Perceived distress, personality characteristics, coping strategies and psychosocial impairments in a national German multicenter cohort of patients with Crohn's disease and ulcerative colitis.

BACKGROUND AND AIMS: This study examined differences in personality, psychological distress, and stress coping in inflammatory bowel disease (IBD) depending on type of disease and disease activity. We compared patients suffering from Crohn's disease (CD) and ulcerative colitis (UC) with controls. While the literature is replete with distinctive features of the pathogenesis of IBD, the specific differences in psychological impairments are not well studied. METHODS: In this German national multicenter study, participants were recruited from 32 centers. Two hundred ninety-seven questionnaires were included, delivering vast information on disease status and psychological well-being based on validated instruments with a total of 285 variables. RESULTS: CD patients were more affected by psychological impairments than patients suffering from UC or controls. Importantly, patients with active CD scored higher in neuroticism (p < 0.01), psychological distress (p < 0.001) and maladaptive stress coping (escape, p = 0.03; rumination, p < 0.03), but less need for social support (p = 0.001) than controls. In contrast, patients suffering from active UC showed psychological distress (p < 0.04) and maladaptive coping (avoidance, p < 0.03; escape, p = 0.01). Patients in remission seemed to be less affected. In particular, patients with UC in remission were not inflicted by psychological impairments. The group of CD patients in remission however, showed insecurity (p < 0.01) and paranoid ideation (p = 0.04). CONCLUSIONS: We identified specific aspects of psychological impairment in IBD depending on disease and disease activity. Our results underscore the need for psychological support and treatment particularly in active CD.

Importance of representing optical depth variability for estimates of global line-shaped contrail radiative forcing.

Estimates of the global radiative forcing by line-shaped contrails differ mainly due to the large uncertainty in contrail optical depth. Most contrails are optically thin so that their radiative forcing is roughly proportional to their optical depth and increases with contrail coverage. In recent assessments, the best estimate of mean contrail radiative forcing was significantly reduced, because global climate model simulations pointed at lower optical depth values than earlier studies. We revise these estimates by comparing the probability distribution of contrail optical depth diagnosed with a climate model with the distribution derived from a microphysical, cloud-scale model constrained by satellite observations over the United States. By assuming that the optical depth distribution from the cloud model is more realistic than that from the climate model, and by taking the difference between the observed and simulated optical depth over the United States as globally representative, we quantify uncertainties in the climate model's diagnostic contrail parameterization. Revising the climate model results accordingly increases the global mean radiative forcing estimate for line-shaped contrails by a factor of 3.3, from 3.5 mW/m(2) to 11.6 mW/m(2) for the year 1992. Furthermore, the satellite observations and the cloud model point at higher global mean optical depth of detectable contrails than often assumed in radiative transfer (off-line) studies. Therefore, we correct estimates of contrail radiative forcing from off-line studies as well. We suggest that the global net radiative forcing of line-shaped persistent contrails is in the range 8-20 mW/m(2) for the air traffic in the year 2000.

The hospitalist as coordinator: an observational case study.

PURPOSE: The hospitalist concept aims for integration and continuity of care in inpatient treatment. The purpose of this paper is to understand how the hospitalist function emerges and unfolds on wards. Therefore, the paper aims to focus on interaction patterns and the role of the hospitalist. DESIGN/METHODOLOGY/APPROACH: Building on methodological approaches in health care team research, this process-oriented case study used participatory observations and semi-structured interviews. Over a year, 14 observational days were conducted, simultaneously accompanying hospitalists, nurses and surgeons. Observational data illustrate the findings. FINDINGS: The hospitalist function was perceived to have a positive impact. He/she serves as an informal leader by taking up five interrelated, mostly coordinative roles, which help to cope with different organisational gaps. The interaction patterns are bilateral, ad hoc, reactive, repetitive and dependent on chance and people. Roles, tasks and responsibilities are continuously negotiated. RESEARCH LIMITATIONS/IMPLICATIONS: Hospitalist research should make use of the debate in health care team research about overlapping roles, tasks and responsibilities. Additionally, one could look at the origins behind the evolvement of interaction patterns and the hospitalist's roles. PRACTICAL IMPLICATIONS: The sole creation of the hospitalist function is not sufficient to tap its full potential. Organisational issues concerning the interaction processes need to be addressed. In so doing, the professions' orientations must be taken into account. ORIGINALITY/VALUE: This paper addresses theoretical and methodological gaps in hospitalist research. Using a process-oriented qualitative design, the findings question the prominent stimulus-response assumption. The focus on the interplay of functions and the hospitalists' roles lead to a more comprehensive picture of the patient-related interaction processes.