliance on agency nurses is also very likely to be cost- ineffective . Investment in a coordinated range of workforce strategies that support recruitment and retention of resident nurses and Aboriginal health practitioners in remote clinics is needed to stabilise the workforce, minimise the risks of high staff turnover and over-reliance on agency nurses and thereby significantly reduce expenditure and improve health outcomes.
Publisher: Springer Science and Business Media LLC
Date: 14-01-2021
DOI: 10.1038/S41598-020-80873-2
Abstract: Vasoactive intestinal polypeptide (VIP) is a neuroendocrine peptide distributed throughout the human body, including the CNS, where it is particularly abundant in brain regions associated with anxiety and depression. Based on earlier studies indicating that peripheral VIP may cross through the blood–brain barrier, we hypothesized plasma VIP levels to be associated with symptoms of anxiety and depression, as well as brain volume and resting-state functional connectivity in the amygdala, hippoc us, parahippoc us, and orbitofrontal cortex. Plasma VIP concentrations and anxiety/depression symptoms were measured in 37 healthy females. Functional and structural magnetic resonance imaging were used to evaluate functional connectivity and brain volume respectively, and their associations with VIP concentrations within brain regions associated with anxiety and depression. Negative correlations were found between VIP levels and symptoms of anxiety ( r = − 0.44, p = 0.002) and depression ( r = − 0.50, p = 0.001). Functional connectivity demonstrated significant VIP-dependent positive associations between the amygdala seed region with both the right parahippoc us ( t (33) = 3.1 , p FDR = 0.02) and right lateral orbitofrontal cortex (OFC t (33) = 2.9 , p FDR = 0.02). Moreover, VIP concentrations were significantly, positively correlated with brain volume in the left amygdala ( r = 0.28, p = 0.007) and left lateral OFC ( r = 0.29, p = 0.004). The present findings highlight a potential role for VIP in the neurobiology of affective symptoms.
Publisher: Informa UK Limited
Date: 04-1992
Publisher: MDPI AG
Date: 04-01-2023
DOI: 10.20944/PREPRINTS202301.0055.V1
Abstract: Nickel foam substrates are frequently utilised for renewable energy applications as porous 3D-substrates. Preparation of these substrates usually includes an acid washing step, however the degree to which this step affects the final electrochemical performance after spray coating a catalyst ink is unreported. Herein, we report the effect of acid washing through physicochemical and electrochemical characterisation. The electrochemical performance was determined by repeated measurements of catalyst-coated nickel foam substrates both with and without the initial step of acid washing. Acid washing increased current density by 17.9% for the acid treated, MoS2-coated nickel foam electrode. This increment was affiliated with an electrochemically active surface area which increased by 87.1%, where Tafel analysis indicated that the acid treated, MoS2-coated electrodes facilitates the initial water dissociation step of the hydrogen evolution reaction with greater ease. Similar effects were also discovered for acid treated PtIr(1:3)/C-coated nickel foam substrates, albeit with less pronounced effects. Stability was also improved where the degradation rate was reduced by 18.9% for the acid treated, MoS2-coated electrodes. This proves the utility of acid washing nickel foam electrodes.
Publisher: Wiley
Date: 19-02-2014
DOI: 10.1111/JGH.12419
Abstract: Functional dyspepsia (FD), defined by unexplained pain or discomfort centered in the upper abdomen, is common. Diagnosis and treatment of FD based on the symptom-based Rome criteria remains challenging. Recently, eosinophilia in the duodenum has been implicated in the pathophysiology of FD in adults, specifically increased eosinophils in early satiety and postprandial distress, but the association remains controversial. The aim of this study was to characterize upper gastrointestinal (GI) tract pathology, specifically duodenal eosinophilia, in an Australian cohort of patients with FD. Patients prospectively referred for an upper GI endoscopy (n = 55 mean age, 49.6 years 61.8% female) were stratified to FD cases (n = 33) and controls (n = 22) using Rome II criteria. All subjects completed a validated bowel symptom questionnaire. The eosinophil count per square millimeter in the duodenal bulb (D1) and second part (D2) was assessed and Helicobacter pylori status determined by gastric histology. Associations with clinical symptoms were assessed. Cases and controls were demographically similar. Duodenal eosinophilia was significantly increased in subjects experiencing early satiety (P = 0.01) and postprandial fullness (P = 0.001). This association was seen in D2 but not D1. Abdominal pain was associated with eosinophilia in both D1 (P = 0.02) and D2 (P = 0.005). Smoking was also associated with higher eosinophil counts in D2 (P = 0.007) and symptoms of early satiety (P = 0.02). Duodenal eosinophilia occurs in a subset of FD. The potential role of duodenal eosinophils in FD has implications for diagnosis and therapeutic trials.
Publisher: Wiley
Date: 15-10-2004
DOI: 10.1002/CNCR.20569
Abstract: Anemia in patients with cancer causes fatigue, weakness, and impaired concentration, negatively impacting quality of life (QOL). In clinical trials involving patients with cancer who had varied characteristics, it has been shown that epoetin alfa treatment increased hemoglobin levels and improved QOL. A systematic review and metaanalysis of data from those trials was conducted to summarize existing knowledge on the role of epoetin alfa in improving QOL for anemic patients with cancer. The Cochrane Library and other data bases were searched for published and unpublished, randomized/controlled and single-arm studies that included > or = 20 patients with cancer per arm, epoetin alfa treatment, and QOL assessment by Cancer Linear Assessment Score (CLAS), Functional Assessment of Cancer Therapy (FACT) scale, Eastern Cooperative Oncology Group (ECOG) scale, and/or Medical Outcomes Study Short-Form 36 (SF-36) scale. Among 11,459 patients from 23 trials, epoetin alfa and control cohorts were indistinguishable (with regard to demographic, clinical, QOL variables) at baseline. Epoetin alfa improved CLAS (20-25%), FACT-Fatigue (17%), and FACT-Anemia (12%) scores (P = 0.05). ECOG scores worsened for control cohorts (P = 0.05) epoetin alfa cohorts remained unchanged. Four of the SF-36 subscales, Physical Function, Role Physical, Vitality, and Social Function, improved with epoetin alfa (P = 0.05). Results adjusted for confounding factors remained consistent. This metaanalysis confirmed that epoetin alfa improves QOL significantly in patients with cancer, emphasizing the need to manage anemia in this population.
Publisher: SAGE Publications
Date: 2015
Abstract: Hypnotherapy has been reported as being beneficial in the treatment of irritable bowel syndrome (IBS). We aimed to test the hypothesis that patients with IBS treated ‘holistically’ by hypnosis (i.e. by combined psychological and physiological symptom imagery) would have greater improvement in their IBS symptoms than patients treated by hypnosis using standard ‘gut-directed’ hypnotherapy, and both would be superior to simple relaxation therapy. Patients ( n = 51) with Rome II criteria were randomised to ‘in idualised’ (holistic) hypnotherapy, standard ‘gut-directed’ hypnotherapy or relaxation therapy for a period of 11 weeks with two follow-up assessments at 2 weeks and at 3 months after the completion of the trial. The primary outcome was bowel symptom severity scale (BSSS). All the participants in this study improved their IBS symptoms (pain, bloating, constipation and diarrhoea) and physical functioning at the end of the treatment from baseline, but this was not significantly different across the treatment arms. Neither ‘in idualised’ nor ‘gut-directed’ hypnotherapy is superior to relaxation therapy in IBS.
Publisher: American Medical Association (AMA)
Date: 13-07-1998
DOI: 10.1001/ARCHINTE.158.13.1427
Abstract: The relationship between Helicobacter pylori infection and symptoms remains controversial. We aimed to determine if an association exists between unexplained dyspepsia (pain or discomfort centered in the upper part of the abdomen) and H pylori. A validated questionnaire was completed by 592 healthy blood donors. Helicobacter pylori serologic values (via enzyme-linked immunosorbent assay), blood group status, and Rh status were measured 4.9% of subjects who had a history of peptic ulcer disease were excluded from the analyses. The prevalence of dyspepsia and no ulcer history was 11% (95% confidence interval [CI], 8.6%-13.8%) 15.4% of subjects with dyspepsia had H pylori while 14.6% of subjects without dyspepsia were infected (P=.90). The mean dyspepsia impact scores (combining frequency and severity) in those with and without H pylori were 4.7 and 5.4, respectively (P=.20). The median H pylori optical density values in dyspepsia vs no dyspepsia were not significantly different (P=.30). Independent risk factors for dyspepsia were the use of aspirin (odds ratio [OR], 2.2 95% CI, 1.3-3.7) and smoking (OR, 2.1 95% CI, 1.3-3.6) but not age, sex, marital status, educational level, income, or the use of alcohol, coffee, or nonsteroidal anti-inflammatory drugs. Independent risk factors for H pylori were increasing age (OR, 1.8 per decade 95% CI, 1.5-2.3), male sex (OR, 2.1 95% CI, 1.3-3.4), and net family income (OR, 1.8 95% CI, 1.2-3.3). Dyspepsia in the community is linked to smoking and aspirin use, but not to H pylori infection.
Publisher: Elsevier BV
Date: 09-1992
DOI: 10.1016/0163-8343(92)90067-K
Abstract: One hundred oncology and hematology cancer patients from a major teaching hospital and their treating doctors were studied regarding their attitudes toward cardiopulmonary resuscitation (CPR). A descriptive approach was used, incorporating semistructured interviews of patients and medical staff and established questionnaire measures, examining knowledge of and attitudes toward disease and treatment, and projected attitude toward CPR and current psychological functioning. One-third of the patient s le anticipated a time when they would not consent to cardiopulmonary resuscitation. This was significantly associated with good disease prognosis. Patients with a psychiatric past history were also overrespresented. It appears that patient attitude to treatment withdrawal and refusal of CPR is related to disease progression and likely to change over time. This supports a dynamic and evolving model of advance directives rather than any fixed decree. Medical staff reported that they planned to provide half the s le with intensive medical treatment (including Intensive Care support in the event of their cardiac arrest), and 32% were designated for ward-based resuscitation only. Eighteen percent would not be resuscitated. These patients were older, had more treatment side effects, and a poorer quality of life. Those patients with either a psychiatric past history or higher ratings of depressive affect were also overincluded in the doctors' "Do-Not-Resuscitate" (DNR) group. These results suggest that there are other qualitative factors (e.g., current psychological functioning and past psychiatric history) that contribute to DNR decisions beyond the usual disease-based criteria seen in formal DNR protocols.
Publisher: Public Library of Science (PLoS)
Date: 27-06-2022
DOI: 10.1371/JOURNAL.PONE.0269981
Abstract: Increasing both the frequency and quality of social interactions within treatments for anxiety and depressive disorders in older adults may improve their mental health outcomes and quality of life. This study aims to evaluate the clinical efficacy and cost utility of an enhanced cognitive behavioural therapy (CBT) plus social participation program in a s le of older adults with depression and/or anxiety. A total of 172 community-dwelling adults aged 65 years or older with an anxiety and/or depressive disorder will be randomly allocated to either an enhanced CBT plus social participation program (n = 86) or standard CBT (n = 86). Both treatments will be delivered during 12 weekly in idual sessions utilising structured manuals and workbooks. Participants will be assessed at pre-treatment, post-treatment, and 12-month follow-up. The primary outcome evaluates mean change in clinician-rated diagnostic severity of anxiety and depressive disorders from baseline to post-treatment (primary endpoint) based on a semi-structured diagnostic interview. Secondary outcomes evaluate changes in symptomatology on self-report anxiety and depression measures, as well as changes in social/community participation, social network, and perceived social support, loneliness, quality of life, and use of health services. Economic benefits will be evaluated using a cost-utility analysis to derive the incremental cost utility ratios for the enhanced CBT program. Outcomes from this study will provide support for the establishment of improved psychosocial treatment for older adults with anxiety and/or depression. Study outcomes will also provide health systems with a clear means to reduce the impact of poor emotional health in older age and its associated economic burden. In addition to the empirical validation of a novel treatment, the current study will contribute to the current understanding of the role of social participation in older adult wellbeing. Prospectively registered on the Australian New Zealand Clinical Trials Registry (ID: ACTRN12619000242123 registered 19 th February 2019) and the ISRCTN registry (ID: ISRCTN78951376 registered 10 th July 2019).
Publisher: BMJ
Date: 28-04-2022
DOI: 10.1136/GUTJNL-2021-325821
Abstract: In Europe, IBS is commonly treated with musculotropic spasmolytics (eg, otilonium bromide, OB). In tertiary care, a low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet provides significant improvement. Yet, dietary treatment remains to be explored in primary care. We evaluated the effect of a smartphone FODMAP-lowering diet application versus OB on symptoms in primary care IBS. IBS patients, recruited by primary care physicians, were randomised to 8 weeks of OB (40 mg three times a day) or diet and followed for 24 weeks. We compared IBS Symptom Severity Score and the proportion of responders (improvement ≥50 points) in all patients and the subgroup fulfilling Rome IV criteria (Rome+). We also evaluated treatment efficacy, quality of life, anxiety, depression, somatic symptom severity (Patient Health Questionnaire (PHQ15, PHQ9)) and treatment adherence and analysed predictors of response. 459 primary care IBS patients (41±15 years, 76% female, 70% Rome+) were randomised. The responder rate after 8 weeks was significantly higher with diet compared with OB (71% (155/218) vs 61% (133/217), p=0.03) and more pronounced in Rome+ (77% (118/153) vs 62% (98/158), p=0.004). Patients allocated to diet (199/212) were 94% adherent compared with 73% with OB (148/202) (p .001). The significantly higher response rate with diet was already observed after 4 weeks (62% (132/213) vs 51% (110/215), p=0.02) and a high symptom response persisted during follow-up. Predictors of response were female gender (OR=2.08, p=0.04) for diet and PHQ15 (OR=1.10, p=0.02) for OB. In primary care IBS patients, a FODMAP-lowering diet application was superior to a spasmolytic agent in improving IBS symptoms. A FODMAP-lowering diet should be considered the first-line treatment for IBS in primary care. NCT04270487 .
Publisher: Wiley
Date: 07-2022
DOI: 10.1111/JGH.15920
Abstract: Symptoms of small intestinal bacterial overgrowth (SIBO) and celiac disease (CeD) often overlap, and studies suggest a link between SIBO and CeD. We thus conducted a systematic review and meta‐analysis to compare SIBO prevalence in CeD patients and controls and assessed effects of antimicrobial therapy on gastrointestinal symptoms in SIBO positive CeD patients. Electronic databases were searched until February 2022 for studies reporting SIBO prevalence in CeD. Prevalence rates, odds ratio (OR), and 95% confidence intervals (CI) of SIBO in CeD and controls were calculated. We included 14 studies, with 742 CeD patients and 178 controls. The pooled prevalence of SIBO in CeD was 18.3% (95% CI: 11.4–28.1), with substantial heterogeneity. Including case–control studies with healthy controls, SIBO prevalence in CeD patients was significantly increased (OR 5.1, 95% CI: 2.1–12.4, P = 0.0001), with minimal heterogeneity. Utilizing breath tests, SIBO prevalence in CeD patients was 20.8% (95% CI: 11.9–33.7), almost two‐fold higher compared with culture‐based methods at 12.6% (95% CI: 5.1–28.0), with substantial heterogeneity in both analyses. SIBO prevalence in CeD patients nonresponsive to a gluten free diet (GFD) was not statistically higher as compared with those responsive to GFD (OR 1.5, 95% CI: 0.4–5.0, P = 0.511). Antibiotic therapy of SIBO positive CeD patients resulted in improvement in gastrointestinal symptoms in 95.6% (95% CI: 78.0–99.9) and normalization of breath tests. This study suggests a link between SIBO and CeD. While SIBO could explain nonresponse to a GFD in CeD, SIBO prevalence is not statistically higher in CeD patients non‐responsive to GFD. The overall quality of the evidence is low, mainly due to substantial “clinical heterogeneity” and the limited sensitivity/specificity of the available diagnostic tests.
Publisher: SAGE Publications
Date: 11-07-2017
Abstract: There is growing awareness of the range of psychosocial, lifestyle, and sociodemographic factors related to self-harm, however this research is often limited by using cross-sectional or convenience s les. And while we generally assume that young adults who self-harm experience poorer long-term outcomes, longitudinal research is needed. This paper builds on prior research using a large, representative, longitudinal s le. 5765 Australian women completed 5 surveys (age 18–23 to 31–36). Six-month self-harm was measured by self-report. We had two aims: firstly to predict future self-harm, separately for women with and without prior self-harm. Secondly, to identify outcomes 3 and 6 years following self-harm. Six-month self-harm prevalence was 2.5%. Predictors among women without recent self-harm included depression, dieting behaviours, number of male sexual partners, and abuse. Among women with recent or current self-harm, predictors were number of dieting behaviours, tiredness of life, and stress. Women who self-harmed reported poorer outcomes, namely greater difficulties in relationships at 3- and 6-year follow-up. Longitudinal risk factors for self-harm differed depending on prior self-harm status, and included depression, dieting behaviours, tiredness of life and stress. These factors may serve as warning signs for new or continued self-harm. This study offers new insight into long-term outcomes up to six years after self-harm, particularly with relationships.
Publisher: Wiley
Date: 05-02-2001
DOI: 10.1046/J.1365-2036.2001.00900.X
Abstract: The Nepean Dyspepsia Index is a reliable and valid measure of quality of life in functional dyspepsia, but responsiveness has been little studied. The Nepean Dyspepsia Index originally contained 42 items designed to measure impairment of a subject's ability to engage in relevant aspects of their life because of dyspepsia, and their enjoyment of these aspects in addition, the in idual importance of areas was assessed. It was subsequently shortened to 25 items, yielding five sub-scales. To test the Nepean Dyspepsia Index's responsiveness and develop a responsive, very short form. A randomized, double-blind controlled trial was performed in 589 patients with documented functional dyspepsia. Symptoms and quality of life were measured at baseline, 2 and 4 weeks. Responsiveness of the Nepean Dyspepsia Index quality-of-life section was evaluated by correlation with symptom scores and calculation of standardized changes in scores. Two items from each sub-scale which best represented the area of life (by factor loadings) were selected to create the 10-item short form (SF short form-Nepean Dyspepsia Index). Internal consistency was assessed by Cronbach's alpha and responsiveness was assessed as above. The Nepean Dyspepsia Index quality-of-life scales demonstrated excellent responsiveness to change in both the active and placebo arms (standardized response means all > 1.0). The Nepean Dyspepsia Index accounted for only 8% of the variance in percentage change in symptoms (by visual analogue scales), indicating that it was evaluating areas of life not covered by symptoms. The 10-item short form had adequate internal consistency (all scales > or = 0.70) and all strongly (and significantly) correlated with the long form sub-scales it was also highly responsive. The Nepean Dyspepsia Index is a responsive disease-specific quality-of-life measure the 10-item short form can be applied in clinical trials of functional dyspepsia.
Publisher: Frontiers Media SA
Date: 25-01-2022
Abstract: Increased cortisol exposure is a risk factor for coronary artery disease (CAD). It is not clear to what degree this risk is independent from the standard modifiable risk factors (SMuRFs) dyslipidemia, hypertension, and diabetes. To use path analysis to test the direct and indirect association, mediated by SMuRFs, between long-term cortisol levels measured in hair cortisol concentration (HCC) and CAD. Hair was s led from patients admitted with acute myocardial infarction ( n = 203) and a population-based s le without a diagnosis or symptoms of CAD ( n = 3,134). The HCC was analyzed using radioimmunoassay and all the participants reported whether they were diagnosed with or treated for diabetes, hypertension, and hyperlipidemia. Path analysis was used to test to what degree the association between logarithmized (ln) HCC and CAD was direct or indirect, mediated by SMuRFs. Participants with CAD had elevated HCC compared to those without elevated HCC [median interquartile range (IQR): 75.2 (167.1) vs. 23.6 (35.0) pg/mg, p & 0.0001]. Higher HCC was associated with diabetes, hypertension, and hyperlipidemia, which, in turn, were associated with CAD. In path models, 80% of the association between ln(HCC) and CAD were mediated by SMuRFs, while the direct path between ln(HCC) and CAD was not statistically significant. The SMuRFs diabetes, hyperlipidemia, and hypertension mediate the association between ln(HCC) and CAD. Some association between ln(HCC) and CAD did not operate via the SMuRFs considered and might have a pathway through atherosclerosis or inflammation.
Publisher: Wiley
Date: 16-11-2012
DOI: 10.1111/APT.12079
Publisher: Informa UK Limited
Date: 1992
DOI: 10.3109/00365529209000167
Abstract: The role of fructose and sorbitol, when ingested together, in the aetiology of irritable bowel syndrome (IBS) is controversial. The aims of this study in IBS patients, therefore, were to compare differences in symptom provocation with various doses of fructose-sorbitol and to relate differences in the extent of colonic hydrogen production after each dose to such symptom provocation. Two different mixtures of fructose and sorbitol--20 g fructose plus 3.5 g sorbitol ('lower' dose) and 25 g fructose plus 5 g sorbitol ('higher' dose)--were administered to 15 patients with IBS and to 24 healthy controls. Breath hydrogen concentrations were determined at 10-min intervals for 3 h after ingestion of each mixture, and the presence and severity of a range of gastrointestinal symptoms were recorded on a standard form before, during, and after the study. Total symptom score in IBS patients, but not controls, was greater (p < 0.05) after the higher than after the lower dose of fructose-sorbitol mixture, and, for the higher dose, symptoms were significantly greater in IBS patients than in controls (p < 0.05). Moreover, the increase in total symptom score between the higher and lower dose mixtures was of a greater magnitude (p = 0.01) in IBS patients than in controls. No significant correlation was observed between the increase in symptom score and the increase in peak hydrogen concentration or the increase in integrated hydrogen response between lower and higher dose mixtures, although these latter increases were at times substantial.(ABSTRACT TRUNCATED AT 250 WORDS)
Publisher: Springer Science and Business Media LLC
Date: 07-2019
Publisher: Public Library of Science (PLoS)
Date: 23-03-2017
Publisher: Royal College of Psychiatrists
Date: 05-1989
Abstract: Alcoholics and heroin addicts were compared with a normal control group to determine whether there were differences in quality of parenting during childhood, assessed using the Parental Bonding Instrument. Maternal and paternal overprotection were reported more commonly by narcotic addicts. Maternal overprotection alone was implicated in alcoholics. Narcotic addicts seem to have more disturbed parenting than alcoholics, especially paternal parenting.
Publisher: Wiley
Date: 10-2009
DOI: 10.1111/J.1365-2923.2009.03506.X
Abstract: Using a novel longitudinal tracking project, this study develops and evaluates the performance of a predictive model and index of rural medical practice intention based on the characteristics of incoming medical students. Medical school entry survey data were obtained from the Medical Schools Outcome Database (MSOD) project implemented in all Australian and New Zealand medical schools and coordinated through Medical Deans Australia and New Zealand, the representative body for the Deans of 18 Australian and two New Zealand medical schools and faculties. The medical school commencement survey collects data on students' education and family background, including rural upbringing, personal circumstances and scholarships, and on their practice intentions in terms of location and specialty. The MSOD will also allow tracking of medical graduates after graduation. Logistic regression modelling was used to develop a predictive model of rural practice intention. Split-s le validation was used to gain some insight into the stability of performance of the model. Response rates to the MSOD survey exceeded 90% on average. The model findings confirm and extend previous research examining the association of medical student characteristics with intention to take up rural medical practice. The statistically significant independent factors in the model included students' rural backgrounds, financial arrangements and intentions regarding specialist versus generalist practice upon graduation. Model performance was good, with an area under the receiver-operator characteristics curve of 0.86, and reproducible, with an area in a validation s le of 0.83. The model and related index provide important insights into in idual factors associated with rural practice intention among students commencing medical studies. The model can also provide a means for optimising the use of scarce medical programme resources, thereby helping to improve the supply of rural medical practitioners. This study illustrates the power and potential of a robust, consistent, systematic longitudinal tracking project.
Publisher: AMPCo
Date: 07-01-2020
DOI: 10.5694/MJA2.50458
Abstract: To determine the incidence of self-reported non-coeliac wheat sensitivity (SR-NCWS) and factors associated with its onset and resolution to describe the prevalence of factors associated with gluten avoidance. Longitudinal cohort study analysis of responses to self-administered validated questionnaires (Digestive Health and Wellbeing surveys, 2015 and 2018). Subset of an adult population s le randomly selected in 2015 from the electoral rolls for the Newcastle and Gosford regions of New South Wales. Prevalence of SR-NCWS (2015, 2018) and incidence and resolution of SR-NCWS, each by demographic and medical factors prevalence of gluten avoidance and reasons for gluten avoidance (2018). 1322 of 2185 eligible participants completed the 2018 survey (response rate, 60.5%). The prevalence of SR-NCWS was similar in 2015 (13.8% 95% CI, 12.0-15.8%) and 2018 (13.9% 95% CI, 12.1-15.9%) 69 of 1301 respondents (5.3%) reported developing new onset (incident) SR-NCWS between 2015 and 2018 (incidence, 1.8% per year). Incident SR-NCWS was significantly associated with a diagnosis of functional dyspepsia, and negatively associated with being male or older. Gluten avoidance was reported in 2018 by 24.2% of respondents (20.5% partial, 3.8% complete avoidance) general health was the most frequent reason for avoidance (168 of 316 avoiders, 53%). All 13 participants with coeliac disease, 56 of 138 with irritable bowel syndrome (41%), and 69 of 237 with functional dyspepsia (29%) avoided dietary gluten. The prevalence of SR-NCWS was similar in 2015 and 2018. Baseline (2015) and incident SR-NCWS (2018) were each associated with functional gastrointestinal disorders. The number of people avoiding dietary gluten exceeds that of people with coeliac disease or SR-NCWS, and general health considerations and abdominal symptoms are the most frequently reported reasons for avoidance.
Publisher: Elsevier BV
Date: 05-2019
Publisher: Wiley
Date: 03-1992
Publisher: SAGE Publications
Date: 2020
Abstract: Fecal incontinence (FI) is a common, debilitating condition that causes major impact on quality of life for those affected. Non-surgical treatment options include anorectal biofeedback therapy (BF) and percutaneous tibial nerve stimulation (PTNS), usually performed separately. The aims of the current study were to determine the feasibility, tolerability, safety, and efficacy of performing a combined BF and PTNS treatment protocol. Female patients with urge FI were offered a novel pilot program combining BF with PTNS. The treatment protocol consisted of 13 weekly sessions: an educational session, followed by 5 combined BF and PTNS sessions, 6 PTNS and a final combined session. Anorectal physiology and clinical outcomes were assessed throughout the program. For efficacy, patients were compared with BF only historical FI patients matched for age, parity, and severity of symptoms. A total of 12/13 (93%) patients completed the full program. Overall attendance rate was 93% (157/169 sessions). Patient comfort score with treatment was rated high at 9.8/10 (SD 0.7) for PTNS and 8.6/10 (SD 1.7) for the BF component. No major side effects were reported. A reduction of at least 50% in FI episodes/week was achieved by 58% of patients by visit 6, and 92% by visit 13. No physiology changes were evident immediately following PTNS compared with before, but pressure during sustained anal squeeze improved by the end of the treatment course. Comparing outcomes with historical matched controls, reductions in weekly FI episodes were more pronounced in the BF only group at visit 6, but not week 13. In this pilot study, concurrent PTNS and anorectal biofeedback therapy has been shown to be feasible, comfortable, and low risk. The combined protocol is likely to be an effective treatment for FI, but future research could focus on optimizing patient selection.
Publisher: BMJ
Date: 07-1995
DOI: 10.1136/THX.50.7.731
Publisher: SAGE Publications
Date: 2019
Abstract: Instrumented anorectal biofeedback (BF) improves symptoms and quality of life in patients with faecal incontinence and defecation disorder-associated chronic constipation. However, demand for BF greatly outweighs availability, so refinement of the BF protocol, in terms of the time and resources required, is of importance. Our aim was to evaluate the outcomes of an abbreviated BF protocol in patients with defecation disorder-associated chronic constipation and/or faecal incontinence compared to standard BF. Data were collected from consecutive patients ( n = 31 age 54 ± 15 29 females 61% functional constipation) undergoing an intentionally abbreviated BF protocol, and compared in a 1:2 ratio with 62 age, gender and functional anorectal disorder-matched control patients undergoing a standard BF. Outcomes included change in symptoms, physiology, patient satisfaction and quality of life. On intention to treat, patients in both protocols showed significant improvement in symptom scores and the magnitude did not differ between groups. Impact on quality of life, satisfaction and control over bowel movements improved in both protocols, but satisfaction improved to a greater extent in the standard BF protocol ( p = 0.009). Physiological parameters were unchanged after BF apart from improvement in rectal sensation in the standard BF group compared to abbreviated BF ( p ⩽ 0.002). Abbreviated anorectal BF offered to patients travelling from far away was not different to a standard BF in providing substantial, at least short term, improvements in symptoms of constipation and faecal incontinence, quality of life and feeling of control over bowel movements. Refinement of the standard BF protocol according to in idual patient phenotypes and desired outcomes warrants further study in order to maximize efficacy and improve access for patients.
Publisher: Springer Science and Business Media LLC
Date: 06-09-2016
Publisher: Elsevier BV
Date: 08-1998
DOI: 10.1111/J.1467-842X.1998.TB01424.X
Abstract: This report compares the results from two s ling strategies used to determine the prevalence of elevated blood lead concentrations and iron status in 12-36 month old children in Central Sydney. The two methods were stratified random s ling using census collector districts and an opportunistic s ling strategy using client registers at Early Childhood Centres (ECCs). The response rates were 75.3% (n = 718 of whom 198 were aged 12-36 months) and 24.1% (n = 304) respectively. The geometric mean blood lead concentrations were 0.40 and 0.34 mumol/L respectively (p = 0.001). The traditional random s ling prevalence survey identified a significantly higher proportion of children with blood lead concentrations greater than 0.48 (OR = 0.61, 95% CI 0.40-0.93) and 0.72 mumol/L (OR = 0.44, 95% CI 0.21-0.92) compared to the simpler opportunistic survey. The median plasma ferritin concentration for both studies was 19 micrograms/L (p = 0.4). The prevalence of iron depletion, iron deficiency and iron deficiency anaemia was not significantly different between the two studies. In conclusion, opportunistic s ling through ECCs does not appear to be a substitute for the traditional random s ling prevalence surveys of determine the prevalence of elevated blood lead concentrations in pre-school children in Central Sydney. However, opportunistic s ling through ECCs may be an appropriate method for monitoring iron status, in particular iron depletion, in pre-school children in Central Sydney.
Publisher: Wiley
Date: 10-08-2016
DOI: 10.1111/AJR.12224
Abstract: To measure the differences in the recording of risk factors and lifestyle advice between those at high risk of cardiovascular disease and those diagnosed with cardiovascular disease, and to identify the practice characteristics associated with such recording in rural primary care. A cross-sectional observation study of 14 general practices. Medical records were audited to measure recording of risk factors and lifestyle advice for those at high risk of and those diagnosed with cardiovascular disease. Practice characteristics were collected, with logistic regression used to test for an association with the recording of risk factors. General practices in rural Australia. Each practice was asked to identify 20 patients 10 at high risk and 10 diagnosed with cardiovascular disease. The recording of risk factors and lifestyle advice in patient records and practice characteristics. 282 records were audited with 142 being high risk and 140 diagnosed with cardiovascular disease.Measures recorded significantly less in the high-risk group were: blood pressure (94% versus 99% P = 0.019) physical activity (24% versus 56% P = 0.000) dietary advice (32% versus 51% P = 0.001) and physical activity advice (34% versus 56% P = 0.000). Recording of risk factors was positively associated with practice involvement in quality improvement (P < 0.001), continuing education (P < 0.001), and greater percentage of general practitioners (P < 0.05) and practice nurses (P < 0.001). There is substantial room for enhanced cardiovascular disease prevention through rural primary care in Australia, particularly for high-risk patients. This study has demonstrated an association between practice factors (including targeted education, quality improvement activities and appropriate workforce) and improved preventive activities.
Publisher: Springer Science and Business Media LLC
Date: 1997
Publisher: Elsevier BV
Date: 02-1993
DOI: 10.1016/0002-9378(93)90514-J
Abstract: Secretory products of immune cells may induce or potentiate coagulation disturbances and vasoconstriction, both central features of pregnancy-induced hypertension. Women with chronic essential hypertension are at high risk of superimposed pregnancy-induced hypertension. The aim of our study was to compare secretory rates of prostanoids (active in coagulation and vascular reactivity) by peripheral blood monocytes and platelets from nonpregnant controls and from women in the third trimester of pregnancy, normals and those with either pregnancy-induced hypertension or uncomplicated chronic essential hypertension. From 100 ml blood, peripheral blood monocytes and platelets were isolated their relative rates of in vitro production of prostacyclin, prostaglandin E2, and thromboxane were measured, and responses to stimulation by arachidonic acid or the calcium ionophore A23187 were compared among the four groups of subjects. Basal peripheral blood monocyte secretory levels of prostanoids were low in all groups, with responses to both stimuli. Cells from women with chronic essential hypertension had a relatively exaggerated rise in thromboxane secretion (and to a lesser extent, prostacyclin) in response to the stimuli used, with a similar but less marked trend for those with pregnancy-induced hypertension. Platelets from women with chronic essential hypertension had particularly high basal secretory levels of thromboxane, with little further response to stimulation by arachidonic acid or A23187. Our work demonstrates clearly for the first time that peripheral blood monocytes from pregnant women secrete low levels of vasoactive prostanoids and respond to the stimuli used in a manner similar to that of nonpregnant women, and that cells from pregnant women with hypertension have a tendency to increased reactivity that is most marked in those with chronic essential hypertension. Platelets from women with chronic essential hypertension secrete near-maximal amounts of thromboxane in the absence of exogenous stimuli, indicating a degree of prior activation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2019
Publisher: Wiley
Date: 02-04-2007
DOI: 10.1111/J.1365-2036.2007.03326.X
Abstract: A genetic contribution has been proposed for irritable bowel syndrome (IBS) and gastro-oesophageal reflux disease (GERD), but is controversial. No twin data exist for dyspepsia. To determine the relative contribution of genetic factors in GERD, dyspepsia (upper abdominal pain) and IBS. A total of 986 twin pairs (from initial mail-out response 51%). Both members completed validated symptom and psychological questionnaires 481 monozygotic pairs [mean (s.d.) age 53 +/- 5.8 years] and 505 dizygotic pairs (mean age 54 +/- 5.6 years). Prevalence of IBS, dyspepsia and GERD was 12%, 10% and 20%, respectively. Polychoric correlation for monozygotic twins for IBS (0.47) and GERD (0.44) were both substantially larger than those for dizygotic twins (0.17 and -0.37, respectively). Polychoric correlation was slightly lower in monozygotic than dizygotic twins for dyspepsia. Genetic modelling confirmed the independent additive genetic effects in GERD and IBS but not dyspepsia. Estimates of genetic variance were 22% for IBS, 13% for GERD and 0% for dyspepsia, but adjusting for anxiety and depression removed the statistical significance for IBS and GERD. There is a genetic contribution to GERD and IBS but not dyspepsia this may be mediated by the hereditability of anxiety and depression.
Publisher: Informa UK Limited
Date: 16-01-2013
DOI: 10.3109/00365521.2012.758767
Abstract: Information on the relationships between stool characteristics and colonic transit time (CTT) in irritable bowel syndrome (IBS) is limited. Our aims were: (i) to relate stool frequency and consistency to total and segmental CTTs, (ii) to correlate changes in these stool characteristics with changes in CTTs between a baseline assessment and a 12-week assessment, and (iii) to examine the confounding effects of mood on these relationships, in patients with IBS. Twenty-one female patients with IBS underwent, on two occasions 12 weeks apart, a colonic transit study and completed at these times Bristol Stool Form Scale (BSFS) and Bowel Symptoms Severity Rating Scale (BSSRS). All patients also completed the Hospital Anxiety and Depression scale. Between baseline and the 12-week assessment, an increase in the number of days over the past week without a bowel motion correlated with prolonged total CTT (r = 0.54, p = 0.01). An increase in the number of days with more than three bowel motions per day correlated with a shorter right CTT (r = -0.52, p = 0.02). Only after adjusting for anxiety and depression, did an increase in loose or watery bowel motions (for BSSRS but not for BSFS) correlate with a shorter right CTT (r = -0.47, p = 0.03). Stool frequency, as well as stool consistency, correlates with CTT. Correlations between stool consistency and CTT are more robust for BSSRS than for BSFS. An effect of mood appears to be important in the relationship between stool consistency and CTT.
Publisher: Cambridge University Press (CUP)
Date: 05-2002
Publisher: Springer Science and Business Media LLC
Date: 10-06-2008
Publisher: Wiley
Date: 03-07-2017
DOI: 10.1111/APT.14207
Abstract: Current subgrouping of Irritable Bowel Syndrome (IBS) is exclusively based on stool consistency without considering other relevant gastrointestinal (GI), extraintestinal somatic or psychological features. To identify subgroups based on a comprehensive set of IBS-related parameters. Mixture model analysis was used, with the following input variables: 13 single-item scores from the IBS-specific Gastrointestinal Symptom Rating Scale, average stool consistency and frequency from a 7-day Bristol Stool Form diary, 12 single-item extraintestinal symptom scores from the Patient Health Questionnaire-12, and anxiety and depression subscale scores from the Hospital Anxiety and Depression scale. The resulting latent subgroups were compared regarding symptom profiles using analysis of variance followed by pair-wise comparisons. One hundred and seventy-two IBS patients (Rome III 69% female mean age 33.7 [range 18-60] years) were included. The optimal subgrouping showed six latent groups, characterised by: (I) constipation with low comorbidities, (II) constipation with high comorbidities, (III) diarrhoea with low comorbidities, (IV) diarrhoea and pain with high comorbidities, (V) mixed GI symptoms with high comorbidities, (VI) a mix of symptoms with overall mild severity. The subgroups showed differences in the distribution of Rome III-subtypes, IBS severity, presence of anxiety and depression, and gender, but not regarding age, IBS duration or reported post-infectious onset of IBS. This model-based subgrouping of IBS partly supports the distinction of subgroups based on bowel habits, but additionally distinguishes subgroups with or without co-morbid extraintestinal somatic and psychological symptoms. The resulting groups show specific profiles of symptom combinations.
Publisher: Portland Press Ltd.
Date: 05-1992
DOI: 10.1042/CS0820505
Abstract: 1. Studies were undertaken in pre-menopausal women to examine the effects of treatment with standard oestrogen-progestogen and progestogen-only oral contraceptives on erythrocyte Na+,K+ co-transport and Na+−Na+ countertransport over 3- and 6-month periods. Concurrent observations were made on other erythrocyte cation transport components, plasma lipid concentrations, plasma renin activity, plasma aldosterone concentration and blood pressure. 2. Na+,K+ co-transport, measured as the ouabain-resistant, frusemide-sensitive component of 86Rb+ influx, and Na+−Na+ countertransport, measured as the ouabain-resistant, phloretin-sensitive component of 22Na+ influx, were both increased in women taking, on days 1–21 of their cycle, ethinyloestradiol (30–50 μg) combined with norethisterone (1000 μg or 500–1000 μg) for 3 or 6 months. Neither of these fluxes was increased in a control group of women, or in women treated for the same time periods with ethinyloestradiol combined with levonorgestrel. 3. In a separate study of erythrocyte cation transport (excluding Na+−Na+ countertransport), in which women undertook treatment with norethisterone only (350 μg/ day) for 6 months starting 6 weeks post partum, no changes in Na+,K+ co-transport were observed at 3 or 6 months there were no changes in cation transport in a corresponding control group. 4. The results of these studies confirm that certain oral contraceptive compounds can alter erythrocyte cation transport, and indicate that norethisterone in higher dose preparations is the component predominantly responsible. The alterations observed could not be explained by a direct link with concurrent changes in plasma triacylglycerol concentrations or in the renin-aldosterone axis and were not closely associated with elevation of blood pressure.
Publisher: Springer Science and Business Media LLC
Date: 2003
Abstract: Proton pump inhibitors have been reported to delay gastric emptying, but this effect is controversial. Our aim was to determine the effect of rabeprazole sodium on several parameters of gastric function including gastric emptying, myoelectrical activity and ingested water volume required to produce fullness. Fifteen healthy males underwent assessment of solid-phase gastric emptying with the [13C] Spirulina platensis breath test as well as electrogastrography and satiety testing using a 5-min water load. Subjects were evaluated at baseline, after administration of placebo, and after rabeprazole sodium 20 mg daily for one week. No significant differences were seen between groups with respect to solid-phase gastric emptying as measured by T1/2 or T(lag). No differences were seen between baseline, placebo, and rabeprazole with respect to the number of normal electrogastrograms and the volume of water required to produce fullness. In conclusion, one week of therapy with rabeprazole sodium does not significantly alter gastric emptying, myoelectrical activity or threshold to fullness.
Publisher: American Medical Association (AMA)
Date: 10-09-2001
DOI: 10.1001/ARCHINTE.161.16.1989
Abstract: Gastrointestinal symptoms are reportedly common in diabetes, but a causal link is controversial and adequate population control data are lacking. To determine whether gastrointestinal symptoms are more frequent in persons with diabetes, particularly in those with poor glycemic control. Fifteen thousand adults were mailed a questionnaire (response rate, 60.0%) containing validated questions on the frequency of troublesome gastrointestinal symptoms within the past 3 months, diabetic status, and self-reported glycemic control. The prevalence of 16 symptoms and 5 symptom complexes, reported to occur often or very often, was compared using logistic regression analysis, adjusting for age and sex. Overall, 8657 eligible subjects responded 423 (4.9%) reported having diabetes. Most (94.8%) had type 2 diabetes mellitus. Adjusting for age and sex, all 16 symptoms and the 5 symptom complexes were significantly more frequent in subjects with diabetes compared with controls. An increased prevalence rate of symptoms was significantly associated with poorer levels of glycemic control but not with duration of diabetes or type of diabetic treatment. Diabetes mellitus is associated with an increased prevalence of upper and lower gastrointestinal symptoms. This effect may be linked to poor glycemic control but not to duration of diabetes or type of treatment.
Publisher: Wiley
Date: 11-07-2021
DOI: 10.1111/APT.16500
Abstract: Psychological distress, strongly associated with functional gastrointestinal disorders (FGIDS), likely plays a central role in the pathophysiology. The role of sleep disturbances in FGIDs is unclear, and an association with psychological factors is uncertain. To determine whether sleep disturbances are associated with irritable bowel syndrome (IBS) and functional dyspepsia (FD) and if a potential association is explained by psychological distress. Adult s le randomly selected from a region in New South Wales, Australia in 2015 who returned a follow‐up mail survey in 2018 (response rate, 60.5%) that contained questions on IBS, FD, sleep (MOS‐Sleep Scale) and psychological distress (Kessler 6 scale). Among this population, 10.4% (95% CI 8.8‐12.2) and 17.9% (95% CI 15.9‐20.1) met Rome III criteria for IBS and FD, respectively. The prevalence of any sleep disturbance at least most of the time was common, with a significantly higher prevalence in FGID (IBS and/or FD) compared with the remaining population (41.8% vs 32.2%, P = 0.003). The total sleep problem index was significantly higher for IBS (OR = 1.71 [95% CI 1.29‐2.27], P 0.0001) (IBS‐diarrhoea predominant and IBS‐mixed but not IBS‐constipation) and FD (OR = 1.80 [1.43‐2.26], P 0.0001) (both epigastric pain syndrome and postprandial distress syndrome) even after adjusting for age, sex and psychological distress. Both IBS and FD, and most of their major subtypes except IBS‐C, are associated with a range of sleep disturbances. These sleep problems do not appear to be explained by psychological factors and may play an independent role in the pathophysiology.
Publisher: Elsevier BV
Date: 07-2020
Publisher: Wiley
Date: 10-10-2017
DOI: 10.1111/JGH.13791
Abstract: A previous UK study showed that 6.1% of patients with diarrhea-predominant irritable bowel syndrome (IBS-D) had evidence of severe pancreatic exocrine insufficiency (PEI), but these findings need replication. We aimed to identify the prevalence of PEI based on fecal elastase stool testing in consecutive outpatients presenting with chronic unexplained abdominal pain and/or diarrhea and/or IBS-D. Patients aged over 40 years presenting to hospital outpatient clinics from six sites within Australia with unexplained abdominal pain and/or diarrhea for at least 3 months and/or IBS-D were studied. Patients completed validated questionnaires and donated a stool s le in which elastase concentration was measured by ELISA. A concentration of < 100 mcg/g stool represented severe and < 200 mcg/g mild to moderate PEI. Patients whose fecal elastase was < 200 mcg/g underwent testing for pancreatic pathology with an endoscopic ultrasound or abdominal CT. Two hundred eighteen patients (mean age of 60 years, 29.4% male) were studied. PEI was found in 4.6% (95% CI 2.2-8.3%) (n = 10), with five patients (2.3% (95% CI 0.8-5.3%) having severe PEI. Only male sex and heavy alcohol use were significantly associated with abnormal versus normal pancreatic functioning. Of seven patients who underwent endoscopic ultrasound or CT, two had features indicative of chronic pancreatitis. One in 50 patients with IBS-D or otherwise unexplained abdominal pain or diarrhea have an abnormal fecal elastase, but unexpected pancreatic insufficiency was detected in only a minority of these. This study failed to confirm the high prevalence of PEI among patients with unexplained GI symptoms previously reported.
Publisher: Elsevier BV
Date: 1991
DOI: 10.1016/0167-5273(91)90126-A
Abstract: This paper reports the immediate effects of thrombolysis and their subsequent influence on revascularisation procedures and clinical outcome over the subsequent twelve months. Coronary arteriography was performed at 21 days on 131 of 145 patients who received recombinant tissue plasminogen activator (n = 68) or placebo (n = 63) within 2.5 hours of symptom onset after primary coronary occlusion. Patency rates (TIMI grades 2 and 3) of the infarct-related artery were 81% with plasminogen activator and 63% with placebo (P = 0.02). Early (within 21 days) angiography for recurrent ischaemia was necessary in 31 (21%) patients (20 plasminogen activator, 11 placebo NS) and definite reinfarction occurred in 8 (5%) patients (4 plasminogen activator, 4 placebo). During one year follow-up without planned secondary intervention, coronary artery bypass grafting was more frequent in patients who had received thrombolytic therapy (23% plasminogen activator, 4% placebo P = 0.001) coronary angioplasty procedures were similar in both groups (12% plasminogen activator, 11% placebo NS). Mortality at 21 days was 5% (4 plasminogen activator, 4 placebo) and at one year was 7% (5 plasminogen activator, 5 placebo). Logistic regression analysis identified models comprising characteristics predictive of subsequent bypass grafting (plasminogen activator, multivessel disease, occluded infarct-related artery) and coronary angioplasty (non-q wave infarction, severe (91-99%) residual stenosis, left anterior descending infarct-related artery). Initial non-q wave infarction was the only predictor of early recurrent ischemia (odds ratio 4, P = 0.02) irrespective of residual stenosis severity.
Publisher: MDPI AG
Date: 17-12-2021
DOI: 10.3390/EN14248535
Abstract: An increasing emphasis on energy storage has resulted in a surge of R& D efforts into producing catalyst materials for the hydrogen evolution reaction (HER) with emphasis on decreasing the usage of platinum group metals (PGMs). Alkaline water electrolysis holds promise for satisfying future energy storage demands, however the intrinsic potential of this technology is impeded by sluggish reaction kinetics. Here, we summarize the latest efforts within alkaline HER electrocatalyst design, where these efforts are ided between three catalyst design strategies inspired by the three prevailing theories describing the pH-dependence of the HER activity. Modifying the electronic structure of a host through codoping and creating specific sites for hydrogen/hydroxide adsorption stand out as promising strategies. However, with the vast amount of possible combinations, emphasis on screening parameters is important. The authors predict that creating a codoped catalyst using the first strategy by screening materials based on their hydrogen, hydroxide and water binding energies, and utilizing the second and third strategies as optimization parameters might yield both active and stable HER catalyst materials. This strategy has the potential to greatly advance the current status of alkaline water electrolysis as an energy storage option.
Publisher: S. Karger AG
Date: 2008
DOI: 10.1159/000121355
Abstract: i Objective: /i We aimed to evaluate if the course of dyspepsia is influenced by medical consultation in primary care. i Design, Setting and Patients: /i Australian general practitioners (n = 27) recruited 157 dyspeptic patients, of whom 94 were eligible for follow-up. Dyspepsia, comorbidity, quality of life, emotional status, locus of control and consultation satisfaction were measured at baseline and follow-up (mean 3 months). i Main Outcome Measure: /i Response was defined as improvement of dyspepsia over time on the Nepean Dyspepsia Index score. i Results: /i Dyspepsia improved in 82% (n = 77). There was no significant change in non-gastrointestinal symptoms. Half were worried or stressed by their symptoms, and 85% wanted reassurance, a need that (univariately) differentiated responders from non-responders (p = 0.02). Most patients seen in primary care with dyspepsia improved. If the doctor believed it was likely that the patient would follow their recommendations, the patient was nearly five times as likely to be a responder (OR 4.9, 95% CI 1.2–19.0). The only other significant predictor was acid suppression therapy (OR 3.5, 95% CI 1.1–10.9). i Conclusion: /i Most primary care visits for dyspepsia are followed by improvement, which may be predicted in part by indicators of patient compliance. Prescription of acid suppression therapy may also improve outcome in dyspepsia.
Publisher: BMJ
Date: 13-04-2010
Abstract: Intrauterine growth restriction (IUGR) can lead to significant intellectual and behavioural problems in later life. IUGR represents a frequent feature of pregnancies of opioid-dependent mothers (ODMs), the causes of which are largely unknown. The objective of this study was to determine the independent risk factors for IUGR in ODMs. We performed a retrospective study analysing maternal and neonatal parameters from pregnancies of ODM maintained on methadone (n=215). These were compared to smoking non-ODM and non-smoking non-ODM control groups matched for maternal age, gestational age at delivery, infant birth date and sex. Logistic regression analysis was performed on all parameters with the outcome of IUGR. Fifty-seven infants (27%) of ODMs showed IUGR. Compared to non-smoking non-ODMs, the risk of IUGR in non-smoking ODMs was almost four times higher (relative risk 3.48, 95% CI 1.70 to 7.14). Growth restriction was independent of the last maternal methadone dose and the cumulative methadone dose during pregnancy. In addition, whereas nicotine and female sex impacted on IUGR in non-ODMs (nicotine: OR 3.45, 95% CI 1.82 to 6.67 sex: OR 2.37, 95% CI 1.25 to 4.50), these parameters had no influence on IUGR in ODMs. Maternal body mass index (BMI) was identified as the only independent risk factor for IUGR in infants of ODMs (OR 1.15, 95% CI 1.03 to 1.28). IUGR in pregnancies of ODM is related to maternal BMI rather than to opiate dosing, nicotine use or infant sex. BMI may itself be an indirect marker of several other genetic, nutritional and/or social determinants of IUGR.
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.JAD.2014.03.009
Abstract: Internet-delivered trauma-focused cognitive behavioural therapy is efficacious for PTSD however, no studies have investigated the roles of in idual treatment components or the safety of online treatments. To compare the efficacy and safety of an online treatment for PTSD comprised of psychoeducation, stress management, cognitive restructuring and exposure components with the equivalent protocol without the exposure components, using a randomised controlled trial design. Sixty-six in iduals were randomised to a non-exposure condition and 59 to the full protocol with exposure components. Treatment duration was 8 weeks and pre-, post-treatment and three-month follow-up outcomes were analysed using a mixed linear modelling approach. Both groups achieved improvements in symptoms with no differences between groups on any primary or secondary outcome measures, diagnostic remission rates or adverse events. The study included several secondary measures that have not been previously validated and treatments were not time matched in terms of number of lessons. These findings indicate that trauma-focused cognitive behavioural therapy for PTSD with or without exposure components can be safe and efficacious.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2014
DOI: 10.1038/AJG.2013.423
Abstract: Constipation is one of the most common outpatient diagnoses in primary care and gastroenterology clinics however, there is limited data on the inpatient burden of constipation in the United States. The aim of this study was to evaluate inpatient admission rates, length of stay, and associated costs related to constipation from 1997 to 2010. We analyzed the National Inpatient S le Database for all patients in which constipation (ICD-9 codes: 564.0-564.09) was the principal discharge diagnosis from 1997 to 2010. The statistical significance of the difference in the number of hospital discharges, length of stay, and hospital costs over the study period was determined by utilizing the Spearman's coefficient to describe various trends. Between 1997 and 2010, the number of hospitalizations for patients with a primary discharge diagnosis of constipation increased from 21,190 patients to 48,450 (P<0.001, GoF test), whereas the mean length of hospital stay increased only slightly from 3.0 days to 3.1 days (b=0.008 (0.003-0.014) P=0.004). The mean charges per hospital discharge for constipation increased from $8869 in 1997 (adjusted for long-term inflation) to $17,518 in 2010 (b=745.4 (685.3-805.6) P<0.001)), whereas the total costs increased from $188,109,249 (adjusted for inflation) in 1997 to $851,713,263 in 2010. Although the elderly (65-84 years) accounted for the largest percentage of constipation discharges, patients in the 1-17 years age group had the highest frequency of constipation per 10,000 discharges. The number of inpatient discharges for constipation and associated costs has significantly increased between 1997 and 2010.
Publisher: JMIR Publications Inc.
Date: 03-10-2016
DOI: 10.2196/RESPROT.5831
Publisher: Baishideng Publishing Group Inc.
Date: 2011
Publisher: Wiley
Date: 30-07-2019
DOI: 10.1111/APT.15406
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: MDPI AG
Date: 30-06-2020
DOI: 10.3390/NU12071947
Abstract: Introduction: Functional dyspepsia (FD), characterised by symptoms of epigastric pain or early satiety and post prandial distress, has been associated with duodenal eosinophilia, raising the possibility that it is driven by an environmental allergen. Non-coeliac gluten or wheat sensitivity (NCG/WS) has also been associated with both dyspeptic symptoms and duodenal eosinophilia, suggesting an overlap between these two conditions. The aim of this study was to evaluate the role of wheat (specifically gluten and fructans) in symptom reduction in participants with FD in a pilot randomized double-blind, placebo controlled, dietary crossover trial. Methods: Patients with Rome III criteria FD were recruited from a single tertiary centre in Newcastle, Australia. All were in idually counselled on a diet low in both gluten and fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) by a clinical dietitian, which was followed for four weeks (elimination diet phase). Those who had a ≥30% response to the run-in diet, as measured by the Nepean Dyspepsia Index, were then re-challenged with ‘muesli’ bars containing either gluten, fructan, or placebo in randomised order. Those with symptoms which significantly reduced during the elimination diet, but reliably reappeared (a mean change in overall dyspeptic symptoms of ≥30%) with gluten or fructan re-challenge were deemed to have wheat induced FD. Results: Eleven participants were enrolled in the study (75% female, mean age 43 years). Of the initial cohort, nine participants completed the elimination diet phase of whom four qualified for the rechallenge phase. The gluten-free, low FODMAP diet led to an overall (albeit non-significant) improvement in symptoms of functional dyspepsia in the diet elimination phase (mean NDI symptom score 71.2 vs. 47.1, p = 0.087). A specific food trigger could not be reliably demonstrated. Conclusions: Although a gluten-free, low-FODMAP diet led to a modest overall reduction in symptoms in this cohort of FD patients, a specific trigger could not be identified. The modified Salerno criteria for NCG/WS identification trialled in this dietary rechallenge protocol was fit-for-purpose. However, larger trials are required to determine whether particular components of wheat induce symptoms in functional dyspepsia.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2009
DOI: 10.1016/J.JURO.2008.10.044
Abstract: We estimated the spectrum and risk factors for daytime urinary incontinence in school-age children. A validated, reproducible, parent administered daytime incontinence questionnaire was distributed to randomly selected school children. The questionnaire elicited information on demographic factors, prenatal and developmental factors, and bowel and urinary history. The spectrum of daytime urinary incontinence was measured by recording the frequency and amount of incontinence. Parents of 2,856 children (mean age 7.3 years) completed the questionnaire. Overall 16.9% reported any daytime urinary incontinence in the previous 6 months, with 64% of cases being very mild, 14.8% mild, 11.6% moderate and 9.6% severe. There was low agreement between frequency and amount of incontinence (weighted kappa 0.03) but risk factors were similar. Independent risk factors were nocturnal enuresis (OR 7.2, 95% CI 3.4 to 15.2), female gender (5.4, 2.6 to 11.1), social concerns (3.4, 1.4 to 8.3), urinary tract infection (5.6, 2.0 to 15.6) and encopresis (3.3, 1.4 to 7.7). Expressed as population attributable risk, 36% of moderate to severe daytime incontinence can be attributed to encopresis, nocturnal enuresis, social concerns, female gender or urinary tract infection. Urinary tract infection was a risk factor for boys but not for girls (interaction p <0.01). Daytime urinary incontinence in children is a common but heterogeneous disorder. Episodes may be frequent or major or both but appear to share the same causal pathway. Given the risk factors identified, interventions should target endogenous hysiological and environmental factors.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-10-2021
DOI: 10.14309/AJG.0000000000001526
Abstract: Rectal perception testing is a recommended component of anorectal physiology testing. Although recent consensus (London) guidelines suggested criteria for categorizing hyporectal and hyper-rectal sensitivity, these were based on scant evidence. Moreover, data regarding diagnostic capabilities and clinical utility of rectal perception testing are lacking. The aims of this study were to determine the association between rectal perception testing and both clinical and physiological variables to enhance the analysis and interpretation of real-life test results. Prospectively documented data from 1,618 (92% female) patients referred for anorectal physiology testing were analyzed for 3 rectal perception thresholds (first, urge, and maximal tolerated). Normal values derived from healthy female subjects were used to categorize each threshold into hyposensitive and hypersensitive to examine the clinical relevance of this categorization. There was poor to moderate agreement between the 3 thresholds. Older age, male sex, and constipation were associated with higher perception thresholds, whereas irritable bowel syndrome, fecal incontinence, connective tissue disease, and pelvic radiation were associated with lower perception thresholds to some, but not all, thresholds ( P 0.01 on multivariate analysis for all). The clinical utility and limitations of categorizing thresholds into “hypersensitivity” and “hyposensitivity” were determined. Commonly practiced rectal perception testing is correlated with several disease states and thus has clinical relevance. However, most disease states were correlated with 2 or even only 1 abnormal threshold, and agreement between thresholds was limited. This may suggest each threshold measures different pathophysiological pathways. We suggest all 3 thresholds be measured and reported separately in routine clinical testing.
Publisher: Wiley
Date: 22-03-2015
DOI: 10.1111/NMO.12542
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.IJPSYCHO.2021.09.006
Abstract: Debate continues as to whether an attentional bias towards threat displayed by sufferers of functional gastrointestinal disorders (FGIDs) is conscious and, thus, more amenable to change through psychological therapy. We compared the litudes of early (unconscious) and later (conscious) electroencephalographic (EEG) event-related potentials following silent reading of symptom-related, emotionally neutral, and emotionally negative nouns across two participant groups: 30 female FGID-sufferers who met diagnostic criteria for irritable bowel syndrome or functional dyspepsia, and 30 female healthy controls. Analogous indices based on alpha desynchronization were also examined, as were correlations between the EEG-based indices and a range of psychosocial variables. FGID-sufferers displayed marginally significantly higher occipital EPN litudes for all nouns, indicating marginally higher levels of unconscious attention in the task. FGID-sufferers also displayed, for negative as compared to neutral nouns, significantly lower central N400 litudes indicative of higher conscious attention. The result was only apparent in post-hoc pairwise comparisons, however. Uniquely among FGID-sufferers, central N400 was strongly negatively correlated with a range of negative psychosocial traits and states. The findings provide preliminary evidence of hypervigilance to general (as opposed to symptom-specific) threat among FGID-sufferers. Amidst concerns over Type I error, recommendations are made for fine-tuning the operationalisation of unconscious and conscious attentional bias in this population.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2008
DOI: 10.1111/J.1572-0241.2008.01943.X
Abstract: To prospectively determine the turnover (gain or loss) of gastrointestinal (GI) symptoms in diabetic subjects in relation to glycemic control, autonomic neuropathy and psychiatric disease over a 2-year follow-up. Type 1 and type 2 diabetic subjects were recruited from the community, as were community controls. In idual GI symptoms were examined by a validated questionnaire and classified as diarrhea, irritable bowel syndrome, upper GI symptoms, and any GI symptoms at baseline, 12 and 24 months. Glycemic control (glycated hemoglobin), autonomic function (using standardized tests), and psychiatric disease (using the Composite International Diagnostic Interview) were also assessed at these time points. Baseline and 2-year follow-up data were available for 139 diabetic subjects and 55 controls. Glycated hemoglobin at baseline was 7.7% (+/-1.36) in the diabetic group 5% had severe autonomic dysfunction. There was a significantly higher prevalence of diarrhea in the diabetic subjects. GI symptom turnover varied between 15% and 25% in the diabetic group and was not significantly different from the controls. There was no clear association between turnover of GI symptoms and either glycemic control or autonomic neuropathy. The appearance of depression was associated with gaining of most symptoms apart from irritable bowel syndrome, although the associations did not always reach significance. The univariate results were confirmed after adjusting for age, gender, body mass index, and metformin use. The turnover of GI symptoms in diabetic subjects was not associated with glycemic control but there was a positive association with change in depression.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Springer Science and Business Media LLC
Date: 25-06-2020
Publisher: Wiley
Date: 07-02-2018
DOI: 10.1111/APT.14551
Publisher: Wiley
Date: 05-2003
DOI: 10.1046/J.1365-2036.2003.01553.X
Abstract: Although gastrointestinal symptoms occur frequently, there is no validated measure of gastrointestinal symptoms in patients with diabetes mellitus. To develop the Diabetes Bowel Symptom Questionnaire. A questionnaire derived from previously validated symptom measures was compiled to assess all relevant gastrointestinal and diabetes items. Face and content validity were ascertained by expert review. One hundred and sixty-eight patients with diabetes mellitus completed the instrument, and reliability was evaluated by a test-re-test procedure 1 week later. Concurrent validity was evaluated by an independent physician interview (n = 33). Measures of glycaemic control (glycated haemoglobin and plasma glucose) were compared with self-reported glycaemic control on a five-point Likert scale in diabetic out-patients (n = 166). The questionnaire had adequate face and content validity. There was good to excellent test-re-test reliability for the gastrointestinal and diabetes items (median kappa: 0.63 and 0.79, respectively) concurrent validity was good to excellent (median kappa: 0.47 and 0.65, respectively), except for the items assessing the severity of gastrointestinal symptoms. Both glycated haemoglobin (P < 0.0001) and plasma glucose (P = 0.005) correlated significantly with self-reported glycaemic control. The Diabetes Bowel Symptom Questionnaire appears to be a useful measure of gastrointestinal symptoms and glycaemic control in diabetes mellitus, and should have applicability in epidemiological and clinical studies.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2010
Publisher: Wiley
Date: 06-07-2023
DOI: 10.1111/JGH.16278
Abstract: Eosinophils contribute to tissue homeostasis, damage, and repair. The mucosa of colonic erticula has not been evaluated for eosinophils by quantitative histology. We aimed to investigate whether mucosal eosinophils and other immune cells are increased in colonic erticula. Hematoxylin and eosin stained sections from colonic surgical resections ( n = 82) containing erticula were examined. Eosinophils, neutrophils, and lymphocytes, in five high power fields in the lamina propria were counted at the base, neck, and ostia of the erticulum and counts compared to non‐ erticula mucosa. The cohort was further subgrouped by elective and emergency surgical indications. Following an initial review of 10 surgical resections from patients with erticulosis, a total of 82 patients with colonic resections containing erticula from the descending colon were evaluated (median age 71.5, 42 M/40F). Eosinophil counts for the entire cohort were increased in the base and neck (median 99 and 42, both P = .001) compared with the control location (median 16). Eosinophil counts remained significantly increased in the erticula base (both P = .001) and neck ( P = 0.01 and .001, respectively) in both elective and emergency cases. Lymphocytes were also significantly increased at the erticula base compared to controls in both elective and emergency subgroups. Eosinophils are significantly and most strikingly increased within the erticulum in resected colonic erticula. While these observations are novel, the role of eosinophil and chronic inflammation is as yet unclear in the pathophysiology of colonic erticulosis and erticular disease.
Publisher: Springer Science and Business Media LLC
Date: 04-2022
Publisher: Informa UK Limited
Date: 1988
DOI: 10.3109/00365528809093875
Abstract: It remains controversial whether psychologic factors contribute to the onset or chronicity of non-ulcer dyspepsia (NUD) and duodenal ulcer. Although such patients on conventional psychologic testing have no clearly defined specific personality type, an inability to express emotion, which may result in excessive autonomic arousal, has been suggested to be important on theoretic grounds. The aim of this study was to assess whether the latter defect is associated with the subgroup of NUD patients with essential dyspepsia and with patients with chronic duodenal ulcer. Eighty-one patients with essential dyspepsia and 53 patients with duodenal ulcer studied after endoscopy were compared with 82 randomly selected dyspepsia-free community controls. All were assessed with the Courtauld emotional control scale, a valid and objective self-report measure. Control of anger, anxiety, unhappiness, and total emotional control over negative reactions were similar in all three groups. It is concluded that patients with essential dyspepsia and duodenal ulcer who present for investigation are unlikely to repress emotional reactions consciously.
Publisher: Health Education and Training Institute - HETI
Date: 12-09-2022
Abstract: Purpose: Inflammatory bowel disease (IBD) management is complex and challenging, and therefore, requires a multidisciplinary approach. Whilst pharmacists may play a key role as the first point of contact for patients with initial symptoms or disease relapse, there is scant literature on pharmacists’ knowledge in IBD management. We conducted a survey to explore pharmacists’ knowledge and their perception of pharmacists and other healthcare professionals’ roles in managing patients with IBD.Design and Methodology: An online survey was distributed to pharmacists through professional organisations. The survey included questions about demographic information, concepts related to IBD management and the roles of pharmacists and healthcare professionals in managing patients with IBD.Findings: Fifty two respondents completed the survey. The overall knowledge score for the majority of respondents was categorised as ‘low’ (25-50%) to ‘average’ (51-75%). IBD concept that demonstrated the highest level of accuracy in knowledge scores among pharmacists was the importance of vaccination in IBD (94.2%). Pharmacists who had exposure to patients with IBD demonstrated better knowledge scores compared to those who did not have any exposure to IBD patients in their practice (p = 0.005). Furthermore, General Practitioners (GPs) were perceived as the key care providers to IBD patients, whilst pharmacists considered themselves as important in providing medication related information to patients. Conclusion: This study indicated that pharmacists’ knowledge of IBD and its’ management was suboptimal, but with education and training there are opportunities for pharmacists to play a more active role in managing patients with IBD.
Publisher: Springer Science and Business Media LLC
Date: 16-03-2021
DOI: 10.1007/S10620-021-06932-4
Abstract: Ustekinumab, an interleukin-12 and interleukin-23 antagonist, is licensed for the treatment of Crohn's disease (CD) and ulcerative colitis (UC) after the phase III trial programs demonstrated efficacy over placebo. However, these findings may not be directly transferable to the real-world due to the stringent inclusion criteria of clinical trials. We conducted a systematic review and meta-analysis of the safety and effectiveness of ustekinumab in inflammatory bowel disease (IBD). A systematic literature search was conducted via Medline and Embase from inception to April 21, 2020. Observational studies assessing ustekinumab's safety and effectiveness by reporting response, remission and/or adverse events (AE) in either CD or UC were included. Two reviewers independently assessed risk of bias and extracted study data. Random-effects meta-analysis was performed to pool rates of clinical response, remission, and safety data. Following deduplication, 2147 records were identified of which 41 studies (38 CD, 3 UC) comprising 4400 patients were included for quantitative analysis. Pooled clinical remission rates for CD were 34% (95% CI, 26%-42%) following induction and 31% (95% CI, 25%-38%) at one year. For UC, post-induction clinical remission rates were 39% (95% CI, 23%-56%). Serious AEs were reported in 5.6% of patients. Pregnancy outcomes were similar to the general population. One-third of patients with active baseline perianal disease responded or had fistula healing with ustekinumab. In the most comprehensive systematic review and meta-analysis to date, and the first to include UC, ustekinumab was shown to be effective and safe in the real-world treatment of IBD.
Publisher: Informa UK Limited
Date: 1988
DOI: 10.3109/00365528809093876
Abstract: A subgroup of patients with endoscopically diagnosed non-ulcer dyspepsia have no definite cause for their symptoms, termed essential dyspepsia such patients have been considered to have 'nervous dyspepsia'. To determine whether social and environmental factors are of importance, both in childhood (before the onset of symptoms) and in adult life, 109 patients with essential dyspepsia and 109 randomly selected dyspepsia-free community controls (matched for age, sex, and one measure of social grade-suburb of residence) were studied. Socioeconomic status, marital status, childhood environment, family structure, and migration were measured. An increased risk of essential dyspepsia was associated with one aspect of social status incongruity compared with controls, patients had a lower occupational status than their place of residence indicated (OR = 2.3 95% CI, 1.5-3.5). There was a trend for patients to report an unhappy childhood (OR = 2.4 95% CI, 0.9-6.7). Being unmarried, undergoing parental separation during childhood, the patient's age at parental separation, the number of siblings, birth order, country of birth, and years of residence were not significantly associated with essential dyspepsia. The importance of psychosocial and childhood factors in essential dyspepsia is probably small.
Publisher: Wiley
Date: 06-2010
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12960-019-0432-Y
Abstract: Residents of remote communities in Australia and other geographically large countries have comparatively poorer access to high-quality primary health care. To inform ongoing policy development and practice in relation to remote area health service delivery, particularly in remote Indigenous communities, this review synthesizes the key findings of (1) a comprehensive study of workforce turnover and retention in remote Northern Territory (NT) of Australia and (2) a narrative review of relevant international literature on remote and rural health workforce retention strategies. This synthesis provides a valuable summary of the current state of international knowledge about improving remote health workforce retention. Annual turnover rates of NT remote area nurses (148%) and Aboriginal health practitioners (80%) are very high and 12-month stability rates low (48% and 76%, respectively). In remote NT, use of agency nurses has increased substantially. Primary care costs are high and proportional to staff turnover and remoteness. Effectiveness of care decreases with higher turnover and use of short-term staff, such that higher staff turnover is always less cost-effective. If staff turnover in remote clinics were halved, the potential savings would be approximately A$32 million per annum. Staff turnover and retention were affected by management style and effectiveness, and employment of Indigenous staff. Review of the international literature reveals three broad themes: Targeted enrolment into training and appropriate education designed to produce a competent, accessible, acceptable and ‘fit-for-purpose’ workforce addressing broader health system issues that ensure a safe and supportive work environment and providing ongoing in idual and family support . Key educational initiatives include prioritising remote origin and Indigenous students for university entry maximising training in remote areas contextualising curricula providing financial, pedagogical and pastoral support and ensuring clear, supported career pathways and continuing professional development. Health system initiatives include ensuring adequate funding providing adequate infrastructure including fit-for-purpose clinics, housing, transport and information technology offering flexible employment arrangements whilst ensuring a good ‘fit’ between in idual staff and the community (especially with regard to cultural skills) optimising co-ordination and management of services that empower staff and create positive practice environments and prioritising community participation and employment of locals. In idual and family supports include offering tailored financial incentives, psychological support and ‘time out’. Optimal remote health workforce stability and preventing excessive ‘avoidable’ turnover mandates alignment of government and health authority policies with both health service requirements and in idual health professional and community needs. Supportive underpinning policies include: Strong intersectoral collaboration between the health and education sectors to ensure a fit-for-purpose workforce A funding policy which mandates the development and implementation of an equitable, needs-based formula for funding remote health services Policies that facilitate transition to community control, prioritise Indigenous training and employment, and mandate a culturally safe work context and An employment policy which provides flexibility of employment conditions in order to be able to offer in idually customised retention packages There is considerable extant evidence from around the world about effective retention strategies that contribute to slowing excessive remote health workforce turnover, resulting in significant cost savings and improved continuity of care. The immediate problem comprises an ‘implementation gap’ in translating empirical research evidence into actions designed to resolve existing problems. If we wish to ameliorate the very high turnover of staff in remote areas, in order to provide an equitable service to populations with arguably the highest health needs, we need political and executive commitment to get the policy settings right and ensure the coordinated implementation of multiple strategies, including better linking existing strategies and ‘filling the gaps’ where necessary.
Publisher: Wiley
Date: 09-03-2014
DOI: 10.1111/MEDU.12399
Abstract: Medical school curricula remain one of the key levers in increasing the future supply of rural doctors. Data from Australia and overseas have suggested exposure to rural practice via rural placements during basic medical training is positively associated with graduates becoming rural doctors. However, previous studies have suffered from serious methodological limitations. This study sought to determine whether rural clinical placements are associated with a higher proportion of graduating students planning rural careers and to explore associations with timing, duration and location of placements. Data were obtained from the Medical Schools Outcomes Database and Longitudinal Tracking Project, which is a longitudinal study with a high response rate that prospectively collects data, including practice location intention, from all Australian medical schools. Using logistic regression analysis, the association between placements and rural career intention was assessed, controlling for a number of demographic and contextual variables. The association between rural/remote placements later in the programme and rural practice intention was strongly positive whether viewed as simple occurrence or as duration, in contrast to later urban placements, which were strongly negative. A longer duration of placement enhanced the associations reported. Non-metropolitan medical schools were also associated with higher odds of intention to take up rural practice. However, the association with rural placements was overshadowed by the strong positive associations with rural background of students and their stated intention to become a rural doctor at the start of their studies. Exposure to rural practice during basic medical training, and the location and curriculum focus of a medical school are confirmed as factors that are positively associated with students' intention to become rural doctors after graduation. However, rural origin and the early intentions at the start of their medical training are better predictors of expressed intention to take up rural practice than rural clinical placements.
Publisher: Wiley
Date: 04-2020
Publisher: Springer Science and Business Media LLC
Date: 1997
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Springer Science and Business Media LLC
Date: 26-11-2019
DOI: 10.1007/S10620-018-5387-7
Abstract: Rumination syndrome is a functional gastrointestinal disorder characterized by effortless, postprandial regurgitation. Duodenal eosinophilia has been described in patients with functional dyspepsia. Because of the significant symptomatic overlap between functional dyspepsia and rumination syndrome, we hypothesized that histological changes might exist among patients with rumination syndrome. We included patients with rumination syndrome in whom we had obtained duodenal biopsies and compared these with controls. Digital images of biopsy specimens were analyzed for routine pathology and eosinophil counts by a pathologist blinded to the case-control status. The 22 patients with rumination syndrome had a mean age of 39.2 years (range 21-71) and 77% were female. The 10 controls had a mean age of 34.3 (range 27-69) and 80% were female. There was a significant increase in the mean eosinophil count among the patients with rumination syndrome compared to controls, 26 per mm Patients with rumination syndrome have subtle duodenal pathology with eosinophilia and increased intraepithelial lymphocyte counts compared to controls.
Publisher: Elsevier BV
Date: 05-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-04-2009
DOI: 10.1038/AJG.2009.136
Abstract: The Nepean Dyspepsia Index (NDI) was specifically developed for trials in functional dyspepsia, but the smallest change on the total or subscale scores, which corresponds to a clinically meaningful change (minimal clinically important difference, MCID), has not been established. An MCID has been established for the SF-36 (> or =5 points on physical or mental health subscales) such information is critical for understanding clinical trial data. We aimed at calculating an MCID for the NDI to help guide the interpretation of future clinical trials. Comprehensive clinical data were collected in outpatients (n=101) and community subjects (n=460), and the MCID for the NDI total score was examined in three ways. The first estimated the average change (over a 2-week period) in the NDI corresponding to a five-point change in the SF-36 mental and physical subscales, and the second repeated this using a 1-s.d. change in symptom level, whereas the third calculated Cohen's d effect size among in iduals changing by at least five points on the SF-36 subscales. A separate cross-sectional study was used to obtain the receiver-operator characteristic curve for discriminating between dyspepsia and non-dyspepsia subjects. Among in iduals improving by at least 1 s.d. on the patient-reported symptom score, the corresponding improvement in NDI quality of life (QoL) was an average of 18 points (s.d.=12) compared with only 7 points (s.d.=15) in those with no/minimal change in symptoms, yielding a Cohen d of 1.0 and a proposed MCID of 10 points. Although the same pattern was found using the SF-36 physical scale, the effect size was smaller (Cohen's d=0.25). Smaller effect sizes were also obtained using the SF-36 mental subscale (Cohen's d=0.1) and the physician global assessment (Cohen's d=0.33). In a separate cross-sectional community study, the NDI-QoL score was shown to provide good discrimination between in iduals meeting and not meeting the Rome criteria for functional dyspepsia, with an area under the receiver-operator characteristic curve of 0.80 (95 % confidence interval: 0.75, 0.85). A change of at least 10 points on the NDI total scale corresponds to a clinically meaningful change in patient status.
Publisher: Wiley
Date: 10-10-2014
DOI: 10.1111/APT.12961
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2001
Publisher: Wiley
Date: 06-01-2014
DOI: 10.1111/APT.12608
Abstract: The development of a reliable biomarker for irritable bowel syndrome (IBS) remains one of the major aims of research in functional gastrointestinal disorders (FGIDs) and is complicated by the absence of a perfect reference standard. Previous efforts based on genetic and immune markers have showed promise, but have not been robust. To evaluate an extensive panel of gene expression and serology markers combined with psychological measures in differentiating IBS from health and between subtypes of IBS. Of subjects eligible for analysis (N = 244), 168 met criteria for IBS (60 IBS-C, 57 IBS-D and 51 mixed), while 76 were free of any FGID. A total of 34 markers were selected based on pathways implicated in pathophysiology of IBS or whole human genome screening. Psychological measures were recorded that covered anxiety, depression and somatisation. Models differentiating disease and health were based on unconditional logistic regression and performance assessed through area under the receiver-operator characteristic curve (AUC), sensitivity and specificity. The performance of a combination of 34 markers was good in differentiating IBS from health (AUC = 0.81) and was improved considerably with the addition of four psychological markers (combined AUC = 0.93). Of the 34 markers considered, discrimination was derived largely from a small subset. Good discrimination was also obtained between IBS subtypes with the best being observed for IBS-C vs. IBS-D (AUC = 0.92) however, psychological variables provided almost no incremental discrimination subtypes over biological markers (combined AUC = 0.94). A combination of gene expression and serological markers in combination with psychological measures shows exciting progress towards a diagnostic test for IBS compared with healthy subjects, and to discriminate IBS-C from IBS-D.
Publisher: Wiley
Date: 12-10-2016
DOI: 10.1111/APT.13818
Publisher: AMPCo
Date: 11-2016
DOI: 10.5694/MJA16.00981
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2015
DOI: 10.1038/AJG.2015.64
Abstract: Although constipation is typically managed in an outpatient setting, there is an increasing trend in the frequency of constipation-related hospital visits. The aim of this study was to analyze trends related to chronic constipation (CC) in the United States with respect to emergency department (ED) visits, patient and hospital characteristics, and associated costs. Data from 2006 to 2011, in which constipation (The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes 564.00-564.09) was the primary discharge diagnosis, were obtained from the National Emergency Department S le (NEDS). Between 2006 and 2011, the frequency of constipation-related ED visits increased by 41.5%, from 497,034 visits to 703,391 visits, whereas the mean cost per patient rose by 56.4%, from $1,474 in 2006 to $2,306 in 2011. The aggregate national cost of constipation-related ED visits increased by 121.4%, from $732,886,977 in 2006 to $1,622,624,341 in 2011. All cost data were adjusted for inflation and reported in 2014 dollars. Infants (<1 year old) had the highest rate of constipation-related ED visits in both 2006 and 2011. The late elders (85+ years) had the second highest constipation-related ED visit rate in 2006 however, the 1- to 17-year-old age group experienced a 50.7% increase in constipation-related ED visit rate from 2006 to 2011 and had the second highest constipation-related ED visit rate in 2011. The frequency of and the associated costs of ED visits for constipation are significant and have increased notably from 2006 to 2011.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2019
Publisher: Springer Science and Business Media LLC
Date: 06-2003
DOI: 10.1007/S10198-002-0164-Z
Abstract: We analysed the factors influencing cost-effectiveness of a health care intervention over time using economic evaluations of erythropoietin as a case study. The analytical framework of a study conducted in 1990 was used to revisit the cost-effectiveness of erythropoietin. Study variables were updated to 2000 using meta-analysis, published sources, and expert opinion. After 10 years of further experience with the use of erythropoietin the cost-effectiveness ratio now falls within the range considered acceptable in the UK. The analysis shows that the vast proportion of the reduction in the cost-effectiveness ratio achieved since 1990 results from reductions in the dose and price of erythropoietin. True cost-effectiveness of a treatment can change over time, and early analysis can reach incorrect conclusions because of data deficiencies. The existence of a body such as NICE might have delayed the widespread adoption of erythropoietin in the UK, but the higher standards of clinical and economic evidence demanded by such a body might have expedited the appropriate pricing,dosage, and hence utilisation of the treatment.
Publisher: No publisher found
Date: 2014
DOI: 10.1111/APT.12846
Abstract: Activation of the immune system has been demonstrated in atopy and functional gastrointestinal disorders (FGIDs). Previous data from our group have suggested a connection between immune dysregulation, FGIDs and mood disorders. To investigate if these data translate to clinical practice and examine connections from the perspective of FGIDs to determine whether atopy and FGIDs are connected via mood disorders. Evidence of irritable bowel syndrome (IBS), functional dyspepsia (FD) and constipation was sought from the medical records of 30,000 primary care records over a minimum 5 year period. The same records yielded diagnoses of four atopic conditions (asthma, eczema, allergic rhinitis/hay fever and conjunctivitis). Atopic conditions were found in excess among all FGID groups considered when compared with controls. In the groups with IBS alone (OR = 1.43, 1.29-1.58), FD alone (OR = 1.41, 1.26-1.58) and those with multiple FGIDs (OR = 1.92, 1.75-2.12) there was elevated prevalence of asthma compared with controls without a FGID. Across disorders the excess was generally highest among patients diagnosed with multiple FGIDs (rhinitis/hay fever OR = 3.74, 3.32-4.20 conjunctivitis OR = 3.00, 2.49-3.62) and was only partly explained by a common association between both FGIDs and atopic conditions with mood disorders, although not for every atopic/FGID combination (rhinitis/hay fever OR = 2.60, 2.29-2.96, conjunctivitis OR = 2.34, 1.90-2.87). Irritable bowel syndrome, functional dyspepsia and constipation share an association with atopy that is only partly explained via a common connection with mood disorders. These data have important implications for understanding both the pathophysiology of functional gastrointestinal disorders and development of new treatments.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2003
DOI: 10.1111/J.1572-0241.2003.07465.X
Abstract: Many factors have been associated with the occurrence of constipation, particularly poor diet and lack of exercise. However, the importance of medications and general medical illnesses in constipation remains more uncertain. We aimed to identify risk factors for constipation from among patient clinical, therapeutic, and demographic characteristics. The s le was composed of patients explicitly diagnosed with chronic constipation (n = 7251), those diagnosed with constipation of unspecified chronicity (n = 6441), and a s le of controls (n = 7103). All were drawn from a general practice research database representing more than 10 yr of data collection. A large number of clinical and therapeutic factors were independently associated with chronic constipation over and above age and gender. Primary neurological diseases were strongly associated with constipation but accounted for few cases. Opioids (OR = 1.6, population attributable risk [PAR] = 2.6%), diuretics (OR = 1.7, PAR = 5.6%), antidepressants (OR = 1.9, PAR = 8.2%), antihistamines (OR = 1.8, PAR = 9.2%), antispasmodics (OR = 3.3, PAR = 11.6%), anticonvulsants (OR = 2.8, PAR = 2.5%) and aluminum antacids (OR = 1.7, PAR = 3.0%) were associated with the highest risk among medications. Constipation is common in primary care, and multiple medications seem to be an important contributing factor. Concurrent diseases are also associated but at most are only contributing to a minority of cases.
Publisher: Oxford University Press (OUP)
Date: 06-02-2014
Publisher: Wiley
Date: 10-2010
Publisher: Wiley
Date: 02-01-2021
DOI: 10.1002/GPS.5486
Publisher: Wiley
Date: 15-05-2020
DOI: 10.1111/APT.15786
Publisher: Springer Science and Business Media LLC
Date: 27-05-2017
DOI: 10.1007/S10620-017-4599-6
Abstract: The clinical assessments of patients with gastrointestinal symptoms can be time-consuming, and the symptoms captured during the consultation may be influenced by a variety of patient and non-patient factors. To facilitate standardized symptom assessment in the routine clinical setting, we developed the Structured Assessment of Gastrointestinal Symptom (SAGIS) instrument to precisely characterize symptoms in a routine clinical setting. We aimed to validate SAGIS including its reliability, construct and discriminant validity, and utility in the clinical setting. Development of the SAGIS consisted of initial interviews with patients referred for the diagnostic work-up of digestive symptoms and relevant complaints identified. The final instrument consisted of 22 items as well as questions on extra intestinal symptoms and was given to 1120 consecutive patients attending a gastroenterology clinic randomly split into derivation (n = 596) and validation datasets (n = 551). Discriminant validity along with test-retest reliability was assessed. The time taken to perform a clinical assessment with and without the SAGIS was recorded along with doctor satisfaction with this tool. Exploratory factor analysis conducted on the derivation s le suggested five symptom constructs labeled as abdominal pain/discomfort (seven items), gastroesophageal reflux disease/regurgitation symptoms (four items), nausea/vomiting (three items), diarrhea/incontinence (five items), and difficult defecation and constipation (2 items). Confirmatory factor analysis conducted on the validation s le supported the initially developed five-factor measurement model ([Formula: see text], p < 0.0001, χ The SAGIS instrument has excellent psychometric properties and supports the clinical assessment of and symptom-based categorization of patients with a wide spectrum of gastrointestinal symptoms.
Publisher: Wiley
Date: 03-1996
Publisher: Wiley
Date: 26-04-2022
DOI: 10.1111/APT.16877
Abstract: This article is linked to Sharma et al papers. To view these articles, visit 0.1111/apt.16369 and 0.1111/apt.16910
Publisher: Elsevier BV
Date: 09-2021
DOI: 10.1016/J.HUMPATH.2021.06.004
Abstract: Whilst intraepithelial lymphocytes (IELs) are considered normal within the distal esophageal mucosa, they have an increasingly recognised role in the pathogenesis of reflux esophagitis, and IEL quantification establishes the diagnosis of lymphocytic esophagitis. Knowledge regarding the upper limit of a normal IEL count in health is lacking. We studied 117 non-healthcare seeking adult volunteers from a random community s le (the Kalixanda study) with esophageal biopsies 2 cm above the gastroesophageal junction. Subjects were ided into four groups based on the presence or absence of gastro-esophageal reflux symptoms and/or esophagitis on endoscopy. Asymptomatic subjects with no endoscopic esophagitis were selected as controls, and the cell counts in this group were used to define the upper limit of normal of IELs, eosinophils and neutrophils. The entire s le was used to identify independent predictors of increased cellular counts by logistic regression analysis. None of the healthy controls had an IEL count of more than three per five high power fields (HPF), and therefore this was considered as the upper limit of normal no controls had eosinophils or neutrophils in esophageal biopsies. Independent predictors of an elevated IEL count were spongiosis on histology (OR 11.17, 95% CI 3.32-37.58, P < 0.01) and current smoking (OR 4.84, 95% CI 1.13-2.71, P = 0.03). A receiver operating characteristics analysis concluded that a threshold of 3 IELs/5HPFs performs best in predicting reflux symptoms when a normal esophageal mucosa is visualized on endoscopy (sensitivity = 100.0%, specificity = 35.2%). The healthy esophageal mucosa does not contain more than three IELs per five HPF in the distal esophagus.
Publisher: Wiley
Date: 30-01-2023
DOI: 10.1002/UEG2.12362
Abstract: Gastroparesis and functional dyspepsia are disorders characterized by upper gastrointestinal symptoms and multifaceted etiologies. One of the main therapeutic approaches is accelerating gastric emptying (GE) by means of prokinetic agents. Their efficacy has been demonstrated, although the association between symptom improvement and acceleration of emptying is less clear. Meta‐analyses have found contradictory results. Differences in applied methodology and included trials might drive these contradictions. To provide a transparent meta‐analysis update to elucidate the association between symptom improvement and acceleration of GE due to gastroprokinetic agents available for long‐term use in patients with gastroparesis. Two approaches from earlier meta‐analyses were executed and compared. One analyzed the relative changes on active treatment versus baseline, the other compared the change from baseline on active treatment versus the change from baseline on placebo. Papers that reported sufficient numerical data for both analyses were selected. Both analyses included the same trials. Overall, both approaches yield the same positive direction of association between symptom improvement and acceleration of emptying (0.291 (−0.391, 0.972), p = 0.4 and 0.453 (0.123, 0.782), p = 0.007 for the active‐only and placebo‐controlled analysis respectively). The association between symptom improvement and GE acceleration for studies using optimal GE tests was either 0.028 ( p 0.9) or 0.463 ( p = 0.007), and for sub‐optimal GE tests was either 0.370 ( p = 0.4) or 0.052 ( p 0.9) depending on the used meta‐analysis methodology. The applied methodology for GE testing, and the meta‐analysis substantially impacts the conclusion. When considering the clinically relevant outcome of improvement from baseline, symptoms and emptying improve with prokinetics, but no correlation is found between both aspects. When the change over placebo is considered, limiting the analysis to scientifically more rigorous study approaches, changes in emptying rate and symptom improvement are positively associated.
Publisher: Georg Thieme Verlag KG
Date: 11-2017
Abstract: The authors conducted a meta-analysis of the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with chronic liver disease (CLD) and controls. Using the search terms “small intestinal bacterial overgrowth (SIBO)” and “chronic liver disease (CLD)” or “cirrhosis,” 19 case-control studies were identified. Utilizing breath tests, the prevalence of SIBO in CLD was 35.80% (95% CI, 32.60–39.10) compared with 8.0% (95% CI, 5.70–11.00) in controls. Using culture techniques, the prevalence was 68.31% (95% CI, 59.62–76.00) in CLD patients as compared with 7.94% (95% CI, 3.44–12.73) in controls. No difference between cirrhotic and noncirrhotic patients was found. SIBO is significantly more frequent in CLD patients as compared with controls. The association of SIBO and CLD was not confined to patients with advanced CLD, suggesting that SIBO is not a consequence of advanced liver disease but may play a role in the progression of CLD.
Publisher: Wiley
Date: 20-05-2019
DOI: 10.1111/APT.15308
Abstract: It is unexplained why functional dyspepsia and gastro-oesophageal reflux disease (GERD) overlap more often than expected by chance. Post-prandial distress syndrome has been linked to impaired gastric fundic accommodation which may induce increased transient lower oesophageal sphincter relaxations and consequent GERD. Duodenal eosinophilia has been linked to functional dyspepsia and post-prandial distress syndrome. To identify if there is an association between duodenal eosinophilia in functional dyspepsia and symptoms of GERD and whether post-prandial distress syndrome or epigastric pain syndrome are associated with new onset GERD. Participants (n = 1000) were randomly selected from the national Swedish population register and surveyed by questionnaires and oesophagogastroduodenoscopy in 1999-2001. All eligible subjects (n = 887) were invited to a follow-up study in 2010 (response rate 79%). In a case-control study of 213 subjects (functional dyspepsia vs healthy controls), histology from the duodenum was evaluated at baseline and the possible association of eosinophilia to new onset GERD symptoms was analysed. Functional dyspepsia (OR 7.6 95% CI 2.93-19.4, P < 0.001) and post-prandial distress syndrome at baseline (OR 9.0, 95% CI 3.36-24.0, P < 0.001) were associated with an increased risk of GERD at follow-up. Eosinophilia in the second part of duodenum only was independently associated with an increased risk of GERD amongst those with functional dyspepsia (OR 4.2 95% CI 1.2-4.77, P = 0.024) and post-prandial distress syndrome at baseline (OR 6.0 95% CI 1.50-23.6, P = 0.011), respectively. Duodenal eosinophilia is associated with increased risk of GERD at 10-year follow-up in those with functional dyspepsia and post-prandial distress syndrome at baseline. Duodenal eosinophilia may explain the link between GERD and functional dyspepsia, suggesting subsets of functional dyspepsia and GERD may be part of the same disease spectrum.
Publisher: BMJ
Date: 06-09-2006
Publisher: CSIRO Publishing
Date: 2001
DOI: 10.1071/AH010091A
Abstract: The problem of how best to recruit and retain doctors in rural and remote communities has led governments to adopt a range of medical workforce incentives, including retention grants. A comprehensive literature survey suggests that medical workforce retention has been poorly distinguished from other supply issues such as recruitment, and that its determinants and the process leading to retention are poorly understood. Such a knowledge gap is likely to limit the effectiveness of retention incentives. This article reports the results of this literature review, and advances a conceptual framework as the basis for ongoing research and evaluating how best to deliver effective retention interventions.
Publisher: Elsevier BV
Date: 02-2020
Publisher: Springer Science and Business Media LLC
Date: 11-08-2012
DOI: 10.1007/S11136-011-9985-5
Abstract: Quality of life is impaired in some people with IBS, but the level of symptoms that may drive this impairment is unclear. We aimed to identify whether current frequency and severity cut-offs for IBS-type symptoms are associated with a clinically meaningful impairment of quality of life in the community. People who met modified Rome III criteria for IBS (n = 201) and controls (n = 1,904) were assessed. Frequency of IBS symptoms was grouped a priori into 'less frequent' (not at all and sometimes) and 'more' frequent (often, very often and almost always). Severity of abdominal pain was grouped into 'mild' (very mild and mild) and severe (moderate, severe and very severe). Mental and physical functioning was measured using the valid SF-12, with 'normal' functioning (defined as a score of >43 and >48) and 'impaired' functioning (defined as a score of ≤43 and ≤48), respectively. Psychological variables were assessed via valid self-report. Having 'more' versus 'less' severe abdominal pain (OR = 9.41 95% CI 1.17-75.43, P = 0.03) and 'more' versus 'less' frequent diarrhoea (OR = 2.19 95% CI 1.13-4.26, P = 0.02) along with increasing age (OR = 1.03 95% CI 1.01-1.05, P = 0.003) were significant independent predictors of having impairment in physical functioning. In terms of psychological factors, having higher levels of depression (OR = 1.61 95% CI 1.36-1.91) and somatic distress (OR = 1.17 95% CI 1.09-1.27) were independently associated with mental and physical impairment, respectively. The current frequency and severity threshold cut-offs for IBS symptoms in the Rome III criteria are associated with a clinically meaningful impairment of quality of life in community subjects with IBS.
Publisher: Oxford University Press (OUP)
Date: 06-09-2016
DOI: 10.1093/CID/CIW610
Abstract: Delayed antifungal therapy for invasive candidiasis (IC) contributes to poor outcomes. Predictive risk models may allow targeted antifungal prophylaxis to those at greatest risk. A prospective cohort study of 6685 consecutive nonneutropenic patients admitted to 7 Australian intensive care units (ICUs) for ≥72 hours was performed. Clinical risk factors for IC occurring prior to and following ICU admission, colonization with Candida species on surveillance cultures from 3 sites assessed twice weekly, and the occurrence of IC ≥72 hours following ICU admission or ≤72 hours following ICU discharge were measured. From these parameters, a risk-predictive model for the development of ICU-acquired IC was then derived. Ninety-six patients (1.43%) developed ICU-acquired IC. A simple summation risk-predictive model using the 10 independently significant variables associated with IC demonstrated overall moderate accuracy (area under the receiver operating characteristic curve = 0.82). No single threshold score could categorize patients into clinically useful high- and low-risk groups. However, using 2 threshold scores, 3 patient cohorts could be identified: those at high risk (score ≥6, 4.8% of total cohort, positive predictive value [PPV] 11.7%), those at low risk (score ≤2, 43.1% of total cohort, PPV 0.24%), and those at intermediate risk (score 3-5, 52.1% of total cohort, PPV 1.46%). Dichotomization of ICU patients into high- and low-risk groups for IC risk is problematic. Categorizing patients into high-, intermediate-, and low-risk groups may more efficiently target early antifungal strategies and utilization of newer diagnostic tests.
Publisher: Wiley
Date: 09-10-2021
DOI: 10.1111/APT.16630
Abstract: Rumination syndrome is a functional gastroduodenal disorder characterised by effortless regurgitation of recently ingested food. Emerging evidence reports duodenal eosinophilic inflammation in a subset, suggesting a shared pathophysiology with functional dyspepsia (FD). To assess the clinical features of rumination syndrome and FD in a community-based study. We mailed a survey assessing gastrointestinal symptoms, diet and psychological symptoms to 9835 residents of Olmsted County, MN, USA in 2017-2018 diagnostic codes were obtained from linked clinical records. The two disorders were assessed as mutually exclusive in 'pure' forms with a separate overlap group, all compared to a control group not meeting criteria for either. Prevalence of associations, and univariate and independent associations with predictors were assessed by logistic regression. Prevalence of rumination syndrome and FD were 5.8% and 7.1%, respectively the overlap was 3.83-times more likely than expected by chance. Independent predictors for rumination (odds ratio (OR), 95% confidence interval (CI)) were female gender (1.79, 1.21-2.63), smoking (1.89, 1.28-2.78), gluten-free diet (1.58, 1.14-2.19), allergic rhinitis (1.45, 1.01-2.08) and depression (1.10, 1.05-1.16). FD was independently associated with female gender, depression, non-coeliac wheat sensitivity, migraine, irritable bowel syndrome and somatic symptoms. A similar reported efficacy (≥54%) of low fat or dairy-free diets was found with both disorders (P = 0.53 and P = 1.00, respectively). The strongest independent associations with overlapping FD and rumination syndrome were a history of rheumatoid arthritis (3.93, 1.28-12.06) and asthma (3.02, 1.44-6.34). Rumination syndrome overlaps with FD with a shared risk factor profile, suggesting a common pathophysiology.
Publisher: Elsevier BV
Date: 05-2021
Publisher: Elsevier BV
Date: 11-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-1998
DOI: 10.1111/J.1572-0241.1998.00530.X
Abstract: Little data on rectal bleeding in the U.S. population are available. We therefore sought to assess the prevalence of different types of rectal bleeding, their association with potential risk factors including other colonic symptoms, and predictors of health care seeking in a U.S. community. We used a crossectional survey by mail, applying a previously validated self-report symptom questionnaire. Our population comprised an age- and gender-stratified random s le of Olmsted County, Minnesota residents aged 20-64 yr. In total, 1643 responded (77%). Rectal bleeding was reported by 235 subjects (age- and gender-adjusted prevalence, 15.5 per 100 95% confidence interval [CI], 13.6-17.4) 218 found blood on wiping, 74 noted blood coating the stools, and 46 reported dark blood mixed in the stools. The prevalence of rectal bleeding was significantly higher in younger persons (18.9%, 20-40 yr vs 11.3% > 40 yr p < 0.001). By stepwise logistic regression analysis, constipation (odds ratio [OR] = 3.03 95% CI, 2.09-4.41) and diarrhea (OR = 1.90 95% CI, 1.25-2.84) were independent predictors of rectal bleeding. Among those with rectal bleeding, 13.9% (95% CI, 9.6-19.1%) had visited a physician for bowel problems in the prior yr only a history of abdominal surgery was an independent predictor of physician visits but this explained just 15.9% of the deviance. In otherwise healthy young and middle-aged persons, approximately one in seven have a history of rectal bleeding and this is more frequent in younger people only a minority seek health care and this is not related to symptom status.
Publisher: Wiley
Date: 04-1994
Publisher: BMJ
Date: 29-07-2017
Publisher: AMPCo
Date: 06-2017
DOI: 10.5694/MJA16.01167
Publisher: Springer Science and Business Media LLC
Date: 28-07-2017
DOI: 10.1007/S10964-017-0721-5
Abstract: Past research identifies a number of risk factors for adolescent self-harm, but often fails to account for overlap between these factors. This study investigated the underlying, broader concepts by identifying different psychological profiles among adolescents. We then compared new self-harm rates over a six-month period across different psychological profiles. Australian high school students (n = 326, 68.1% female) completed a questionnaire including a broad range of psychological and socioenvironmental risk and protective factors. Non-hierarchical cluster analysis produced six groups with different psychological profiles at baseline and rate of new self-harm at follow-up. The lowest rate was 1.4% in a group that appeared psychologically healthy the highest rate was 37.5% in a group that displayed numerous psychological difficulties. Four groups with average self-harm had varied psychological profiles including low impulsivity, anxiety, impulsivity, and poor use of positive coping strategies. Identifying multiple profiles with distinct psychological characteristics can improve detection, guide prevention, and tailor treatment.
Publisher: Wiley
Date: 23-07-2012
DOI: 10.1111/J.1365-2982.2012.01985.X
Abstract: Previous work indicated that psychosocial factors (depression and somatization) are more strongly associated with symptom severity and weight loss in functional dyspepsia (FD) than gastric sensorimotor function. However, there is conflicting evidence regarding the association of these etiopathogenetic factors with Rome III symptom-based subgroups in FD [epigastric pain syndrome (EPS), postprandial distress syndrome (PDS)]. We aimed to test whether gastric sensitivity and emptying, depression, and somatization are differentially associated with empirically derived functional gastroduodenal disorders (FGD) symptom factors in one comprehensive model. In 259 tertiary care FD patients, we studied gastric sensorimotor function with barostat and gastric emptying breath test. Depression, somatization, and FGD symptoms were measured using self-report questionnaires. Confirmatory factor analysis (CFA) on 7 FGD symptoms was used to determine the fit of a latent variable structure based on Rome III symptom-based subgroups. Structural equation modeling (SEM) was used to test the putative relationships of the symptom factors with gastric sensorimotor function, depression, and somatization. The results of the CFA show a good fit [C(min) /DF = 1.54, CFI(comparative fit index) = 0.97] for the three-factor solution based on Rome III subgroups. The SEM also fitted the data well (C(min) /DF = 1.24, CFI = 0.98) and demonstrated that gastric sensitivity and depression are associated with PDS and nausea and vomiting. Gastric emptying is uniquely associated with EPS and somatization is strongly associated with all three symptom factors. Confirmatory factor analysis confirms the existence of three FGD symptom factors, corresponding to Rome III symptom-based subgroups. The SEM results suggest that different psychobiological mechanisms may play a role in these subgroups.
Publisher: Informa UK Limited
Date: 16-08-2016
DOI: 10.1080/00365521.2016.1218537
Abstract: To determine whether anorectal biofeedback therapy can improve the symptoms of fecal incontinence (FI) in patients with scleroderma when compared to patients with functional FI, and also whether there is any effect on anorectal physiology or quality of life (QOL). FI in patients with scleroderma is highly prevalent and is associated with significant loss of QOL. Biofeedback has been proven to be an effective treatment for functional FI, but there are no data to support its use in scleroderma. 13 consecutive female patients (median age 59, IQR 47-65 years) with scleroderma, and 26 age- and parity-matched female patients with functional FI (disease controls, 2:1), underwent biofeedback therapy for management of FI. Fecal incontinence severity index (FISI), anorectal physiology, feeling of control and QOL were collected before and after 6 weeks of biofeedback therapy, with additional scoring repeated at 6-month follow-up. After biofeedback treatment FISI, feeling of control and QOL significantly improved in both groups (p < 0.005). There was no difference in the degree in improvement in physiology, FISI or QOL between scleroderma patients and functional FI patients. Long-term improvement in FISI and control were seen in both groups and for QOL only in the scleroderma cohort (p < 0.05). Patients with scleroderma benefit from biofeedback therapy to the same extent as that achieved in patients with functional FI. There are significant improvements in symptoms, physiology and QOL. Biofeedback is an effective, low-risk treatment option in this patient group.
Publisher: Wiley
Date: 06-07-2017
DOI: 10.1111/AJR.12301
Abstract: To identify factors influencing whether Australian medical graduates prefer to, or actually, work rurally. Secondary analysis of longitudinal data from Medical Schools Outcomes Database (MSOD) using univariate and multivariate logistic regression. Twenty Australian medical schools. Australian or New Zealand citizens and Australian permanent residents who completed MSOD questionnaires between 2006 and 2013. Preferred and actual work locations 1 (PGY1) and 3 (PGY3) years postgraduation. Of 20 784 participants, 4028 completed a PGY1 or PGY3 questionnaire. Self-reported preference for rural practice location at medical school commencement was the most consistent independent predictor of whether a graduate would have a rural location preference at PGY1 (odds ratio (OR) 6.07, 95% confidence interval (CI) 4.91-7.51) and PGY3 (OR 7.95, 95% CI 4.93-12.84), and work rurally during PGY1 (OR 1.38, 95% CI 1.01-1.88) and PGY3 (OR 1.86, 95% CI 1.30-2.64). The effect of preferred practice location at medical school commencement is independent of, and enhances the effect of, rural background. Graduates of graduate-entry programs or with dependent children were less likely to have worked rurally during PGY1 and PGY3 respectively. The most consistent factor associated with rural preferences and work location was students' preferred location of practice at medical school commencement this association is independent of, and enhances the effect of, rural background. Better understanding of what determines rural preference at medical school commencement and its influence on rural workplace outcomes beyond PGY3 is required to inform Australian medical school selection policies and rural health curricula.
Publisher: Hindawi Limited
Date: 08-09-2008
DOI: 10.1111/J.1742-1241.2008.01851.X
Abstract: To compare the healthcare resource utilisation of men diagnosed with premature ejaculation (PE) with that of age-matched men without a PE diagnosis, through a retrospective analysis of US medical claims data. Data were from the PHARMetrics Database. Records of patients > or = 18 years of age diagnosed with PE (n = 1245) and age-matched controls (n = 3915) were compared with regard to number of physician encounters, concomitant medical diagnoses, drug therapies and treatment costs. Men diagnosed with PE visited their physicians twice as frequently in the year before their diagnosis as men in the control group. Men diagnosed with PE were more likely to receive a prescription for a selective serotonin reuptake inhibitor or a phosphodiesterase-5 inhibitor after their diagnosis than before and used more of these compared with controls. Prior to their PE diagnosis, patients received more (and more frequent) comorbid diagnoses than controls, and their mean yearly diagnosis and prescription costs were $1320 (vs. $447 for controls). In the year after the PE diagnosis, diagnosis and prescription costs fell by 24% (to $998), primarily because of a reduction in physician visits. Compared with controls, men with PE who sought help from a healthcare professional consumed more medical resources, primarily because of a higher number of physician visits and greater use of prescription drugs. Further research is warranted to determine if the observed associations between PE and other diagnoses indicate genuine aetiological factors or reporting bias.
Publisher: Wiley
Date: 04-2003
Publisher: Wiley
Date: 18-04-2005
DOI: 10.1002/CNCR.21062
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/PY15091
Abstract: Rural primary care services have the potential to play a major role in reducing the gap in cardiovascular disease (CVD) outcomes between rural and metropolitan Australians, particularly in men at high risk of CVD. The aim of this study was to explore the self-reported behaviours and satisfaction with their general practice ractitioner of men at high risk of CVD, and attitudes of rural primary care clinicians regarding the role of primary care in CVD prevention. This observational research was addressed through survey questionnaires with rural men at high risk of CVD and semi-structured interviews with rural primary care clinicians. Fourteen rural primary care practices from towns with populations less than 25000 participated. One hundred and fifty-eight high-risk men completed the questionnaire. Their responses demonstrated poorly controlled risk factors despite a willingness to change. Alternatively, rural primary care clinicians (n=20) reported that patients were unlikely to change and that illness-based funding models inhibited cardiovascular preventive activities. Australians living in rural areas have worse CVD outcomes. In addition, there is a disparity in the assumptions of health providers and male patients at high risk of CVD in rural areas. This necessitates innovative rural primary care models that include a blended payment system that incentivises or funds preventive care alongside an emphasis on lifestyle advice, as well as an explicit strategy to influence clinician and patient behaviour to help address the disparity.
Publisher: Informa UK Limited
Date: 1993
DOI: 10.3109/00365529309096092
Abstract: Patients with non-cardiac chest pain (NCCP) (n = 387) and cardiac chest pain (CCP) (n = 93) were compared with community controls (n = 81), using a symptom questionnaire that assessed the presence of irritable bowel syndrome (IBS), functional dyspepsia, and oesophageal dysfunction and chest pain characteristics. A significantly (p < 0.05) increased prevalence of symptoms compatible with IBS occurred in NCCP patients when compared with those with CCP and with controls. Dysphagia was more frequent in both those with non-cardiac and cardiac chest pain than in controls this was not apparent, however, when patients with concomitant IBS were excluded. The presence of oesophageal or gastrointestinal symptoms did not enable discrimination with regard to the chest pain characteristics. We conclude that unselected referred patients with documented NCCP are more likely to have IBS and that the presence of oesophageal symptoms such as dysphagia may merely reflect the spectrum of the 'irritable gut'.
Publisher: Wiley
Date: 06-04-2011
DOI: 10.1111/J.1365-2036.2011.04653.X
Abstract: Anorectal biofeedback therapy (BFT) is a safe and effective treatment in patients with constipation. Given the high prevalence of constipation and therefore high demand for BFT, there is a need to prioritise patients. To explore clinical features and anorectal physiology which predict success or failure of BFT and to derive a statistical model which helps to predict the success of BFT. A total of 102 patients with constipation referred for BFT were evaluated. All patients underwent comprehensive clinical and anorectal function assessment, including balloon expulsion testing. The BFT protocol consisted of a comprehensive 6-weekly visit programme comprising instruction on toilet behaviour and abdominal breathing, achieving adequate rectal pressure and anal relaxation, and balloon expulsion and rectal sensory retraining. Success of BFT was based on an improvement in global bowel satisfaction. Harder stool consistency (P=0.009), greater willingness to participate (P<0.001), higher resting anal sphincter pressure (P=0.04) and prolonged balloon expulsion time (P=0.02) correlated with an improvement in bowel satisfaction score. A longer duration of laxative use (P=0.049) correlated with no improvement in bowel satisfaction score. Harder stools, shorter duration of laxative use, higher straining rectal pressure and prolonged balloon expulsion independently predicted successful BFT. A model (S(i) = (p)∑ β(j)X(ij), where β represents a regression coefficient, X is a given predictive variable and S(i) is the weighted index score for each in idual) incorporating these four variables enabled prediction of successful BFT, with sensitivity and specificity of 0.79 and 0.81, respectively. Important clinical and anorectal physiological features were found to be associated with outcome of anorectal biofeedback therapy in patients with constipation. This information and the predictive model will assist clinicians to prioritise patients for anorectal biofeedback therapy.
Publisher: Wiley
Date: 22-07-2004
Publisher: Wiley
Date: 12-02-1988
DOI: 10.1111/J.1753-6405.1988.TB00607.X
Abstract: Multicomponent reactions are employed extensively in many areas of organic chemistry. Despite significant progress, the discovery of such enabling transformations remains challenging. Here, we present the development of a parallel, label-free reaction-discovery platform that can be used in the identification of new multicomponent transformations. Our approach is based on parallel mass spectrometric screening of interfacial chemical reactions on arrays of self-assembled monolayers. This strategy enabled the identification of a simple organic phosphine that can catalyse a previously unknown condensation of siloxyalkynes, aldehydes and amines to produce 3-hydroxyamides with high efficiency and diastereoselectivity. The reaction was further optimized using solution-phase methods.
Publisher: Springer Science and Business Media LLC
Date: 24-08-2022
DOI: 10.3758/S13428-022-01954-W
Abstract: The force-matching task integrates haptic technology and electrical engineering to determine an in idual’s level of sensory attenuation to somatic stimuli. The task requires a detailed methodology to facilitate reliable and replicable estimates, and there has been a distinct lack of re-evaluation of the methodological processes related to this paradigm. In this task, participants are asked to match a force delivered to their finger, either by pressing directly on their own finger with their other hand (known as the direct condition) or by controlling the device using an external potentiometer to control the force indirectly through a torque motor (known as the slider condition). We analysed 138 participants to determine 1) the optimal number of replications (2, 4, 6, or 8 replications) of the target force, 2) the optimal time window (1–1.5 s, 1.5–2 s, 2–2.5 s and 2.5–3 s) to extract the estimate of sensory attenuation, 3) if participants’ performance during the task improved, worsened or was stable across the experimental period regardless of condition, and 4) if learning effects were related to psychological traits. Results showed that the number of replications of the target forces may be reduced from 8 without compromising the estimate of sensory attenuation, the optimal time window for the extraction of the matched force is 2.5–3 s, the performance is stable over the duration of the experiment and not impacted by the measured psychological traits. In conclusion, we present a number of methodological considerations which improve the efficiency and reliability of the force-matching task. • The force-matching task determines an in idual’s level of sensory attenuation • The optimal number of replications of the target force may be reduced from 8 • The optimal time window to extract the matched force is 2.5–3.0 s • The estimate of sensory attenuation is stable across the duration of the task
Publisher: Wiley
Date: 28-05-2018
DOI: 10.1002/EJP.1239
Abstract: The evidence for Internet-delivered pain management programs for chronic pain is growing, but there is little empirical understanding of how they effect change. Understanding mechanisms of clinical response to these programs could inform their effective development and delivery. A large s le (n = 396) from a previous randomized controlled trial of a validated internet-delivered psychological pain management program, the Pain Course, was used to examine the influence of three potential psychological mechanisms (pain acceptance, pain self-efficacy, fear of movement/re-injury) on treatment-related change in disability, depression, anxiety and average pain. Analyses involved generalized estimating equation models for clinical outcomes that adjusted for co-occurring change in psychological variables. This was paired with cross-lagged analysis to assess for evidence of causality. Analyses involved two time points, pre-treatment and post-treatment. Changes in pain-acceptance were strongly associated with changes in three (depression, anxiety and average pain) of the four clinical outcomes. Changes in self-efficacy were also strongly associated with two (anxiety and average pain) clinical outcomes. These findings suggest that participants were unlikely to improve in these clinical outcomes without also experiencing increases in their pain self-efficacy and pain acceptance. However, there was no clear evidence from cross-lagged analyses to currently support these psychological variables as direct mechanisms of clinical improvements. There was only statistical evidence to suggest higher levels of self-efficacy moderated improvements in depression. The findings suggest that, while clinical improvements are closely associated with improvements in pain acceptance and self-efficacy, these psychological variables may not drive the treatment effects observed. This study employed robust statistical techniques to assess the psychological mechanisms of an established internet-delivered pain management program. While clinical improvements (e.g. depression, anxiety, pain) were closely associated with improvements in psychological variables (e.g. pain self-efficacy and pain acceptance), these variables do not appear to be treatment mechanisms.
Publisher: Wiley
Date: 02-04-2021
DOI: 10.1111/NMO.14130
Abstract: Enteric glial cells (EGC) and mast cells (MC) are intimately associated with gastrointestinal physiological functions. We aimed to investigate EGC‐MC interaction in irritable bowel syndrome (IBS), a gut‐brain disorder linked to increased intestinal permeability, and MC. Parallel approaches were used to quantify EGC markers in colonic biopsies from healthy controls (HC) and patients with IBS. Data were correlated with MC, vasoactive intestinal polypeptide (VIP) and VIP receptors (VPAC1/VPAC2) expressions, and bacterial translocation through biopsies mounted in Ussing chambers. In addition, we investigated the effects of EGC mediators on colonic permeability and the pharmacological‐induced responses of EGC and MC cell lines. Immunofluorescence of IBS colonic mucosa, as well as Western blotting and ELISA of IBS biopsy lysates, revealed increased glial fibrillary intermediate filament (GFAP) expression, indicating EGC activation. Mucosal GFAP correlated with increased MC and VPAC1 + MC numbers and decreased VIP + MC, which seemed to control bacterial translocation in HC. In the contrary, EGC activation in IBS correlated with less MC and VPAC1 + MC numbers, and more VIP + MC. In vitro, MC and EGC cell lines showed intracellular calcium responses to each other's mediators. Furthermore, EGC mediators prevented VIP‐induced MC degranulation, while MC mediators induced a reactive EGC phenotype. In Ussing chambers, EGC mediators decreased paracellular passage through healthy colonic biopsies. Findings suggest the involvement of EGC and MC in the control of barrier function in the human colon and indicate a potential EGC‐MC interaction that seems altered in IBS, with detrimental consequences to colonic permeability. Altogether, results suggest that imbalanced EGC‐MC communication contributes to the pathophysiology of IBS.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2019
Publisher: Wiley
Date: 08-08-2014
DOI: 10.1111/APT.12903
Abstract: There is increasing evidence that impaired mucosal defence mechanisms are implicated in the pathogenesis of the functional gastrointestinal disorders (FGIDs), allowing inappropriate immune activation. To test the hypothesis that an excess of autoimmune disorders among sufferers, using a large primary care database to examine this. Cases were diagnosed with FGIDs - irritable bowel syndrome (IBS), functional dyspepsia (FD), chronic idiopathic constipation (CIC), and multiple FGIDs. Controls were those without FGIDs. Prevalence of autoimmune disorders was compared between cases and controls using odds ratios (ORs) and 95% confidence intervals (CIs). We included 23,471 patients (mean age 51.4 years, 66.1% female). Prevalence of autoimmune disorders was greater among all FGIDs, compared with controls without. In those with FD (OR 1.35 95% CI 1.12-1.63), CIC (OR 1.75 95% CI 1.11-2.75), or multiple FGIDs (OR 1.49 95% CI 1.25-1.77) this was statistically significant after controlling for age and gender. Rheumatological autoimmune disorders were significantly more frequent in those with FD (OR 1.44 95% CI 1.15-1.80), CIC (OR 1.84 95% CI 1.08-3.13), or multiple FGIDs (OR 1.53 95% CI 1.24-1.88), after controlling for age and gender. However, endocrine autoimmune disorders were no more frequent in those with FGIDs, after controlling for age and gender. In a large s le of primary care patients, there was a significantly higher prevalence of autoimmune disorders among those with FD, CIC, or multiple FGIDs not explained by differences in age or gender. We were unable to control for concomitant drug use, which may partly explain this association.
Publisher: Springer Science and Business Media LLC
Date: 28-01-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2001
DOI: 10.1111/J.1572-0241.2001.03521.X
Abstract: The efficacy of prokinetic agents in functional (nonulcer) dyspepsia has been questioned based on recent trial results. We performed a meta-analysis to determine the efficacy of cisapride and domperidone in functional dyspepsia. Computer and manual searching was used to identify placebo-controlled studies that included >20 patients. The statistical analysis focused on: global assessment by the investigator, epigastric pain, early satiety, abdominal distension and nausea (all rated on four-point scales). Results are reported as odds ratios (OR) in favor of treatment. Regression analysis was performed to evaluate possible effect modifiers. The relationship between improvement in gastric emptying and symptoms was also evaluated. For cisapride, 17 studies met the inclusion criteria, but varying numbers of studies had to be used for the different outcome measures. For all outcome measures, there was a statiscally significant benefit in favor of cisapride: global assessment of improvement by the investigator or patient (OR 2.9, 95% CI 1.5-5.8), epigastric pain (OR 0.19, 95% CI 0.05-0.7), early satiety (OR 0.18, 95% CI 0.9-0.4), abdominal distension (OR 0.32, 95% CI 0.1-0.7), and nausea (OR 0.26, 95% CI 0.1-0.5). Age of patient, year of publication, and country where study was performed had only small modifying effects. There were insufficient data to determine whether there is a relationship between improvement in gastric emptying and response to treatment. For domperidone, four of eight studies could be used for the analysis of global assessment of improvement by the investigator. This showed an OR of 7.0 (95% CI 3.6-16) in favor of domperidone. Both cisapride and domperidone seem to be efficacious in functional dyspepsia, although this conclusion is largely based on global assessment by the investigator, which may not be an optimal outcome measure.
Publisher: Dustri-Verlgag Dr. Karl Feistle
Date: 06-2010
DOI: 10.5414/CPP48383
Abstract: Atypical antipsychotics are widely used in the pharmacologic management of schizophrenia. Information to guide evidence-based clinical decision making must be continually updated, particularly as new clinical trial data and new antipsychotic agents become available. This meta-analysis of oral atypical antipsychotics assessed the relative effectiveness and tolerability profile of a recently introduced agent, paliperidone extended-release (ER), to determine its place within the efficacy and tolerability spectrum of the labeled dose ranges of other oral atypical antipsychotics. Randomized placebo-controlled studies of risperidone, olanzapine, quetiapine, and aripiprazole were identified via database search (MEDLINE, EMBASE, Cochrane Library, PsycInfo, and Cumulative Index to Nursing & Allied Health Literature). Baseline demographic, efficacy, and safety data were extracted and combined in meta-analysis. Random effects meta-regression assessed potential confounding by patient mean age, gender ratio, and duration of therapy on variability in efficacy and safety. Within the spectrum of efficacy and safety of the class, paliperidone ER demonstrated a novel efficacy-tolerability profile versus the other oral atypical antipsychotics, including lower odds of withdrawal for any reason and less weight gain. Odds of withdrawal due to adverse events were lower with paliperidone ER compared with risperidone and with atypical antipsychotics as a class. Paliperidone ER was associated with lower odds of somnolence and agitation than the atypical class as a whole and with lower odds of weight gain than all of the atypical antipsychotics, including risperidone. The main factor in the observed variability in efficacy results between studies was the antipsychotic, rather than patient-related factors or duration of therapy. Paliperidone ER is an effective and well-tolerated oral atypical antipsychotic that provides an important new treatment option for patients with schizophrenia. Owing to the heterogeneity within the class, information on in idual benefit/risk profiles of antipsychotics is necessary for selecting an appropriate treatment for each patient.
Publisher: Elsevier BV
Date: 05-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2019
DOI: 10.14309/CTG.0000000000000064
Abstract: Anti-cytolethal distending toxin B (CdtB) and anti-vinculin antibodies have been proposed as biomarkers that discriminate irritable bowel syndrome (IBS) diarrhea from inflammatory bowel disease however, it is unknown whether they can also discriminate patients with IBS and IBS subtypes and functional dyspepsia (FD) from healthy in iduals in the general population. We aimed to determine whether anti-CdtB and anti-vinculin can discriminate IBS and FD from health and from organic gastrointestinal (GI) disease. Adults were enrolled from 2 Australian studies: (i) a random, population-based study (n = 331) with subjects diagnosed with IBS (n = 63) or FD (n = 61) by modified Rome III criteria or healthy control subjects (n = 246) who did not meet criteria for IBS and/or FD and (ii) an outpatient-based study with subjects diagnosed with IBS (n = 256) and/or FD (n = 55) or organic GI disease (n = 182) by an independent clinician. Serum levels of anti-CdtB/anti-vinculin antibodies were determined by enzyme-linked immunosorbent assay. There was a significantly higher mean value of anti-CdtB in FD vs healthy controls (mean = 2.46 [SD = 0.72] vs mean = 2.14 [SD = 0.77] P = 0.005) and IBS/FD overlap vs healthy controls (mean = 2.47 [SD = 0.78] vs mean = 2.14 [SD = 0.77] P = 0.02). There were no significant differences in anti-CdtB in IBS and FD outpatients or IBS/FD subgroups compared with patients with organic GI disease. In terms of anti-vinculin, there were no significant differences between IBS and FD and healthy controls or between IBS and FD and organic GI disease controls. We did not confirm that anti-CdtB/anti-vinculin discriminated IBS diarrhea from organic GI disease in Australian subjects. However, we did find higher anti-CdtB in FD and IBS/FD overlap vs healthy controls. Postinfectious FD may be more common than currently recognized.
Publisher: Informa UK Limited
Date: 1994
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2015
DOI: 10.1038/AJG.2015.101
Abstract: Sacral nerve stimulation (SNS) is a potential treatment for constipation refractory to standard therapies. However, there have been no randomized controlled studies examining its efficacy. In patients with slow transit constipation, we evaluated the efficacy of suprasensory and subsensory SNS compared with sham, in a prospective, 18-week randomized, double-blind, placebo-controlled, two-phase crossover study. The primary outcome measure was the proportion of patients who, on more than 2 days/week for at least 2 of 3 weeks, reported a bowel movement associated with a feeling of complete evacuation. After 3 weeks of temporary peripheral nerve evaluation (PNE), all patients had permanent implantation and were randomized to subsensory/sham (3 weeks each) and then re-randomized to suprasensory/sham (3 weeks each) with a 2-week washout period between each arm. Daily stool dairies were kept, and quality of life (QoL SF36) was measured at the end of each arm. Between November 2006 and March 2012, 234 constipated patients were assessed, of whom 59 were willing and deemed eligible to participate (4 male median age 42 years). Of the 59 patients, 16 (28%) responded to PNE. Fifty-five patients went on to permanent SNS implantation. The proportion of patients satisfying the primary outcome measure did not differ between suprasensory (30%) and sham (21%) stimulations, nor between subsensory (25%) and sham (25%) stimulations. There were no significant changes in QoL scores. In patients with refractory slow transit constipation, SNS did not improve the frequency of complete bowel movements over the 3-week active period.
Publisher: Informa UK Limited
Date: 27-10-2022
Publisher: Wiley
Date: 22-07-2015
DOI: 10.1111/NMO.12626
Abstract: The role of childhood environment including exposure to infection via siblings and pets in irritable bowel syndrome (IBS) and dyspepsia is relatively unknown. We assessed proxy measures of microbial exposure in early childhood to assess if these are associated with IBS and functional dyspepsia in later life. Participants (n = 767, response rate = 53%) were a random population s le from Sydney, Australia who previously responded to a validated survey. IBS and functional dyspepsia were defined using Rome III criteria. Early environmental risk factors assessed included type of birth delivery, premature birth, breastfeeding, bedroom sharing, and pet exposure (the latter two then combined as early hygiene factors) up to 5 years of age. Post infectious IBS (PI-IBS) was assessed by development of IBS following gastroenteritis. In this s le, in adult life 17% developed IBS (of which 20% had PI-IBS) and 12% functional dyspepsia. Development of IBS was associated with childhood factors-a shorter duration of breastfeeding (odds ratios [OR] = 0.87, 95% CI: 0.78-0.97, p = 0.01), sharing a bedroom (OR = 1.89, 95% CI: 1.73-3.08, p = 0.01), exposure to a herbivore pet (OR = 1.65 (1.10, 2.48), p = 0.02), and hygiene factors (OR = 4.39 95% CI: 1.89-10.21, p = 0.001). The sole factor associated with functional dyspepsia was exposure to a herbivore pet (1.79 95% CI: 1.19-2.87, p = 0.02). Childhood environment factors, particularly bedroom sharing and pet exposure, combined with subsequent risk of microbial exposure are a risk factor for IBS in later life. These associations however need confirmation to rule out any risk of a type I error.
Publisher: Wiley
Date: 14-11-2017
DOI: 10.1111/NMO.12986
Abstract: We aimed to explore the natural history of irritable bowel syndrome (IBS) in Denmark over 3 years by studying development of IBS symptoms and associated factors. A cohort study was carried out using a web panel representative of the Danish general population 18-50 years. The survey, including a questionnaire based on the Rome III criteria for IBS, was conducted in January 2010, January 2011, and March 2013. The prevalence of IBS was 15.4% (920/5986). The incidence was 10.3%, and was three times higher for persons with unspecific gastrointestinal (GI) symptoms compared to asymptomatic persons. Of respondents with IBS symptoms in both 2010 and 2011, 69% (131/191) also reported symptoms of IBS in 2013, which was significantly more compared to respondents with IBS symptoms in 2010 reporting to be asymptomatic or having unspecific GI symptoms in 2011 (20% and 39%, respectively, P<.001). Being diagnosed with IBS predicted fulfilling the criteria for IBS 3 years later (OR: 2.59, 95% CI: 1.11-6.10). Fulfilling criteria for IBS after 1 year also led to a high risk of IBS symptoms 3 years later in asymptomatic persons and persons with unspecific symptoms at baseline. The vast majority of persons fulfilling criteria for IBS report GI symptoms after one and 3 years. Fulfilling IBS criteria after 1 year led to a high risk of reporting IBS symptoms after 3 years. In the general population having an IBS diagnosis predicts persistently fulfilling the Rome III criteria for IBS 3 years later.
Publisher: Wiley
Date: 06-06-2016
DOI: 10.1111/NMO.12865
Abstract: The autonomic nervous system (ANS) modulates intestinal inflammation in animal models. Human evidence confirming such modulating influence is limited. We aimed to investigate whether ANS function is associated with inflammatory parameters at disease onset, and whether it predicts the evolution of inflammation in patients with ulcerative colitis (UC). We prospectively monitored 51 patients from onset of UC for 3 years. Upon remission of the onset flare, ANS activity was assessed by heart rate variability analysis and compared with healthy controls. Inflammatory parameters in blood, stool, and colonic biopsies obtained at onset and during follow-up visits were analyzed. Generalized linear models were used to test cross-sectional associations between ANS activity and inflammatory parameters at onset linear mixed models were used to test whether ANS function at onset predicted the evolution of inflammation over the following 3 years. Sympathovagal balance was different in UC patients compared to healthy controls, and cross-sectional associated with higher levels of systemic (erythrocyte sedimentation rate [ESR], CRP, TNF-α, IFN-γ) and mucosal inflammation (interleukin-8, IFN-γ) at onset. Conversely, a negative cross-sectional association with parasympathetic activity was found for ESR & TNF-α. Longitudinally, parasympathetic activity at onset predicted systemic (ESR, WBC), but not mucosal inflammation during follow-up. This study further strengthens the association between the ANS system and intestinal inflammation previously found in animal models and recently in patients with inflammatory bowel disease. These results may have important implications for the pathogenesis and treatment of UC.
Publisher: Wiley
Date: 11-1998
DOI: 10.1111/J.1471-0528.1998.TB09971.X
Abstract: To determine the likelihood of progression from gestational hypertension (GH) to pre-ecl sia (PE) in hypertensive pregnant women and whether this change can be identified in advance by available clinical and laboratory measures. A retrospective analysis and a prospective study. St George Hospital, Sydney, a teaching hospital of the University of New South Wales delivering 2500 women per year. Eight hundred and forty-five women with new hypertension in the second half of pregnancy, managed by a uniform protocol (661 in the retrospective analysis, 184 in the prospective study). Clinical and laboratory data at initial presentation were compared among women with GH who developed PE and those who remained with a diagnosis of GH until delivery. Data predictive for progression from GH to PE were analysed by logistic regression analysis. Progression from GH to PE. In the retrospective analysis, 416 women initially presented as having GH and 62 (15%) progressed to PE. In the prospective study, 112 women initially presented with GH and 29 (26%) progressed to PE, giving an overall progression of 17%. In both studies, women who developed PE from GH presented earlier than those who remained with GH until delivery. In multiple logistic regression analyses prior miscarriage and early gestation at presentation were associated with increased likelihood of progressing from GH to PE. Approximately 15-25% of women initially diagnosed with GH will develop PE and this is more likely with earlier presentation or if the woman has had a prior miscarriage. Women with gestational hypertension diagnosed after 36 weeks of gestation have only about 10% risk of developing PE. These data should help stratify the risks of mildly hypertensive pregnant women being managed as outpatients in their third trimester.
Publisher: Elsevier BV
Date: 02-2004
Publisher: Cambridge University Press (CUP)
Date: 10-2010
DOI: 10.1111/J.1601-5215.2010.00482.X
Abstract: Jones MP, Bartrop RW, Forcier L, Penny R. The long-term impact of bereavement upon spouse health: a 10-year follow-up. This study is the first to examine the effect of bereavement of a first-degree family member on subsequent morbidity over a 10-year follow-up period. A s le of bereaved subjects ( n = 72) were compared with a control group ( n = 80) recruited in the same period with respect to morbidity experience during follow-up. Morbidity events were ascertained from the subject themselves, their health care providers and these sources were also compared. Bereavement was associated with an elevated total burden of illness as well as with mental health and circulatory system categories diagnosed according to the International Classification of Diseases - Clinically Modified (ICD-9) classification system. The elevation ranged from approximately 20% for any illness to 60–100% among circulatory system disorders. Although in an earlier study there was a downregulation of T-cell function in the bereaved during the first 8 weeks, there was no evidence that the bereavement was associated with increased morbidity in the respiratory or immune system ICD-9 categories long-term. Past epidemiological research has indicated that bereavement of a close family member is associated with adverse health consequences of a generalised morbidity. Our study suggests an increase in mental health and circulatory system effects in particular. Further research is required to determine whether other systems are also affected by bereavement.
Publisher: Wiley
Date: 13-05-2021
DOI: 10.1111/APT.16372
Abstract: It is uncertain if functional dyspepsia (FD) or irritable bowel syndrome (IBS) are linked to smoking, and smoking cessation is not part of the routine advice provided to these patients. To assess if smoking is an independent risk factor for FD and IBS. Three population-based endoscopy studies in Sweden with 2560 community in iduals in total (mean age 51.5 years, 46% male). IBS (14.9%), FD (33.5%), and associated symptoms were assessed using the validated abdominal symptom questionnaire, and smoking (17.9%) was obtained from standardised questions during a clinic visit. The effect of smoking on symptom status was analysed in an in idual person data meta-analysis using mixed effect logistic regression, adjusted for snuffing, age and sex. In iduals smoking cigarettes reported significantly higher odds of postprandial distress syndrome (FD-PDS) (OR 10-19 cig/day = 1.42, 95% CI 1.04-1.98 P = 0.027, OR ≥20 cig/day = 2.16, 95% CI 1.38-3.38, P = 0.001) but not epigastric pain. In iduals smoking 20 or more cigarettes per day reported significantly higher odds of IBS-diarrhoea (OR = 2.40, 95% CI 1.12-5.16, P = 0.025), diarrhoea (OR = 2.01, 95%CI 1.28-3.16, P = 0.003), urgency (OR = 2.21, 95%CI 1.41-3.47, P = 0.001) and flatus (OR = 1.77, 95%CI 1.14-2.76, P = 0.012) than non-smokers. Smoking was not associated with IBS-constipation or IBS-mixed. Smoking is an important environmental risk factor for postprandial distress syndrome, the most common FD subgroup, with over a twofold increased odds of PDS in heavy smokers. The role of smoking in IBS-diarrhoea, but not constipation, is also likely important.
Publisher: Elsevier BV
Date: 09-2001
Abstract: The purpose of this study was to determine the predictive ability of parameters of 24-hour ambulatory blood pressure monitoring for the development of preecl sia or gestational hypertension in women who are already considered at risk for these disorders. One hundred twenty-two pregnant women who were considered high risk for the development of preecl sia underwent 24-hour ambulatory blood pressure monitoring between 18 and 30 weeks gestation, while their condition was normotensive according to routine mercury sphygmomanometry. One hundred sixty-four healthy primigravid women who were considered at usual risk for preecl sia underwent the same tests as a parallel study. Routine blood pressure, awake and sleep average blood pressure, and 24-hour mean average blood pressure were entered into multiple logistic regression as predictors of either preecl sia or gestational hypertension significant variables were then tested by a series of receiver operator curves. Eight percent of usual risk and 45% of high risk women experienced the development of preecl sia or gestational hypertension. In both groups, the average routine mercury blood pressure and awake, sleeping, and 24-hour ambulatory blood pressure monitoring-derived blood pressure were significantly higher in women who later experienced the development of preecl sia or gestational hypertension. In usual risk women, 24-hour systolic blood pressure of >or=115 mm Hg and sleeping systolic blood pressure of >or=106 mm Hg were predictive of later preecl sia or gestational hypertension, but sensitivities were low (77% and 54%, respectively). In high risk women, sleeping diastolic blood pressure of >or=62 mm Hg and sleeping mean arterial pressure of >or=79 mm Hg were predictive of preecl sia or gestational hypertension, but again sensitivities were low (70% and 65%, respectively). Awake and sleeping blood pressure are higher in midpregnancy in women who later experience the development of preecl sia or gestational hypertension. Twenty-four-hour ambulatory blood pressure monitoring provides a noninvasive method of selecting some of these women, but this test has a sensitivity no better than that of other predictive tests, even in women at high risk for preecl sia.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.CGH.2016.12.032
Abstract: Understanding the interactions between brain and gastrointestinal disorders requires analysis of the order of disease onset. We analyzed data from 2 independent studies to determine the proportion of in iduals with diagnoses of functional gastrointestinal disorders (FGIDs) before diagnoses of mood or anxiety disorders (gut to brain), and vice versa (brain to gut). We collected data from a retrospective study of 4966 patients diagnosed with a FGID (irritable bowel syndrome, dyspepsia, or constipation) and mood or anxiety disorder at general practices in the United Kingdom (health care seekers) over an average period of 13.1 years we recorded which diagnosis appeared first and compared these with patients' sex and socioeconomic factors. We also collected data from a population study of 1002 randomly selected in iduals in Australia (non-heath care seekers) followed from 1997 through 2009 we determined whether subjects were free of either FGID or an anxiety or mood disorder at baseline but developed either one after a 12-year follow-up period. Among the 4966 health care seekers, 3279 patients were diagnosed with a mood or anxiety disorder before an FGID (ratio of 2:1). This ratio increased with socioeconomic disadvantage. The time period between diagnosis of mood or anxiety disorder and FGID was longer (median, 3.5 years) than time period between diagnosis of an FGID and a mood or anxiety disorder (median, 1.8 years). Among non-heath care seekers (population study), equal proportions were diagnosed with a mood or anxiety disorder before versus after an FGID. In an analysis of data from a study of patients and a population-based study of in iduals with these diagnoses, we found 2-fold more patients to receive a diagnosis of a mood or anxiety disorder before an FGID, but equal proportions of in iduals in the population to be diagnosed with the mood or anxiety disorder before versus after an FGID. Among patients, the mood or anxiety disorder was on average diagnosed more than 3 years before the FGID, offering opportunity for prevention. Our findings support a role for adverse socioeconomic factors in development of FGIDs in patients with psychological disorders.
Publisher: Wiley
Date: 06-2020
Publisher: Springer Science and Business Media LLC
Date: 08-07-2017
Publisher: Springer Science and Business Media LLC
Date: 17-05-2016
DOI: 10.1038/SC.2016.67
Abstract: A case-control study of prospectively collected data was performed. To compare anorectal biofeedback (BF) outcomes in patients with incomplete motor spinal cord injury (SCI) and neurogenic bowel dysfunction (NBD) with a group of functional anorectal disorder-matched control patients. Neurogastroenterology Unit affiliated with a Spinal Injury Unit in a tertiary referral centre in Sydney, Australia. All consecutive patients with SCI and NBD referred for anorectal manometry and BF were matched in a 1:2 ratio with age, gender, parity and functional anorectal disorder-matched control patients. Instrumented BF was performed in six nurse-guided weekly visits. Outcomes included changes in anorectal physiology measures, symptom scores and quality-of-life measures. Twenty-one patients were included. These were matched with 42 patient controls. Following BF, symptom scores improved significantly in both groups, as did effect of bowel disorder on quality of life. Improvement in these measures did not differ between the groups. Patients with SCI and NBD showed improvement in their sensory and motor anorectal function, including lowering of first sensation threshold and more effective balloon expulsion. Patients with incomplete motor SCI responded as well to anorectal BF as functional anorectal disorder-matched controls. Spinal cord-injured patients also showed improvement in anorectal sensorimotor dysfunction and balloon expulsion. These novel findings indicate that clinicians should not be dissuaded from considering behaviour-based therapeutic interventions such as anorectal BF in selected spinal cord-injured patients.
Publisher: Wiley
Date: 08-09-2016
DOI: 10.1111/HEL.12267
Abstract: In populations with a low prevalence rate of Helicobacter pylori (H. pylori) infection from Western countries, guidelines for the management of uninvestigated dyspepsia generally recommend that the "test and treat" strategy should be avoided in favor of empiric proton-pump inhibitor therapy in younger patients (on average < 50 years of age) without alarm symptoms and signs. The prevalence of H. pylori infection has fallen from about 30% to about 10% in Sweden and other countries. We aimed to explore whether the rationale for test and treat is relevant in contemporary clinical practice. In settings with an infection rate in the adult population of 30% and 10%, we modeled the positive and negative predictive values for indirect (nonendoscopy) tests on current H. pylori infection with a presumed sensitivity and specificity of 95%. We then calculated the difference in false-negative and false-positive test outcome, and eradication prescription rates in the two scenarios. While the positive predictive value for the test decreased from 0.89 to 0.68 when the prevalence of H. pylori fell from 30% to 10%, there were only 1% more false-negative tests and 1% less false-positive tests. The eradication prescription rate would decrease by 18% with a 10% prevalence rate. The recommendation to stop applying "test and treat" at lower prevalence rates of H. pylori should be reconsidered. The test and treat strategy is the preferred approach for most patients who present with dyspepsia.
Publisher: Elsevier BV
Date: 05-2021
Publisher: Wiley
Date: 25-03-2020
DOI: 10.1002/OSP4.418
Publisher: AMPCo
Date: 08-2017
DOI: 10.5694/MJA16.01022
Publisher: Informa UK Limited
Date: 29-02-2016
DOI: 10.1080/16506073.2016.1149876
Abstract: This paper describes the development and preliminary psychometric evaluation of an instrument that measures the frequency of adaptive behaviours and cognitions related to therapeutic change during cognitive behavioural therapy (CBT), for symptoms of anxiety and depression. Two studies were conducted. In study one, 661 participants completed an online survey with 28 items targeting adaptive behaviours and cognitions. Exploratory factor analysis performed on part of the s le (n = 451) revealed that a four-factor solution 'characterised' the data. This led to the development of a 12-item instrument, the Frequency of Actions and Thoughts Scale (FATS). Confirmatory factor analysis was used to confirm the factor structure of the FATS using the remaining s le (n = 210), which revealed an acceptable model fit. In study two, 125 participants with clinically significant symptoms of anxiety, depression, or both were recruited to an Internet-delivered CBT (iCBT) treatment course. Participants completed the FATS and other measures throughout treatment, after treatment, and at three-month follow-up. Correlations and residual change scores of the FATS and its subscales with measures of anxiety, depression, behavioural activation, and CBT-related skills usage supported the construct validity of the FATS. A significant increase in FATS scores over treatment was also observed. The findings provide preliminary support for the psychometric properties of the FATS, which appears to have utility in research investigating mechanisms of change in CBT.
Publisher: Wiley
Date: 16-11-2016
DOI: 10.1016/J.ADOLESCENCE.2016.11.004
Abstract: Researchers have begun to consider whether there may be more than one psychological profile to describe adolescents who engage in self‐harm. Limited past research suggests multiple different profiles. Australian high school students (n = 1,521, age 11–19, 56.4% female) completed an online questionnaire reporting risk and protective factors and self‐harm frequency. Non‐hierarchical cluster analysis allocated 256 students who reported 6‐month self‐harm to mutually exclusive profiles based on psychological similarity. Five distinct psychological profiles were identified: 1) Psychologically 'normal' 2) Anxiety symptoms 3) Impulsive 4) Pathological and 5) Pathological‐Impulsive. The proportion of adolescents that reported 11 or more episodes of self‐harm varied from 5.7% in the psychologically 'Normal' group to 27.7% in the 'Pathological‐ Impulsive' group. These results indicate that multiple psychological profiles exist. Adolescents with different risk factors may require disparate strategies for treatment and prevention. Given the variability in profiles, screening may assist in detecting adolescents who self‐harm.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-12-2020
Publisher: MDPI AG
Date: 29-06-2018
DOI: 10.3390/NU10070849
Publisher: Informa UK Limited
Date: 16-04-2010
Publisher: BMJ
Date: 23-08-2012
DOI: 10.1136/GUTJNL-2012-302634
Abstract: Gastric sensorimotor function, abuse history, 'trait' and 'state' psychological factors and 'somatisation' all play a role in functional dyspepsia (FD) and its associated impaired quality of life (QoL), but their interplay remains poorly understood. We aimed to test a comprehensive, a priori hypothesised model of interactions between these dimensions in FD. In 259 FD patients, we studied gastric sensitivity with a barostat. We measured abuse history (sexual hysical, childhood/adulthood), 'trait' (alexithymia, trait anxiety) and 'state' (positive/negative affect, depression, panic disorder) psychological factors, somatic symptom reporting (somatic symptom count, dyspepsia, irritable bowel syndrome and fatigue symptoms) and QoL (physical, mental) using validated questionnaires. Confirmatory factor analysis (CFA) was used to assess whether four a priori hypothesised latent variables ('abuse', 'trait affectivity', 'state affect' and 'somatic symptom reporting') were adequately supported by the data. Structural equation modelling (SEM) was used to test the a priori hypothesised relationships between these latent variables and the observed variables gastric sensitivity and QoL. Both the CFA and SEM models fitted the data adequately. Abuse exerted its effect directly on 'somatic symptom reporting', rather than indirectly through psychological factors. A reciprocal relationship between 'somatic symptom reporting' and 'state affect' was found. Gastric sensitivity influences 'somatic symptom reporting' but not vice versa. 'Somatic symptom reporting' and 'trait affectivity' are the main determinants of physical and mental QoL, respectively. We present the first comprehensive model elucidating the complex interactions between multiple dimensions (gastric sensitivity, abuse history, 'state' and 'trait' psychological factors, somatic symptom reporting and QoL) in FD.
Publisher: Wiley
Date: 1991
DOI: 10.1111/J.1440-1681.1991.TB01378.X
Abstract: 1. Psychological characteristics were studied in 25 hypertensives (mean and standard deviation of blood pressure 150/95 +/- 12/5 mmHg), who received blood pressure (BP) biofeedback (BFB). Personality factors and success in BFB-BP modifying ability were correlated and the predictive value of psychological factors was estimated. 2. Questionnaires consisted of a Locus of Control of Behaviour (LCB) scale, the Spielberger state trait anxiety inventory and the Framingham Type A personality inventory. 3. BP was monitored continuously from the finger by volume cl plethysmography during eight BFB sessions, each with three trials of raising, ignoring and lowering systolic blood pressure (SP). 4. SP was raised/lowered by 12 +/- 11/6 +/- 9 mmHg and heart rate (HR) increased by 10 +/- 3.9/+ 1 +/- 6.1. Ten subjects were able to lower SP by greater than or equal to 5 mmHg (15 +/- 7.5) and raise it by 17 +/- 11. The others achieved no decrease in SP and were also less successful at raising (8 mmHg, P = 0.04). 5. Changes in LCB and trait anxiety correlated with DP rise, whereas type A and pre-study state anxiety correlated with rising HR. Lowering of SP correlated weakly with change in LCB (r = 0.47, P = 0.06). 6. Combinations of psychological factors had independent predictive value for BP and HR change: trait anxiety (P = 0.03) and change in LCB (P = 0.009) with rise in diastolic blood pressure (DP) type A (P = 0.009), pre-study LCB (P = 0.02) and pre-study state anxiety (P = 0.01) with HR rise.(ABSTRACT TRUNCATED AT 250 WORDS)
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-03-2021
DOI: 10.14309/AJG.0000000000001197
Abstract: This systematic review and meta-analysis aimed to determine the role of small intestinal bacterial overgrowth (SIBO) in patients with functional dyspepsia (FD). Electronic databases were searched until July 2020 for studies reporting prevalence of SIBO in FD. The prevalence rates, odds ratio, and 95% confidence intervals (CIs) of SIBO in FD and controls were calculated. Seven studies with 263 patients with FD and 84 controls were identified. The odds for SIBO in patients with FD were significantly higher as compared to that in controls (odds ratio = 4.3, 95% CI, 1.1–17.5, 4 studies, 234 participants) however, there was moderate heterogeneity in this analysis. Including high-quality, case-control studies (all using glucose breath tests [GBTs]), the risk of SIBO in patients with FD as compared to controls was 2.8 higher (95% CI 0.8–10.0, 3 studies, 200 participants) with minimal heterogeneity in this analysis. Using the lactulose breath test, SIBO prevalence in FD was significantly higher (53.4%, 95% CI 33.9–71.9, 3 studies, 110 participants) as compared to that with GBT (17.2%, 95% CI 8.6–31.6, 4 studies, 153 participants). Substantial heterogeneity was found in studies using the lactulose breath test but not in studies using GBT. There was no significant difference in SIBO prevalence in patients with FD according to FD subtype. This meta-analysis suggests a link between FD and SIBO. The quality of evidence is low and can be largely attributed to the type of breath test for SIBO diagnosis and clinical heterogeneity. More appropriately designed studies are required to confirm the link between SIBO and FD.
Publisher: Wiley
Date: 02-08-2021
DOI: 10.1111/RESP.14122
Abstract: Use of in‐laboratory polysomnography (PSG) to diagnose obstructive sleep apnoea (OSA) is cost and resource intensive. Questionnaires, physical measurements and home monitors have been studied as potential simpler alternatives. This study aimed to develop a diagnostic model for OSA for use in primary care. Primary care practitioners were trained to recognize symptoms of sleep apnoea and recruited patients based on the clinical need to investigate OSA. Assessment was by symptom questionnaires, anthropomorphic measurements, digital facial photography, and a single‐channel nasal flow monitor (Flow Wizard©, DiagnoseIT, Sydney, Australia) worn at home for 3 nights. The in‐laboratory PSG was the reference test, with OSA defined as apnoea–hypopnoea index (AHI) ≥10 events/h. In the model development phase, 25 primary care practitioners studied 315 patients in whom they suspected OSA, of which 57% had AHI≥10 and 22% had AHI≥30. Published OSA questionnaires provided low to moderate prediction of OSA (area under the curve [AUC] 0.53–0.73). The nasal flow monitor alone yielded high accuracy for predicting OSA with AUC of 0.87. Sensitivity was 0.87 and specificity 0.77 at a threshold respiratory event index (REI) of 18 events/h. A model adding age, gender, symptoms and BMI to the nasal flow monitor REI only modestly improved OSA prediction (AUC 0.89), with similar AUC (0.88) confirmed in the validation population of 114 patients. Sleep apnoea can be diagnosed in the primary care setting with a combination of clinical judgement and portable monitor test outcomes.
Publisher: Wiley
Date: 13-05-2015
DOI: 10.1111/APT.13219
Publisher: Wiley
Date: 06-2018
DOI: 10.1111/NMO.13389
Abstract: Long-term outcome data for anorectal biofeedback (BF) for fecal incontinence (FI) is scarce. Our aims were to describe the long-term symptom profile, quality of life, and need for surgery in FI patients following BF. One hundred and eight consecutive female patients with FI who completed an instrumented BF course were identified for long-term follow-up. In 61 of 89 contactable patients, outcome measures were assessed at short-term (end of BF), mid-term (9 months median), and long-term (7 years median) follow-up after treatment. Long-term response rate (50% or more reduction in FI episodes/wk compared to before BF and not requiring surgical intervention) was seen in 33/61 (54%) patients. Thirteen of these had complete continence. Improvement was seen at short, mid, and long-term follow-up for patients' satisfaction and control of bowel function. In contrast, fecal incontinence severity index and quality of life measures, which improved in short and mid-term, were no different from baseline by long-term follow-up. Patients classified as short-term responders were far more likely to display a long-term response compared to short-term non-responders (68% vs 18%, P < .001). Long-term symptom improvement was observed in more than half of FI patients at 7 year post BF follow-up. Quality of life improvements, however, were not maintained. Patients improving during the initial BF program have a high chance of long-term improvement, while patients who do not respond to BF should be considered early for other therapies.
Publisher: Springer Science and Business Media LLC
Date: 10-2022
DOI: 10.1007/S12664-022-01286-9
Abstract: In patients with primary sclerosing cholangitis (PSC), antimicrobial therapy with oral vancomycin (OV) is increasingly used to prevent progression of the liver disease and control concomitant ulcerative colitis (UC) however, there are concerns regarding the risk of development of vancomycin-resistant enterococci (VRE). Thus, we aimed to determine the incidence of VRE in PSC-UC patients. We conducted a retrospective study of PSC-UC patients, treated with OV at the Department of Gastroenterology at the Princess Alexandra Hospital. VRE testing was performed utilizing rectal swabs. We included 7 PSC-UC patients (age 22–53 years, 2 females) treated with OV with daily dose ranging from 250 to 1500 mg. All patients were treated for at least 6 months with OV (range 9–31 months, mean 32.1 months). All patients achieved complete clinical remission of the UC, with mean reduction of fecal calprotectin by 634 μg/mg (87.3%), mean reduction in the C-reactive protein by 21.9 mg/L (74.2%), and mean reduction in the total Mayo score by 9.3 (93.3%). With regard to the liver parameters, mean improvement in alkaline phosphatase enzyme and total bilirubin was −48.7 U/L (−19.7%) and −2.7 mg/dL (−19.6%), respectively. No patient treated with OV developed VRE or reported any adverse events. This cohort study including PSC-UC patients did not provide evidence for development of VRE, while treatment with vancomycin was associated with clinical and endoscopic remission of the UC. Larger, prospective trials are required to define the efficacy and safety of antimicrobial therapy in PSC-UC, while the risk of VRE appears small.
Publisher: Cambridge University Press (CUP)
Date: 05-2002
Publisher: Wiley
Date: 05-1999
DOI: 10.1111/J.1471-0528.1999.TB08301.X
Abstract: To determine the prevalence of white coat hypertension and white coat effect among hypertensive pregnant women and to assess whether the presence of a significant white coat effect was associated with adverse pregnancy outcome when clinical management was based upon standard sphygmomanometric blood pressure recordings. Prospective blinded studies assessing the presence of a white coat effect. Antenatal ward and pregnancy day assessment unit of St George Hospital, a teaching hospital in Sydney, Australia. One hundred and twenty-one hypertensive pregnant women in the second half of their pregnancy admitted to hospital or the day assessment unit for management of their hypertensive disorders. Routine sphygmomanometric blood pressures were recorded by midwives in the ward or day assessment unit and awake blood pressure recordings were averaged. These blood pressures were compared with average awake blood pressures recorded by ambulatory blood pressure monitor (ABPM) (Spacelabs 90207, Seattle, Washington, USA). White coat hypertension was defined as an average sphygmomanometer blood pressure > or = 140 mmHg systolic and/or > or = 90 mmHg diastolic with awake ABPM average blood pressure within the normal range for ABPM-derived blood pressures in pregnancy, according to gestation. White coat effect was the difference between average sphygmomanometer blood pressure and average awake ABPM-derived blood pressure. All clinical management was based upon routine sphygmomanometer recordings and clinicians were blinded to ABPM data. Prevalence of white coat hypertension and white coat effect maternal and fetal outcomes in those with and without a white coat effect of > or = 20 mmHg systolic and/or > or = 10 mmHg diastolic. Systolic and diastolic white coat hypertension were present in only 3.2% and 4.2% of the group, respectively. A systolic white coat effect > or = 20 mmHg was found in only 4.2% but 20.2% (26% for day assessment unit patients vs 15% for inpatients P = 0.17) had a diastolic white coat effect > or = 10 mmHg. There was no difference in maternal or fetal outcomes between women with and without a white coat effect. White coat hypertension is an infrequent occurrence in mildly hypertensive pregnant women. Although a white coat effect is present more often, this is associated with clinical outcomes similar to women who do not exhibit this phenomenon. Using ABPM to identify a white coat effect in women presenting with hypertension in the second half of their pregnancy does not appear to be clinically useful.
Publisher: Elsevier BV
Date: 05-1994
Publisher: Wiley
Date: 10-04-2023
DOI: 10.1111/NMO.14592
Abstract: Patients with obstructed defecatory symptoms (ODS) are commonly referred to either gastroenterologists (GE) or colorectal surgeons (CS). Further management of these patients may be impacted by this choice of referral. An online survey of specialist practice was disseminated to GE and CS in Australia and New Zealand. A case vignette of a patient presenting with ODS was described, with multiple subsequent scenarios designed to delineate the responder's preferred approach to management of this patient. A total of 107 responders participated in the study, 62 CS and 45 GE. For a female patient with ODS not responding to pharmacological treatment, GE were more likely than CS to refer patients for anorectal manometry, while CS were more likely to refer for dynamic imaging. A quarter of CS and GE referred patients directly to pelvic floor physiotherapy, without any pre‐treatment testing. Knowing the result of dynamic imaging, especially if a rectocele was demonstrated, substantially influenced management for both of the specialties: GE became more likely to refer the patients for CS consultation and less likely to refer directly for biofeedback or physiotherapy and CS were more likely to opt for an operative pathway over conservative management than they were prior to knowledge of the imaging findings. The majority ( %) of GE and CS did not find it necessary to obtain a gynecological consultation, even in the presence of a rectocele. Practice variation across medical specialties affects diagnostic and management recommendations for patients with ODS, impacting treatment pathways. Our findings provide an incentive toward establishing interdisciplinary, uniform, management guidelines.
Publisher: Wiley
Date: 10-10-2023
DOI: 10.1111/NMO.14471
Abstract: Psychological and lifestyle factors have been associated with gastrointestinal (GI) symptoms in in iduals with diabetes mellitus, but it remains unclear whether they explain the relationship over time. We aimed to determine in two independent population‐based studies whether diabetes is an independent risk factor for GI symptoms at a 1‐ and 3‐year follow‐up, adjusting for these factors. In study 1, 1900 in iduals completed a baseline and 1‐year follow‐up survey, while in study 2, 1322 in iduals completed a baseline and 3‐year follow‐up survey. Both studies asked about self‐reported diagnoses of diabetes and GI symptoms over the previous 3 months. Psychological, lifestyle factors (body mass index [BMI], smoking) and age and sex were assessed. The baseline prevalence of diabetes was 7.8% in Survey 1 and 8.9% in Survey 2. In a multivariate model that included age, sex, BMI, anxiety, depression and smoking status at follow‐up, reporting diabetes at baseline was an independent predictor of at least weekly early satiation (OR 1.58, 95% CI 1.05, 2.39, p = 0.03 OR = 1.67, 95% CI 1.14, 2.45, p = 0.009), fecal urgency (OR 1.44,95% CI 1.06, 1.95, p = 0.02 OR = 2.17, 95% CI 1.47, 3.22, p = 0.0001), 3 bowel motions a day (OR 1.50, 95% CI 1.08, 2.07, p = 0.02 OR = 1.67, 95% CI 1.11, 2.51, p = 0.01), and loose stools (OR 1.40, 95% CI 1.04, 1.90, p = 0.03 OR = 1.68, 95% CI 1.13, 2.51, p = 0.01) at the 1‐ and 3‐year follow‐ups, respectively. Diabetes is an independent risk factor for a greater frequency of early satiation and diarrhea, adjusting for lifestyle and psychological factors.
Publisher: BMJ
Date: 12-2006
Publisher: BMJ
Date: 05-2020
DOI: 10.1136/BMJGAST-2020-000387
Abstract: Dyspepsia accounts for a significant burden of worldwide disease, but there is a relative paucity of data from the sub-Saharan African setting. We undertook to describe the burden, risk factors and severity of dyspepsia across Rwanda. We performed a population-based clustered cross-sectional survey between November 2015 and January 2016, nationwide in Rwanda, using the Short Form Leeds Dyspepsia Questionnaire to describe the presence and severity of dyspepsia, and the Short Form Nepean Dyspepsia Index to describe the concomitant quality of life effects. Univariate and multivariate logistic regression models were constructed to correlate measured sociodemographic factors with dyspepsia. The prevalence of clinically significant dyspepsia in the general Rwandan population was 14.2% (283/2000). The univariate factors that significantly predicted severity were gender, profession, socioeconomic status, and non-steroidal anti-inflammatory drug, aspirin and alcohol use, with gender, current smoking, aspirin use both in the past and currently, and alcohol use in the past remaining significant on multivariate modelling. Dyspeptics had a significantly lower gastrointestinal-related quality of life, though the sociodemographic factors measured did not modify the observed quality of life. Dyspepsia is prevalent in the Rwandan setting and is associated with a significant burden on quality of life. More work is required to determine the pathological entities involved, and the optimal approach to mitigating this burden.
Publisher: Informa UK Limited
Date: 20-07-2017
DOI: 10.1080/16506073.2017.1347195
Abstract: Cognitive-behavioural therapy (CBT) is an effective treatment for clinical and subclinical symptoms of depression and general anxiety, and increases life satisfaction. Patients' usage of CBT skills is a core aspect of treatment but there is insufficient empirical evidence suggesting that skills usage behaviours are a mechanism of clinical change. This study investigated if an internet-delivered CBT (iCBT) intervention increased the frequency of CBT skills usage behaviours and if this statistically mediated reductions in symptoms and increased life satisfaction. A two-group randomised controlled trial was conducted comparing internet-delivered CBT (n = 65) with a waitlist control group (n = 75). Participants were in iduals experiencing clinically significant symptoms of depression or general anxiety. Mixed-linear models analyses revealed that the treatment group reported a significantly higher frequency of skills usage, lower symptoms, and higher life satisfaction by the end of treatment compared with the control group. Results from bootstrapping mediation analyses revealed that the increased skills usage behaviours statistically mediated symptom reductions and increased life satisfaction. Although skills usage and symptom outcomes were assessed concurrently, these findings support the notion that iCBT increases the frequency of skills usage behaviours and suggest that this may be an important mechanism of change.
Publisher: Informa UK Limited
Date: 23-08-2023
Publisher: Elsevier BV
Date: 07-1994
DOI: 10.1016/0163-8343(94)90007-8
Abstract: One hundred oncology patients from a major teaching hospital and their treating health staff were studied in the second phase of research examining attitudes towards cardiopulmonary resuscitation (CPR). A descriptive approach was used incorporating semistructured interviews of patients and established questionnaire measures, examining knowledge of and attitude towards disease and treatment, psychological functioning, and current and projected attitude toward resuscitation. Health staff also participated in a semistructured interview. This phase of the project focused particularly on a direct comparison of patient and staff assessments. In current circumstances, 10% of patients refused resuscitation. This was associated with disease of good prognosis. In a future hypothetical deteriorated scenario presented to patients, 39% declined resuscitation. This was associated with a past history of suicidal behavior. In current circumstances, health staff designated 14% of patients "Do-Not-Resuscitate" (DNR)--this was associated with a number of variables considered to predict poor outcome in resuscitation. In the future scenario, staff designated 54% of patients DNR--this was associated again with poor resuscitation outcome variables, but also independently, with a past psychiatric history. Comparison of patient and health staff preferences for resuscitation showed moderate yet significant concordance in current circumstances but not in the future scenario. The findings indicate firstly the feasibility of discussing resuscitation preferences with seriously ill patients and secondly an urgent need to improve patient and staff discussions regarding resuscitation, as staff and patients' attitudes to resuscitation differ.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.JPSYCHORES.2019.03.182
Abstract: To determine whether pain-related treatment outcomes, following an online Cognitive Behavioural Therapy (CBT) intervention for chronic pain, were moderated by the pain etiology of a medically explained or unexplained origin. Data were available from 471 participants who completed the online pain management program between March 2013 and August 2014. Participants' pain symptoms were classified as being medically explained symptoms (MES: n = 292) or medically unexplained symptoms (MUS: n = 222) via analysis of clinical data. Outcome variables were pain-related disability, average pain intensity, depression and anxiety. Moderation analyses were non-significant for all dependent variables. Between group differences (CBT and control) were larger for depression in those classified with MES, compared with MUS (MUS: mean change = -3.50 [95% CI = -4.98 to -2.22] MES: mean change = -5.72 [95% CI = -7.49 to -4.09]). However, between group differences were small for pain intensity (MUS: mean change = -0.03 [95% CI = -0.83 to 0.81] MES: mean difference = -1.12 [95% CI = -1.84 to 0.40]). The therapeutic outcomes examined in this study associated with an online CBT program do not appear to be altered by whether the participants' pain symptoms are medically explained or unexplained.
Publisher: Wiley
Date: 21-03-2012
DOI: 10.1111/J.1440-1584.2012.01263.X
Abstract: Little is known about the role of personality and related constructs in general practitioners' (GPs) choices of geographic location of medical practice. There is however some theory suggesting a role for personality in career decision making and some limited empirical evidence that this applies in medical career decisions. The aim of this study is to gain insight into whether personality plays a role in GPs' decisions to work in rural areas and the length of time that they intend to remain as a rural practitioner. S les of rural (n=372) and urban (n=100) GPs from New South Wales (Australia) completed the Neuroticism, Extraversion, Openness--Five Factor Inventory (NEO-FFI) and Adjective Checklist personality instruments and answered questions about demographics and rural upbringing. Rural GPs scored, on average, more highly than urban GPs with respect to conscientiousness and agreeableness but lower on openness, which can also be taken to mean a more 'down-to-earth' personality. Personality together with age, gender, experience as a GP, time in current location and rural childhood yield an area under the receiver operating characteristic curve of 0.81 in discriminating rural from urban GPs. Among rural GPs openness (P=0.007) was positively correlated with intended longevity as a rural doctor as was nurturing (P=0.06). Personality appears to play some role both in discriminating rural from urban GPs and in how long existing rural GPs intend to remain as rural GPs. Consideration of personality might assist in selection of in iduals who will better fit the professional and social environment of rural life.
Publisher: American College of Physicians
Date: 13-03-2018
DOI: 10.7326/M18-0503
Publisher: Elsevier BV
Date: 11-2018
Publisher: Springer Science and Business Media LLC
Date: 15-04-2023
DOI: 10.1038/S41598-023-32869-X
Abstract: The objective of this paper was to investigate if socioeconomic status (SES), measured by maternal education and household income, influenced the risk of developing autoimmune disease (Type 1 Diabetes, Celiac disease, Juvenile Idiopathic Arthritis, Crohn’s disease, Ulcerative colitis, and autoimmune thyroid disease), or age at diagnosis, and to analyse pathways between SES and autoimmune disease. We used data from the All Babies in Southeast Sweden (ABIS) study, a population-based prospective birth cohort, which included children born 1997–1999. Diagnoses of autoimmune disease was collected from the Swedish National Patient Register Dec 2020. In 16,365 in iduals, low maternal education, but not household income, was associated with increased risk of Type 1 Diabetes middle education RR 1.54, 95% CI 1.06, 2.23 P 0.02, low education RR 1.81, 95% CI 1.04, 3.18 P 0.04. Maternal education and household income was not associated with any other autoimmune disease and did not influence the age at diagnosis. Part of the increased risk of Type 1 Diabetes by lower maternal education was mediated by the indirect pathway of higher BMI and higher risk of Serious Life Events (SLE) at 5 years of age. The risk of developing Type 1 Diabetes associated to low maternal education might be reduced by decreasing BMI and SLE during childhood.
Publisher: Elsevier BV
Date: 06-2005
DOI: 10.1016/S1542-3565(05)00153-9
Abstract: This study examined the prevalence of upper gastrointestinal (GI) symptoms and symptom groupings and determined impact on disability days in a nationally representative US s le. A telephone survey of 21,128 adults was conducted including questions about the presence of upper GI symptoms during the past 3 months. Respondents were categorized as symptomatic (ie, reported GI symptoms once per month) or asymptomatic. The survey included questions about missed work, leisure activity, or household activity days. Symptom groupings were identified by using factor analysis, and cluster analysis was used to assign respondents into distinct groups on the basis of these symptom groupings. The prevalence of an average of 1 or more upper GI symptoms during the past 3 months was 44.9%. The most common symptoms experienced during the past 3 months were early satiety, heartburn, and postprandial fullness. Factor analysis identified 4 symptom groupings: (1) heartburn/regurgitation (2) nausea/vomiting (3) bloating/abdominal pain and (4) early satiety/loss of appetite. Five respondent clusters were identified the largest clusters were primarily early satiety/fullness (44%) and gastroesophageal reflux disease-like symptoms (28%). Two small clusters reflected nausea and vomiting (7%) and a heterogeneous symptom profile (4%). Symptomatic respondents reported significantly more missed work, leisure, and household activity days than asymptomatic respondents (all P < .0001). Factor analysis separated GI symptoms into groupings reflecting gastroesophageal reflux disease and dyspepsia: early satiety, postprandial fullness, and loss of appetite bloating and abdominal pain/discomfort and nausea and vomiting. These upper GI symptoms were associated with significant loss of work and activity days.
Publisher: Elsevier BV
Date: 04-2005
DOI: 10.1016/J.IJCARD.2004.08.051
Abstract: Improving anemia in patients with chronic renal failure (CRF) and congestive heart failure (CHF) also improves left ventricular hypertrophy (LVH). No previous meta-analyses have been conducted to further examine this association, including the association between LVH and mortality in these patients. Literature searches on MEDLINE, EMBASE, and OVID were performed using Cochrane Library protocols. Two hundred sixteen abstracts were reviewed preliminarily for inclusion in the meta-analysis of epoetin alfa, anemia and 5 pre-selected parameters of LVH. One hundred seventy-nine abstracts were reviewed for LVH and mortality. The predominant hematologic and left ventricular function changes observed during epoetin alfa treatment in patients with CHF and CRF are (1) increases in hemoglobin (Hb) and hematocrit (Hct) (2) decreases in left ventricular mass (LVM) and LVM index (3) increase in ejection fraction (EF) and (4) decreases in left ventricular end-diastolic and end-systolic volume. Three independent factors-target Hb, duration of disease, and duration of follow-up-each had a statistically significant association with Hb, Hct, and EF, respectively. A separate meta-analysis using 3 risk models showed LVH is strongly and positively associated with both cardiovascular and all-cause mortality, with two- to three-fold increases in risk. LVH is common in patients with CRF and CHF. Current findings indicate epoetin alfa therapy results in anemia amelioration, as evidenced by higher Hb and Hct levels, and reduction of key LVH parameters. LVM regression is associated with lower incidence of cardiovascular-related morbidity and mortality, therefore epoetin alfa therapy may provide a survival benefit.
Publisher: Wiley
Date: 02-1999
DOI: 10.1046/J.1365-2036.1999.00445.X
Abstract: There is not at present a suitable disease-specific health-related quality of life instrument for uninvestigated dyspepsia and functional (non-ulcer) dyspepsia. To develop a new multi-dimensional disease-specific instrument. The Nepean Dyspepsia Index (NDI) was designed to measure impairment of a subject's ability to engage in relevant aspects of their life and also their enjoyment of these aspects in addition, the in idual importance of each aspect is assessed. A 42-item quality of life measure was developed and tested, both in out-patients presenting to general practice with upper gastrointestinal complaints (n = 113) and in a randomly chosen population-based s le (n = 347). Adequate face and content validity was documented by an expert panel. Factor analysis identified four clinically relevant subscales: interference with activities of daily living, work, enjoyment of life and emotional well-being lack of knowledge and control over the illness disturbance to eating or drinking and disturbance to sleep because of dyspepsia. These scales had high internal consistency. Both symptoms and the quality of life scores discriminated dyspepsia from health. The Nepean Dyspepsia Index is a reliable and valid disease-specific index for dyspepsia, measuring symptoms and health-related quality of life.
Publisher: Elsevier BV
Date: 02-2021
Publisher: SAGE Publications
Date: 07-2014
DOI: 10.5127/PR.034613
Abstract: Cognitive behaviour therapy (CBT) is an efficacious treatment for paediatric anxiety disorders, yet not all children improve following standard treatment protocols. Identifying pre-treatment predictors of poor treatment response is an important area of research to maximise outcomes for children with anxiety disorders. This paper presents a systematic review of pre-treatment predictors of child/adolescent anxiety treatment outcome, including child demographic, child diagnostic and parental factors. Results are based on 47 peer-reviewed articles and 4 dissertations. Results for each predictor are reported according to method of measuring outcome (e.g., endpoint or rate of change). No consistent and clear pre-treatment predictors of paediatric anxiety outcome were identified. Yet, it is worth noting that a number of trends emerged some significant predictors were identified in more than one study including primary anxiety diagnosis, severity, comorbidity and parental anxiety sychopathology. With regards to primary anxiety diagnosis, there was emerging evidence that Social Anxiety Disorder predicted poorer treatment response, while GAD predicted better outcome. Greater symptom severity and comorbid externalising symptoms/disorder were also associated with poorer treatment response but not dependably across studies. Some inconsistent evidence also emerged showing that presence of comorbidity, comorbid depression, parental psychopathology, parental anxiety and maternal anxiety were associated with poorer outcomes when outcome was assessed as an endpoint. There were a number of pre-treatment factors that were not related to treatment outcome: age, gender, ethnicity and socio-economic status. Based on a small number of studies, comorbid anxiety, maternal depression, paternal anxiety and paternal depression also failed to predict treatment outcome. Further methodologically strong research is needed to clarify the conclusions made in this review and to investigate a range of predictors considered under preliminary investigation.
Publisher: Elsevier BV
Date: 1988
DOI: 10.1016/0022-3999(88)90090-6
Abstract: The relation of the Type A behaviour pattern to coronary atherosclerosis was assessed in a s le of 519 coronary angiography patients. Type A measures were the Structured Interview and the Framingham questionnaire. Angiographic indices included a composite coronary occlusion index and number of coronary vessels significantly diseased. Univariate analysis involving the entire s le showed no significant relation between Type A and severity of coronary vessel disease. Analyses for two subs les, namely males currently employed in white collar occupations and persons found to have significant disease at angiography, also failed to indicate a relationship between Type A and coronary disease. Multivariate analysis revealed sex, cholesterol and age to be risk factors for atherosclerosis Type A behaviour was not. The implications of these findings are discussed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2018
DOI: 10.1038/S41395-018-0095-7
Abstract: Wheat avoidance in the absence of celiac disease (CD) is common but occurrence of concurrent functional gastrointestinal disorders (FGIDs) in this group is uncertain. The aims of this study were to determine the prevalence of self-reported wheat or gluten sensitivity and doctor diagnosed CD in an Australian population, define the associated gastrointestinal (GI) symptoms and FGIDs, and determine the relationship between self-reported wheat sensitivity, demographic and medical factors. A total of 3542 people randomly selected from the Australian population returned a mail survey which contained questions on wheat avoidance, GI symptoms, demographic, medical, and lifestyle factors. We defined self-reported wheat sensitivity as people who reported gastrointestinal symptoms on ingestion of wheat based foods, but did not suffer from celiac disease, inflammatory bowel disease or colorectal cancer. Functional dyspepsia (FD) and irritable bowel syndrome (IBS) were diagnosed by Rome III criteria. CD status was self-reported. The prevalence of self-reported wheat sensitivity in this cohort was 14.9% (95% CI 13.7-16.2). The prevalence of CD was 1.2% (95%CI 0.8-1.6). Doctor diagnosed CD was significantly associated with a diagnosis of FD (OR 3.35, 95%CI 1.72-6.52) and IBS (OR 2.28, 95%CI 1.08-4.81). Those with self-reported wheat sensitivity were more likely to report multiple abdominal symptoms (of the 18 assessed) than those without (3.9 symptoms with self-reported wheat sensitivity vs. 1.6 without, p = 0.0001). In a multivariate analysis, self-reported wheat sensitivity was independently associated with IBS (OR 3.55, 95%CI 2.71-4.65) and FD (1.48, 95%CI 1.13-1.94). Self-reported wheat sensitivity is common, with a prevalence of 14.9% in this cohort. There is a strong association between both celiac disease and self-reported wheat sensitivity, and chronic gastrointestinal symptoms, as well as a diagnosis of FD and IBS.
Publisher: Wiley
Date: 15-10-2021
DOI: 10.1002/UEG2.12164
Abstract: While the etiopathogenesis of functional gastrointestinal disorders (FGIDs) is not completely understood, alterations of the intestinal microbiome have been observed. Antibiotics can induce dysbiosis, but whether antibiotics are a risk factor for the onset of FGIDs is uncertain. Antibiotics have been reported as both a risk factor for new onset FGID but also as a therapy for existing FGID. This study aimed to estimate the fraction of cases where antibiotics provoked the onset of FGID. Electronic medical records were obtained from general practices (primary care) in the United Kingdom. Dates of antibiotic prescription (AP) were compared with first date of FGID diagnosis and contrasted across three prevalent FGIDs and controls without gastrointestinal disorders. There were 10,926 GI healthy controls, 4326 IBS alone, 3477 FD alone, 340 chronic constipation and 4402 with overlap of multiple conditions. Both the prevalence of AP and rate were higher in FGID patients and increased with diagnosis of multiple FGIDs. 7%–14% of FGID patients were prescribed their first recorded antibiotic in the 12 months prior to their first FGID diagnosis and 20%–33% were prescribed an antibiotic in the same period. Differences between FGID groups were not accounted for by social deprivation and only rate of AP was moderated by social deprivation. In contrast, only 5%–10% of patients ever had a gastrointestinal infection recorded and only 1.5%–3.5% prior to their first FGID diagnosis. These data indicate that antibiotics are prescribed prior to FGID diagnosis in a significant minority of care‐seeking FGID patients, opening the potential for this medication to contribute to the pathophysiology. APs appears to mostly be for non‐gastrointestinal conditions.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.JPSYCHORES.2016.12.009
Abstract: Stress is an important component in the pathophysiology of irritable bowel syndrome (IBS). Long term Hypothalamus Pituitary Adrenal (HPA)-axis activity can be studied by measuring hair cortisol concentrations (HCC). Some previous studies have indicated a dysregulated HPA-axis in IBS patients, but cortisol levels in hair have not yet been studied. We investigated whether HCC and self-reported stress differentiate IBS patients from controls. In a cross-sectional study within 10 Swedish Primary Health Care Centers we compared patients in working age with active IBS to patients without GI complaints. The participants donated hair s les and completed questionnaires including a scale of self-reported perceived stress (PSS). 169 Rome III-fulfilling IBS patients and 316 non-IBS patients were available for final analyses. IBS patients had significantly lower HCC, median=16.3pg/mg, IQR=26.9pg/mg, compared to non-IBS patients, median=22.8pg/mg, IQR=29.1pg/mg. There was also a difference in the distribution of HCC quintiles between the two groups, with 30.2% IBS patients and 14.2% of non-IBS patients in the lowest quintile of HCC. PSS was higher among IBS patients with a mean (SD) total score of 25.3 (8.0) compared to controls 21.4, (7.5). Quintiles of HCC and PSS stayed significantly but very weakly related to IBS (B=-0.332, Std error=0.146, p<0.005) in multivariable analyses. This study suggests a possible suppression of the HPA-axis activity in a considerable portion of IBS patients.
Publisher: Wiley
Date: 12-06-2009
DOI: 10.1111/J.1469-7610.2009.02067.X
Abstract: Research to date suggests that as many as 12-15% of young people engage in self-harm behaviour however, the current understanding of the psychological basis of adolescent self-harm is limited. The objective was to determine whether adolescents who self-harm are a psychologically homogenous group. It was hypothesised that psychological subtypes would exist and these groups would report different rates of self-harm. Nine hundred and forty-four school students aged 11 to 19 and 166 first-year psychology students aged 21 or younger completed a self-report questionnaire. Participants were aged 11 to 21 (mean = 15.4, SD = 2.1). Sixty-two percent of the s le were female (n = 692). Students were allocated to psychologically distinct groups. Rates of self-harm were compared for the psychological subtypes of self-harmers. Two hundred and thirty-four participants reported lifetime self-harm (21.1% 95% CI 19-23%) and 78 reported recent self-harm (7.0% 95% CI 6.7-7.3%). The present study identified three psychologically quite distinct groups of adolescents within those who reported self-harm - a psychologically pathological group, a psychologically 'normal' group, and an impulsive group. The pathological group reported the highest rate of recent self-harm (50.9%) the psychologically 'normal' and impulsive groups reported similar rates of self-harm (28.7% and 24.6%, respectively). Adolescents who self-harm are not a psychologically homogenous group. One pathological subtype of self-harmers appears to most closely reflect a number of the psychological and social factors previously associated with self-harm. However, a large proportion of the s le was allocated the psychologically 'normal' subtype. This finding highlights the importance of psychological screening of adolescents presenting for treatment for self-harm as subtypes of self-harmers may require disparate strategies for intervention. Further research is required in order to identify appropriate treatment strategies for each subtype.
Publisher: Wiley
Date: 09-03-2021
DOI: 10.1111/NMO.14109
Abstract: The concept of gut‐to‐brain communication via microbial or inflammatory pathways is gaining increased attention but genuine pathology directly linking gut perturbation to anxiety is lacking. We hypothesized that duodenal eosinophilia, as known to occur in functional dyspepsia (FD), may be an underlying cause of anxiety and may help explain the striking association between FD and anxiety. Randomly selected subjects from the national population register of Sweden completed the validated Abdominal Symptom Questionnaire 1000 completed esophagogastroduodenoscopy and the Hospital Anxiety and Depression Scale questionnaire. Duodenal biopsies were obtained from 1 st (D1) and 2 nd portion (D2). Eligible subjects who underwent endoscopy ( n = 887) were invited to participate in a 10‐year follow‐up study with the same questionnaires. Among endoscopy normal subjects, FD was identified by Rome criteria, and controls were symptom free. Duodenal eosinophilia was based on pre‐defined cut‐offs. Finding are reported as odds ratios (ORs) with 95% confidence interval and p‐value. The study population comprised 89 cases with FD and 124 healthy controls (mean age 62 years, SD 12, 34% male). Clinical anxiety at follow‐up was elevated in those with D1 eosinophilia at baseline considering either new‐onset anxiety (OR = 4.5, 95% CI 0.8, 23.8 p = 0.08) or follow‐up anxiety adjusting for baseline anxiety (OR = 4.51 (95% CI 1.03, 19.81 p = 0.046). Duodenal eosinophilia may potentially be a mechanism linked to anxiety independent of FD.
Publisher: Informa UK Limited
Date: 10-03-2010
DOI: 10.1080/09297040903352564
Abstract: The Test of Memory Malingering (TOMM) and the Word Memory Test (WMT) are measures designed to detect poor effort that have been extensively used with adults. Little research has been conducted examining whether these tests are suitable for use in children. The aims of the present study were to (a) examine if children between the ages of 6 and 11 years were able to obtain scores above cutoffs recommended for adults on the TOMM, (b) identify clinically useful cutoff scores for the oral WMT, (c) determine whether the TOMM and the oral WMT were able to differentiate controls (n = 50) and coached simulators (n = 40) aged 6 to 11 years, and, lastly, (d) reading ability, nonverbal reasoning and vocabulary level were measured to determine if these factors affected performance on the TOMM and oral WMT. Results revealed that 98% of children instructed to perform at their best were able to meet criteria on the TOMM. Based on a cutoff score of less than 78.5% on the mean of the Immediate and Delayed Trials of the oral WMT, 98% of the controls and 90% of the coached simulators were correctly identified. Results indicated that the TOMM and oral WMT are useful measures for the detection of enactment in children as young as 6.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2019
Publisher: Wiley
Date: 16-03-2022
DOI: 10.1111/NMO.14349
Abstract: Co‐occurring (overlapping) irritable bowel syndrome (IBS), functional dyspepsia (FD), and heartburn has been observed. However, whether it is a distinct entity has not been established, nor what clinical, demographic, lifestyle, and psychological traits are associated with it. This study sought to estimate the prevalence and temporal stability of this overlap and to identify features specific to it in order to gain some insights into the potential etiopathogenesis. Two waves of a survey to a population‐representative s le were conducted 3 years apart, recruiting 1312 in iduals for this study. The chance‐expected probability of complete overlap (CO) was calculated and compared with the observed CO. A range of demographic, lifestyle factors, medical diagnoses, sleep quality, and psychological distress were tested to identify predictors of overlap using logistic regression. CO was observed in 2.1% (95% confidence interval 1.9, 3.7) of the s le and was closely replicated in wave 2 at 2.0%. The observed CO was greater than expected by chance (0.2%) to a statistically significant extent ( p 0.001). Overlap between IBS subtypes, FD subtypes, and heartburn was also elevated above chance expectation. In iduals with CO were separately differentiated from others with respect to elevated rates of self‐reported medically diagnosed asthma, elevated psychological distress score, and elevated impact on sleep quality. The discrimination provided by these factors was further independent of age and sex. Overlap between IBS, FD, and heartburn (GERD) appears to be a distinct entity that has a profile including psychological morbidity, sleep disturbance, and elevated rates of atopy.
Publisher: Elsevier BV
Date: 09-1998
Publisher: Wiley
Date: 05-04-2023
DOI: 10.1111/NMO.14588
Abstract: The Rome Foundation carried out a worldwide epidemiology study on DGBI according to the Rome IV criteria in 33 countries, including Belgium. DGBI prevalence varied between continents and countries, but prevalence differences within language groups in a single country have not yet been described. We analyzed the prevalence rates of 18 DGBI and their psychosocial impact in Belgium in the French and Dutch language groups. DGBI prevalence was similar in the French‐speaking and Dutch‐speaking population. Having one or more DGBI was negatively associated with psychosocial well‐being. The scores for depression were lower in the Dutch‐speaking participants with one or more DGBI compared to the French‐speaking participants. Interestingly, we also found significantly lower scores in the general Dutch‐speaking versus the French‐speaking population for depression and non‐gastrointesinal somatic symptoms, and higher global physical health and mental health quality‐of‐life component scores. In the Dutch‐speaking group, medication use for gastric acid was lower, but use of prescribed analgesics was more common. Nevertheless, the use of non‐prescribed pain medication was higher in the French‐speaking group. Anxiety and sleep medication use was also higher in the latter group. The results of this first in‐depth analysis of Rome IV DGBI in Belgium show a higher prevalence for some DGBI in the French‐speaking cohort, and a larger associated disease burden. These differences between language/culture groups in the same country support the psychosocial pathophysiological model of DGBI.
Publisher: Wiley
Date: 24-05-2021
DOI: 10.1111/APT.16396
Publisher: Elsevier BV
Date: 05-2012
Publisher: Elsevier BV
Date: 04-1994
Publisher: Elsevier BV
Date: 10-2015
Publisher: Elsevier BV
Date: 04-2016
Publisher: Frontiers Media SA
Date: 2011
Publisher: Wiley
Date: 29-03-2023
DOI: 10.1111/NMO.14580
Abstract: The use of a footstool has been advocated to optimize posture when sitting on the toilet and thus facilitate bowel evacuation. We aimed to assess the alterations in defecatory posture, and the changes in simulated defecation with use of a footstool in patients with constipation. Forty‐one patients (female 93%, mean 52 year, SD 14 year) with constipation referred to a tertiary neurogastroenterology unit were enrolled. A bowel questionnaire, Hospital Anxiety and Depression Scale, and Rome questionnaire were administered prior to anorectal manometry. Each patient underwent three rectal balloon expulsion tests in randomized order with no footstool, a 7‐inch, and a 9‐inch footstool. Additional assessments included angle between spine and femur, and visual analogue scales assessing ease of evacuation, urge to defecate, and discomfort with expulsion. Defecatory posture was significantly altered by footstool use, with progressive narrowing of the angle between the spine and femur as footstool height increased ( p 0.001 for all comparisons). Compared with no footstool, the use of a footstool was not associated with a change in balloon expulsion time and there was no difference between the two footstool heights. Subjectively, no significant change was identified in any of the three perceptions of balloon expulsion between no footstool and footstool use. Although the use of a footstool led to changes in defecatory posture, it did not improve subjective or objective measures of simulated defecation in patients with undifferentiated constipation. Therefore, the recommendation for its use during evacuation cannot be applied to all patients with constipation.
Publisher: Georg Thieme Verlag KG
Date: 17-07-2019
Abstract: The authors conducted a systematic review and meta-analysis to assess the effect of antibiotic therapy in primary sclerosing cholangitis (PSC). Effect of antibiotic therapy on Mayo PSC Risk Score (MRS), serum alkaline phosphatase (ALP), total serum bilirubin (TSB), and adverse events (AEs) rates were calculated and expressed as standardized difference of means or proportions. Five studies including 124 PSC patients who received antibiotics were included. Overall, antibiotic treatment was associated with a statistically significant reduction in ALP, MRS, and TSB by 33.2, 36.1, and 28.8%, respectively. ALP reduction was greatest for vancomycin (65.6%, p 0.002) and smallest with metronidazole (22.7%, p = 0.18). Overall, 8.9% (95% confidence interval: 3.9–13.9) of patients had AEs severe enough to discontinue antibiotic therapy. In PSC patients, antibiotic treatment results in a significant improvement in markers of cholestasis and MRS. Antibiotics, particularly vancomycin, may have a positive effect on PSC either via direct effects on the microbiome or via host-mediated mechanisms.
Publisher: Springer Science and Business Media LLC
Date: 29-06-2017
Publisher: Elsevier BV
Date: 05-1992
DOI: 10.1016/0167-5273(92)90183-4
Abstract: Infarct size may influence left ventricular filling after acute myocardial infarction. Pulsed Doppler transmitral flow velocities were compared in 47 patients at 7 +/- 6 days following acute myocardial infarction and 47 age-matched controls. Patients were stratified by angiographic infarct size into Groups I, II, III (corresponding angiographic hypokinetic scores less than 2 2-2.99 greater than or equal to 3 SD/cord). Early diastolic transmitral Doppler flow velocities did not differ between infarct groups but atrial transmitral Doppler flow measurements did: peak A velocity (p = 0.001), A velocity time integral (p less than 0.001), and total velocity time integral (p = 0.001). Compared to controls atrial transmitral Doppler flow was augmented in Group I, whilst atrial and total transmitral Doppler flow were depressed in Group III. Peak A velocity and A velocity time integral were inversely related to infarct size (R = -0.44 to -0.54) and directly to left ventricular ejection fraction (R = 0.59 to 0.65). Large infarct size following myocardial infarction is associated with lower atrial and total transmitral Doppler flow velocities.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2009
DOI: 10.1016/J.JURO.2009.08.060
Abstract: Although nocturnal enuresis is common in children, its etiology is multifactorial and not fully understood. We evaluated potential risk factors for presence and severity of nocturnal enuresis. A validated, reproducible questionnaire was distributed to 8,230 school children in Sydney, Australia. Nocturnal enuresis was defined as any wetting in the previous month and categorized as mild (1 to 6 nights), moderate (7 or more nights but less than nightly) or severe (nightly). Parents of 2,856 children (mean +/- SD age 7.3 +/- 1.3 years) completed the questionnaire (response rate 35%). Overall prevalence of nocturnal enuresis was 18.2%, with 12.3% of patients having mild, 2.5% moderate and 3.6% severe enuresis. Multivariate analysis showed that daytime incontinence (OR 4.8, 95% CI 2.9 to 7.9), encopresis (OR 2.7, 95% CI 1.6 to 4.4), bladder dysfunction (OR 3.6, 95% CI 2.4 to 5.3) and male gender (OR 2.0, 95% CI 1.3 to 3.1) were associated with severe nocturnal enuresis after adjustment for age. Emotional stressors (OR 2.3, 95% CI 1.2 to 4.2) and social concerns (OR 2.4, 95% CI 1.2 to 4.5) were associated with moderate nocturnal enuresis only. Encopresis and daytime incontinence are significant modifiable risk factors for nocturnal enuresis. Expressed as population attributable risk, 23% of nocturnal enuresis is associated with encopresis and daytime incontinence. Psychosocial factors appear to contribute to moderate but not severe nocturnal enuresis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
DOI: 10.1038/AJG.2013.137
Abstract: Very little is known about whether the reported health-related impact of constipation is worse in people who experience constipation over a long period of time vs. those with more transient symptoms. We aimed to determine the impact of persistent vs. transient constipation on health-related quality of life (QOL), depression, and mortality. We analyzed data from 5,107 women (aged 70-75 years in 1996) who answered "Have you had constipation in the past 12 months?" in all five surveys sent out every 3 years of the Australian Longitudinal Study on Women's Health. Of the 5,107 women, 20.9, 54.1, and 24.7% reported having persistent constipation on at least 4 out of 5 surveys, transient constipation reported on 1-3 surveys, or none reported over the 15-year time frame, respectively. Women who reported persistent constipation had significantly lower scores for all domains of QOL on the SF-36 except role-emotional, and had higher levels of self-reported depression, even after adjusting for number of chronic illnesses and fluid intake. Mortality rates were increased when comparing women with no reported constipation with persistently reported constipation (8.2% vs. 11%, odds ratio = 1.32, 95% confidence interval 1.0, 1.74, P = 0.05) controlling for specific chronic illnesses. Persistent constipation among older women is associated with poor health outcomes.
Publisher: Wiley
Date: 03-2009
DOI: 10.1111/J.1440-1754.2008.01435.X
Abstract: To identify risk factors for urinary tract infection (UTI) in children to inform the development of preventative strategies. A validated questionnaire covering demographic factors, perinatal, developmental, bowel and urinary history was sent to a cross-sectional s le of parents of elementary school children randomly selected from the first 4 years of school. UTI was ascertained by parental report, verified by cross-referencing with microbiological reports for all positive cases and 50 randomly selected negative cases. Parents of 2856 children (mean age 7.3 years, range 4.8-12.8 years) responded. A total of 3.6% of children had a bacteriologically verified UTI, compared with 12.6% by parental report alone. Multivariate polychotomous logistic regression showed that a history of structural kidney abnormalities (odds ratio (OR) 15.7, 95% confidence interval 8.1-30.4), daytime incontinence (OR 2.6, 1.6-4.5), female gender (OR 2.4, 1.5-3.8), and encopresis (OR 1.9, 1.1-3.4) were independently associated with UTI. Daytime incontinence increased risk more in boys (8.3% vs. 1.2%) than girls (8.1% vs. 4.6%), and kidney problems increased risk in older compared with younger children (29% vs. 2% in > or =8 year olds, 0% vs. 4% in 4-6 year olds). Parents over-report UTI by about threefold. Effective treatment of daytime urinary incontinence and encopresis may prevent UTI in children, especially boys.
Publisher: MDPI AG
Date: 21-02-2023
DOI: 10.3390/EN16052083
Abstract: Nickel foam substrates are frequently utilised as porous 3D substrates for renewable energy applications. The preparation of these substrates usually includes an acid-washing step, but the degree to which this step affects the final electrochemical performance after spray-coating a catalyst ink is unreported. Herein, we report the effects of acid washing through physicochemical and electrochemical characterisation. The electrochemical performance was determined through repeated measurements of catalyst-coated nickel foam substrates both with and without the initial step of acid washing. It was found that acid washing increased the current density by 17.9% for the acid-treated MoS2-coated nickel foam electrode. This increment was affiliated with an electrochemically active surface area that increased by 11.2%, and a Tafel analysis indicated that the acid-treated MoS2-coated electrodes facilitated the initial water dissociation step of the hydrogen evolution reaction with greater ease. Similar effects were also discovered for acid-treated PtIr(1:3)/C-coated nickel foam substrates. The stability was also improved the degradation rate was reduced by 18.9% for the acid-treated MoS2-coated electrodes. This demonstrates the utility of acid washing nickel foam electrodes.
Publisher: Springer Science and Business Media LLC
Date: 2002
Abstract: Laxatives are commonly used to treat constipation and can be bought over-the-counter in many countries, although some preparations need to be prescribed by physicians. A meta-analysis was conducted to quantitatively evaluate the published evidence on the efficacy of laxatives in constipation. We found that large, well-controlled, published studies whose data were comparable were lacking. Of 250 articles, 35 met the inclusion criteria but only 11 yielded usable data (N = 375 patients on laxatives, 174 on placebo). There was an effect of laxatives on stool frequency (mean increase 1.9 stools per week) and stool weight (mean increase 476 g) but this was not clearly distinguishable from that of placebo therapies (1 stool and 434 g, respectively) in studies up to 4 weeks in duration. Similarly, studies of 5-12 weeks yielded no differences overall. These results cannot definitively rule out laxatives as an effective treatment, due to the poor published evidence. Better evidence is required to justify the continued expenditure of funds on laxatives by both patients and formularies.
Publisher: Wiley
Date: 31-03-2022
DOI: 10.1111/NMO.14337
Abstract: Itopride, a mixed D2 antagonist and cholinesterase inhibitor, has prokinetic effects on gastric motility. The Leuven Postprandial Distress Scale is a validated patient-reported outcome instrument for functional dyspepsia (FD) postprandial distress syndrome (PDS). We aimed to use the LPDS to assess treatment outcome in PDS and PDS/EPS (epigastric pain syndrome). Patients with PDS, with or without non-predominant EPS symptoms, were enrolled in an 8-week double-blind placebo-controlled multi-center trial with itopride (100 mg t.i.d.). Patients completed LPDS diaries and questionnaires to assess treatment response. Mann-Whitney test and mixed models were used. One hundred patients (79% females, 39.1 ± 1.5 yo) were included. No significant difference was observed between treatment arms (p = 0.6). Compared to baseline, itopride treatment significantly improved the LPDS score (p = 0.001) and all in idual symptoms (p < 0.0001). In the placebo arm, this was only the case for belching and epigastric pain (p < 0.05). In an exploratory analysis, outcomes in "pure" PDS (n = 45) and overlapping PDS/EPS (n = 55) patients were assessed and showed that the latter subgroup has the largest benefit with itopride compared to placebo (p = 0.03). Using the LPDS score in a pilot controlled trial in FD, itopride shows no therapeutic benefit over placebo after 8 weeks of treatment. In an exploratory post hoc analysis, itopride but not placebo was associated with improvement of symptoms compared to baseline, and this was most prominent in patients with overlapping PDS/EPS. The efficacy of itopride in this subgroup needs to be evaluated in a large study using the same outcome measure. (clinialtrials.org ref.: NCT04647955).
Publisher: Wiley
Date: 21-05-2013
DOI: 10.1111/NMO.12155
Abstract: Abdominal pain is common in the community, but only a subset meet diagnostic criteria for irritable bowel syndrome (IBS). Although anxiety and depression have been linked to IBS, the role of mood disturbances in the remainder with symptoms remains unclear. We aimed to study the associations between abdominal pain, anxiety, depression, and quality of life in the general population who were free of organic colonic disease by colonoscopy. Two hundred and seventy-two randomly selected subjects from the general population, mean age 54 years (27-71), were clinically evaluated, had a colonoscopy and laboratory investigations to exclude organic gastrointestinal (GI) disease. All subjects completed GI symptom diaries for 1 week, the Rome II modular questionnaire, the Hospital Anxiety and Depression Scale, and Short Form 36. Twenty-two subjects were excluded due to organic disease 1532 daily symptom records were available for analysis in the remainder. Thirty-four percent (n = 83) recorded at least one episode of abdominal pain on the diary. Twelve percent fulfilled Rome II criteria for IBS. Both anxiety and depression scores were higher in subjects who reported abdominal pain vs those who did not (P < 0.0005 and P < 0.0005). Anxiety and depression scores independently from IBS diagnosis (Rome II) predicted pain reporting and also correlated positively with pain burden. Quality of life scores were generally lower in subjects with abdominal pain. Anxiety and depression are linked to functional abdominal pain, not only in subjects with IBS but also in otherwise healthy people with milder, subtle GI symptoms.
Publisher: Informa UK Limited
Date: 2001
DOI: 10.1080/136515001317021644
Abstract: Since 1990 novel antipsychotics have been available to treat schizophrenia. Risperidone and olanzapine have emerged as the two most popular members of this class. The current report aims to synthesize the clinical trial data currently available on these two novel antipsychotics and compare them with conventional products in terms of efficacy and safety. Published randomized clinical trials, which included a risperidone or olanzapine arm, were sought through the MEDLINE, EMBASE and PSYCLIT databases. Trials were only excluded due to reporting failures or design incompatibilities (not randomized). A random effects approach was applied to compare information across trials, and meta-regression was used to compare product categories and gain insight into patient factors related to clinical outcomes. Outcome variables measured were total Positive and Negative Symptom Scale (PANSS) score, withdrawals due to inefficacy and use of medication for extrapyramidal symptoms (EPS). Risperidone and olanzapine offer advantages over conventional products in terms of both efficacy and safety. Of the two novel antipsychotics studied, the benefits of risperidone were clearer than those with olanzapine in terms of efficacy this could not be assessed for safety due to inconsistencies in the reporting of extrapyramidal symptoms between studies. Patients receiving novel antipsychotics, particularly risperidone, are likely to gain improved control of symptoms of schizophrenia and are less likely to require medication to counteract extrapyramidal symptoms than patients receiving conventional neuroleptics.
Publisher: Wiley
Date: 08-02-2019
DOI: 10.1111/APT.15133
Abstract: Current data on small intestinal bacterial overgrowth (SIBO) in patients with inflammatory bowel diseases (IBD) are controversial. To conduct a systematic review and meta-analysis to determine the prevalence of SIBO in patients with ulcerative colitis (UC) and Crohn's disease (CD). Electronic databases were searched up to May 2018 for studies reporting prevalence of SIBO in IBD patients. The prevalence rate of SIBO among IBD patients and the odds ratio (OR) and 95% CI of SIBO in IBD patients compared with controls were calculated. The final dataset included 11 studies (1175 adult patients with IBD and 407 controls), all utilising breath test for diagnosis of SIBO. The proportion of SIBO in IBD patients was 22.3% (95% CI 19.92-24.68). The OR for SIBO in IBD patients was 9.51 (95% CI 3.39-26.68) compared to non-IBD controls, and high in both CD (OR = 10.86 95% CI 2.76-42.69) and UC (OR = 7.96 95% CI 1.66-38.35). In patients with CD, subgroup analysis showed the presence of fibrostenosing disease (OR = 7.47 95% CI 2.51-22.20) and prior bowel surgery (OR = 2.38 95% CI 1.65-3.44), especially resection of the ileocecal valve, increased the odds of SIBO. In idual studies suggest that combined small and large bowel disease but not disease activity may be associated with SIBO. Overall, there is a substantial increase in the prevalence of SIBO in IBD patients compared to controls. Prior surgery and the presence of fibrostenosing disease are risk factors for SIBO in IBD.
Publisher: Wiley
Date: 30-10-2018
DOI: 10.1111/APT.15012
Publisher: Wiley
Date: 12-08-2016
DOI: 10.1111/APT.13753
Abstract: A validated patient-reported outcome instrument is lacking for the functional dyspepsia ostprandial distress syndrome. To validate the Leuven Postprandial Distress Scale (LPDS). The LPDS diary, comprising eight symptoms with verbal descriptors rated for severity (0-4), was derived from focus groups and cognitive debriefing. It was used in a 2-week run-in, 8-week double-blind placebo-controlled trial of itopride 100 mg t.d.s. Results in 60 patients, with concealed treatment allocation, were used to analyse LPDS content validity, consistency, reliability and responsiveness. Patients also filled out Patient Assessment of Gastrointestinal Symptoms (PAGI-SYM), Nepean Dyspepsia Index, overall treatment evaluation and overall symptom severity questionnaires. Construct validity was evaluated by known-group analyses and by correlating LPDS with these additional questionnaires. Minimum Clinically Important Difference was determined from threshold changes in anchor questionnaires. Symptom patterns and factor analysis identified three cardinal symptoms of postprandial distress syndrome (early satiation, postprandial fullness, upper abdominal bloating), whose mean intensities generate weekly LPDS scores. Known-groups analysis showed large-effect-size differences in LPDS scores (Cohen's d = 2.16). Strong correlations (r > 0.57) between LPDS scores and relevant anchors at baseline indicate good convergent validity. Internal consistency of LPDS was good (α > 0.85) with high inter-item correlations (0.67-0.76), and test-retest reliability (r = 0.85). Changes in LPDS scores were highly convergent with changes in overall treatment evaluation, overall symptom severity and PAGI-SYM (r > 0.52). minimum clinically important difference analysis generated thresholds of 0.4-0.6. The Leuven Postprandial Distress Scale, which is supported by the European Medicines Agency, is a sensitive and reliable patient-reported outcome instrument to assess symptoms in the functional dyspepsia ostprandial distress syndrome.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.GENHOSPPSYCH.2019.04.015
Abstract: Patients with depression frequently seek care in the emergency department (ED), especially in the context of suicidal ideation (SI) and self-harm (SH). However, the prevalence and trends in the United States (US) of ED visits for depression have not yet been characterized using a nationally representative s le. This study evaluates ED trends for depression in the US from 2006 to 2014. Data was obtained from the Nationwide Emergency Department S le (NEDS) in 2006 and 2014 using a primary ICD-9 diagnosis of depression or a primary diagnosis of suicidal ideation (SI) and a secondary diagnosis of depression. Between 2006 and 2014, there was a 25.9% increase in visits to the ED for depression, which was higher than the 14.8% increase in total ED visits during this time period. The mean inflation adjusted charges associated with depression-related ED visits increased by 107.7%, which was higher than the increase in mean charges for all ED visits in the same time period (40.47%). Visit rates were bimodally distributed with respect to age, with peaks in adolescence and middle age. Notably there was a 61.3% increase in ED visits for depression in in iduals younger than 20 between 2006 and 2014. Over half of patients were admitted for inpatient care with a mean length of stay of 5.6 days in both years. Inpatient charges increased 71.8% between 2006 and 2014. ED visits for depression in the United States rose 25.9% between 2006 and 2014, which was higher than the 14.8% increase in total ED visits during this time period. Over half of ED depression visits were admitted to inpatient stay (mean 5.6 days both years).
Publisher: AMPCo
Date: 11-2016
DOI: 10.5694/MJA16.00489
Publisher: Elsevier BV
Date: 10-2004
Publisher: Springer Science and Business Media LLC
Date: 09-03-2017
DOI: 10.1007/S10620-017-4496-Z
Abstract: Case control studies suggest an inverse association between Helicobacter pylori (H. pylori) and Crohn's disease (CD). It is possible this could be accounted for by confounders such as antibiotic therapy. Analyzing the geographic distribution of H. pylori and the links with the incidence and prevalence of CD would be an alternative approach to circumvent these confounders. The literature was searched for studies published between 1990 and 2016 that reported incidence or prevalence data for CD in random population s les in developed countries (GDP per capita >20,000 USD/year). Corresponding prevalence studies for H. pylori in these same regions were then sought matched to the same time period (±6 years). The association between the incidence and prevalence of CD and H. pylori prevalence rates were assessed before and after adjusting for GDP and life expectancy. A total of 19 CD prevalence and 22 CD incidence studies from 10 European countries, Japan, USA, and Australia with date-matched H. pylori prevalence data were identified. The mean H. pylori prevalence rate was 43.4% (range 15.5-85%), and the mean rates for incidence and prevalence for CD were 6.9 and 91.0/100,000 respectively. The incidence (r = -0.469, p < 0.03) and prevalence (r = -0.527, p = 0.02) of CD was inversely and significantly associated with prevalence of H. pylori infection. Our data demonstrate a significant inverse association between geographic distribution of H. pylori and CD. Thus, it is highly unlikely that the findings of previous case control studies were simply due to confounding factors such as concomitant antibiotic use in CD patients.
Publisher: SAGE Publications
Date: 22-10-2013
Abstract: This study investigates the relationship between psychosocial factors and functional gastrointestinal disorder symptomatology by testing a more comprehensive and integrated model than found in prior research. A total of 233 respondents completed an online battery to assess factors such as personality, dysfunctional cognitions and gastrointestinal anxiety. Results based on path modelling provided support for the majority of the hypothesised pathways. This study implicates a number of personality factors and dysfunctional cognitive processes as relevant to functional gastrointestinal disorder symptom burden. These findings have implications for future research, including which dysfunctional cognitive processes should be targeted therapeutically.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2016
Publisher: Wiley
Date: 02-1988
DOI: 10.1111/J.1445-5994.1988.TB02243.X
Abstract: A multivariate predictive model for early (six-month) survival based on Cox's proportional-hazards regression model was developed using data collected prospectively from 317 consecutive patients admitted with acute myocardial infarction to a coronary care unit (CCU). Of these, 63 (19.8%) died within the follow-up period. Patients with cardiogenic shock were excluded from the study. Variables associated with survival were sought from clinical, historical, electrocardiographic and radiographic variables recorded at the time of admission. On multivariate analysis, a stepwise selection procedure identified four variables which described the probability of survival for the six-month follow-up. These were: age, upper lung crepitations, marginal and also definite radiographic cardiomegaly on an anteroposterior radiograph. With this combination of clinical variables alone, using a survival probability partition value of 80%, the model had a sensitivity of 67% and a specificity of 75%. However, the model's predictive accuracy for death was 40%, compared to a predictive accuracy for survival of 90%. This clinical model is most useful for early discrimination of those patients at low risk of death within six months of CCU admission. Other predictive tests for premature death would need to exceed these discriminatory criteria to justify their cost and risks.
Publisher: Springer Science and Business Media LLC
Date: 31-08-2019
Publisher: Oxford University Press (OUP)
Date: 08-1985
Publisher: Elsevier BV
Date: 05-2018
Publisher: Wiley
Date: 30-06-2021
DOI: 10.1111/NMO.14209
Publisher: Springer Science and Business Media LLC
Date: 14-04-2023
DOI: 10.1007/S10567-023-00433-8
Abstract: This systematic review and meta-analysis aimed to examine the effectiveness of psychological interventions for internalising disorders in youth when delivered in routine settings. Secondary aims were to examine the effectiveness of cognitive behavioural therapy and determine moderators of treatment response. The study was pre-registered (PROSPERO 2020 CRD42020202776). Databases were systematically searched (PsycINFO, Medline, Embase, PubMed, ERIC) in December 2022 and screened according to the PRISMA 2020 statement. Inclusion: School aged participants (4–18 years) with a primary internalising disorder psychotherapy delivered in a routine setting (e.g. outpatient clinic, school) by setting staff compared psychotherapy to any control in a randomised controlled trial reported pre-to-post or pre-to-follow-up comparisons on the primary disorder according to child, parent or independent evaluator report and was published in English. Risk of bias was assessed using the ROB 2.0 Cochrane tool. Results were synthesised using random effects to pool estimates. Risk ratios were used to analyse dichotomous data and standardised mean differences (SMD) for continuous data. Forty-five studies were included ( N = 4901 participants M = 13 years range 8–16 SD = 2.5). Nine used waitlist control, 17 treatment as usual, 4 placebo 15 compared psychotherapy to active control. Psychotherapy was associated with small significant effects pre- to post-treatment compared to non-active controls for anxiety (SMD = − 0.24 to 0.50) and depression (SMD = − 0.19 to 0.34) with effects differing by informant. Psychotherapy led to small significant pre-to-post-benefits in youth internalising disorders in routine settings. Results are limited by reporter type and follow-up.
Publisher: Springer Science and Business Media LLC
Date: 02-1992
DOI: 10.1007/BF01308167
Publisher: Cambridge University Press (CUP)
Date: 11-2009
DOI: 10.1017/S1355617709990610
Abstract: Despite the sensitivity of neuropsychological tests to educational level, improved diagnostic accuracy for demographically corrected scores has yet to be established. Diagnostic efficiency statistics of Wechsler Adult Intelligence Scale-III (WAIS-III) and Wechsler Memory Scale-III (WMS-III) indices that were corrected for education, sex, and age (demographically corrected) were compared with age corrected indices in in iduals aged 16 to 75 years with moderate to severe traumatic brain injury (TBI) and 12 years or less education. TBI participants ( n = 100) were consecutive referrals to an outpatient rehabilitation service and met careful selection criteria. Controls ( n = 100) were obtained from the WAIS-III/WMS-III standardization s le. Demographically corrected indices did not provide higher diagnostic efficiency than age corrected indices and this result was supported by reanalysis of the TBI group against a larger and unmatched control group. Processing Speed Index provided comparable diagnostic accuracy to that of combined indices. Demographically corrected indices were associated with higher cut-scores to maximize overall classification, reflecting the upward adjustment of those scores in a lower education s le. This suggests that, in clinical practice, the test results of in iduals with limited education may be more accurately interpreted with the application of demographic corrections. Diagnostic efficiency statistics are presented, and future research directions are discussed. ( JINS , 2009, 15 , 938–950.)
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2001
Publisher: Wiley
Date: 10-2013
Publisher: Elsevier BV
Date: 02-2000
DOI: 10.1016/S0738-3991(99)00051-8
Abstract: Using the responses of 115 adults attending an asthma educator training course, the Asthma General Knowledge Questionnaire for Adults (AGKQA) was found to be an acceptably valid and reliable measure for assessing knowledge related to the management of asthma by adults. Content and face validity: expert assessors considered the AGKQA to be a relevant and plausible test of the asthma general knowledge content of the programme. Criterion-related validity: the pretraining scores of educators were significantly higher (P < 0.001) than those of adults with no experience of asthma total scores for the AGKQA and an asthma knowledge questionnaire developed for parents of children with asthma correlated strongly, 0.72. Test-retest reproducibility: the Spearman rank correlation for the test-retest score was 0.72 (P < 0.02), kappas for concordance of item responses were moderate to very good for two thirds of the items. Internal consistency for the total scale was also acceptable, KR20 0.66.
Publisher: Wiley
Date: 27-01-2019
DOI: 10.1111/APT.15120
Abstract: The pathogenesis of functional GI disorders (FGIDs) is uncertain. However, underlying immune activation and psychological distress has been documented in irritable bowel syndrome (IBS) and functional dyspepsia (FD). Epidemiological data from the UK suggest that FGIDs are linked to atopy and certain autoimmune diseases but this has not been confirmed. To test if allergic or autoimmune diseases are independently associated with FGIDs, irrespective of psychological distress in a large population based study. A total of 3542 people (mean age 57.9 years and 52.7% females) randomly selected from the Australian population, returned a mail survey (response rate = 43%). The survey asked about a physician diagnosis of autoimmune disease (scleroderma, psoriasis, rheumatoid arthritis and diabetes mellitus) or allergic conditions (asthma, food, pollen and/or animal allergy). The questionnaire assessed psychological distress and Rome III criteria for FD and IBS. Asthma, food, pollen and animal allergies, psoriasis and rheumatoid arthritis were univariately significantly associated with IBS and FD. Food allergy (OR = 1.66 95% CI = 1.15-2.40, P = 0.007), psoriasis (OR = 1.81 95% CI = 1.19-2.74, P = 0.006) and rheumatoid arthritis (OR = 1.68 95% CI = 1.15-2.4, P = 0.007) were independent risk factors for IBS, controlling for age, gender and psychological distress. In FD, asthma (OR = 1.32 95% CI = 1.04-1.68, P = 0.025) and food allergy (OR = 1.78 95% CI = 1.28-2.49, P = 0.001) were independent predictors, controlling for age, sex and psychological distress. There is evidence that both atopic and autoimmune diseases are risk factors for FGIDs, independent of psychological distress, differing in IBS and FD. This provides evidence that different peripheral pathways may be involved in the pathogenesis of certain FGIDs.
Publisher: Wiley
Date: 05-2003
DOI: 10.1046/J.1365-2036.2003.01557.X
Abstract: Little is known about the prevalence and importance of non-cardiac chest pain in the general population. To evaluate the magnitude and impact of this condition. A validated self-report questionnaire was mailed to a s le of 1000 residents of Penrith, selected randomly from the electoral rolls. Symptoms, risk factors, psychological distress, quality of life and demographics were measured. The response rate was 73% (n = 672 mean age, 46 years 52% female). Chest pain ever was reported by 39% of the population 7% reported a history of myocardial infarction and 8% a history of angina. Two hundred and nineteen (33%) cases were classified as non-cardiac chest pain only 23% had consulted a physician about chest pain in the previous year. The only independent risk factor for non-cardiac chest pain was the frequency of heartburn (odds ratio, 1.74 95% confidence interval, 1.08-2.79 P = 0.02). None of the gastrointestinal (heartburn, dysphagia, acid regurgitation) or psychological (anxiety, depression, neuroticism) risk factors were significantly associated with consulting for non-cardiac chest pain. Non-cardiac chest pain is remarkably common in the general population and negatively impacts on the quality of life. Gastro-oesophageal reflux disease is a key risk factor for non-cardiac chest pain in the community. Health care seeking for non-cardiac chest pain remains unexplained.
Publisher: Elsevier BV
Date: 07-2001
Abstract: This study was undertaken to document vascular reactivity in both phases of normal menstrual cycles and anovulatory cycles of women receiving oral contraceptives and to compare vascular reactivity of women in the follicular phase of the normal menstrual cycle with that of men of a similar age group. Forearm blood flow was measured with plethysmography in 15 women with ovulatory cycles during the follicular and luteal phases of the normal cycle, at equivalent times in 14 women receiving oral contraceptives, and in 15 age-matched men. Changes in forearm blood flow, an index of vascular reactivity, were measured during a randomly ordered brachial artery infusion schedule of norepinephrine, sodium nitroprusside, angiotensin II, and Nomega-monomethyl-L -arginine and were analyzed with repeated measures analysis of variance. Forearm blood flow responses were similar in the two phases of the normal cycle. Responses were similar between women with ovulatory cycles and users of oral contraceptives, apart from a significantly greater response to angiotensin II in the oral contraceptive group during the medication phase than during the withdrawal phase (P =.027). Basal forearm blood flow was higher in men than in women (7 +/- 1.6 vs 5 +/- 1.4 mL/100 mL per minute P =.015), and men demonstrated a significantly greater vasoconstrictor response to norepinephrine (P <.05) than did women. Vascular reactivity is similar in the two phases of the normal menstrual cycle, but women who use oral contraceptives have an exaggerated response to angiotensin II during the medication phase. Men demonstrate greater vascular reactivity to norepinephrine than do women, perhaps because of the lack of estrogen-mediated protective effects and increased adrenergic activity.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
DOI: 10.1038/AJG.2014.17
Publisher: Wiley
Date: 29-10-2013
DOI: 10.1111/APT.12532
Abstract: Irritable bowel syndrome (IBS) is one of the most common out-patient diagnoses in primary care and gastroenterology. There are limited data on the rate and costs associated with in-patient discharges for IBS. To estimate the incidence and costs of hospital discharges for IBS in the United States. We analysed the National Inpatient S le database for all subjects in which IBS (ICD-9 code: 564.1) was the principal discharge diagnosis from 1997 to 2010. The National Inpatient S le contains data from approximately 8 million hospital stays each year. Our findings reflected patient and hospital characteristics like geographical region and bed size. In 1997, there were 11 433 patients with a principal discharge diagnosis of IBS as compared to 12 842 in 2010 (P > 0.9, GoF test). The mean length of stay for IBS also remained the same between 1997 and 2010 at 3.7 ± 0.1 days. However, during this period, the mean hospital charges per hospitalization increased by 207.8% from $6873 ± 198 in 1997 to $21 153 ± 598 in 2010 (P < 0.01). The aggregate charges (i.e., 'national bill') for IBS increased by 245.5% from $78 524 129 ± 3 781 316 in 1997 to $271 311 405 ± 14 023 289 in 2010 (P < 0.01). The number of in-patient discharges and length of stay for IBS have remained relatively stable between 1997 and 2010, whereas the cost associated with these discharges has increased significantly. In-patient costs associated with IBS contribute significantly to the total healthcare bill. Further research on the cost-effectiveness of diagnostic procedures and therapies in IBS is required.
Publisher: Springer Science and Business Media LLC
Date: 27-05-2022
DOI: 10.1038/S41598-022-13175-4
Abstract: We investigated whether sensory attenuation (or failure of) might be an explanation for heightened pain perceptions in in iduals with chronic pain. N = 131 (50% chronic pain) in iduals underwent a single experimental session, which included the force-matching task and several self-reported symptom and psychological measures. In iduals matched a force delivered to their finger, either by pressing directly on their own finger with their other hand (direct) or by using potentiometer to control the force through a torque motor (slider). All participants overestimated the target force in the direct condition reflecting the sensory attenuation phenomenon. No differences in the magnitude of sensory attenuation between chronic pain and control groups were observed (direct: Z = − 0.90, p = 0.37 and slider: Z = − 1.41, p = 0.16). An increased variance of sensory attenuation was observed in chronic pain in iduals (direct: F(1, 129) = 7.22, p = 0.008 and slider: F(1, 129), p = 0.05). Performance in the slider condition was correlated with depressive symptoms ( r = − 0.24, p = 0.05), high symptom count ( r = − 0.25, p = 0.04) and positive affect ( r = 0.28, p = 0.02). These were only identified in the chronic pain in iduals. Overall, our findings reveal no clear differences in the magnitude of sensory attenuation between groups. Future research is needed to determine the relevance of sensory attenuation in neuro-cognitive models related to pain perception.
Publisher: The Sax Institute
Date: 2001
DOI: 10.1071/NB01099
Publisher: Public Library of Science (PLoS)
Date: 04-11-2013
Publisher: Elsevier BV
Date: 2019
Publisher: Center for Open Science
Date: 25-04-2021
Abstract: Debate continues as to whether an attentional bias towards threat displayed by sufferers of functional gastrointestinal disorders (FGIDs) is conscious and, thus, more amenable to change through psychological therapy. We compared the litudes of early (unconscious) and later (conscious) electroencephalographic (EEG) event-related potentials following silent reading of symptom-related, emotionally neutral, and emotionally negative nouns across two participant groups: 30 female FGID-sufferers who met diagnostic criteria for irritable bowel syndrome or functional dyspepsia, and 30 female healthy controls. Analogous indices based on alpha desynchronization were also examined, as were correlations between the EEG-based indices and a range of psychosocial variables. FGID-sufferers displayed marginally significantly higher occipital EPN litudes for all nouns, indicating marginally higher levels of unconscious attention in the task. FGID-sufferers also displayed, for negative as compared to neutral nouns, significantly lower central N400 litudes indicative of higher conscious attention. The result was only apparent in post-hoc pairwise comparisons, however. Uniquely among FGID-sufferers, central N400 was strongly negatively correlated with a range of negative psychosocial traits and states. The findings provide preliminary evidence of hypervigilance to general (as opposed to symptom-specific) threat among FGID-sufferers. Amidst concerns over Type I error, recommendations are made for fine-tuning the operationalisation of unconscious and conscious attentional bias in this population.
Publisher: Center for Open Science
Date: 24-03-2023
Abstract: Somatic symptoms – chronic physical complaints, such as headaches and joint pain – present a challenge for the healthcare system, partly because patients often resist psychological explanations and treatments. To inform conversations with patients around which factors (psychological or physiological) might represent a first-pass target for treatment, we used data from two waves of the Australian Longitudinal Study on Women’s Health to longitudinally explore a comprehensive set of largely modifiable psychosocial and physiological predictors of somatic symptoms. Our s le was broadly representative and consisted of 8,261 women aged 22 to 27. In a linear regression with multiple imputation, eight physiological predictors and seven psychosocial predictors were explored. Psychosocial predictors accounted for more variance than physiological predictors: 29.7% vs. 11.5%, but the five strongest predictors (psychological distress, having at least one physiological condition, stress, being overweight, and having a sexual condition) included three physiological factors. The results highlight the benefits of multi-disciplinary treatment approaches that address physiological as well as psychological risk factors.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.JAD.2019.06.044
Abstract: There has been growing interest in the potential of emerging internet-delivered psychological treatments for supporting the mental health needs of university students. However, no large-scale prospective effectiveness trials examining their real-world potential have been reported. The aim of the current study was to evaluate the acceptability and effectiveness of a brief, 5-week, internet-delivered and therapist-guided intervention for anxiety and depression, when delivered as part of routine care by a university counselling service. A large, prospective, single-group Phase-IV clinical trial. Students (n = 1326) engaging with the university counselling service were provided the opportunity to receive the intervention based on their preferences and identified needs. Students completed standardised measures of anxiety and depression at pre-treatment, each week of the intervention, post-treatment and 3-month follow-up. Over a 4 year period, 1081 students (10% of those presenting to the counselling service) participated in the intervention. Large clinical reductions in symptoms of both anxiety (% reduction = 41% Cohen's d = 0.94) and depression (% reduction = 36% Cohen's d = 0.81) were observed alongside high levels of acceptability. The intervention required relatively little counsellor time (M = 36.28 mins SD = 20.56) per student, and symptom deterioration was observed in less than 5% of students. The findings of the current study are supportive of internet-delivered interventions provided as routine care to university students. Further research is needed to carefully explore whether these interventions could be used with a larger proportion of students presenting to counselling services, paying close attention to acceptability, engagement and clinical outcomes.
Publisher: Elsevier BV
Date: 05-2019
Publisher: Springer Science and Business Media LLC
Date: 23-05-2021
DOI: 10.3758/S13428-021-01605-6
Abstract: In this paper we describe the design, development and functionality of a haptic force-matching device. This device measures precise sensorimotor perception by determining a subject's ability to successfully attenuate incoming sensory signals. Sensory attenuation provides a novel method of investigating psychophysical aspects of perception and may help to formulate neurocognitive models that may account for maladaptive interoceptive processing. Several similar custom-made devices have been reported in the literature however, a clear description of the mechanical engineering necessary to build such a device is lacking. We present, in detail, the hardware and software necessary to build such a device. Subjects (N = 25) were asked to match a target force on their right index finger, first by pressing directly on their finger with their other hand, then by controlling the device through an external potentiometer to control the force (indirectly) though a torque motor. In the direct condition, we observed a consistent overestimation of the force reproduced mean force error 0.50 newtons (standard error = 0.04). In the slider condition we observed a more accurate, yet small, underestimation of reproduced force: -0.30 newtons (standard error = 0.03).
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2020-043902
Abstract: Access to high-quality primary healthcare is limited for remote residents in Australia. Increasingly, remote health services are reliant on short-term or ‘fly-in, fly-out/drive-in, drive-out’ health workforce to deliver primary healthcare. A key strategy to achieving health service access equity, particularly evident in remote Australia, has been the development of Aboriginal Community Controlled Health Services (ACCHSs). This study aims to generate new knowledge about (1) the impact of short-term staffing in remote and rural ACCHSs on Aboriginal and Torres Strait Islander communities (2) the potential mitigating effect of community control and (3) effective, context-specific evidence-based retention strategies. This paper describes a 3-year, mixed methods study involving 12 ACCHSs across three states. The methods are situated within an evidence-based programme logic framework for rural and remote primary healthcare services. Quantitative data will be used to describe staffing stability and turnover, with multiple regression analyses to determine associations between independent variables (population size, geographical remoteness, resident staff turnover and socioeconomic status) and dependent variables related to patient care, service cost, quality and effectiveness. Qualitative assessment will include interviews and focus groups with clinical staff, clinic users, regionally-based retrieval staff and representatives of jurisdictional peak bodies for the ACCHS sector, to understand the impact of short-term staff on quality and continuity of patient care, as well as satisfaction and acceptability of services. The study has ethics approval from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493), Western Australian Aboriginal Health Ethics Committee (WAAHEC-938) and Far North Queensland Human Research Ethics Committee (HREC/2019/QCH/56393). Results will be disseminated through peer-reviewed journals, the project steering committee and community/stakeholder engagement activities to be determined by each ACCHS.
Publisher: Elsevier BV
Date: 07-1993
DOI: 10.1016/0378-3782(93)90145-K
Abstract: There are few published data on plasma ACTH and cortisol in very low birth weight (VLBW) infants beyond the first week of life. We therefore measured plasma ACTH and cortisol longitudinally in 25 infants (mean birth weight 1025 g, mean gestational age 28 weeks) at 1, 2, 4 and 8 postnatal weeks to document normative values for infants not receiving dexamethasone. We also examined the influence of clinical state and dexamethasone treatment on plasma ACTH and cortisol levels. Median plasma ACTH increased significantly with advancing postnatal age from 1 week to 8 weeks (21.0 vs. 40.0 ng/l P = 0.01) but did not correlate with postconceptional age. Median plasma cortisol decreased significantly with advancing postnatal age from 1 week to 8 weeks (216 vs. 50 nmol/l P = 0.001) and correlated inversely with postconceptional age (P = 0.004). At 8 weeks infants who were clinically well (n = 6) had lower plasma ACTH values compared with sick (n = 6) infants (median: 37.0 vs. 63.5 ng/l P = 0.033). Plasma ACTH did not correlate with clinical state at 1, 2 and 4 weeks. At none of the postnatal ages studied was plasma cortisol influenced by the degree of sickness. Five infants received dexamethasone to assist weaning from mechanical ventilation. Their median plasma ACTH level, at 8 weeks, was significantly lower than that of the 12 infants who did not receive dexamethasone (11.0 vs. 40.0 ng/l P = 0.0006). Plasma cortisol was not significantly influenced by dexamethasone treatment (P = 0.27). These data provide further information on the evolution of adrenocortical function in VLBW infants in the first months of life.
Publisher: No publisher found
Date: 2017
DOI: 10.5694/MJA16.00491
Publisher: BMJ
Date: 10-01-2012
DOI: 10.1136/GUTJNL-2011-300474
Abstract: Psychological factors are known to be associated with functional gastrointestinal disorders (FGIDs) including irritable bowel syndrome (IBS) and functional dyspepsia (FD). No prospective studies have evaluated whether it is the brain (eg, via anxiety) that drives gut symptoms, or whether gut dysfunction precipitates the central nervous system features such as anxiety. In a 12-year longitudinal, prospective, population-based study, we aimed to determine the directionality of the brain-gut mechanism in FGIDs. Participants (n=1775) were a random population s le from Australia who responded to a survey on FGIDs in 1997 and agreed to be contacted for future research 1002 completed the 12-year follow-up survey (response rate =60%), with 217, 82 and 45 people meeting Rome II for new onset FGIDs, IBS and FD, respectively. Anxiety and depression were measured using the Delusions Symptom States Inventory at baseline and follow-up. Among people free of a FGID at baseline, higher levels of anxiety (OR 1.11 95% CI 1.03 to 1.19, p=0.006) but not depression at baseline was a significant independent predictor of developing new onset FGIDs 12 years later. Among people who did not have elevated levels of anxiety and depression at baseline, those with a FGID at baseline had significantly higher levels of anxiety and depression at follow-up (mean difference coefficient 0.76, p<0.001 and 0.30, p=0.01 for anxiety and depression, respectively). In IBS higher levels of anxiety and depression at baseline were predictive of IBS at follow-up, while only depression was predictive of FD at follow-up. The central nervous system and gut interact bidirectionally in FGIDs.
Publisher: American Physiological Society
Date: 2017
Abstract: Fecal incontinence (FI) in men is common, yet data on sex differences in clinical features, physiology, and treatment are scarce. Our aim was to provide insights into FI in males compared with females. Prospectively collected data from 73 men and 596 women with FI in a tertiary referral center were analyzed. Anorectal physiology, clinical characteristics, and outcome of instrumented biofeedback (BF) were recorded. Thirty-one men with FI proceeded to BF and were matched with 62 age-matched women with FI who underwent BF. Men with FI had higher resting, squeeze, and cough anal sphincter pressures ( P 0.001) and were more able to hold a sustained squeeze compared with women ( P = 0.04). Men with FI had higher rectal pressure and less inadequate rectal pressure on strain and higher sensory thresholds ( P 0.05). Men, but not women, with isolated soiling had higher anal resting and squeeze pressures compared with those with overt FI ( P 0.05). Men were less likely to undergo BF when offered compared with women. Baseline symptom severity did not differ between the groups. In men, the absence of an organic cause for the FI and the presence of overt FI, but not isolated soiling, were correlated with improvement in patient satisfaction following BF. The outcomes of 50% reduction in FI episodes, physician assessment, symptoms, and quality of life scores after BF all significantly improved in men similarly to women. We conclude that men, compared with women, with FI have unique clinical features and physiology and are less likely to have investigations and treatment despite successful outcome with BF. Future studies to customize treatment in males and determine barriers to therapy are warranted. NEW & NOTEWORTHY Fecal incontinence in men is common, yet data on sex differences in clinical features, physiology, and treatment are scarce. We provide evidence that men, compared with women, with fecal incontinence have unique clinical features and physiology and are less likely to have investigations and treatment despite successful outcome with anorectal biofeedback therapy.
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.JPSYCHORES.2010.10.004
Abstract: A single previous paper on this topic found a direct pathway between cognitive behavioral therapy (CBT) and an irritable bowel syndrome (IBS) global symptom score. This is controversial since under the biopsychosocial model, the expectation is that CBT's effect would be mediated by mood. Using more sensitive bowel symptom scales and measurements at additional time points, we aimed to compare the relative strengths of direct pathways between CBT and change in IBS symptoms and indirect pathways that operate via mood state using structural equation modeling. Our data set included 105 people with Rome I IBS randomized to in idual CBT (n=34), relaxation therapy (n=36), and usual medical care (n=35). The primary outcome was defined as adequate relief of IBS symptoms in terms of the distress, frequency, and impairment according to the Bowel Symptom Severity Scale. Outcomes in functional status (according to the 36-item Short-Form Health Survey) and psychological status (Hospital Anxiety and Depression Scale) were secondary outcomes. Our data suggest indirect pathways that operate via mood, most clearly anxiety but to a lesser extent depression. Statistically significant pathways were identified that lead from CBT to change in mood state thence to change in bowel symptoms, followed by further changes in mood then changes in bowel symptoms. Our data provide no evidence of direct effect of CBT on bowel symptoms. The present study suggests that CBT may operate via changes in mood state while not ruling out the possibility of direct effects. Our findings do not directly support, but are consistent with, a biopsychosocial model.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2003
Publisher: Springer Science and Business Media LLC
Date: 31-12-2020
DOI: 10.1038/S41598-020-80559-9
Abstract: Long term stress exposure is typical for modern societies and might trigger different diseases. This case–control study reveals that persons who had suffered an acute myocardial infarction (AMI) had elevated cortisol concentrations in the month before the acute event. Middle-aged patients admitted to cardiology clinics with acute myocardial infarction (AMI) (n = 174) were compared to 3156 controls from a population-based cohort in southeast Sweden. The median Hair Cortisol Concentrations (HCC) for those who had suffered an AMI was 53.2 pg/mg compared to 22.2 pg/mg for the control group (p 0.001). In bivariate analysis, higher levels of HCC were strongly (OR = 5.69) and statistically significantly associated with current AMI status. The discrimination of cases with AMI from controls remained statistically significant (OR = 5.04) even after controlling for established cardiovascular risk factors in a multivariate analysis. Middle-aged persons with acute myocardial infarction had significantly elevated cortisol levels during the month before the cardiac event. This was evident for both men and women. The biomarker cortisol concentration was independently and statistically significantly related to AMI. Chronic stress seems to be a new promising risk factor for AMI.
Publisher: Informa UK Limited
Date: 2021
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.CGH.2022.01.014
Abstract: This study explored the link between duodenal eosinophils and mast cells in patients with functional dyspepsia (FD). MEDLINE (PubMed) and Embase electronic databases were searched until June 2021 for case-control studies reporting duodenal eosinophils and mast cells in FD. Pooled standardized mean difference (SMD), odds ratio, and 95% CIs of duodenal eosinophils and mast cells in FD patients and controls were calculated, using a random-effects model. Twenty-two case-control studies with 1108 FD patients and 893 controls were identified. Duodenal eosinophils (SMD, 1.29 95% CI, 0.85-1.73 P = .0001) and mast cells (SMD, 2.11 95% CI, 1.14-3.07 P = .0001) were increased in FD patients compared with controls. Substantial heterogeneity was found (I 2 = 93.61, P = .0001 and I 2 = 96.69, P = .0001, respectively) and visual inspection of funnel plots confirmed publication bias. Degranulation of duodenal eosinophils was significantly higher in FD patients compared with controls (odds ratio, 3.78 95% CI, 6.76-4.48 P = .0001), without statistically significant heterogeneity. We conducted a sensitivity analysis for duodenal eosinophils, by including only high-quality studies, and the results remained unchanged (SMD, 1.73 95% CI, 1.06-2.40 P = .0001), with substantial heterogeneity. Postinfectious FD patients had increased duodenal eosinophils compared with controls (SMD, 3.91 95% CI, 1.32-6.51 P = .001) and FD patients without any history of infection (SMD, 1.42 95% CI, 0.88-1.96 P = .001). Helicobacter pylori-negative FD patients had significantly higher duodenal eosinophils compared with controls (SMD, 3.98 95% CI, 2.13-5.84 P = .0001), with substantial heterogeneity. No significant difference in duodenal eosinophils was seen according to FD subtypes. This meta-analysis suggests a link between duodenal microinflammation and FD. However, the quality of evidence is very low, largely owing to the unexplained heterogeneity and serious risk of publication bias in all comparative analyses. Thus, causality remains uncertain and further studies are required.
Publisher: BMJ
Date: 10-2021
DOI: 10.1136/BMJOPEN-2021-055635
Abstract: To evaluate the relationship between markers of staff employment stability and use of short-term healthcare workers with markers of quality of care. A secondary objective was to identify clinic-specific factors which may counter hypothesised reduced quality of care associated with lower stability, higher turnover or higher use of short-term staff. Retrospective cohort study (Northern Territory (NT) Department of Health Primary Care Information Systems). All 48 government primary healthcare clinics in remote communities in NT, Australia (2011–2015). 25 413 patients drawn from participating clinics during the study period. Associations between independent variables (resident remote area nurse and Aboriginal Health Practitioner turnover rates, stability rates and the proportional use of agency nurses) and indicators of health service quality in child and maternal health, chronic disease management and preventive health activity were tested using linear regression, adjusting for community and clinic size. Latent class modelling was used to investigate between-clinic heterogeneity. The proportion of resident Aboriginal clients receiving high-quality care as measured by various quality indicators varied considerably across indicators and clinics. Higher quality care was more likely to be received for management of chronic diseases such as diabetes and least likely to be received for general reventive adult health checks. Many indicators had target goals of 0.80 which were mostly not achieved. The evidence for associations between decreased stability measures or increased use of agency nurses and reduced achievement of quality indicators was not supported as hypothesised. For the majority of associations, the overall effect sizes were small (close to zero) and failed to reach statistical significance. Where statistically significant associations were found, they were generally in the hypothesised direction. Overall, minimal evidence of the hypothesised negative effects of increased turnover, decreased stability and increased reliance on temporary staff on quality of care was found. Substantial variations in clinic-specific estimates of association were evident, suggesting that clinic-specific factors may counter any potential negative effects of decreased staff employment stability. Investigation of clinic-specific factors using latent class analysis failed to yield clinic characteristics that adequately explain between-clinic variation in associations. Understanding the reasons for this variation would significantly aid the provision of clinical care in remote Australia.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2013
DOI: 10.1038/AJG.2013.118
Abstract: The relationship between symptom improvement (SI) and acceleration of gastric emptying (GE) for different drugs used in the treatment of idiopathic and diabetic gastroparesis is uncertain. In this paper we examined the study-specific correlations between SI and GE, and we performed a meta-regression analysis of the association across multiple studies. The MEDLINE database (1,946 to present) was searched, and only controlled trials or trials with an established effective comparator that compared both SI and GE were included. Studies were identified for metoclopramide (n=6), domperidone (n=6), cisapride (n=14), erythromycin (n=3), botulinum toxin (n=2), and levosulpiride (n=3). Even though most drugs concomitantly improved symptoms and accelerated GE, no study reported a significant correlation between SI and GE. Moreover, a correlation analysis over all studies using meta-regression did not show a significant relationship between SI and GE. Our findings need to be qualified by inconsistencies in study methods, which is a limitation but also suggests that our findings are robust to methodological factors. In this review, no evidence of a relationship between SI and GE was identified for different drugs used for the treatment of gastroparesis. This finding questions the use of GE measurement to direct drug development for gastroparesis.
Publisher: American Medical Association (AMA)
Date: 19-07-2016
Abstract: Rapid-fire weapons are often used by perpetrators in mass shooting incidents. In 1996 Australia introduced major gun law reforms that included a ban on semiautomatic rifles and pump-action shotguns and rifles and also initiated a program for buyback of firearms. To determine whether enactment of the 1996 gun laws and buyback program were followed by changes in the incidence of mass firearm homicides and total firearm deaths. Observational study using Australian government statistics on deaths caused by firearms (1979-2013) and news reports of mass shootings in Australia (1979-May 2016). Changes in intentional firearm death rates were analyzed with negative binomial regression, and data on firearm-related mass killings were compared. Implementation of major national gun law reforms. Changes in mass fatal shooting incidents (defined as ≥5 victims, not including the perpetrator) and in trends of rates of total firearm deaths, firearm homicides and suicides, and total homicides and suicides per 100,000 population. From 1979-1996 (before gun law reforms), 13 fatal mass shootings occurred in Australia, whereas from 1997 through May 2016 (after gun law reforms), no fatal mass shootings occurred. There was also significant change in the preexisting downward trends for rates of total firearm deaths prior to vs after gun law reform. From 1979-1996, the mean rate of total firearm deaths was 3.6 (95% CI, 3.3-3.9) per 100,000 population (average decline of 3% per year annual trend, 0.970 95% CI, 0.963-0.976), whereas from 1997-2013 (after gun law reforms), the mean rate of total firearm deaths was 1.2 (95% CI, 1.0-1.4) per 100,000 population (average decline of 4.9% per year annual trend, 0.951 95% CI, 0.940-0.962), with a ratio of trends in annual death rates of 0.981 (95% CI, 0.968-0.993). There was a statistically significant acceleration in the preexisting downward trend for firearm suicide (ratio of trends, 0.981 95% CI, 0.970-0.993), but this was not statistically significant for firearm homicide (ratio of trends, 0.975 95% CI, 0.949-1.001). From 1979-1996, the mean annual rate of total nonfirearm suicide and homicide deaths was 10.6 (95% CI, 10.0-11.2) per 100,000 population (average increase of 2.1% per year annual trend, 1.021 95% CI, 1.016-1.026), whereas from 1997-2013, the mean annual rate was 11.8 (95% CI, 11.3-12.3) per 100,000 (average decline of 1.4% per year annual trend, 0.986 95% CI, 0.980-0.993), with a ratio of trends of 0.966 (95% CI, 0.958-0.973). There was no evidence of substitution of other lethal methods for suicides or homicides. Following enactment of gun law reforms in Australia in 1996, there were no mass firearm killings through May 2016. There was a more rapid decline in firearm deaths between 1997 and 2013 compared with before 1997 but also a decline in total nonfirearm suicide and homicide deaths of a greater magnitude. Because of this, it is not possible to determine whether the change in firearm deaths can be attributed to the gun law reforms.
Publisher: American Society for Microbiology
Date: 04-2015
DOI: 10.1128/JCM.03239-14
Abstract: Colonization with Candida species is an independent risk factor for invasive candidiasis (IC), but the minimum and most practicable parameters for prediction of IC have not been optimized. We evaluated Candida colonization in a prospective cohort of 6,015 nonneutropenic, critically ill patients. Throat, perineum, and urine were s led 72 h post-intensive care unit (ICU) admission and twice weekly until discharge or death. Specimens were cultured onto chromogenic agar, and a subset underwent molecular characterization. Sixty-three (86%) patients who developed IC were colonized prior to infection 61 (97%) tested positive within the first two time points. The median time from colonization to IC was 7 days (range, 0 to 35). Colonization at any site was predictive of IC, with the risk of infection highest for urine colonization (relative risk [RR] = 2.25) but with the sensitivity highest (98%) for throat and/or perineum colonization. Colonization of ≥2 sites and heavy colonization of ≥1 site were significant independent risk factors for IC (RR = 2.25 and RR = 3.7, respectively), increasing specificity to 71% to 74% but decreasing sensitivity to 48% to 58%. Molecular testing would have prompted a resistance-driven decision to switch from fluconazole treatment in only 11% of patients infected with C. glabrata , based upon species-level identification alone. Positive predictive values (PPVs) were low (2% to 4%) and negative predictive values (NPVs) high (99% to 100%) regardless of which parameters were applied. In the Australian ICU setting, culture of throat and perineum within the first two time points after ICU admission captures 84% (61/73 patients) of subsequent IC cases. These optimized parameters, in combination with clinical risk factors, should strengthen development of a setting-specific risk-predictive model for IC.
Publisher: Hogrefe Publishing Group
Date: 09-2014
DOI: 10.1027/1614-0001/A000143
Abstract: This research examined in idual differences in how people think about social status via a scale with eight proposed factors. Items designed to measure these factors were administered to an online s le (n = 1,009). A factor analysis revealed eight meaningful factors: rejection of status, high-perceived status, respect for hierarchy, low-perceived status, status display, egalitarianism, belief in hierarchy, and enjoyment of status. The 40 items forming these eight factors were then administered to a new s le of online participants (n = 303) alongside measures of self-esteem, social dominance orientation, competitiveness, assertiveness, social comparison orientation, narcissism, and hypersensitive narcissism. Confirmatory factor analyses from this subsequent study supported the model derived in the first study. A preliminary analysis of the construct validity of this new “Status Consciousness Scale” scale was undertaken by examining the correlations between the factors and other personality variables that were predicted to relate to each factor.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-01-2020
DOI: 10.14309/AJG.0000000000000504
Abstract: We conducted a systematic review and meta-analysis to compare the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS) and controls. Electronic databases were searched up to December 2018 for studies reporting SIBO prevalence in patients with IBS. Prevalence rates, odds ratios (ORs), and 95% confidence intervals (CIs) of SIBO in patients with IBS and controls were calculated. We included 25 studies with 3,192 patients with IBS and 3,320 controls. SIBO prevalence in patients with IBS was significantly increased compared with controls (OR = 3.7, 95% CI 2.3–6.0). In studies using only healthy controls, the OR for SIBO in patients with IBS was 4.9 (95% CI 2.8–8.6). With breath testing, SIBO prevalence in patients with IBS was 35.5% (95% CI 33.6–37.4) vs 29.7% (95% CI 27.6–31.8) in controls. Culture-based studies yielded a SIBO prevalence of 13.9% (95% CI 11.5–16.4) in patients with IBS and 5.0% (95% CI 3.9–6.2) in controls with a cutoff value of 10 5 colony-forming units per milliliter vs 33.5% (95% CI 30.1–36.9) in patients with IBS and 8.2% (95% CI 6.8–9.6) in controls with a cutoff value of 10 3 colony-forming unit per milliliter, respectively. SIBO prevalence diagnosed by lactulose breath test is much greater in both patients with IBS (3.6-fold) and controls (7.6-fold) compared with glucose breath test. Similar difference is seen when lactulose breath test is compared with culture methods. OR for SIBO in patients with IBS-diarrhea compared with IBS-constipation was 1.86 (95% CI 1.83–2.8). Methane-positive breath tests were significantly more prevalent in IBS-constipation compared with IBS-diarrhea (OR = 2.3, 95% CI 1.2–4.2). In patients with IBS, proton pump inhibitor was not associated with SIBO (OR = 0.8, 95% CI 0.5–1.5, P = 0.55). This systematic review and meta-analysis suggests a link between IBS and SIBO. However, the overall quality of the evidence is low. This is mainly due to substantial “clinical heterogeneity” due to lack of uniform selection criteria for cases and controls and limited sensitivity and specificity of the available diagnostic tests.
Publisher: Wiley
Date: 17-05-2016
DOI: 10.1111/APT.13657
Abstract: Liver-related mortality varies across developed nations. To assess the relative role of various risk factors in relation to liver-related mortality in an ecological study approach. Data for liver-related mortality, prevalence data for hepatitis B and C, human immunodeficiency virus (HIV), alcohol consumption per capita, Type 2 Diabetes mellitus (T2DM), overweight and obesity were extracted from peer-reviewed publications or WHO databases for different developed countries. As potential other risk-modifying factors, purchase power parity (PPP)-adjusted gross domestic product (GDP) per capita and health expenditure per capita were assessed. As an environmental 'hygiene factor', we also assessed the effect of the prevalence of Helicobacter pylori. Only countries with a PPP-adjusted GDP greater than $20 000 and valid information for at least 8 risk modifiers were included. Univariate and multivariate analyses were utilised to quantify the contribution to the variability in liver-related mortality. The proportion of chronic liver diseases (CLD)-related mortality ranged from 0.73-2.40% [mean 1.56%, 95% CI (1.43-1.69)] of all deaths. Univariately, CLD-related mortality was significantly associated with Hepatitis B prevalence, alcohol consumption, PPP-adjusted GDP (all P < 0.05) and potentially H. pylori prevalence (P = 0.055). Other investigated factors, including hepatitis C, did not yield significance. Backward elimination suggested hepatitis B, alcohol consumption and PPP-adjusted GDP as risk factors (explaining 66.3% of the variability). Hepatitis B infection, alcohol consumption and GDP, but not hepatitis C or other factors, explain most of the variance of liver-related mortality.
Publisher: Elsevier BV
Date: 07-2023
Publisher: Elsevier BV
Date: 07-2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2001
DOI: 10.1111/J.1572-0241.2001.03605.X
Abstract: Gastrointestinal (GI) symptoms are common in patients with long-standing diabetes mellitus, but the pathogenesis is controversial. We aimed to determine if GI symptoms are linked to psychological distress in diabetes. A consecutive s le of outpatients with diabetes mellitus (n = 209) and a random s le of community diabetics (n = 892) completed a validated questionnaire measuring GI symptoms, the Hospital Anxiety and Depression (HAD) Scale for anxiety and depression, and the Eysenck short neuroticism scale. Overall, 42% reported one or more GI symptoms: bloating, abdominal pain, loose stools, and urgency were most common. The mean HAD and neuroticism scores were significantly higher for most GI symptoms (11 of 14, all p or = 11). Anxiety, depression, and neuroticism were each independently associated with the number of GI symptoms, adjusting for age, gender, duration and type of diabetes, and self-reported glycemic control. Increased levels of state anxiety and depression and neuroticism are associated with upper and lower GI symptoms in diabetes mellitus. It is uncertain whether psychological distress is causally linked to symptoms, or whether GI symptoms per se increase levels of anxiety and depression.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-1999
DOI: 10.1111/J.1572-0241.1999.01363.X
Abstract: The lack of a suitable disease-specific, health-related quality of life instrument for dyspepsia prompted the development of the Nepean Dyspepsia Index (NDI). The utility of the NDI in functional dyspepsia is unknown. We aimed to assess the validity of this new quality of life instrument for the first time in United States patients with documented functional dyspepsia. The long form of the NDI contains a symptom index and 42 items designed to measure impairment of subjects' ability to engage in and to enjoy relevant aspects of their life because of dyspepsia, as well as a ranking of the in idual importance of each aspect. Patients (n = 101, mean age 51 yr, 62% female) who had a history of functional dyspepsia for > or = 1 month and a negative endoscopy within the prior 1 yr were followed for 14 days. Patients completed the NDI and the validated Speilberger State-Trait Anxiety Inventory, Beck Depression Inventory, Short Form-36, and a global assessment of symptoms and quality of life at baseline and 14 days later the NDI was also retested at 48 h and 2 wk. Five clinically relevant factors (subscales), namely, tension/sleep, interference, eating/drinking, knowledge/control, and work/study were identified by factor analysis, after incorporating in idual importance ratings (25 items total). All subscales had excellent face validity and internal consistency (Chronbach's alpha, all >0.85). Reliability was also excellent (intraclass correlations all >0.84). There were modest typically negative correlations between a number of the NDI subscales and the Short Form-36, anxiety, and depression, indicating that the NDI is disease-specific and supporting its validity. Changes in NDI scales correlated moderately with global assessment of change (total score r = -0.49), indicating initial responsiveness. The Nepean Dyspepsia Index is a valid, disease-specific index for functional dyspepsia, measuring symptoms and health-related quality of life.
Publisher: Elsevier BV
Date: 07-1992
DOI: 10.1016/0022-3999(92)90003-K
Abstract: The aetiological importance of stressful life events and psychological characteristics was assessed amongst 280 appendicectomy patients of whom 80% were classified with 'acutely inflamed' (organic) appendicitis and 20% with 'non-inflamed' (non-organic) appendicitis. Patients were compared with a community comparison group. Specific characteristics of life stressors, namely severe goal frustration for organic patients and severe threat for non-organic patients, were the best predictors of patient outcome. Whilst psychological characteristics were not useful in discriminating between patients, depression in particular, was clearly associated with both conditions, with 38% of non-organic and 28% of organic patients with depression scores in the clinical range. As the patient's clinical depression status failed to modify the effect of the life stress predictors, it was concluded that life stress played an important role in the development of the patients GI symptoms, irrespective of their clinical depression status.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-03-2023
DOI: 10.1097/DCR.0000000000002422
Abstract: Incontinence to gas can be a troublesome symptom impacting quality of life for patients even in the absence of fecal incontinence. Whether isolated flatus incontinence represents part of the spectrum of true fecal incontinence or a separate condition with a different pathophysiology remains unclear. This study aimed to evaluate the clinical features and anorectal physiology in women presenting with severe isolated flatus incontinence compared to women with fecal incontinence and healthy asymptomatic women. This was a retrospective case-control study of prospectively collected data. Data from participants were obtained from a single tertiary Neurogastroenterology Unit in Sydney, Australia. Data from 34 patients with severe isolated flatus incontinence, 127 women with fecal incontinence‚ and 44 healthy women were analyzed. The primary outcomes were clinical (including demographic, obstetric, and symptom variables) and physiological differences across the 3 groups. Patients with flatus incontinence were significantly younger (mean 39 versus 63 years p = 0.0001), had a shorter history of experiencing their symptoms ( p = 0.0001), and had harder stool form than patients with fecal incontinence ( p = 0.02). Those with flatus incontinence had an adverse obstetric history and impaired anorectal physiology (motor and sensory, specifically rectal hypersensitivity) but to a lesser extent than patients with fecal incontinence. This study was limited by its retrospective design and modest s le size. Anorectal physiology was impaired in patients with flatus incontinence compared to healthy controls, but to a lesser extent than in those with fecal incontinence, raising the possibility that flatus incontinence could be a precursor to fecal incontinence. As clinical and physiological findings are different from healthy controls (including the presence of visceral hypersensitivity), isolated flatus incontinence should be considered a distinct clinical entity (like other functional GI disorders), or possibly part of an incontinence spectrum rather than purely a normal phenomenon. See Video Abstract at links.lww.com/DCR/B946. ANTECEDENTES: La incontinencia de gases puede ser un síntoma molesto que afecta la calidad de vida de los pacientes incluso en ausencia de incontinencia fecal. Aún no está claro si la incontinencia de flatos aislada representa parte del espectro de la incontinencia fecal verdadera o una condición separada con una fisiopatología poco clara. OBJETIVO: Evaluar las características clínicas y la fisiología anorrectal en mujeres que presentan incontinencia grave aislada de flatos, en comparación con la incontinencia fecal y mujeres sanas asintomáticas. DISEÑO: Este fue un estudio retrospectivo de casos y controles de datos recolectados prospectivamente. AJUSTE: Los datos de los participantes se obtuvieron de una sola Unidad de Neurogastroenterología terciaria en Sydney, Australia. PACIENTES: Se analizaron los datos de 34 pacientes con incontinencia grave aislada de flatos, junto con 127 mujeres con incontinencia fecal y 44 mujeres sanas. PRINCIPALES MEDIDAS DE RESULTADO: Los resultados primarios fueron clínicos (incluidas las variables demográficas, obstétricas y de síntomas), así como las diferencias fisiológicas entre los tres grupos. RESULTADOS: Los pacientes con incontinencia de flatos eran significativamente más jóvenes (media de 39 años frente a 63 años, p = 0,0001), tenían un historial más corto de experimentar sus síntomas (p = 0,0001) y tenían heces más duras que los pacientes con incontinencia fecal (p = 0,02). Aquellos con incontinencia de flatos tenían antecedentes obstétricos adversos y fisiología anorrectal alterada (motora y sensorial, específicamente hipersensibilidad rectal) aunque en menor medida que las pacientes con incontinencia fecal. LIMITACIONES: Este estudio estuvo limitado por su diseño retrospectivo y tamaño de muestra modesto. CONCLUSIONES: La fisiología anorrectal se vio afectada en las pacientes con incontinencia de flatos en comparación con las controles sanos, pero en menor medida que en aquellas con incontinencia fecal, lo que plantea la posibilidad de que la incontinencia de flatos pueda ser un precursor de la incontinencia fecal. Dado que los hallazgos clínicos y fisiológicos son diferentes a los de los controles sanos (incluida la presencia de hipersensibilidad visceral), la incontinencia de flatos aislada debe considerarse como una entidad clínica distinta (al igual que otros trastornos gastrointestinales funcionales), o posiblemente como parte de un espectro de incontinencia en lugar de un trastorno puramente a un fenómeno normal. Consulte Video Resumen en links.lww.com/DCR/B946. (Traducción—Dr Yolanda Colorado )
Publisher: S. Karger AG
Date: 2022
DOI: 10.1159/000522530
Abstract: b i Introduction: /i /b Psychological adjustment to chronic health conditions is important, as poor adjustment predicts a range of adverse medical and psychosocial outcomes. Psychological treatments demonstrate efficacy for people with chronic health conditions, but existing research takes a disorder-specific approach and they are predominately delivered in face-to-face contexts. The internet and remotely delivered treatments have the potential to overcome barriers to accessing traditional face-to-face treatment. b i Objective: /i /b The current study examined the efficacy and acceptability of an internet-delivered transdiagnostic psychological intervention to promote adjustment to illness, based on cognitive behaviour therapy principles. b i Methods: /i /b In a two-arm randomised controlled trial, participants ( i n /i = 676) were randomly allocated to the 8-week intervention or a waitlist control. Treatment included five core lessons, homework tasks, additional resources, and weekly contact with a psychologist. Primary outcomes included depression, anxiety, and disability, assessed at pre-treatment, post-treatment, 3-month follow-up, and 12-month follow-up. b i Results: /i /b The treatment group reported significantly greater improvements in depression (between-groups i d = /i 0.47), anxiety ( i d /i = 0.32), and disability ( i d /i = 0.17) at post-treatment (all i s /i & #x3c .001). Improvements were sustained over the 3-month and 12-month follow-ups. High treatment completion rates (69%) and levels of satisfaction (86%) were reported by participants in treatment. The intervention required a mean clinician time of 56.70 min per participant. b i Conclusions: /i /b The findings provide preliminary and tentative support for the potential of internet-delivered transdiagnostic interventions to promote adjustment to chronic health conditions. Further research using robust control groups, and exploring the generalisability of findings, is needed before firm conclusions can be drawn.
Publisher: Springer Science and Business Media LLC
Date: 15-08-2017
Publisher: Springer Science and Business Media LLC
Date: 10-2020
Publisher: Informa UK Limited
Date: 1990
Publisher: Elsevier BV
Date: 05-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-1997
DOI: 10.1007/BF02050927
Publisher: Wiley
Date: 04-2013
DOI: 10.1111/AJR.12013
Abstract: Recent efforts to redress the deficit of rural medical practitioners have considered the problem of recruitment and retention of rural doctors as one of influencing in iduals' career choices. Exposure to rural medical environments during basic medical training is one long-standing ex le of an initiative aimed in this direction and there is some evidence that it is effective. This study sought to determine whether or not various domains of personality are related to medical students' attitude to practising as rural doctors after graduation. The s le comprised 914 students commencing medical studies in Australian universities. They were recruited as part of the Medical Schools Outcomes Database project and indicated intended location of future medical practice. Seven Australian basic medical training programs. All students completed the NEO five-factor index (NEO-FFI) and Adjective Checklist (ACL) personality instruments. A preference for a rural practice location was associated with a combination of six domains of personality. The probability of rural preference was greater with higher scores on openness to experience, agreeableness and self-confidence but lower with higher scores on extraversion, autonomy and intraception. Taken together these six domains of personality provide useful although imperfect discrimination between students with a rural versus urban location preference. After controlling for student age the associations with extraversion and agreeableness failed to reach statistical significance. While personality does not fully explain medical students' attitude towards practicing as a rural doctor, the data suggest it is an important factor and that some in iduals may be better suited to a rural medical career than others. Considering personality along with other characteristics of the in idual might allow targeted 'marketing' of rural practice.
Publisher: Wiley
Date: 17-01-2001
DOI: 10.1046/J.1365-2036.2001.00896.X
Abstract: Gastrointestinal symptoms are commonly reported as side-effects of oral hypoglycaemic drugs. It may be very difficult to distinguish between spontaneous and truly drug-related symptoms due to the high background incidence of gastrointestinal symptoms. Gastrointestinal symptoms in diabetic patients have also been linked to factors associated with long-standing disease and suboptimal control. To explore the association between gastrointestinal symptoms and treatment with oral hypoglycaemic drugs in a large cohort of subjects with type 2 diabetes. 956 subjects with type 2 diabetes participated in the study. All subjects completed a validated, self-administered questionnaire on gastrointestinal symptoms, diabetes, drug use and various potential risk factors for gastrointestinal symptoms. The association between oral hypoglycaemics and nine gastrointestinal symptom groups was assessed based on logistic regression. 405 of the 956 patients used oral hypoglycaemic drugs. Metformin use was independently associated with chronic diarrhoea (odds ratio 3.08, 95% CI: 1.29-7.36, P < 0.02) and with faecal incontinence (odds ratio 1.95, 95% CI: 1.10-3.47, P < 0.05). Use of sulphonylureas was associated with less abdominal pain, but not with any other gastrointestinal symptom. Troublesome gastrointestinal symptoms do not appear to be caused by oral hypoglycaemics, except for diarrhoea and faecal incontinence, which are strongly and independently associated with metformin use.
Publisher: Informa UK Limited
Date: 1991
DOI: 10.3109/00365529109043641
Abstract: The mortality, causes of death, and the factors that are influencing deaths from bleeding acute and chronic peptic ulcers were evaluated retrospectively. During a 2-year period (1986-87) 272 patients were endoscoped for acute gastrointestinal hemorrhage and were found to have bled from a peptic ulcer (chronic gastric ulcers, 90 chronic duodenal ulcers, 114 acute gastroduodenal ulcers, 66 stomal ulcers, 2). The overall mortality was 9.6% (n = 26) (gastric ulcers, 6.7% duodenal ulcers, 11.4% acute ulcers, 10.6%). Statistically significant factors adversely affecting prognosis for gastric ulcer were re-bleeding, need for operation and serious intercurrent illness for duodenal ulcer were units of transfused blood, re-bleeding, signs of recent hemorrhage at endoscopy, need for operation, and serious intercurrent illness and for acute ulcer were increasing age, shock, units of transfused blood, re-bleeding, and serious intercurrent illness. Multivariate analysis was only attempted for duodenal ulcers because of s le sizes it suggested that active bleeding or visible vessel at endoscopy, re-bleeding, and serious intercurrent illness were independent factors for mortality. From this study it is apparent that the major determinants of a fatal outcome in bleeding peptic ulcer diseases were serious intercurrent illness and rebleeding. As it must be anticipated that patients with these particular problems are at high risk of a poor outcome, it follows that it is important they have access to skilled treatment as provided by a specialist team in an intensive care ward. It also follows that every effort should be made to keep ulcers in remission to free the ulcer patient of potentially lethal complications.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.BRAT.2016.10.004
Abstract: Use of the partial NMDA receptor agonist d-Cycloserine (DCS) to increase extinction to feared cues among anxious adults has shown mixed, although overall positive effects. Few studies have extended this effect to youth and none have addressed young people with broad-based anxiety such as separation anxiety, social anxiety, or generalised anxiety. In the current trial 51 children and adolescents with diagnosed anxiety disorders, aged 7-14 years received four sessions of graduated, experimenter-led, in vivo exposure to a hierarchy of feared cues relevant to their primary fear. They were randomly allocated to receive either 50 mg of DCS or a matched placebo capsule in a fully double-blind design. Both groups showed large reductions across sessions in their primary fear according to both parent and child report, but there were no significant differences between conditions at any session. The results are consistent with most studies to date of DCS-augmented exposure in young people.
Publisher: Wiley
Date: 02-12-2021
DOI: 10.1111/NMO.14304
Abstract: There is limited empirical evidence of the magnitude of the discrepancy between prospectively recorded gastrointestinal symptom burden and that reported in recall questionnaires. Further, potential sources of the discrepancy are largely unknown. This study sought to quantify the discrepancy and to evaluate the potential role of mood disorder and emotion regulation in the discrepancy. One hundred and forty nine subjects (mean age 20 years, 75% female) who met Rome IV criteria for irritable bowel syndrome and/or functional dyspepsia completed a 7‐day prospective recording of the symptoms on a smartphone implemented ecological momentary assessment app, and then on day 8 were asked to recall their symptoms for the preceding 7 days. Gastrointestinal symptom burden assessed by recall was exaggerated relative to that recorded prospectively. The discrepancy was moderate for overall score (Cohen d = 0.52), abdominal pain ( d = 0.61) and indigestion ( d = 0.49). The discrepancy was generally larger among subjects who reported a physician diagnosis of a gastrointestinal condition with d = 0.87 for overall score and d = 0.89 for abdominal pain. A number of correlations between the discrepancy and psychological traits were identified, including neuroticism with diarrhea discrepancy ( r = 0.23, p = 0.004) and visceral‐specific anxiety with abdominal pain discrepancy ( r = −0.18, p = 0.03). There was no evidence of recency or Hawthorne (observer) effects. Reports of gastrointestinal symptoms obtained via recall are likely to be exaggerated relative to the actual patient experience, particularly among healthcare seekers. While psychological traits are likely to play some role, much more needs to be understood about the discrepancy.
Publisher: Wiley
Date: 16-09-2016
DOI: 10.1111/APT.13766
Publisher: Elsevier BV
Date: 03-2021
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.JPSYCHORES.2019.01.015
Abstract: Irritable Bowel Syndrome (IBS) is a chronic gastrointestinal disease associated with impaired quality of life and an increased use of healthcare services. Self-ratings of health have proven a powerful predictor of health outcomes. The aim of this study was to evaluate the unique impacts of comorbidities, gastrointestinal symptoms, perceived stress and sense of coherence on the number of healthcare contacts and self-rated health of IBS patients in Swedish primary care. In this cross-sectional study, 186 primary-care IBS patients and 360 non-IBS patients (as a reference group) were administrated a test battery of validated questionnaires. Data on comorbidities and healthcare-seeking frequency were obtained from a registry. In the reduced multivariable logistic regression model, average days of abdominal pain/week (OR = 0.83, 95% CI = 0.72-0.96), age (OR = 0.95, 95% CI = 0.92-0.97) and sense of coherence (OR = 1.07, 95% CI = 1.03-1.11) remained independent, statistically significant predictors of IBS (and non-IBS) patients reporting good health. Only the number of comorbidities in general (OR = 1.22, 95% CI = 1.14-1.32) and sleep disorders in particular (OR = 5.40, 95% CI = 1.85-15.76) independently predicted high levels of primary healthcare utilisation among IBS patients. Lack of gastrointestinal symptoms, a high sense of coherence and younger age were associated with better self-rated health in both IBS and non-IBS patients. The number of comorbidities in general and sleep disorders in particular were associated with frequent PHC contacts in IBS patients. The association between frequent primary-care contacts and sleep disorders was not seen in the control group, indicating a unique association with IBS patients.
Publisher: Elsevier BV
Date: 03-2004
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-10-2020
DOI: 10.14309/AJG.0000000000000972
Abstract: We hypothesized that the prevalence of functional dyspepsia and gastroesophageal reflux disease in the community may be increasing. Randomly selected adults were surveyed on 4 occasions: 1988 (n = 1,151, 21–79 years, response rate [rr] = 90%), 1989 (n = 1,097, 22–80 years, rr = 87%), 1995 (n = 1,139, 20–85 years, rr = 76%), and 2011 (n = 1,175, 20–93 years, rr = 63%). In functional dyspepsia, the odds of postprandial distress syndrome tripled over 23 years' follow-up (odds ratio [OR]: 3.55 95% confidence interval [CI]: 2.60–4.84, mixed-effect regression analysis), whereas a small decrease in epigastric pain syndrome was observed (OR: 0.65, 95% CI: 0.42–1.00). The odds of reporting gastroesophageal reflux disease doubled (OR: 2.02 95% CI: 1.50–2.73). The underlying mechanisms behind the increase in postprandial distress syndrome and gastroesophageal reflux disease remain to be determined.
Publisher: Wiley
Date: 09-12-2009
DOI: 10.1111/J.1365-2982.2008.01240.X
Abstract: In patients with gastrointestinal symptoms, weight loss is an alarm symptom, indicative of organic disease. Recent studies reported weight loss in subsets of functional dyspepsia (FD) patients. The aim of this study was to analyse symptom patterns associated with weight loss in tertiary care FD. Six hundred and thirty-six FD patients (67% female, mean age 43 years) completed a dyspepsia questionnaire, and underwent gastric emptying and gastric barostat studies. After identifying independent symptom domains through orthogonal factor analysis, patients were clustered on the basis of symptom profile. Clusters were compared in terms of their association with weight loss and gastric emptying or sensorimotor function. Weight loss (4.2 kg on average) correlated most strongly with early satiety followed by nausea and vomiting (rho respectively 0.38, 0.28 and 0.23, all P < 0.0001). Factor analysis revealed three factors: Factor 1 characterized by nausea, vomiting and early satiety factor 2 by early satiety, postprandial fullness and bloating and factor 3 by pain, epigastric burning and belching. Subsequent cluster analysis revealed six patient clusters. The most severe cluster, which loaded high on all three factors, and a cluster dominated factor 2 were associated with the highest average weight loss (6.8 and 8.0 kg, respectively). The former cluster was also characterized by visceral hypersensitivity and delayed gastric emptying. The lowest weight loss occurred in the two clusters that had depressed scores for both early satiety associated factors (2.4 and 2.5 kg, respectively). In tertiary care FD, weight loss is strongly associated with two early satiety associated symptom clusters.
Publisher: Wiley
Date: 04-07-2017
DOI: 10.1111/APT.14178
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.JPSYCHORES.2018.10.017
Abstract: The objective of the present study was to test the moderating impact of an unknown pain etiology on the relationship between psychological factors and chronic pain intensity and disability. N = 471 chronic pain sufferers presented to an online Cognitive Behavioral Therapy randomized control trial, known as the Pain Course. Participants' etiology was classified as medically unexplained or medically explained via interview and self-reported data. Standardized psychological measures at baseline were used in a non-hierarchical cluster analysis, which allocated chronic pain participants into mutually exclusive groups. Four distinct clusters were identified: Psychologically healthy, mild psychological distress, high psychological distress, and average. The profile with high psychological distress experienced the greatest pain intensity (mean: 6.44 (SD = 1.66)) and disability (mean: 17.53 (SD: 3.65)). This relationship was not moderated by preceding pain etiology being medically explained or unexplained (χ These findings indicate that an unknown pain etiology has little role in altering the relationship between psychological factors and pain disability in in iduals experiencing chronic pain. This suggests that the psychological association with pain disability and intensity experienced by people with medically unexplained symptoms is similar to people with medically explained symptoms.
Publisher: Springer Science and Business Media LLC
Date: 15-05-2008
DOI: 10.1007/S10620-007-9830-4
Abstract: The efficacy of antidepressants in irritable bowel syndrome (IBS) is controversial. No trials have directly compared a tricyclic with a selective serotonin reuptake inhibitor. Our aim was to determine whether imipramine and citalopram are efficacious in IBS. This was a randomized, double-blind, placebo-controlled, parallel group pilot trial with imipramine (50 mg) and citalopram (40 mg). Of 51 IBS patients randomized, baseline characteristics were comparable among the treatment arms the majority was diarrhea-predominant. Adequate relief of IBS symptoms (primary endpoint) was similar for each treatment arm. Improvements in bowel symptom severity rating for interference (P = 0.05) and distress (P = 0.02) were greater with imipramine versus placebo, but improvements in abdominal pain were not. There was a greater improvement in depression score (P = 0.08) and in the SF-36 Mental Component Score (P = 0.07), with imipramine. Citalopram was not superior to placebo. Approximately 20% of the variance in scores was explained by treatment differences for abdominal pain, bowel symptom severity disability, depression and the mental component of the SF-36. Neither imipramine nor citalopram significantly improved global IBS endpoints over placebo.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.JPSYCHORES.2012.07.013
Abstract: We aim to evaluate the psychological impact and risk factors associated with new onset FI over 12 years in adults over 18 years for the first time in a population-based study. Participants (n = 1775) were a random population s le from Penrith, Australia who responded to a survey in 1997 and completed a 12-year follow-up survey (response rate = 60%). FI was defined as having leakage of stool over the past 12 months. The original and follow-up surveys contained valid questions on demographic, gastrointestinal and psychological symptoms. 114 (11.4%) reported new onset FI at the 12 year follow-up. People who reported FI at the 12 year follow-up were significantly more anxious and depressed. In terms of baseline risk factors only bloating (OR = 1.3 95%CI 1.0-1.6, P = 0.026) was an independent predictor of developing new onset FI. However, current bowel symptoms measured at follow-up including less likelihood of <3 bowel motions a week, increased urgency and mucus were independently associated with having FI at follow-up. FI is associated with anxiety and depression. Baseline GI symptoms do not appear to be as important as current bowel symptoms in determining who develops FI.
Publisher: Springer Science and Business Media LLC
Date: 20-12-2010
DOI: 10.1007/S10964-009-9492-Y
Abstract: Assessing self-harm through brief multiple choice items is simple and less invasive than more detailed methods of assessment. However, there is currently little validation for brief methods of self-harm assessment. This study evaluates the extent to which adolescents' perceptions of self-harm agree with definitions in the literature, and what level of question detail produces optimal concordance rates. Two hundred and thirty-three (69% female) first year university students aged 17-21 completed a self-harm coding task we created three levels of question detail and randomly allocated participants to three study groups: brief, low detail, and high detail. The present findings suggest that that adolescents' perceptions of self-harm are generally concordant with a consensus definition of self-harm. Low level of detail in the question produced greatest accuracy in responses adolescents who demonstrated adequate task understanding were able to correctly identify 94% of ex les of self-harm behaviour and 86% of ex les of behaviour that were not self-harm. We identified lower concordance rates for eating disordered behaviour and recreational petrol sniffing. This indicates that adolescents perceive these behaviours to be self-harm, in contrast to the reference definition we utilised. Overall, this study provides support for using a brief assessment of self-harm where minimal detail regarding self-harm behaviour is required.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2008
DOI: 10.1111/J.1572-0241.2008.01935.X
Abstract: A link between dyspepsia symptoms and weight loss is controversial. We aimed to determine whether or not weight loss is a marker of dyspepsia. Independent community-based cross-sectional studies. Subjects were randomly selected from the general population in Sydney, Australia. All subjects completed validated community health surveys. Two distinct data collections were used the first as a training s le (N = 888) and the second as a validation s le to confirm the findings of the first (N = 2,907). The study was focused on weight loss, which was categorized as (a) any weight loss, (b) substantive weight loss (> or =3 kg), and (c) weight loss expressed as percentage of body weight. All dyspepsia symptoms studied were positively associated with weight loss although the strength of association did vary. Nausea and vomiting were most strongly associated with weight loss as were meal-related complaints such as postprandial fullness. Similarly, clusters formed based on symptoms were strongly differentiated in terms of weight loss with clusters characterized by nausea, vomiting, and early satiety ostprandial fullness reporting 25-30% weight loss prevalence over the previous 3 months compared with around 10% prevalence in clusters characterized by low dyspepsia symptom burden. Weight loss > or =3 kg followed a similar pattern but with a prevalence approximately half that of any weight loss, while weight loss expressed as percentage of body weight followed the same pattern. Dyspepsia symptoms are clearly and, in some cases, strongly associated with weight loss, both any loss of weight and substantive weight loss. Weight loss should be considered a warning symptom of dyspepsia.
Publisher: Informa UK Limited
Date: 14-09-2021
DOI: 10.1080/00365521.2021.1974087
Abstract: Gastrointestinal (GI) symptoms are intimately related to our wellbeing. The Short Health Scale for GI symptoms (SHS-GI) is a simple questionnaire to measure the impact of GI inconvenience and symptoms on quality of life. The aim was to validate the SHS-GI in a general population s le and to compare it with SHS-data across different patient groups. A subs le of 170 participants from a population-based colonoscopy study completed the Rome II questionnaire, GI diaries, psychological questionnaire (hospital anxiety and depression scale) and SHS-GI at follow-up investigation. Psychometric properties of SHS-GI as an overall score were determined by performing a confirmatory factor analysis (CFA). Spearman correlation between SHS total score and symptoms was calculated in the general population s le. SHS-GI data was compared with SHS data from patients with inflammatory bowel disease (IBD) and fecal incontinence (FI). As expected, the general population rated their impact of GI inconvenience on quality of life as better than the patient populations in terms of all aspects of the SHS-GI. The CFA showed a good model fit meeting all fit criteria in the general population. Cronbach's alpha for the total scale was 0.80 in the general population s le and ranged from 0.72 in the FI s le to 0.88 and 0.89 in the IBD s les. SHS-GI demonstrated appropriate psychometric properties in a s le of the normal population. We suggest that SHS-GI is a valid simple questionnaire suitable for measuring the impact of GI symptoms and inconvenience on quality of life in both general and patient populations.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-06-2021
Publisher: BMJ
Date: 20-04-2010
DOI: 10.1136/BMJ.C1594
Publisher: Elsevier BV
Date: 03-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2001
Publisher: Elsevier BV
Date: 05-2018
Publisher: Oxford University Press (OUP)
Date: 03-1993
DOI: 10.1111/J.1365-2249.1993.TB05907.X
Abstract: Lymphocyte binding to cultured human umbilical vein endothelial cells was evaluated using a modified centrifugation binding assay in 15 patients with psoriasis and compared with three patients with atopic dermatitis, 11 patients with rheumatoid arthritis and 28 normal controls. Patients with psoriasis demonstrated 61% augmented lymphocyte binding compared with normal controls (P& .0001), which was not explained by differences in age and sex or an effect of psoriatic sera. In serial studies of six patients, this difference was found to be reversible with treatment and clinical improvement. Lymphocytes from patients with atopic dermatitis demonstrated decreased binding to endothelium (P& .005), while those from patients with rheumatoid arthritis were not different from normal controls. This is the first skin disease described in which augmented lymphocyte binding to endothelium occurs, and may represent a mechanism by which lymphocytes are targeted to psoriatic skin.
Start Date: 07-2010
End Date: 06-2013
Amount: $180,000.00
Funder: Australian Research Council
View Funded ActivityStart Date: 08-2019
End Date: 12-2023
Amount: $796,931.00
Funder: Australian Research Council
View Funded ActivityStart Date: 06-2015
End Date: 12-2020
Amount: $517,600.00
Funder: Australian Research Council
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