Esophageal Hypervigilance and Symptom-Specific Anxiety in Patients with Eosinophilic Esophagitis.

BACKGROUND & AIMS: Patient symptom reporting often does not correlate with the pathophysiological markers of esophageal disease, including eosinophilic esophagitis (EoE). Esophageal hypervigilance and symptom-specific anxiety are emerging as important considerations in understanding symptom reporting. As such, we aimed to conduct the first study of these constructs in EoE. METHODS: A retrospective review of an EoE patient registry was conducted and included eosinophils per high power field (from esophagogastroduodenoscopy biopsy: proximal, distal), endoscopic reference score, distal distensibility plateau (functional luminal imaging probe), Brief Esophageal Dysphagia Questionnaire, Visual Dysphagia Question of EoE Activity Index, Northwestern Esophageal Quality of Life scale, and the Esophageal Hypervigilance and Anxiety Scale. Correlational and regression analyses evaluated relationships of hypervigilance and anxiety with Brief Esophageal Dysphagia Questionnaire, Visual Dysphagia Question of EoE Activity Index, and Northwestern Esophageal Quality of Life scale when controlling for histology and endoscopic severity. RESULTS: One hundred and three patients had complete data, 69.9% were male, and the mean (SD) age was 40.66 (13.85) years. Forty-one percent had elevated dysphagia and 46% had elevated hypervigilance and anxiety. Esophageal symptom-specific anxiety emerged as the most important predictor of Brief Esophageal Dysphagia Questionnaire severity (44.8% of the variance), Visual Dysphagia Question of EoE Activity Index severity (26%), and poor health-related quality of life (HRQoL) (55.3%). Hypervigilance was also important, but to a lesser extent. Pathophysiological variables did not significantly predict symptoms or HRQoL. Recent food impaction can predict symptom-specific anxiety and proton pump inhibitor use can reduce hypervigilance. CONCLUSIONS: Hypervigilance and symptom-specific anxiety are important for our understanding of self-reported patient outcomes in EoE. These processes outweigh endoscopic and histologic markers of EoE disease activity across dysphagia, difficulty eating, and HRQoL. Clinicians should assess hypervigilance and anxiety, especially in patients with refractory symptoms and poor HRQoL.

When dietary modification turns problematic in patients with esophageal conditions.

BACKGROUND: Patients with chronic illness affecting the esophagus often modify their eating habits to manage symptoms. Although this begins as a protective strategy, anxiety around eating can become problematic, and lead to poor outcomes. We administered a survey to examine the factors associated with problematic eating behaviors in patients who have reflux and difficulty swallowing (esophageal dysphagia). METHODS: In total, 277 adult patients aged above 18 diagnosed with achalasia, eosinophilic esophagitis, and gastroesophageal reflux completed an online survey: (1) demographic and disease information; (2) reflux and dysphagia severity (3) eating behaviors, as measured by a study-specific, modified version of the Eating Disorder Questionnaire (EDE-Q) for patients with esophageal conditions; and (4) Food related quality of life (FRQOL). Descriptive statistics, one-way ANOVA, and Pearson's correlations evaluated the sample data and a hierarchical linear regression evaluated predictors of problematic eating behaviors. KEY RESULTS: Problematic eating behaviors were associated with reflux severity, dysphagia severity, symptom anxiety, and hypervigilance, and negatively associated with FRQOL. While reflux and dysphagia severity predicted greater problematic eating, symptom anxiety explained more of these behaviors. Although hypervigilance and anxiety also predicted poorer FRQOL, problematic eating was the largest predictor. CONCLUSION & INFERENCES: Problematic eating behaviors are associated with increased symptom severity and symptom anxiety, and diminished FRQoL. Symptom anxiety, rather than symptom severity, appears to be a driving factor in problematic eating behaviors. Interventions aimed at diminishing symptom anxiety may be useful in reducing problematic eating behaviors in patients with gastrointestinal symptoms.

Psychometric Properties of a Spanish Version of the Basic Needs Satisfaction in Sports Scale.

The Basic Needs Satisfaction in Sport Scale (BNSSS) is an instrument designed to measure the level of satisfaction of the three basic psychological needs (BPN) in sports, according to The Self-Determination Theory (SDT). The purpose of this research was to adapt BNSSS to Mexican Spanish and analyze its psychometric properties (factorial validity, factorial invariance, internal consistency, convergent validity, and nomological validity). Thus, 542 athletes (average age: 12.06 years; SD = 1.83) were asked to answer a set of questionnaires. Confirmatory factor analyses (CFA) supported both the structure of five related factors and the trifactorial structure after eliminating an item. Nevertheless, the reliability analysis indicated strong internal consistency, and the average variance extracted (AVE) from the subscales was acceptable except for the volition factor, thus supporting the trifactorial model. Scores derived from the instrument's three-factors offered evidence of the criterion validity, through a positive and meaningful relation with enjoyment and subjective vitality. Moreover, results of multi-sample analysis supported that factorial structure is invariant between men and women. In conclusion, this BNSSS Spanish version displayed adequate psychometric properties, showing that it can be used to measure the three basic psychological needs.

COVID-19, las enfermedades no transmisibles y el envejecimiento saludable en México / COVID-19, Noncommunicable Diseases and Healthy Aging in Mexico

Resumen Introducción. La pandemia de COVID-19 ha visibilizado la situación actual de los sistemas y las condiciones de salud de la población en todo el mundo. Objetivo. Analizar las condiciones de salud de la población en México, sobre todo en el grupo de 45 a 59 años, y cómo las enfermedades no transmisibles y la edad son factores de mal pronóstico para COVID-19, a fin de mostrar al envejecimiento saludable como una alternativa para replantear las políticas públicas. Argumentos para la discusión. Se requiere que el grupo etario de 45 a 59 años sea considerado como objetivo dentro de la cobertura del Paquete Garantizado de Servicios de Salud, cuyas acciones se aplican en todo el sector a manera de medicina preventiva; esto, porque actualmente está incluido en un grupo etario más amplio y se debe tomar en cuenta el incremento de la mortalidad asociada con la edad y la comorbilidad ocurrida por la pandemia. Conclusiones. México demanda un replanteamiento sobre la política pública de envejecimiento saludable, mediante la implementación de estrategias y acciones en todo el curso de vida, pero de forma urgente durante la segunda mitad, después de los 45 años, con medidas de prevención secundaria de enfermedades no transmisibles, ya que es a partir de esta edad y hasta los 79 años donde se han presentado la mayor cantidad de defunciones por COVID-19; de tal modo, se busca enfrentar con mejores condiciones de salud de la población las siguientes pandemias que se presenten.

Abstract Introduction. The COVID-19 pandemic has unleashed the current situation of health systems and the health conditions of the population throughout the world. Objective. Analyze the health conditions of the population in Mexico, especially in the 45 to 59 age group, and how non-communicable diseases and age are poor prognostic factors for COVID-19, showing healthy aging as an alternative to rethink public policies. Arguments for discussion. The age group from 45 to 59 years is required to be considered as a target group for the coverage of the Guaranteed Package of Health Services, whose actions are applied throughout the sector as preventive medicine actions, since it is currently included in a broader age group, taking into account the increase in mortality associated with age and comorbidity caused by the pandemic. Conclusions. Mexico requires a rethinking of the public policy of healthy aging, with the application of strategies and actions throughout the life course, seeking to apply urgent measures from the second half of life, starting at age 45, with secondary prevention actions of non-communicable diseases, since it is from this age and up to 79 years where the highest number of deaths has occurred in Mexico due to COVID-19, thus seeking to face the following pandemics with better health conditions of the population they come forward.