Comorbidities between temporomandibular disorders and somatization in young adults: exploring links with personality, emotional, and sleep disturbances.

OBJECTIVE: The comorbidities between temporomandibular disorders (TMDs) and somatization and their associations with personality traits, emotional disorders, and sleep disturbances were investigated. STUDY DESIGN: Adults aged 18 to 24 years completed an electronic survey encompassing TMD symptoms (5Ts), Patient Health Questionnaire-15, Big Five Personality Inventory-10, Depression Anxiety Stress Scales-21, and Pittsburgh Sleep Quality Index. Data were assessed using non-parametric tests/correlation analysis and logistic regression analysis (α = 0.05). RESULTS: The sample comprised 365 participants, of whom 22.2% and 19.5% were 5Ts-negative without and with somatization, respectively, and 18.1% and 40.3% were 5Ts-positive without and with somatization, respectively. Significant differences in neuroticism, distress, depression, anxiety, stress, and sleep quality were observed between 5Ts-negative participants with somatization and 5Ts-positive participants with somatization compared with 5Ts-negative participants without somatization and 5Ts-positive participants without somatization. Distress, anxiety, stress, and sleep were moderately correlated with somatic but not TMD symptoms (rs = 0.45-0.52). CONCLUSIONS: Irrespective of whether they had TMDs, participants with somatization exhibited heightened levels of neuroticism and emotional and sleep disturbances.

Clinical outcomes, medical costs, and medication usage patterns of different somatic symptom disorders and functional somatic syndromes: a population-based study in Taiwan.

BACKGROUND: Somatic symptom disorders (SSD) and functional somatic syndromes (FSS) are often regarded as similar diagnostic constructs; however, whether they exhibit similar clinical outcomes, medical costs, and medication usage patterns has not been examined in nationwide data. Therefore, this study focused on analyzing SSD and four types of FSS (fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, functional dyspepsia). METHODS: This population-based matched cohort study utilized Taiwan's National Health Insurance (NHI) claims database to investigate the impact of SSD/FSS. The study included 2 615 477 newly diagnosed patients with SSD/FSS and matched comparisons from the NHI beneficiary registry. Healthcare utilization, mortality, medical expenditure, and medication usage were assessed as outcome measures. Statistical analysis involved Cox regression models for hazard ratios, generalized linear models for comparing differences, and adjustment for covariates. RESULTS: All SSD/FSS showed significantly higher adjusted hazard ratios for psychiatric hospitalization and all-cause hospitalization compared to the control group. All SSD/FSS exhibited significantly higher adjusted hazard ratios for suicide, and SSD was particularly high. All-cause mortality was significantly higher in all SSD/FSS. Medical costs were significantly higher for all SSD/FSS compared to controls. The usage duration of all psychiatric medications and analgesics was significantly higher in SSD/FSS compared to the control group. CONCLUSION: All SSD/FSS shared similar clinical outcomes and medical costs. The high hazard ratio for suicide in SSD deserves clinical attention.

Prevalence of DSM-5 somatic symptom disorder in Chinese patients with breast cancer.

OBJECTIVE: The aims of this study were to explore the frequency of somatic symptom disorder (SSD) and the relationship between SSD and somatic, psychological, and social factors in Chinese patients with breast cancer. METHODS: This multicenter cross-sectional study enrolled 264 patients with breast cancer from three different departments in Beijing. The structured clinical interview for fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (SCID-5) for SSD. Standardized questionnaires and clinical data were used to compare patients with and without SSD. RESULTS: Somatic symptom disorder was diagnosed in 21.6% (57/264) of all enrolled patients. No differences were found between SSD patients and non-SSD patients in terms of sociodemographic characteristics and tumor-specific variables, except radiotherapy. However, patients with SSD reported higher levels of depression, anxiety and cancer-related worry. They also showed a longer duration of symptoms, greater impairment in daily life, more concern over their physical complaints and more doctor visits. In a stepwise binary logistic regression analysis, among others, higher health anxiety (WI-8, Exp(B) = 0.107, p = 0.009) and more doctor visits (OR = -1.841, p < 0.001) showed a significant association with SSD; the model explained 53.7% of the variance. CONCLUSIONS: Similar to other physical diseases, there is a high prevalence of SSD in patients with breast cancer. Somatic symptom disorder patients differ from non-SSD patients by exhibiting higher cancer-related emotional distress and dysfunctional illness perception and behavior. There remain substantial challenges in the diagnosis of SSD in patients with cancer and other medical conditions. CLINICAL TRIAL REGISTRATION: ChiCTR2100051525.

Stigma perceived by patients with functional somatic syndromes and its effect on health outcomes - A systematic review.

BACKGROUND: Patients with functional somatic syndromes (FSS) experience stigma which arguably affects their health. AIM: To determine the presence of perceived stigma and its effects on physical and mental health in patients with FSS compared to patients with comparable explained conditions. METHODS: A comprehensive search of PubMed, Embase, PsycINFO, CINAHL and Cochrane Library was performed to select studies focusing on stigma perceived by patients with irritable bowel syndrome (IBS), fibromyalgia (FM) or chronic fatigue syndrome (CFS), comparing these patients to patients with comparable but explained conditions. RESULTS: We identified 1931 studies after duplicate removal. After screening we included eight studies: one study about all three FSS, one about IBS, five about FM and one about CFS. We found that patients with IBS did not consistently experience higher levels of stigma than those with a comparable explained condition. Patients with CFS and FM experienced higher levels of stigma compared to patients with comparable explained conditions. All studies showed a correlation between stigma and negative health outcomes. DISCUSSION: Patients with FSS experience stigma and negative health outcomes. However, experiencing stigma is not restricted to patients with FSS, as many patients with explained health conditions also experience stigma. Whether stigma has more negative health consequences in patients with FSS compared to patients with explained health conditions remains unclear and should be assessed in future research.

Concordance between Self-reported Symptoms and Clinically Ascertained Peripheral Neuropathy among Childhood Cancer Survivors: the St. Jude Lifetime Cohort Study.

BACKGROUND: Childhood cancer survivors are at elevated risk for motor and/or sensory neuropathy. The study aims to evaluate the concordance between self-report peripheral neuropathy compared with clinically ascertained peripheral neuropathy, and to identify factors associated with misclassification of peripheral neuropathy among survivors. METHODS: The concordance between self-report and clinically ascertained peripheral neuropathy was evaluated among 2,933 5+ years old childhood cancer survivors (mean age 33.3, SD = 8.9). The sensitivity, specificity, and accuracy of self-report peripheral motor neuropathy (PMN) and peripheral sensory neuropathy (PSN) were calculated with reference to clinically assessed peripheral neuropathy. RESULTS: Female survivors were more likely than male survivors to have clinically ascertained PMN (8.4% vs. 5.6%, P = 0.004). For females, having either PSN or PMN the most sensitive, specific, and accurate self-reported symptom was endorsing ≥2 symptoms on the self-report questionnaire (43.2%, 90.3%, and 85.2%, respectively), with kappa of 0.304. For males, having either PSN or PMN the most sensitive, specific, and accurate self-reported symptom was endorsing ≥2 symptoms on the self-report questionnaire (38.8%, 90.5%, and 86.3%, respectively) with kappa of 0.242. Age at diagnosis, emotional distress, and reporting pain in legs in the past 4 weeks were associated with an increased risk for false-positive reporting of peripheral neuropathy. Race (White), age at assessment, and emotional distress were associated with increased risk for false-negative reporting of peripheral neuropathy. CONCLUSIONS: Agreement between self-report and clinically ascertained peripheral neuropathy was poor in survivors. Choosing self-report versus clinical ascertained peripheral neuropathy should be carefully considered. IMPACT: The current study identifies the need for a self-report questionnaire that accurately assesses symptoms of peripheral neuropathy among cancer survivors.

The clinical utility of a comprehensive psychosomatic assessment in the program for colorectal cancer prevention: a cross-sectional study.

Few studies have investigated psychosocial characteristics and lifestyle behaviors of participants at programs for secondary prevention of colorectal cancer (CRC). This study aimed, through a comprehensive psychosomatic assessment based on clinimetric principles, to evaluate psychosocial characteristics and lifestyle behaviors in participants at CRC secondary prevention program, and to investigate the associations between these variables and endoscopic outcomes. In this cross-sectional study, the first 150 consecutive asymptomatic participants at the CRC prevention program who resulted positive to fecal occult blood test (FOBT) and were thus referred to colonoscopy, underwent a psychosomatic assessment including psychiatric diagnoses (DSM-5), psychosomatic syndromes (DCPR-R), psychological distress, psychological well-being and lifestyle behaviors. Whereas only 5.3% of the sample showed at least one DSM-5 diagnosis, 51.3% showed at least one DCPR syndrome, such as allostatic overload, alexithymia, Type A behavior, and demoralization. Patients affected by psychosomatic syndromes presented with significantly higher psychological distress, lower psychological well-being and unhealthy lifestyle behaviors, such as tobacco smoking and unhealthy diet, in comparison with patients without DCPR syndromes. Among endoscopic outcomes, the presence of adenomas was significantly associated with DCPR irritable mood. In a clinical context of secondary prevention addressing asymptomatic patients with positive FOBT, a comprehensive psychosomatic assessment may provide relevant clinical information for those patients who present certain psychosomatic syndromes associated with high psychological distress, impaired psychological well-being, unhealthy lifestyle behaviors and colorectal precancerous lesions. The results of the present study indicate a road to the practice of "preventive" medicine at CRC screening program.

Effect of psychosocial trauma and stress on sexual dysfunction in women with endometriosis.

BACKGROUND: Endometrial tissue plays an important role in the regulation of female fertility and there is evidence that endometrial pathology (including endometriosis) is closely related to endocrine disorders. On the other hand, various neuroendocrine changes can be significantly affected by psychosocial stress. In connection with these findings, we tested the relationship between neuroendocrine changes, sexual dysfunction, psychosocial/traumatic stress, and dissociative symptoms in women with endometriosis. METHODS: A total of 65 patients with endometriosis were included in the study. Clinical examinations were focused on the biochemical analysis of neuroendocrine markers of endometriosis (cancer antigen 125 [CA 125] and cancer antigen 19-9 [CA 19-9]), estradiol, psychometric evaluation of sexual dysfunction, psychosocial/traumatic stress, and dissociative symptoms. RESULTS: The results showed significant Spearman correlations between the values of the revised range of sexual difficulties for sexual dysfunction (Revised Female Sexual Distress Scale), psychosocial/traumatic stress (Trauma Symptoms Checklist) (R = 0.31), and dissociative symptoms (Somatoform Dissociation Questionnaire) (R = 0.33). Positive correlations were also found between CA 125 and CA 19-9 (R = 0.63), and between CA 125 and the results of the values of the revised scale of sexual difficulties for sexual dysfunction (Revised Female Sexual Distress Scale) (R = 0.29). Also psychosocial/traumatic stress (Trauma Symptoms Checklist) significantly correlated with CA 125 (R = 0.38) and with CA 19-9 (R = 0.33). CONCLUSION: These results represent the first findings regarding the relationship of the neuroendocrine markers CA 125 and CA 19-9 and sexual dysfunction with trauma/stress-related symptoms and dissociative symptoms in women with endometriosis.

Public mental health under the long-term influence of COVID-19 in China: Geographical and temporal distribution.

BACKGROUND: The mental health status caused by major epidemics is serious and lasting. At present, there are few studies about the lasting mental health effects of COVID-19 outbreak. The purpose of this study was to investigate the mental health of the Chinese public during the long-term COVID-19 outbreak. METHODS: A total of 1172 online questionnaires were collected, covering demographical information and 8 common psychological states: depression, anxiety, somatization, stress, psychological resilience, suicidal ideation and behavior, insomnia, and stress disorder. In addition, the geographical and temporal distributions of different mental states were plotted. RESULTS: Overall, 30.1% of smokers increased smoking, while 11.3% of drinkers increased alcohol consumption. The prevalence rates of depression, anxiety, mental health problems, high risk of suicidal and behavior, clinical insomnia, clinical post-traumatic stress disorder symptoms, moderate-to-high levels of perceived stress were 18.8%, 13.3%, 7.6%, 2.8%, 7.2%, 7.0%, and 67.9%, respectively. Further, the geographical distribution showed that the mental status in some provinces/autonomous regions/municipalities was relatively more serious. The temporal distribution showed that the psychological state of the participants was relatively poorer on February 20, 24 to 26 and March 25, especially on March 25. LIMITATIONS: This cross-sectional design cannot make causal inferences. The snowball sampling was not representative enough. CONCLUSION: Our findings suggest that the prevalence rate of mental disorders in the Chinese public is relatively low in the second month of the COVID-19 pandemic. In addition, people's mental state is affected by the geographical and temporal distributions.

Somatización, ansiedad y depresión en niños y adolescentes / Somatization disorder, anxiety and depression in children and adolescents

Los trastornos de salud mental como depresión y ansiedad tienden a coexistir frecuentemente con los trastornos de somatización, siendo estos últimos una causa frecuente de consulta en especialidades médicas en niños y adolescentes. Es necesario poder pesquisarlos y diagnosticarlos para poder tratarlos adecuadamente. En la actualidad se cuenta con tratamientos eficaces y seguros para estos cuadros, ya sea estén aislados o en comorbilidad. Tanto la terapia cognitivo conductual como los inhibidores selectivos de recaptura de serotonina, solos o combinados, han demostrado ser intervenciones exitosas en estos niños y adolescentes. En el presente artículo se realiza una revisión de cómo se conceptualizan como una dimensión psicopatológica actualmente estos trastornos y cómo se relacionan entre ellos.

Psychiatric disorders such as depression and anxiety are frequently comorbid with somatization disorders, the latter ones are a common cause for medical specialties consultation in the pediatric population. It is thus necessary to identify and diagnose these disorders in order to be able to treat them. Currently, there are safe and effective treatments for these disorders, whether they are isolated or comorbid. Both cognitive behavioral therapy and selective serotonin reuptake inhibitors, alone or combined, have proven to be successful in treating these children and adolescents. This is a review of the current conceptualization of this psychopathologic dimension and how these disorders are interrelated.

Association between personal, medical and positive psychological variables with somatization in university health sciences students.

OBJECTIVE: To measure personal, medical and psychological positive and negative variables and to determine their relation with somatization in a sample of health sciences students. Subjects and methods: A total of 594 (34.43%) of the 1725 health science students of a public university answered an online survey with personal and medical information as well as the following psychological variables: phsychological well-being, five facets mindfulness questionnaire (FFMQ), life satisfaction, depression, and academic stress. Additionally, the presence of 11 somatic symptoms and 11 diseases during the last year was measured. Results: Most students were women (74.06%) who were 19.96 ± 4.28 years old. The global frequency of somatization in the previous year was 66.59%, and the presence of any measured disease 14.75%. With the multivariate analysis, self-acceptance was the most related variable (negatively) with somatization, followed by the sum of diseases, female gender, academic stress, smoking, and depression, in a model with an R-value of 0.634, self-acceptance was also the most related variable (negatively) with depression, being this last the most related variable with academic stress. Conclusions: After analyzing all variables considered in this study, self-acceptance was the most related variable with somatization and depression; this highlights the importance of strengthening the acceptance of the self in the student population in order to prevent these conditions and their consequences.

Explicações de familiares sobre o sofrimento psíquico: diversidade e integralidade em questão / Explicaciones de familiares sobre el sufrimiento psíquico: diversidad e integralidad en cuestión / Explanations of family members about psychological distress: diversity and comprehensiveness in question

RESUMO Este estudo apresenta como tema as explicações de familiares sobre o sofrimento psíquico pelos itinerários terapêuticos de usuários na atenção em saúde mental a partir da ótica da família. O Itinerário Terapêutico (I.T.) é entendido como todos os movimentos suscitados por grupos ou indivíduos a fim de resguardar ou recuperar a saúde, que podem impulsionar diversos recursos, desde práticas religiosas e cuidados caseiros até os dispositivos biomédicos predominantes. O objetivo deste estudo foi identificar as explicações dadas pelo familiar a respeito do problema de saúde mental da pessoa em sofrimento psíquico. Efetuou-se um estudo qualitativo em que foram realizadas dez entrevistas com familiares de usuários de um Centro de Atenção Psicossocial (CAPS). De acordo com a análise das entrevistas com base na Teoria Fundamentada em Dados foi possível o agrupamento das explicações dadas em: (1) espirituais, (2) orgânicas, (3) histórico familiar, (4) eventos de vida, (5) diagnóstico e (6) outros. As explicações dadas pelos familiares envolvem um olhar múltiplo, que incorpora diferentes causas e motivos, aproximando-se da ideia de integralidade em saúde.

RESUMEN En este estudio se presenta como tema las explicaciones de familiares sobre el sufrimiento psíquico por intermedio de los itinerarios terapéuticos de usuarios en la atención en salud mental a partir de la óptica de la familia. El Itinerario Terapéutico (I.T.) es entendido como todos los movimientos suscitados por grupos o individuos a fin de resguardar o recuperar la salud, que pueden impulsar diversos recursos, desde prácticas religiosas y cuidados caseros hasta los dispositivos biomédicos predominantes. El objetivo de este estudio fue identificar las explicaciones dadas por el familiar acerca del origen del problema de salud mental de la persona en sufrimiento psíquico. Se efectuó un estudio cualitativo en el que se realizaron 10 entrevistas con familiares de usuarios de un Centro de Atención Psicosocial (CAPS). De acuerdo con el análisis de las entrevistas con base en la Teoría Fundamentada en Datos fue posible la agrupación de las explicaciones dadas en: (1) Espiritual, (2) Orgánico, (3) Historia familiar, (4) Eventos de la vida (5) Diagnóstico y (6) Otros. Las explicaciones, dadas por los familiares, involucra una mirada múltiple, que incorpora diferentes causas y motivos, aproximándose a la idea de integralidad en salud.

ABSTRACT. This study presents the explanations of family members about psychological distress through the therapeutic itineraries of patients in mental health care from the perspective of the family. The Therapeutic Itinerary (T.I.) is understood as all movements raised by groups or individuals in order to safeguard or recover health, which can boost various resources, from religious practices and home care to the predominant biomedical devices. This study aimed to identify the explanations given by the family member regarding the mental health problem of the person in psychological distress. A qualitative study was carried out in which 10 interviews were conducted with family members of users of a Psychosocial Care Center (CAPS). According to the analysis of the interviews based on the Grounded Theory, it was possible to group the explanations into: (1) Spiritual, (2) Organic, (3) Family history, (4) Life events, (5) Diagnosis and (6) Others. The explanations given by family members involve a multiple look, which incorporates different causes and reasons, approaching the idea of integrality in health.

Physical and psychological symptoms and psychological distress among the spouses of cancer survivors: The mediating effect of family communication and coping.

OBJECTIVE: The current study examined the relationships among physical and psychological symptoms, family communication, family coping and psychological distress for the spouses of cancer survivors. METHODS: A total of 91 spouses of cancer survivors who were diagnosed with breast, colorectal or prostate cancer who were recruited from the University Hospital registry in Cleveland, Ohio, participated in this study. Standardised questionnaires that assessed family communication, family coping and psychological distress were used. RESULTS: The results indicate that the relationships among variables of interests varied by the depression, anxiety and somatisation subscales of psychological distress. For example, depression was negatively associated with family communication, while somatisation was negatively associated with reframing coping. Mediating effects of family communication and family coping were observed only for the somatisation and depression subscales. CONCLUSION: Findings suggest that spouses of cancer survivors may experience different psychological distress symptoms in the survivorship period according to how well the family communicates and how it copes when facing a crisis situation. Spouses may benefit from psychosocial interventions that facilitate their ability to effectively communicate and cope with the challenges of life, which may reduce psychological distress.

Medication prescriptions in 322 motor functional neurological disorder patients in a large UK mental health service: A case control study.

OBJECTIVE: This study describes medication prescribing patterns in patients with motor functional neurological disorder (mFND) treated in South London and Maudsley NHS Foundation Trust (SLaM), comparing outcomes to a control group of psychiatric patients from the same hospital trust. METHOD: This is a retrospective case-control study using a psychiatric case register. Cross-sectional data were obtained from 322 mFND patients and 644 psychiatry controls who had had contact with SLaM between 1st January 2006 and 31st December 2016. RESULTS: A slightly lower proportion of mFND patients received medication compared to controls (76.6% v. 83.4%, OR: 0.59, CI: 0.39-0.89, p < 0.05). Of medication recipients, mFND patients were prescribed a higher number of agents (mean: 4.7 v 2.9, p = 0.001) and had higher prescription rates of antidepressants, anti-epileptics, analgesics, and certain non-psychotropic medications. Higher numbers of prescriptions were associated with co-morbid physical conditions, and previous psychiatric admissions. CONCLUSIONS: This is the first study to describe medication prescriptions in a large cohort of mFND patients. Patients were prescribed a wide range of psychiatric and physical health medications, with higher rates of polypharmacy than controls. Psychotropic medication prescription is not necessarily the first line treatment for mFND, where physiotherapy and psychotherapy may be offered initially. There is limited, early-phase evidence for pharmacological therapies for mFND, and as such, the benefit-to-risk ratio of prescribing in this complex and poorly understood disorder should be carefully assessed.

[One or more functional somatic syndromes? Comparison of the health status of fibromyalgia and electro-hypersensitive people]. / Un ou plusieurs syndromes somatiques fonctionnels ? Comparaison de l'état de santé de personnes fibromyalgiques et électro-hypersensibles.

INTRODUCTION: Functional somatic syndromes, grouping somatic symptoms without an organic explanation, are defined either by their predominant symptoms or by an attribution to an, often hypothetical, cause. Due to many similarities, some authors consider that there is only one FSS due to a general phenomenon of "somatization". The objective of this work was to compare two functional somatic syndromes, one defined by its symptoms, fibromyalgia, and the other by a specific contested attribution, electro-hypersensitivity. METHOD: Fibromyalgia or electro-hypersensitive participants (EHS) were recruited from September 2016 to April 2017 through associations of patients in Auvergne-Rhône-Alpes. Home interviews included the collection of medical, psychopathological, and symptom histories. The assessment of psychological distress, quality of life and the search for other functional somatic syndromes was performed through structured questionnaires, self-administrated scales, and clinical examination. RESULTS: Sixteen fibromyalgia subjects and sixteen EHS subjects were included. There are differences in symptomatology, although many symptoms are common to both conditions. Lifetime history of psychiatric disorders and current psychological distress and psychopathology are frequent in both groups but more prevalent in fibromyalgia subjects. The experience of the symptoms, their interpretation, the diagnostic itineraries and the therapeutic behaviours differ radically according to the group, even if for all socio-professional impact is high and quality of life are altered. CONCLUSION: The health status of fibromyalgia persons is overall worse than the health status of electro-hypersensitive individuals in this small sample. Despite the overlap in symptoms and a similar impact on daily functioning, this exploratory study suggests that heterogeneous mechanisms of "somatization" may be at stake in functional somatic syndromes.

[Therapy of Chronic Back Pain Considering Psychosocial Aspects]. / Therapie des chronischen Rückenschmerzes unter Berücksichtigung psychosozialer Faktoren.

Chronic pain and especially back pain rank among the most meaningful medical conditions worldwide. This leads to extensive costs in medical care systems. In about 80-85% of cases there is no morphologic evidence for a possible pain etiology, hence such forms are called "non-specific back pain". Therapies with a pure focus on symptomatic aspects are not effective to treat non-specific pain. The origin of chronic back pain can be best explained via a multi causal mechanism with a combination of bio-psycho-social, biographical, neurobiological, genetic, and cognitive factors. Since various aspects of the pain genesis have to be considered, multidisciplinary treatment shows much better results.

Do patients with gastroesophageal reflux disease and somatoform tendencies benefit from antireflux surgery?

BACKGROUND: The clinical presentation of gastroesophageal reflux disease (GERD) shows a large symptom variation also in different intensities among patients. As several studies have shown, there is a large overlap in the symptomatic spectrum between proven GERD and other disorders such as dyspepsia, functional heartburn and/or somatoform disorders. AIM: To prospectively evaluate the GERD patients with and without somatoform disorders before and after laparoscopic antireflux surgery. METHODS: In a tertiary referral center for foregut surgery over a period of 3 years patients with GERD, qualifying for the indication of laparoscopic antireflux surgery, were investigated prospectively regarding their symptomatic spectrum in order to identify GERD and associated somatoform disorders. Assessment of symptoms was performed by an instrument for the evaluation of somatoform disorders [Somatoform Symptom Index (SSI) > 17]. Quality of life was evaluated by Gastrointestinal Quality of Life Index (GIQLI). RESULTS: In 123 patients an indication for laparoscopic antireflux surgery was established and in 43 patients further medical therapy was suggested. The portion of somatoform tendencies in the total patient population was 20.48% (34 patients). Patients with a positive SSI had a preoperative GIQLI of 77 (32-111). Patients with a normal SSI had a GIQLI of 105 (29-140) (P < 0.0001). In patients with GERD the quality of life could be normalized from preoperative reduced values of GIQLI 102 (47-140) to postoperative values of 117 (44-144). In patients with GERD and somatoform disorders, the GIQLI was improved from preoperative GIQLI 75 (47-111) to postoperative 95 (44-122) (P < 0.0043). CONCLUSION: Patients with GERD and associated somatoform disorders have significantly worse levels of quality of life. The latter patients can also benefit from laparoscopic fundoplication, however they will not reach a normal level.

Effects of the neuropeptide S receptor gene on the mediating effect of somatization on the association between life-event scores and psychological distress.

BACKGROUND: The mechanisms underlying the relationship between life events and psychological distress are unclear. However, evidence of genetic involvement, including the neuropeptide S receptor gene (NPSR1), exists. METHODS: A total of 600 Chinese adults were enrolled in this cross-sectional study using random cluster sampling. Demographic information, measures of life events and psychiatric symptoms, and fasting blood samples were collected. RESULTS: Significant correlations were observed among life-event scores, somatization, and psychological distress (i.e., anxiety and depressive symptoms). Regression revealed life-event scores and somatization predicted anxiety, depressive symptoms, and psychological distress, while controlling for sex, age, income, education, and marital status. Structural equation modeling indicated that somatization mediated the association between life-event scores and psychological distress. Moreover, the mediating effect was influenced by the NPSR1 gene, suggesting that the NPSR1 polymorphisms rs324981, rs6947841, and rs6972158 influenced the association between life-event scores and somatization (ps < 0.05). The NPSR1 polymorphisms rs12673132 significantly affected the relationship of somatization with psychological distress (p < 0.05). CONCLUSIONS: In conclusion, somatization mediated the association between life-event scores and psychological distress. The current study is the first to demonstrate this relationship with a Chinese sample, whereby the NPSR1 gene affects the mediating effect of somatization on the association between life-event scores and psychological distress.

A Comparison of the Influence of Anticipated Death Trajectory and Personal Values on End-of-Life Care Preferences: A Qualitative Analysis.

OBJECTIVES: We examined anticipated preferences for end-of-life (EOL) care in healthy older adults in the context of various terminal disease scenarios to explore the relationship between personal values and diseases and conditions that would influence EOL care choices. METHODS: Qualitative Descriptive Analysis was used to derive themes and the relationship between EOL preference themes and personal value themes in 365 respondents in a national sample of healthy older adults who completed a survey on their anticipated preferences for end-of-life (EOL) care. RESULTS: Reluctance to burden close others was the most frequently voiced personal value across all conditions affecting EOL preferences, followed by the personal value of quality of life. Concern about whether one's wishes would be honored was more commonly voiced in the context of hypothetical, prospective terminal cancer than in neurological conditions. Respondents who voiced desire for autonomy in how they would die clearly attributed extreme pain as the primary influence on EOL preferences. CONCLUSIONS: Comprehensive assessment of patient personal values should include consideration of particular chronic disease scenarios and death trajectories to fully inform EoL preferences. CLINICAL IMPLICATIONS: Because personal values do influence EOL preferences, care should be taken to ascertain patient values when presenting diagnoses, prognoses, and treatment options. In particular, patients and families of patients with progressive neurological diseases will likely face a time when the patient cannot self-represent EOL wishes. Early discussion of values and preferences, particularly in the context of cognitive disease is vital to assure patient-directed care.

[Effects of Depressive Comorbidities on Revenues of Somatic Inpatients in the G-DRG-System]. / Erlösrelevanz depressiver Nebendiagnosen bei somatischen Krankenhauspatienten.

BACKGROUND: Depressive comorbidity is common with physically ill inpatients and is associated with many negative medical and economic effects (e. g., increased morbidity and mortality, increased length of stay, poorer quality of life and increased utilization of health services). The aim of this study is to clarify the question whether the additional costs caused by comorbid depressive diseases are recovered by additional G-DRG-specific revenues in order to finance necessary diagnostics and therapies of this comorbidity. METHODS: We analysed the revenues generated by depressive secondary diagnoses. Consequently, we selected patients with relevant F-diagnoses according to ICD-10 from billing data of the University Hospital Greifswald between 2010 and 2014. We recoded each case without a comorbid depression, taking into account the specifications of the relevant accounting year. Subsequently, the revenues with and without coding the comorbidity were compared (n=6,563). RESULTS: In 115 out of 6,563 patients (1.75%), mainly with unspecific recurrent depressions, the documentation and coding of a comorbid depression led to a change in the proceeds. Taking into account the applicable base rate between 2010 and 2014, the coding leads to an additional revenue of 216,737.01 Euro for the entire observation period. This corresponds to an increase of approximately 1,885 Euro per patient (n=115). In relation to the total number of patients with comorbid depressions (n=6,563) it is a surplus of 33.02 Euro. However, predominantly unspecific depressive diagnoses (e. g., F 32.8) are encoded, which do not increase the level of severity in the DRG system and, thus, have no effect on the proceeds. DISCUSSION: In very few cases, the inclusion of depressive comorbidities leads to an increase in revenue. Only some depressive diagnoses have a CCL. Due to the relatively low CCL (1 or 2), depressive comorbidities often show no effect on PCCL of multimorbid patients. Currently there is no adequate financial incentive for the hospitals to recognize and treat depressions, since the additional costs do not lead to increased revenues. In the context of a systemic treatment, depression will have to be taken into account more strongly in the financing system, especially in view of the numerous negative effects of this comorbidity.

HPV vaccine confidence and cases of mass psychogenic illness following immunization in Carmen de Bolivar, Colombia.

We report the case of multiple adverse reactions following HPV vaccination in Colombian adolescents in Carmen de Bolivar. In August 2012, the country introduced a school-based HPV immunization programme which successfully reached over 90% of the target population in the first year. In 2014, between May 29th and June 2nd,15 adolescent girls in one school presented adverse reactions after vaccination and were admitted to the local hospital. Soon, videos of girls fainting, twitching, and arriving unconscious at emergency rooms started to appear in national news media as well as on social media platforms such as YouTube. The viral spread of these videos and disturbing images were followed by the viral spread of symptoms, with over 600 cases reported across Colombia. Thorough epidemiological investigation by Colombian health authorities found no organic association between the teenagers' symptoms and the HPV vaccine, concluding this was a case of mass psychogenic reaction to vaccination. Scientific evidence did not appease the anxious public whose confidence in HPV immunization dropped dramatically. By 2016, HPV vaccine uptake among eligible girls declined to 14% for the first dose and 5% for the complete course, down from 98% and 88%, respectively, in 2012. We document this case and discuss the role of news and social media, particularly YouTube, as a driver of contagious psychogenic reactions. We also discuss the role of health authorities and government, and the importance of acting rapidly and appropriately to contain the spread of such symptoms and maintain public confidence in vaccines.