When Your Pregnancy Echoes Your Illness: Transition to Motherhood With Inflammatory Bowel Disease.

Our aim is to provide an understanding of the experience of women with inflammatory bowel disease (IBD) who have made the transition to motherhood. A total of 22 mothers with IBD were recruited from around the United Kingdom. Semi-structured interviews were conducted and analyzed using thematic analysis. The central concept- Blurred Lines-offers a novel frame for understanding the transition to motherhood with IBD through identifying parallels between having IBD and becoming, and being, a mother. Parallels clustered into three main themes: Need for Readiness, Lifestyle Changes, and Monitoring Personal and Physical Development. Hence, women with IBD are in some ways well prepared for the challenges of motherhood even though, as a group, they tend to restrict their reproductive choices. We recommend health professionals initiate conversations about reproduction early and provide a multidisciplinary approach to pregnancy and IBD in which women have confidence that their ongoing treatment will be integrated successfully with their maternity care.

Stimulating and evaluating acquired knowledge of addiction among residents through repeat testing: a pilot study.

BACKGROUND: Addictive disorders receive little attention in medical school and residency program curricula. OBJECTIVE: To evaluate an innovative learning approach encouraging and stimulating residents to focus on key competencies by testing before and after their addiction psychiatry rotation. METHODS: We developed a 50-item test on substance use disorders. Twenty-six general psychiatry residents, post-graduate year I (PGY-I) and II (PGY-II), participated in the pilot study and were divided into three groups. PGY-I residents were divided into Group 1, who were tested the last day of the rotation and again 2 months later, and Group 2, who were tested on the first and the last day of the rotation. Eight of 11 PGY-II residents agreed to participate as controls (Group 3), as they had previously completed their 2-month addiction psychiatry rotation as PGY-I's. All residents were informed that the testing would not affect their individual grade. After taking the first test, all three groups received related study materials. RESULTS: A statistically significant increase in re-test scores occurred in the combined groups (p < .001). The largest changes in scores were among Group 2 (the group taking the test on first and last day of their addiction psychiatry rotation). CONCLUSION: The greatest learning seemed to occur when residents were tested at beginning and end of the rotation. However, all residents' test scores improved to some degree, regardless of their level of training or the timing of the test. SCIENTIFIC SIGNIFICANCE: This study offers support for testing as a learning guide and as a means of stimulating residents' learning.

Levels of Trust in Information Sources as a Predictor of Protective Health Behaviors During COVID-19 Pandemic: A UAE Cross-Sectional Study.

Health information sources and the level of trust in a particular source may influence the subsequent adoption of advocated health behaviors. Information source preference and levels of trust are also likely to be influenced by sociodemographic (culture, age, gender) variables. Understanding these source-trust-behavior relationships across various national and cultural contexts is integral to improved health messaging. The present study identified the sources most frequently consulted to obtain information about COVID-19 during the pandemic's early stages in the United Arab Emirates (UAE). The study quantified levels of trust across an array of information sources, factoring in sociodemographic variables. Finally, the study explored the relationship between sociodemographic variables, levels of trust in information sources, and the adoption of COVID-19 related protective behaviors. Participants (n = 1585) were recruited during the first 2 weeks of April 2020 via announcements in the UAE media and through email networks. All participants completed a web-based survey presented in English or Arabic, as preferred. The most frequently consulted information sources were websites (health information websites), social media, government communications, and family and friends. The sources rated most trustworthy were: personal physicians, health care professionals, and government communications. There were differences in the use of sources and levels of trust according to age, gender, and education. The levels of trust in sources of information were associated with the adoption of protective behaviors, significantly so for citizens of the UAE. These findings may help inform the improvement of pandemic-related health messaging in multicultural contexts.

Validation of the Italian translation of the perceived stigma scale and resilience assessment in inflammatory bowel disease patients.

BACKGROUND: Stigmatization is the separation of an individual from a group due to aspects that make them different. Resilience may in turn influence the perception of stigma. Patients with inflammatory bowel disease (IBD) are susceptible to stigma, although data are very limited. AIM: To validate an Italian translation of the IBD perceived stigma scale (PSS) in relation to patients' resilience. METHODS: Consecutive IBD outpatients were prospectively enrolled (December 2018-September 2019) in an Italian, tertiary referral, IBD center. Clinical and demographic data were collected. Stigma and resilience were evaluated through the IBD-PSS and the 25-item Connor-Davidson Resilience Scale, respectively. The International Quality of Life Assessment Project approach was followed to translate the IBD-PSS into Italian and to establish data quality. Higher scores represent greater perceived stigma and resilience. Multivariable analysis for factors associated with greater stigma was computed. RESULTS: Overall, 126 IBD patients (mean age 46.1 ± 16.9) were enrolled. The International Quality of Life Assessment criteria for acceptable psychometric properties of the scale were satisfied, with optimal data completeness. There was no ceiling effect, whilst floor effect was present (7.1%). The discriminant validity and the internal consistency reliability were good (Cronbach alpha = 0.87). The overall internal consistency was 95%, and the test-retest reliability was excellent 0.996. The median PSS score was 0.45 (0.20-0.85). Resilience negatively correlated with perceived stigma (Spearman's correlation = -0.18, 95% confidence intervals: -0.42-0.08, P = 0.03). CONCLUSION: We herein validated the Italian translation of the PSS scale, also demonstrating that resilience negatively impacts perceived stigma.

Stigmatisation and resilience in inflammatory bowel disease.

Inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, is an immune-mediated, chronic relapsing disorder characterised by severe gastrointestinal symptoms that dramatically impair patients' quality of life, affecting psychological, physical, sexual, and social functions. As a consequence, patients suffering from this condition may perceive social stigmatisation, which is the identification of negative attributes that distinguish a person as different and worthy of separation from the group. Stigmatisation has been widely studied in different chronic conditions, especially in mental illnesses and HIV-infected patients. There is a growing interest also for patients with inflammatory bowel disease, in which the possibility of disease flare and surgery-related issues seem to be the most important factors determining stigmatisation. Conversely, resilience represents the quality that allows one to adopt a positive attitude and good adjustments despite adverse life events. Likewise, resilience has been studied in different populations, age groups, and chronic conditions, especially mental illnesses and cancer, but little is known about this issue in patients with inflammatory bowel disease, even if this could be an interesting area of research. Resilience can be strengthened through dedicated interventions that could potentially improve the ability to cope with the disease. In this paper, we focus on the current knowledge of stigmatisation and resilience in patients with inflammatory bowel disease.

Psychosocial Correlates of Depression and Anxiety in the United Arab Emirates During the COVID-19 Pandemic.

The impact of the COVID-19 pandemic on mental health is likely to be significant. Identifying vulnerable groups during the pandemic is essential for targeting psychological support, and in preparation for any second wave or future pandemic. Vulnerable groups are likely to vary across different societies; therefore, research needs to be conducted at a national and international level. This online survey explored generalized anxiety and depression symptoms in a community sample of adults (N = 1,039) in the United Arab Emirates (UAE) between April 8th and April 22nd, 2020. Respondents completed symptom measures of depression (PHQ8) and generalized anxiety (GAD7), along with psychosocial and demographic variables that might potentially influence such symptoms. Bivariate and multivariate associations were calculated for the main study variables. Levels of anxiety and depression were notably higher than those reported in previous (pre-pandemic) national studies. Similar variables were statistically significantly associated with both depression and anxiety, most notably younger age, being female, having a history of mental health problems, self or loved ones testing positive for COVID-19, and having high levels of COVID-related anxiety and economic threat. Sections of the UAE population experienced relatively high levels of depression and anxiety symptoms during the early stages of the pandemic. Several COVID-related and psychosocial variables were associated with heightened symptomatology. Identifying such vulnerable groups can help inform the public mental health response to the current and future pandemics.

Pregnancy and inflammatory bowel disease: Do we provide enough patient education? A British study of 1324 women.

AIM: To examine patient knowledge and factors influencing knowledge about pregnancy in British women with inflammatory bowel disease (IBD). METHODS: This is a post hoc analysis of a study of female members of Crohn's and Colitis United Kingdom, aged 18-45 years who were sent an online questionnaire recording patient demographics, education, employment, marital status, and disease characteristics. Disease related pregnancy knowledge was recorded using Crohn's and colitis pregnancy knowledge score (CCPKnow). RESULTS: Of 1324 responders, 776 (59%) suffered from Crohn's disease, 496 (38%) from ulcerative colitis and 52 (4%) from IBD-uncategorised. CCPKnow scores were poor (0-7) in 50.8%, adequate (8-10) in 23.6%, good (11-13) in 17.7% and very good (≥ 14) in 7.8%. Multiple linear regression analysis revealed that higher CCPKnow scores were independently associated with higher educational achievement (P < 0.001), younger age at diagnosis (P = 0.003) and having consulted a health care professional about pregnancy and IBD (P = 0.001). CONCLUSION: Knowledge was poor in 50%. Speaking with health-care professionals was a modifiable factor associated with better knowledge. This illustrates the importance of disease related pregnancy education.

What Factors Might Drive Voluntary Childlessness (VC) in Women with IBD? Does IBD-specific Pregnancy-related Knowledge Matter?

INTRODUCTION: Inflammatory Bowel Disease (IBD) affects many women of childbearing age, and rates of voluntary childlessness (VC) exceed those of the general population by far. The factors surrounding VC remain incompletely understood. METHODS: Female members of the patient organisation Crohn's and Colitis UK aged 18-45 years were invited to complete an online questionnaire collecting data on demographics, disease characteristics, Crohn's and Colitis pregnancy-specific disease-related knowledge (CCPKnow), and childlessness status. RESULTS: A total of 1324 women (mean age 33 years) completed the survey: 776 (59%) were diagnosed with Crohn's disease (CD), 496 (38%) with ulcerative colitis (UC) and 4% with inflammatory bowel disease-unclassified (IBD-U); 40% had children (14% pre-diagnosis (I); 26% post-diagnosis (II)), 36% planned to have children at some stage (III), 7% reported fertility problems (IV), and 17% were classified as voluntarily childless (VC). VC was associated with poorer CCPKnow scores [5.98 vs. 7.47 in (III); p < 0.001], older age [35 years old vs. 28 years old in (II); p < 0.001], unemployment (9.7% VC; p < 0.001), being single (34.5% VC; p < 0.001) not seeking medical advice (p < 0.001), and diagnosis of CD (19.3% vs. 13.9% UC; p = 0.015). Women with VC had more hospital admissions [mean 2.85 vs. 2.17 (III); p = 0.03] and surgical interventions [mean 1.27 vs. 0.65 (III); p < 0.001] CONCLUSION: The aetiology of VC in women with IBD is multifactorial. Women's choice regarding children appears related to disease burden. VC is also associated with poor knowledge (CCPKnow), and women may stay childless unnecessarily. Patient education programmes could help to reduce the rate of VC in women with IBD, through correcting misconceptions and alleviating patient concerns.