Self-efficacy beliefs, faecal incontinence and health-related quality of life in patients born with anorectal malformations.

AIM: Anorectal malformations (ARMs) are rare congenital colorectal anomalies with long lasting consequences, among which faecal incontinence is one of the most relevant since it may strongly affect patients' health-related quality of life (HRQoL). Although a growing body of literature supports the importance of self-efficacy in chronic disease health outcomes, only few studies have focused on self-efficacy in ARMs and in faecal incontinence. The purpose of the present study is to examine the mediational role of self-efficacy in the path between faecal incontinence and HRQoL in patients born with ARMs. METHOD: Ninety-eight adult patients from the Italian Association for Anorectal Malformations (AIMAR) responded to measures of faecal incontinence, self-efficacy for managing ARM consequences, and physical and mental HRQoL (SF-36). Data were analysed by means of structural equation models. RESULTS: The tested model provides support for the guiding hypothesis. Fit indices indicate that the model fits the data well (χ2  = 33.48, df = 23, P = 0.07; comparative fit index [CFI] = 0.97; root mean square error of approximation [RMSEA] = 0.07; standardized root mean square residual [SRMR] = 0.05). Faecal incontinence has negative effects on both physical and mental HRQoL, as well on self-efficacy. In turn, self-efficacy has a positive and direct effect on mental HRQoL. CONCLUSION: Faecal incontinence is the most relevant and negative factor influencing HRQoL; in addition, self-efficacy contributes in reducing emotional distress and in improving mental health outcomes. Longitudinal and controlled studies may be helpful to evaluate the effectiveness of self-efficacy interventions in improving mental HRQoL in patients with faecal incontinence.

A Self-determination theory based intervention to promote healthy eating and physical activity in school-aged children / Una intervención basada en la teoría de la autodeterminación para promover la alimentación saludable y la actividad física en los niños en edad escolar / Uma intervenção baseada na teoria de auto-determinação para promover a alimentação saudável e atividade física em crianças em idade escolar

Childhood overweight and obesity in both girls and boys is reaching epidemic proportions over the world, Italy included. Childhood obesity has been linked to deleterious health consequences. There is a need to develop theory based and cost-effective interventions to promote healthy eating and physical activity with the aim to reduce obesity. The purpose of this study was to evaluate a long-term theory-based intervention to promote healthy lifestyles in underserved school-aged children. A quasi experimental design was adopted, in order to evaluate the effectiveness of the intervention, considering information from their parents. Parents were asked to rate their children attitude, motivation and behaviour regarding two energy balance-related behaviours. Results indicate that pupils involved in the intervention were more likely to do physical activity in leisure time and have more positive attitudes toward exercise compared to the control group. About eating habits, children involved in the intervention were more likely to choose healthy foods and less likely to choose fat foods compare to the control group. Changes in attitude and motivation between the baseline and the follow up and the two groups are also shown, even if not significant. Despite several limitations in the design, this study provided further support to the argument that Self-determination theory-based interventions could result in meaningful health-behavior changes (AU)

Niñez sobrepeso y obesidad en niños y niñas está alcanzando proporciones epidémicas en el mundo entero, Italia incluida. La obesidad infantil se ha relacionado con consecuencias perjudiciales para la salud. Hay una necesidad de desarrollar intervenciones teoría basada y rentables para promover la alimentación saludable y la actividad física con el objetivo de reducir la obesidad. El propósito de este estudio fue evaluar una intervención basada en la teoría de largo plazo para promover estilos de vida saludables en niños en edad escolar de escasos recursos. Se adoptó un diseño cuasi experimental, con el fin de evaluar la eficacia de la intervención, teniendo en cuenta la información de sus padres. Se pide a los padres para evaluar a sus hijos la actitud, la motivación y el comportamiento con respecto a los comportamientos relacionados con saldo de dos energías. Los resultados indican que los alumnos que participan en la intervención tenían más probabilidades de hacer actividad física en el tiempo libre y tienen actitudes más positivas hacia el ejercicio en comparación con el grupo control. Acerca de los hábitos alimenticios, los niños que participaron en la intervención eran más propensos a elegir alimentos saludables y menos propensos a elegir alimentos ricos en grasas en comparación con el grupo control. Los cambios en la actitud y la motivación entre el inicio y el seguimiento y los dos grupos se muestran también, aunque no significativamente. A pesar de varias limitaciones en el diseño, este estudio proporcionan más apoyo al argumento de que las intervenciones basadas en teoría de la autodeterminación podrían resultar en cambios significativos que afectan a su salud significativamente (AU)

Infância sobrepeso e obesidade em meninas e meninos Ambas está atingindo proporções epidêmicas no mundo inteiro, Itália incluído. Infância a obesidade tem-se ligado a consequências para a saúde deletérios. ere a necessidade de desenvolver a teoria com base e de custou-se intervenções estive para promover saudável comer e atividade física Com o objetivo de reduzir a obesidade. e efeitos de estudo ESTA foi avaliar uma intervenção baseada na teoria de longo prazo para promover estilos de vida saudáveis em crianças em idade escolar carentes. Um projeto quase-experimental foi adotado, a fim de avaliar o estiveres da intervenção, considerando as informações de seus pais. Os pais foram convidados a avaliar sua atitude infantil, motivação e comportamento em relação dois comportamentos relacionados com o balanço de dois energia. Os resultados indicam que alunos envolvidos na intervenção eram mais propensos a fazer atividade física no tempo livre e têm atitudes mais positivas em relação ao exercício comparado ao grupo controle. Sobre os hábitos alimentares, as crianças na intervenção envolvidos eram mais propensos a escolher alimentos saudáveis e menos propensos a escolher alimentos ricos em gordura comparar com o grupo de controle. Mudanças de atitude e motivação Entre a linha de base e o acompanhamento e os dois grupos são mostrados Além disso, mesmo que não seja significante. Apesar das limitações na concepção Vários, Este estudo forneceu ainda apoio ao argumento de que intervenções baseadas em teoria da autodeterminação poderia resultar em mudanças de comportamento de saúde significativos (AU)

The role of coping strategies on health-related quality of life in adults with anorectal malformations.

PURPOSE: Coping strategies have been acknowledged as crucial for the well-being and for health-related quality of life (HRQoL). The main aim of the present study is to determine whether different types of coping strategies predict HRQoL in patients born with ARM, above and beyond the variance explained by fecal and urinary continence. METHODS: 71 adult patients from the Italian Parents' and Patients' Organization for Anorectal Malformations (AIMAR) participated in the study. Participants completed measures of fecal and urinary continence of the Hirschsprung Disease/Anorectal Malformation Quality of Life (HAQL) (Hanneman et al. in Dis Col Rect 44:1650-1660, 2001), the Short Form Health Survey (SF-36) (Apolone and Mosconi in J Clin Epidemiol 51:1025-1036, 1998), and the Brief Coping Orientation to Problems Experienced (COPE) Inventory (Carver in Int J Behav Med 4:92-100, 1997), which measures different coping strategies: maladaptive, problem-focused and emotion-focused. RESULTS: Hierarchical regression analyses showed that fecal continence (ß = 0.53, p < 0.01) and urinary continence significantly predict (ß = 0.23, p < 0.05) Physical HRQoL. Fecal continence (ß = 0.36, p < 0.01) and maladaptive coping strategies significantly predict (ß = -0.27, p < 0.05) Mental HRQoL. CONCLUSION: Besides considering the importance of fecal and urinary continence for Physical HRQoL, these findings indicate that maladaptive coping strategies are associated with worse Mental HRQoL. Interventions aimed at enhancing the patients' HRQoL should target coping strategies by reducing denial, behavioral disengagement, substance abuse, and self-blame.

Running away from stress: How regulatory modes prospectively affect athletes' stress through passion.

A prospective field study conducted with runners training for an upcoming marathon (Marathon of Rome 2013) examined the relation between regulatory modes, locomotion and assessment, and stress. Integrating regulatory mode theory and the dualistic model of passion, we hypothesized that the relation between regulatory modes (evaluated 3 months before the race) and the experience of stress approaching the marathon, is mediated by the type of passion (harmonious vs obsessive) athletes experience with regard to marathoning. Results revealed that (a) locomotion positively predicted harmonious passion, which in turn reduced athletes' experience of stress; and (b) assessment positively predicted obsessive passion, which in turn enhanced athletes' experience of stress. Overall, the present results suggest that proximal psychological mechanisms such as basic regulatory mode orientations can predict distal outcomes such as stress indirectly through their relation with motivational phenomena such as passion.

Transition from childhood to adolescence: Quality of life changes 6 years later in patients born with anorectal malformations.

BACKGROUND/PURPOSE: Disease-specific quality of life (QoL) may be more or less relevant when children enter preadolescence/adolescence. Few attentions have been given to development and transition periods. Aim of the present longitudinal study is to evaluate ARM specific changes in QoL and the stability of QoL over 6 years. METHODS: Questionnaires were sent to families of the AIMAR Association (in 2007 and in 2013/2014). They included the Hirschsprung's Disease/ARM QoL Questionnaire (HAQL, [1]). Rank correlations and within group comparisons for the HAQL subscales were conducted analyzing the scores of time 1 vs time 2. Gender effects were tested. RESULTS: 134 parents answered the questionnaires at time 1 and 73 at time 2. Results of the repeated Analyses of Variance indicated improvements in the continence subscales ("Presence of Diarrhea," "Fecal Continence"). QoL significantly worsened in "Social and Emotional Functioning" and in "Body Image" areas. The analysis of stability of change indicates that QoL scores remain stable, with the exception of the Body Image area. CONCLUSIONS: Despite improvements in the continence areas, parents reported worse levels of QoL in the psychosocial areas, as their child grow. As patients grow, they might have more difficulties in daily and social activities, and feel more frequently ashamed and more dissatisfied with their body.

Nutritional supplement and doping use in sport: Possible underlying social cognitive processes.

There is growing evidence suggesting that nutritional supplement (NS) use is strongly associated to doping use in elite and amateur sports. However, there is a paucity of research on the psychological processes that underlie this association. The present study investigated the cognitive and behavioral components of the association between NS use and doping among adolescent sub-elite athletes. Six hundred and fifty adolescent athletes completed a questionnaire including measures of doping intentions, attitudes, norms, and beliefs about NS use. The results showed that NS users who did not report doping use had significantly stronger doping intentions and more positive attitudes and favorable beliefs toward doping use, as compared with athletes who did not use NS. In support of the "shared mental representations" hypothesis, the present findings show that NS use is associated with biased reasoning patterns in favor of doping use. This mechanism may explain why some NS users decide to engage in doping.

Feelings of depression in people with ARM: the role of critical incidents and perceived difficulties in close and sexual relationships.

PURPOSE: Managing a chronic disease may be a difficult task which may lead patients to experience psychological distress and depression. Some studies showed that, in ARM patients, fecal incontinence (FI) is related to symptoms of depression while others studies did not. No studies investigated this relationship in adults. Since fear of having FI episodes, negative feelings associated with these episodes, and difficulties in close and sexual relationships are often reported by patients as important consequences of ARM, we were interested in investigating whether these aspects contribute in explaining feelings of depression. METHODS: Questionnaires were sent to 160 adult members of the Italian Association for Anorectal Malformation. A new scale measuring the fear of having FI episodes, negative feelings associated with these episodes and difficulties in close/sexual relationship was developed. Depressive feelings and FI were also measured. RESULTS: Seventy-two adults answered the questionnaires. Regression analyses showed that, in males, depressive feelings were predicted by difficulties in close and sexual relationships (B = 0.46; P < 0.01), while, in females, they were predicted by the fear of having FI episodes (B = 0.53; P < 0.05) and by negative feelings (B = 0.58; P < 0.01). CONCLUSIONS: Interventions aimed to prevent depression in ARM patients should consider gender and should be targeted on different aspects.

Quality of life in children and adolescents with anorectal malformation.

PURPOSE: Quality of life (QOL) is an important endpoint in health outcomes research, especially in pediatric chronic conditions. While some studies suggest that patients with ARM report a lower level of physical and psychosocial QOL, as compared to healthy peers, not all research shows this consistently. The aim of this study was to compare the QOL of Italian children and adolescents with ARM to the QOL of a large control sample of healthy peers. METHODS: Parents of 109 children with ARM and 336 schoolchildren, completed the Pediatric Quality of Life Inventory. Analysis of variances were used to compare the groups. RESULTS: Compared to healthy peers, children with ARM showed lower emotional functioning (F = 8,41; p = .004), social functioning (F = 4,9; p = .027) and school functioning (F = 14,7; p = .000). In the adolescent group, females had a worse QOL in the physical functioning domain (F = 5,01; p = .03) than males, independent of group membership. CONCLUSIONS: While children with ARM show a more impaired QOL compared to their peers, this difference does not emerge in the adolescent group. Our results are consistent with previous findings which hypothesize that while patients with ARM face more difficulties during childhood, by adolescence they may have learned to overcome these difficulties.

Does mothers' perception of social support mediate the relationship between fecal incontinence and quality of life of the child?

PURPOSE: Fecal incontinence is a common problem in children and adolescents with anorectal malformation (ARM) and may negatively impact psycho-social well-being. Mothers' perception of social support has been proved to contribute to children's quality of life (QOL). Considering ARM studies, the role of family and social resources have received little attention. The aim of the present study was to analyze whether mothers' perception of social support mediates the impact of child fecal incontinence on his/her QOL. METHODS: One hundred and nine mothers with a child born with ARM (aged 6-15 years old; mean age = 11 years) completed questionnaires including the fecal incontinence subscale of the Hirschsprung's Disease/Anorectal Malformation QOL Questionnaire, the Pediatric QOL Inventory, and a social relationship questionnaire. Structural equation models were used to explore the relations hypothesized. RESULTS: No differences were found in the QOL scores across gender. The hypothesized model fits the data well; mothers' perception of social support partially mediated the relationship between fecal incontinence and QOL. CONCLUSIONS: An important direction for pediatric surgeons and their interdisciplinary teams may be to develop strategies to strengthen mothers' social relationships.