Use of complementary and alternative medicine and low quality of life associate with the need for psychological and psychotherapeutic interventions in inflammatory bowel disease.

INTRODUCTION: Patients with inflammatory bowel disease (IBD) suffer from various symptoms, impairing their quality of life and often affecting psychosocial issues. This may lead to the need for additional psychological care. This study investigated patients' subjective need for integrated psychosomatic support and psychotherapy and indicators for it. MATERIALS AND METHODS: This is a cross-sectional multicentre study in Austrian IBD patients who were in routine care at 18 IBD outpatient clinics. Patients filled in an anonymous, validated questionnaire (Assessment of the Demand for Additional Psychological Treatment Questionnaire [ADAPT]) assessing the need for psychological care. The ADAPT gives two separate scores: the need for integrated psychosomatic support and for psychotherapy. In addition, health-related quality of life and the use of complementary and alternative medicine as well as clinical and socio-demographic variables were queried. Multivariable regression analysis was performed to estimate the effect of the previously mentioned variables on the need for additional psychological care. RESULTS: Of 1286 patients, 29.7% expressed a need for additional psychological care, 19.6% expressed a need for integrated psychosomatic support and 20.2% expressed a need for psychotherapy. In the multivariable analysis, the two strongest indicators for the need for both types of psychological care were the use of complementary and alternative medicine (for integrated psychosomatic support: odds ratio = 1.64, 95% confidence interval 1.13-2.39, p = 0.010; for psychotherapy: odds ratio = 1.74, 95% confidence interval 1.20-2.53, p = 0.004), and a low health-related quality of life score (for integrated psychosomatic support: odds ratio = 0.95, 95% confidence interval 0.94-0.96, p < 0.001; for psychotherapy: odds ratio = 0.96, 95% confidence interval 0.94-0.97, p < 0.001). DISCUSSION: About 30% of the Austrian IBD patients expressed a need for integrated psychosomatic support and/or psychotherapy. The most important indicators for this need were the use of complementary and alternative medicine and low quality of life.

Prevalence and indicators of use of complementary and alternative medicine in Austrian patients with inflammatory bowel disease.

OBJECTIVE: Complementary and alternative medicine (CAM) seems to be frequently used among patients with inflammatory bowel disease (IBD). We aimed to determine the prevalence and indicators of CAM use in Austrian IBD patients. METHODS: In a multicentre cross-sectional study, adult patients with IBD attending 18 Austrian outpatient clinics completed a multi-item questionnaire that recorded use of CAM as well as medical and socioeconomic characteristics. Patients were recruited between June 2014 and June 2015. The study outcome was the prevalence of CAM use and its socioeconomic and disease-related associations. RESULTS: A total of 1286 patients (Crohn's disease 830, ulcerative colitis 435, IBD unclassified 21; females 651) with a median age of 40 years (interquartile range 31-52 years) and a median disease duration of 10 years (4-18 years) were analysed. The prevalence of previous and/or current CAM use was 50.7%, with similar results for Crohn's disease and ulcerative colitis. In the multivariable analysis, female gender and a university education were independent socioeconomic indicators of CAM use. IBD-related indicators were longer duration of the disease and previous and/or current treatment with steroids and TNF-α inhibitors. CONCLUSION: CAM use for IBD is frequent in Austrian IBD patients and associated with female gender, higher educational level of university degree, longer duration of the disease, and treatment with steroids and TNF-α inhibitors.

Diagnostic delay in patients with inflammatory bowel disease in Austria.

BACKGROUND: Delayed diagnosis seems to be common in inflammatory bowel diseases (IBD). The study was carried out to investigate the diagnostic delay and associated risk factors in Austrian IBD patients. METHODS: In a multicenter cross-sectional study adult patients with IBD attending 18 Austrian outpatient clinics completed a multi-item questionnaire that recorded medical and socioeconomic characteristics. The study outcome was diagnostic delay defined as the period from symptom onset to diagnosis of IBD. RESULTS: A total of 1286 patients (Crohn's disease 830, ulcerative colitis 435, inflammatory bowel disease unclassified 21; females 651) with a median age of 40 years (interquartile range 31-52 years) and a median disease duration of 10 years (4-18 years) were analyzed. The median diagnostic delay was 6 months (2-23 months) in Crohn's disease and 3 months (1-10 months) in ulcerative colitis (p < 0.001). In the multivariable regression analysis Crohn's disease, greater age at diagnosis and a high educational level (compared to middle degree level) were independently associated with longer diagnostic delay. CONCLUSION: The diagnostic delay was longer in Crohn's disease than in ulcerative colitis patients and was associated with greater age at diagnosis and a higher educational level.

Diffusion tensor imaging of the spinal cord: a review / Imagem da medula espinal por tensor de difusão / Imagen de difusión tensora de la médula espinal: una revisión

Diffusion tensor imaging (DTI) is a magnetic resonance technique capable of measuring the magnitude and direction of water molecule diffusion in various tissues. The use of DTI is being expanded to evaluate a variety of spinal cord disorders both for prognostication and to guide therapy. The purpose of this article is to review the literature on spinal cord DTI in both animal models and humans in different neurosurgical conditions. DTI of the spinal cord shows promise in traumatic spinal cord injury, cervical spondylotic myelopathy, and intramedullary tumors. However, scanning protocols and image processing need to be refined and standardized.

O exame por imagem de ressonância magnética utilizando a técnica de tensores de difusão (DTI, Diffusion tensor imaging) consegue medir a magnitude e direção da difusão de moléculas de água em vários tecidos. A DTI está começando a ser usada para avaliar uma série de patologias da medula espinal, tanto para prognósticos como para orientar o tratamento. O presente artigo revisa a literatura sobre DTI da medula espinhal, em modelos animais e humanos, em diferentes condições neurocirúrgicas. A DTI da medula espinal é promissora para lesões traumáticas da medula, mielopatia espondilótica cervical e tumores intramedulares. Contudo, os protocolos de escaneamento e processamento de imagens precisam ser refinados e padronizados.

La técnica de imagen por difusión tensora (DTI, Diffusion tensor imaging) es una técnica de resonancia magnética que mide la magnitud y dirección de la difusión de moléculas de agua en varios tejidos. El uso de DTI se ha expandido para evaluar una variedad de disturbios de la columna vertebral tanto para pronóstico como para orientación de la terapia. La finalidad de este artículo es revisar la literatura sobre DTI de la médula espinal tanto en modelos animales como en humanos en diferentes condiciones neuroquirúrgicas. La DTI de la médula espinal se muestra promisora en las lesiones traumáticas de la médula, en la mielopatía espondilótica cervical y en los tumores intramedulares. Sin embargo, los protocolos de barrido y el procesamiento de imágenes necesitan ser refinados y estandarizados.

Thermoregulation and rheological properties of blood in primary Raynaud's phenomenon and the vibration-induced white-finger syndrome.

OBJECTIVE: Frequent use of vibrating tools may lead to typical attacks of Raynaud's phenomenon (RP). The present study assesses the feasibility of the use of thermographic measurements of blood rheometry in the diagnosis of vibration-induced white-finger (VWF) syndrome. SUBJECTS AND METHODS: We studied 38 patients that were suffering from RP (primary RP, n=29; VWF, n=9) and 13 controls (six men and 45 women; mean age 49.1+/-11.6 years). Superficial finger skin blood flow was assessed with an infrared thermocamera before and after exposure to heat and cold. Fibrinogen, whole-blood viscosity and erythrocyte aggregation at different shear rates and plasma viscosity were measured. MAIN RESULTS: In patients with RP finger temperatures after re-warming were lower than those in controls [right hand digit (DIG) I P<0.02; DIG II-V P<0.01; left hand DIG I P<0.01; DIG II-V p<0.02], male patients with primary RP had higher Fg-values (P<0.02) and a trend to higher plasma viscosity. Patients with VWF had a trend to lower plasma viscosity than controls. Whole-blood viscosity at each shear rate was highest in patients with VWF. CONCLUSION: Provocation manoeuvres are essential in the diagnosis of RP. We speculate that the decreased plasma viscosity in VWF is a compensatory physiological mechanism, probably counteracting the chronic effects of vasospasm. The rise in whole-blood viscosity could be due to endothelial injury or to a reduction in the venous blood pH level. The abnormal cold reactivity of patients with RP may be partly related to rheological factors.

High prevalence of chronic venous disease in hospital employees.

OBJECTIVES: Chronic venous disease (CVD), which comprises primary/idiopathic abnormalities of the venous system, and secondary sequels after deep venous thrombosis are major health issues in Western countries. The present study was conducted to prove the hypothesis that the development of CVD might be triggered by exogenous, occupational risk factors. METHODS: We determined the prevalence and social relationship of CVD in a wide cross-section of hospital employees (n = 209; medical doctors and nurses, medical technician assistants, secretaries, scientific staff, cleaners and utility workers) without predocumented CVD. Prevalence, known endogenous risk factors for CVD and occupational and environmental risk factors (family history of venous disease, history of deep venous thrombosis, current oral contraceptive therapy, obesity, regular participation in sports or frequent use of saunas or sun-baths, and long periods of standing during work) were investigated. The restriction in quality of life due to symptoms of CVD was also evaluated. CVD was classified according to the CEAP criteria. RESULTS: CVD was present in a total of 70 employees (34%), predominantly in women. Standing at work was a predisposing factor. We found the highest prevalence of CVD in utility workers and cleaners and the lowest prevalence in medical technician assistants, secretaries and scientific staff. CONCLUSION: The study demonstrated that within a representative cross-section of hospital employees in a University hospital the prevalence of CVD was highest in women, especially in those working in a standing position or under conditions of high temperature and humidity. The results warrant regular evaluation of risk factors with subsequent primary prophylaxis of CVD.