Effect of Early Adverse Life Events on Adult Irritable Bowel Syndrome / 胃肠病学

Background: Irritable bowel syndrome (IBS) is a commonly seen functional bowel disorder in clinical practice. Previous researches demonstrated that early adverse life events (EALs) were associated with the development of IBS. However, there are few researches focused on this field in China. Aims: To explore the effect of childhood abuse, a type of EALs, on the development of IBS in adults. Methods: Fifty-six IBS patients and 50 healthy subjects in Tongji Hospital of Tongji University from Oct. 2017 to Apr. 2018 were enrolled. The EALs and quality of life of these two groups were evaluated using Childhood Trauma Questionnaire (CTQ) and the MOS 36-Item Short-Form Health Survey (SF-36) scale. Furthermore, Irritable Bowel Syndrome Severity Scoring System (IBS-SSS), SF-36 and Irritable Bowel Syndrome Quality Of Life (IBS-QOL) scales were compared between IBS patients with and without childhood abuse. Results: The CTQ score and incidence of childhood abuse were significantly higher in IBS group than in control group (P<0.05), while the scores of bodily pain, general health, vitality, social functioning and mental health in SF-36 were significantly lower in IBS group than in control group (P<0.05). Compared with patients without childhood abuse, IBS patients with childhood abuse had a higher IBS-SSS score (P<0.05); the physical functioning, general health, vitality, social functioning and mental health in SF-36 and the dysphoria, interference with activity, body image, health worry, social reaction, sexual intercourse and relationship in IBS-QOL were poorer in patients with childhood abuse than those without (P<0.05). Conclusions: Experience of EALs plays an important role in the development of IBS and might affect the symptom severity, quality of life and social function in adult IBS.

Predictores cognitivos de la toma de decisiones en la experiencia de los síntomas de Síndrome Coronario Agudo / Cognitive predictors of decision making in the experience of symptoms of Acute Coronary Syndrome

Objetivo: Determinar el valor predictivo de la Evaluación cognitiva, la Severidad de los síntomas, el Control personal y la Autoeficacia sobre la toma de decisiones en la experiencia de los síntomas de Síndrome Coronario Agudo. Diseño: La presente investigación es de tipo correlacional predictivo de corte transversal, cuyo propósito fue conocer los efectos entre las variables independientes Evaluación Cognitiva, Severidad de los síntomas, Control personal, Auto eficiencia y dependiente Toma de decisiones, a partir de las proposiciones teóricas del Modelo Conceptual del Manejo de los síntomas, mediante la obtención de datos en la experiencia de los síntomas de Síndrome Coronario Agudo en tres instituciones de la ciudad de Bogotá. Análisis: Se realizó un análisis descriptivo de la población estudiada empleando herramientas y técnicas de la estadística descriptiva. Para el análisis bivariado se definieron las variables dependientes e independientes. Las pruebas de hipótesis que se utilizaron fueron determinadas por la naturaleza y el nivel de medición de la variable dependiente, la distribución normal o no y el número de categorías que tomaron. Por lo tanto, para las variables dependientes cuantitativas las pruebas utilizadas fueron la U de Mann Whitney o la prueba de Kruskal Wallis (ANOVA), dependiendo si siguieron una distribución normal. Posteriormente con el fin de abordar las hipótesis de esta investigación en las cuales se predice la Evaluación cognitiva, la Severidad de los síntomas, el Control Personal y la Autoeficacia sobre la toma de decisiones, se realizó un Modelo Lineal Generalizado, considerando que este modelo permite unificar tanto los modelos como las variables de respuesta numérica y categórica, lo cual lleva a considerar datos dicotómicos, ordinales, categóricos o de elecciones discretas, es decir, de modelos de probabilidad de un evento. Por último se desarrolló un Modelo de ecuaciones estructurales para realizar una comprobación del modelo conceptual, que permitió establecer las relaciones causales, es decir, se examinó el efecto de una variable explicativa sobre la explicada, y en qué medida la variación observada fue debida a los cambios producidos en las variables explicativas. Resultados: Se logró la validación de los instrumentos RSQ, CISS-21, CSE, CAS-R en versión español, al instrumento IES se le realizó un aporte a la medición por medio del análisis factorial confirmatorio. Se plantearon tres modelos predictivos por medio del software R y se realizó una comprobación del modelo conceptual para el manejo de los síntomas por medio del planteamiento de ecuaciones estructurales con el software IMOS. Finalmente se plantearon dos rutas de atención en salud, desde la prevención cardiovascular y una ruta de la experiencia del síntoma específica de mujeres con síndrome coronario agudo a partir de lo reportado en los modelos predictivos.

Objective: To determine the predictive value of the Cognitive Assessment, the Severity of the symptoms, the Personal Control and the Self-efficacy on the decision making in the experience of the symptoms of Acute Coronary Syndrome. Design: The present investigation was of a cross-sectional predictive correlation type, whose purpose was to know the effects between independent variables (Cognitive Evaluation, Severity of the symptoms, Personal control, Self efficiency) and dependent (Decision making), from the Theoretical propositions of the Conceptual Model of the Management of the symptoms, by obtaining data in the experience of the symptoms of Acute Coronary Syndrome in men and women in three institutions of the city of Bogotá. Analysis: A descriptive analysis of the studied population was carried out, for which tools and techniques of descriptive statistics will be used. For the bivariate analysis, the dependent and independent variables were defined. The hypothesis tests that were used were determined by the nature and level of measurement of the dependent variable, the normal distribution or not and the number of categories that they took. Therefore, for the quantitative dependent variables, the tests used were the Mann Whitney U test or the Kruskal Wallis test (ANOVA), depending on whether they followed a normal distribution. Subsequently, in order to address the hypotheses of this research in which Cognitive Assessment, Severity of symptoms, Personal Control and Self-efficacy on decision making are predicted, a Generalized Linear Model was carried out, considering that this model allows unify both the models and the numerical and categorical response variables, which leads to consider dichotomous, ordinal, categorical or discrete election data, that is, probability models of an event. Finally, a Model of structural equations was developed to make a verification of the conceptual model, which allowed to establish the causal relationships, that is, I examined the effect of an explanatory variable on the explained one, and to what extent the observed variation of this one is due to the changes produced in that one. Results: Validation of the RSQ, CISS-21, CSE, CAS-R instruments was achieved and the IES instrument made a contribution to the measurement by means of factor analysis and reliability. Three predictive models were proposed by means of software R and a verification of the conceptual model for symptom management was carried out by means of the structural equations approach with the IMOS software. Finally two health care routes were proposed, from the cardiovascular prevention and a route of the experience of the symptom of women with acute coronary syndrome.

Neurocognitive Characteristics According to Depression Severity in Patients with Major Depressive Disorder

OBJECTIVES: This study investigated associations between symptom severity and neurocognitive functions in patients with major depressive disorder using comprehensive neuropsychological tests. METHODS: Ten patients with low depression (LD) and 22 patients with high depression (HD) participated. Symptom severity was determined by both the Beck Depression Inventory and the Hamilton Depression Rating Scale. Additionally, anxiety was measured by the Korean version of the State-Trait Anxiety Inventory (STAI-KYZ). Ten subtests of the Korean-Wechsler Adult Intelligence scale (K-WAIS), Stroop test, the word/design fluency tests were administered to assess cognition. RESULTS: The LD and HD groups did not differ in any of cognitive measures but anxiety level. Namely, the HD group obtained significantly higher scores on the state (U = 29.50, p < 0.01) and trait (U = 28.50, p < 0.001) anxiety scales than the LD group. A significant interaction effect between trait anxiety and depression severity was observed on the picture arrangement subtest of the K-WAIS [F (1, 27) = 5.09, p < 0.05]. CONCLUSIONS: Cognitive deficits observed in patients with major depressive disorder may be related to other factors rather than current symptom severity. Trait anxiety possibly moderates the effect of current symptom severity on social judgment in these patients.