Difficulties in emotion regulation and well-being in breast cancer.

Objective: Breast cancer is responsible for disruptive changes in women's lives, causing them to experience diverse and intense negative emotions that can affect their perception of well-being. The present study aimed to characterize difficulties in emotion regulation (ER), according to Gratz and Roemer's multidimensional assessment, in women with breast cancer and to relate them with General Well-Being and its different domains: Physical, Social/Familial, Emotional, and Functional. Method: Ninety-five Portuguese women with breast cancer aged between 32 and 75 years answered a sociodemographic and clinical questionnaire and the Portuguese versions of the Difficulties in Emotion Regulation Scale and the Functional Assessment of Cancer Therapy - General. Data were collected in an oncology public hospital. Results: In general, difficulties in ER presented negative correlations with General Well-Being and its domains. The multiple regression analysis findings indicated that two specific types of difficulties, Limited Access to ER Strategies and Lack of Emotional Clarity, play a significant role in predicting well-being, especially in the Emotional domain, which was most compromised in these patients. Conclusions: These difficulties should be approached within psycho-oncological interventions as they are essential contributors to improving emotional and general well-being and fostering psychological adaptation to breast cancer.

Psychometric analysis of the body responsiveness questionnaire in the Portuguese population.

Body responsiveness refers to the tendency to be attuned to the body's needs and use interoceptive information to guide behavior. Despite its potential beneficial effect on the development of positive body image, this construct is currently understudied. To boost research in this area, we examined the factor structure, gender invariance, and psychometric properties of a Portuguese translation of the Body Responsiveness Questionnaire (BRQ). A total of 650 men and women (aged 18-80 years) completed the Portuguese BRQ. To assess its convergent validity, participants also completed measures of body appreciation, emotion regulation, depression symptoms, and psychological quality of life. Exploratory factor analysis indicated a two-factor structure of the BRQ, which was upheld using confirmatory factor analysis: "Importance of Interoceptive Awareness" (ω = .85-.87) and "Perceived Connection" between body and mind (ω = .71-.74). BRQ scores had partial scalar invariance across gender, and no significant gender differences. Convergent and known-groups validity was supported. Participants with overweight/obesity (vs. normal weight) and middle-aged adults (vs. young adults) assigned higher importance to body signals to guide behavior. The Portuguese version of the BRQ is a psychometrically sound measure of body responsiveness and it may contribute to a comprehensive assessment of positive body image to guide intervention.

Oral-motor function in older people: Exploring new dimensions of frailty.

BACKGROUND: Oral-motor performance for speech and swallowing, and verbal fluency represent important domains that can determine frailty thresholds in older people. OBJECTIVES: The study aims to explore the association between oral-motor performance and verbal fluency to achieve a comprehensive measurement of the frailty phenotype. METHODS AND PROCEDURES: An exploratory and inferential cross-sectional study was carried out in two nursing homes and 2 day care centres. The study comprised a sample of 95 individuals with a mean age of 83 years. The oral-diadochokinesis test (ODDK), water swallow test (WST), time of mastication and swallowing (TOMASS), maximum tongue pressure, verbal fluency, physical phenotype and Mini-Mental State Examination (MMSE) were used as measurements variables. RESULTS: The comparison of mean values between the performance of observed and normative values for the target population was shown to be statistically significant for all the measurements and between the pre-frail and frail. CONCLUSIONS: The results of this study add to the growing body of evidence that oral-motor function for speech and swallowing and verbal fluency are relevant to the diagnosis and management of the frailty condition in older people. The frailty syndrome is more than just the traditionally observed physical function, rather it is a multidimensional construct, where additional dimensions should be considered when evaluating frailty in clinical practice.

Relating transcription, executive functions and text quality in Grades 2-3: A cross-lagged panel analysis.

BACKGROUND: It has been suggested that children's writing is dependent on transcription and executive functions. However, there is a need for more research examining the relationships among those variables in primary school children, given that most existing studies are cross-sectional and assess transcription and executive functions separately, and there are scarce and mixed longitudinal findings. AIMS: This study used a cross-lagged panel model to explore the relationships among transcription skills, executive functions and text quality from Grade 2 to Grade 3. SAMPLE: The sample included 353 Portuguese children (195 boys, 155 girls) in Grade 2, who were reassessed in Grade 3. METHODS: Children were assessed on transcription, executive functions and writing tasks at two time points. RESULTS: Transcription skills and executive functions in Grade 2 positively predicted the same variables in Grade 3. At Grade 2, transcription skills were associated with executive functions and text quality. At Grade 3, we only found an association between executive functions and text quality. Finally, text quality in Grade 2 predicted transcription skills in Grade 3, but both transcription and executive functions in Grade 2 did not predict text quality in Grade 3. CONCLUSIONS: Transcription skills and executive functions seem to be stable over time, but previous performance on these skills does not seem to predict later text quality. Overall, these findings do put into question the direction of the typically assumed relationships, especially between transcription and text quality. Findings also provide information that can guide the development of instructional programmes in primary school.

Psychometric properties and convergent and divergent validity of the Portuguese Yale Food Addiction Scale 2.0 (P-YFAS 2.0).

PURPOSE: The construct of food addiction has been gaining increased attention as a research topic. Currently, the Yale Food Addiction Scale 2.0 is the only measure to operationalize the addictive-like eating behavior according to addiction criteria proposed by the Diagnostic and Statistical Manual of Mental Disorders. The present study aimed at examining the psychometric properties of the Portuguese version of the Yale Food Addiction Scale 2.0, as well as investigating the convergent and divergent validity between this scale and the following measures: Eating Disorders Examination Questionnaire, Body Investment Scale, and Difficulties in Emotion Regulation Scale. We also sought to explore the moderator role of difficulties in emotion regulation in the relationship between food addiction and binge eating METHODS: A sample of 302 female college students (Mage = 21.37, SD = 3.24) completed self-report measures. RESULTS: Sixteen (5.3%) participants were diagnosed as having food addiction. The confirmatory factor analysis suggested that the original one-dimensional structure is adequate to represent the Portuguese Yale Food Addiction Scale 2.0. The symptom count scores of the scale were correlated with body mass index, eating disordered behavior, body investment, and difficulties in emotion regulation. The severity level of the scale also discriminated the severity of eating disordered behaviors, body investment, and difficulties in emotion regulation. Finally, the relationship between food addiction and binge eating was moderated by difficulties engaging in goal-directed behavior when experiencing negative emotions. CONCLUSION: The Portuguese version of the Yale Food Addiction Questionnaire 2.0 may be a useful tool to investigate food addiction. LEVEL: IV descriptive studies.

Rapid test detection of anti-infliximab antibodies: performance comparison with three different immunoassays.

BACKGROUND AND AIMS: Therapeutic drug monitoring (TDM) of infliximab (IFX) and anti-infliximab antibodies (ATIs) is essential for treatment optimisation in inflammatory bowel disease (IBD) patients. The aim of this study was to estimate and compare the agreement and accuracy between a new rapid test and three established enzyme-linked immunosorbent assays (ELISAs) to quantify ATIs levels, and to evaluate the impact of exogenous IFX on the performance of these assays. METHODS: We analysed 200 serum samples from 57 IBD outpatients in IFX induction or maintenance therapy at six IBD centres in Portugal. ATI levels were quantified using the rapid test Quantum Blue® (QB) Anti-Infliximab (Bühlmann) and three established ELISAs: In-House, Theradiag (Lisa Tracker Anti-Infliximab), and Immundiagnostik (IDKmonitor Infliximab). ATIs were quantified in patients' serum samples and spiked samples with exogenous IFX, based on analytical and clinical cutoffs. Qualitative agreement and accuracy were estimated by Cohen's kappa (k) with 95% confidence intervals. RESULTS: ATIs quantification with clinical cutoffs showed a slight agreement between QB rapid test and In-House [k = 0.163 (0.051-0.276)] and Immundiagnostik [k = 0.085 (0.000-0.177)]. Regarding IFX/ATIs status, the QB rapid test showed a substantial agreement with Theradiag [k = 0.808 (0.729-0.888)] and a fair agreement with In-House [k = 0.343 (0.254-0.431)] and Immundiagnostik [k = 0.217 (0.138-0.297)]. The QB rapid test could not detect ATI-positive levels in samples with exogenous IFX at 5-300 µg/ml. Interference on ATIs detection was observed at exogenous IFX ⩾30 µg/ml for In-house and Immundiagnostik assays. CONCLUSION: QB rapid test is only suitable to detect ATI-positive levels in the absence of IFX.

The Portuguese version of the body investment scale: psychometric properties and relationships with disordered eating and emotion dysregulation.

BACKGROUND: This study aimed to examine the psychometric properties of the Portuguese version of the Body Investment Scale (BIS) in a nonclinical sample of students and a clinical sample of outpatients with eating disorders, to analyse the differences in the BIS factors between the samples and to explore the relationships among body investment, eating disorder symptoms and difficulties in emotion regulation. METHODS: The clinical (n = 93) and nonclinical (n = 448) samples completed self-report measures. RESULTS: In contrast to the nonclinical sample, confirmatory factor analysis showed an acceptable fit for the original four-factor solution of the BIS in the clinical sample. This scale also demonstrated adequate internal consistency in both samples. Significant differences in BIS factors were found between the samples; outpatients with eating disorders presented more negative feelings about the body, less comfort with touch and lower levels of body protection than those of the students. In the clinical sample, significant relationships were found between these factors and a higher severity of disordered eating, as well as between these factors and higher difficulties in emotion regulation. CONCLUSIONS: The Portuguese version of the BIS is a psychometrically sound measure for the assessment of body investment, and it is especially appropriate in a clinical setting of outpatients with eating disorders.

Psychometric properties of the Portuguese version of the Invalidating Childhood Environment Scale.

PURPOSE: The current study aimed to examine the psychometric properties of the Portuguese version of the invalidating childhood environment scale (ICES) in a non-clinical and clinical sample of eating disorder (ED) patients. This study also investigated the between-sample differences regarding invalidating parental behaviors and family styles and explored the associations between invalidating childhood environments and eating pathology. METHODS: A sample of 410 high school and college students and 101 patients with a diagnosis of ED completed self-report measures. Principal component analyses and confirmatory factor analyses were conducted to examine the factor structure of the ICES. The internal consistency and the between-sample differences and associations between invalidating childhood environments and eating pathology were also tested. RESULTS: Principal component analyses and confirmatory factor analyses indicated a two-factor solution for each parent. The ICES demonstrated high internal consistency and was able to differentiate between non-clinical and clinical samples. The perception of parental invalidation was higher in ED patients, and the clinical sample presented higher scores in the chaotic and perfect family styles and lower scores in the validating family style, in comparison with the non-clinical sample. Both maternal invalidation and invalidating styles were significantly associated with a higher ED symptomatology. CONCLUSIONS: The Portuguese version of the ICES revealed adequate psychometric properties. Considering the relationship between invalidation in family and eating pathology, the ICES may be useful in clinical practice, especially among ED patients. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

The role of the perception of family environment in relation to body dissatisfaction, disordered eating and difficulties in close relationships.

PURPOSE: Invalidating childhood environments have been characterised as those in which caregivers do not validate a child's personal experiences and the communication of emotions is considered inappropriate, being either ignored or punished. The current study assessed the relationships among invalidating childhood environments, body dissatisfaction, disordered eating and difficulties in close relationships in a sample of college students. METHODS: In this study, 362 non-clinical participants with ages ranging from 17 to 25 years (M = 20.02, SD = 1.51) completed self-report measures. RESULTS: Difficulties in close relationships, body dissatisfaction and disordered eating were significantly higher in invalidating families than in validating families. Invalidating childhood environments were associated with higher body dissatisfaction and disordered eating, and both associations were mediated by difficulties in close relationships. Finally, body dissatisfaction mediates the effects of BMI and difficulties in close relationships on eating disorder symptoms. CONCLUSIONS: Perceived experiences of invalidation in childhood may be associated with eating disorder symptomatology. In addition, difficulties in close relationships during adulthood possibly contribute to the emergence of eating disorder symptoms. LEVEL OF EVIDENCE: Level V, descriptive study.

Comparing the Continuous Geboes Score With the Robarts Histopathology Index: Definitions of Histological Remission and Response and their Relation to Faecal Calprotectin Levels.

BACKGROUND AND AIMS: The histological status of ulcerative colitis [UC] patients in clinical and endoscopic remission has gained space as an important prognostic marker and a key component of disease monitoring. Our main aims were to compare two histological indexes-the continuous Geboes score [GS] and the Robarts Histopathology index [RHI]-regarding their definitions of histological remission and response, and the ability of faecal calprotectin [FC] levels to discriminate between these statuses. METHODS: This was an analysis of three prospective cohorts including 422 patients previously enrolled in other studies. RESULTS: The two continuous scores [GS and RHI] were shown to be significantly correlated [correlation coefficient of 0.806, p < 0.001] and particularly close regarding their definition of histological response: 95% and 88% of all patients classified as having/not having [respectively] histological response according to RHI also did so according to GS. Moreover, median FC levels in patients with histological response were lower than those in patients without histological response [GS: 73.00 vs 525.00, p < 0.001; RHI: 73.50 vs 510.00, p < 0.001]; a similar trend was observed when FC levels of patients in histological remission were compared to those of patients with histological activity [GS: 76.00 vs 228.00, p < 0.001; RHI: 73.50 vs 467.00, p < 0.001]. FC levels allowed us to exclude the absence of histological remission [according to RHI] and absence of histological response [according to RHI and GS], with negative predictive values varying from 82% to 96%. However, optimization of the FC cut-off to exclude the absence of histological remission, as for the continuous GS, falls within values that resemble those of the healthy population. CONCLUSION: The continuous GS and RHI histological scores are strongly correlated in their definitions of histological response. An absence of histological remission could only be excluded at physiological levels of FC.

Sexual Quality of Life in Inflammatory Bowel Disease: A Multicenter, National-Level Study.

BACKGROUND: The impact of inflammatory bowel disease (IBD) on sexual health is a leading concern among patients. Most studies focus on sexual dysfunction rather than patient-perceived sexual quality of life (SQoL). We aimed to assess SQoL in IBD patients compared with healthy controls. METHODS: This is a multicenter, cross-sectional study of IBD patients (n = 575 with Crohn's disease and n = 294 with ulcerative colitis), compared with healthy controls (n = 398), that used an anonymous self-administered questionnaire. This multimodal questionnaire included sociodemographic data and 4 validated instruments: Short IBD Questionnaire, Social Desirability Scale, Sexual QoL Questionnaire-Male/Female, Nine-item Patient Health Questionnaire. RESULTS: Inflammatory bowel disease patients reported lower SQoL (men: 77.29 vs 83.83; P < 0.001; women: 70.40 vs 81.63; P < 0.001) compared with controls. Among IBD patients, SQoL was positively correlated with health-related quality of life (HRQoL) and negatively correlated with depression symptoms. Perianal disease was associated with lower HRQoL and higher incidence of depression, but only impacted SQoL in men. In linear regression analysis for men, SQoL was associated with age, marital status, and depression (ß, -2.101; 95% confidence interval [CI], -2.505 to -1.696; P < 0.001). In women, SQoL was associated with depression (ß, -1.973; 95% CI, -2.313 to -1.632; P < 0.001) only. CONCLUSIONS: Patients with IBD had impaired SQoL compared with healthy controls. Age, widow status, and depression were independent predictors of SQoL in men with IBD, whereas in women depression was the only independent predictor. Emotional and self-esteem issues were the main concerns reported by IBD patients regarding sexual health.

Edible Coatings Enriched with Essential Oils on Apples Impair the Survival of Bacterial Pathogens through a Simulated Gastrointestinal System.

Edible coatings supplemented with essential oil components have been investigated to control spoilage microorganisms. In this study, the survival of Listeria monocytogenes and Salmonella enterica serovar Typhimurium on apples treated with edible coatings based on sodium alginate (2%) (ECs) and supplemented with essential oil components, namely eugenol (Eug) at 0.2% or in combination with 0.1% (v/v) of Eug and citral (Cit) at 0.15% was determined. Both bacterial pathogens were exposed on apples treated with ECs supplemented with Eug or Eug + Cit and challenged with gastrointestinal fluids and their survival was examined. Both pathogens were able to survive on the surface of 'Bravo de Esmolfe' apple. The use of ECs in fresh-cut fruits impaired the survival of both bacterial populations over 72 h at 4 °C. The exposure of the pathogens on apples with ECs supplemented with Eug and Cit and challenged with gastrointestinal fluids significantly reduced their survival. This study evidences that the use of alginate edible coating enriched with Eug or the combination of Eug and Cit can contribute to the safer consumption of minimally processed fruits.

Comparison of different histological indexes in the assessment of UC activity and their accuracy regarding endoscopic outcomes and faecal calprotectin levels.

OBJECTIVE: Histological remission is being increasingly acknowledged as a therapeutic endpoint in patients with UC. The work hereafter described aimed to evaluate the concordance between three histological classification systems-Geboes Score (GS), Nancy Index (NI) and RobartsHistopathologyIndex (RHI), as well as to evaluate their association with the endoscopic outcomes and the faecal calprotectin (FC) levels. DESIGN: Biopsy samples from 377 patients with UC were blindly evaluated using GS, NI and RHI. The results were compared with the patients' Mayo Endoscopic Score and FC levels. RESULT: GS, NI and RHI have a good concordance concerning the distinction between patients in histological remission or activity. RHI was particularly close to NI, with 100% of all patients classified as being in remission with NI being identified as such with RHI and 100% of all patients classified as having activity with RHI being identified as such with NI. These scores could also predict the Mayo Endoscopic Score and the FC levels, with their sensitivity and specificity levels depending on the chosen cut-offs. Moreover, higher FC levels were statistically associated with the presence of neutrophils in the epithelium, as well as with ulceration or erosion of the intestinal mucosa. CONCLUSIONS: GS, NI and RHI histopathological scoring systems are comparable in what concerns patients' stratification into histological remission/activity. Additionally, FC levels are increased when neutrophils are present in the epithelium and the intestinal mucosa has erosions or ulcers. The presence of neutrophils in the epithelium is, indeed, the main marker of histological activity.

Eating disorders and non-suicidal self-injury: Structural equation modelling of a conceptual model.

Evidence suggests several risk factors for both eating disorders (ED) and nonsuicidal self-injury (NSSI), but the relationships between these factors are not well understood. Considering our previous work and a conceptual model, this cross-sectional study aimed to assess the relationships among distal and proximal factors for the presence of NSSI in ED. We assessed 245 ED patients with the Oxford Risk Factor Interview for ED. Structural equation modelling revealed that both distal and proximal factors were related to the presence of NSSI in ED, disclosing a mediating role of the proximal factors. Stressful life events mediated the relationship between childhood sexual abuse, peer aggression, and both ED and NSSI. Childhood physical abuse was related to ED and NSSI via substance use, negative self-evaluation, and suicide attempts. Findings provided support for the conceptual model and highlight the possible mechanisms by which psychosocial factors may lead to ED and NSSI.

Unisensory and multisensory Self-referential stimulation of the lower limb: An exploratory fMRI study on healthy subjects.

BACKGROUND: The holistic view of the person is the essence of the physiotherapy. Knowledge of approaches that develop the whole person promotes better patient outcomes. Multisensory Self-referential stimulation, more than a unisensory one, seems to produce a holistic experience of the Self ("Core-Self"). OBJECTIVES: (1) To analyze the somatotopic brain activation during unisensory and multisensorial Self-referential stimulus; and (2) to understand if the areas activated by multisensorial Self-referential stimulation are the ones responsible for the "Core-Self." METHODS: An exploratory functional magnetic resonance imaging (fMRI) study was performed with 10 healthy subjects, under the stimulation of the lower limbs with three Self-referential stimuli: unisensory auditory-verbal, unisensory tactile-manual, and multisensory, applying the unisensory stimuli simultaneously. RESULTS: Unisensory stimulation elicits bilateral activations of the temporoparietal junction (TPJ), of the primary somatosensory cortex (S1), of the primary motor cortex (BA4), of the premotor cortex (BA6) and of BA44; multisensory stimulation also elicits activity in TPJ, BA4, and BA6, and when compared with unisensory stimuli, activations were found in: (1) Cortical and subcortical midline structures-BA7 (precuneus), BA9 (medial prefrontal cortex), BA30 (posterior cingulated), superior colliculum and posterior cerebellum; and (2) Posterior lateral cortex-TPJ, posterior BA13 (insula), BA19, and BA37. Bilateral TPJ is the one that showed the biggest activation volume. CONCLUSION: This specific multisensory stimulation produces a brain activation map in regions that are responsible for multisensory Self-processing and may represent the Core-Self. We recommend the use of this specific multisensory stimulation as a physiotherapy intervention strategy that might promote the Self-reorganization.

Putative Risk Factors for Non-Suicidal Self-Injury in Eating Disorders.

Evidence suggests a common association between eating disorders (EDs) and non-suicidal self-injury (NSSI). The present study aimed to investigate the potential risk factors for NSSI among ED patients. We assessed 245 ED patients with the Oxford Risk Factor Interview for ED. The results showed that 33% of ED patients reported NSSI in their lifetime. NSSI appeared to occur more frequently among binge eating/purging type ED patients than among patients with other ED and to be related to a more severe eating pathology. A younger age at the onset of eating problems, more negative self-evaluation, suicide attempts, substance abuse, parents' low weight, family tension at mealtime, parental alcohol problems, childhood abuse, peer aggression, and negative antecedent life events were more common among patients with co-occurring EDs and NSSI than among patients without NSSI. The results may inform the risk assessment and treatment of NSSI in EDs in the early detection period. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Clinical performance of an infliximab rapid quantification assay.

BACKGROUND: Therapeutic drug monitoring (TDM)-based algorithms can be used to guide infliximab (IFX) adjustments in inflammatory bowel disease (IBD) patients. This study aimed to explore a rapid IFX-quantification test from a clinical perspective. METHODS: This manuscript describes a prospective cohort study involving 110 ulcerative colitis (UC) patients on the maintenance phase of IFX. IFX trough levels were quantified using a rapid quantification assay and a commonly-used reference kit. RESULTS: Irrespective of the assay used to measure IFX, its through levels were statistically different between patients with and without endoscopic remission (Mayo endoscopic score = 0), as well as between patients stratified by their faecal calprotectin (FC) levels. Despite the fact that the two methods correlated well with each other [Spearman's rank correlation coefficient = 0.843, p < 0.001; intraclass correlation coefficients = 0.857, 95% confidence interval (CI): 0.791-0.903], there was a discernible systematic variation; values obtained with the reference kit were on average 2.62 units higher than those obtained with the rapid assay. Notwithstanding, 3 µg/ml was shown to be an acceptable cut-off to assess endoscopic status and inflammatory burden levels using both assays. The percentage of patients that had a positive outcome when the IFX concentration measured by the rapid assay ranked above 3 µg/ml was 88% both for a Mayo endoscopic score ⩽ 1 and for an FC concentration <250 µg/g. CONCLUSIONS: Based on this study, we concluded that using the rapid IFX assessment system with a 3 µg/ml threshold is a reliable alternative to the time-consuming enzyme-linked immunosorbent assays in patients on the maintenance phase of IFX.

Calprotectin and the Magnitude of Antibodies to Infliximab in Clinically-stable Ulcerative Colitis Patients are More Relevant Than Infliximab Trough Levels and Pharmacokinetics for Therapeutic Escalation.

Although infliximab (IFX) is an efficient therapy for ulcerative colitis (UC) patients, a considerably high rate of therapeutic failures still occurs. This study aimed at a better understanding of IFX pharmacokinetics and pharmacodynamics among clinically-asymptomatic UC patients. This was a multicentric and prospective study involving 65 UC patients in the maintenance phase of IFX therapy. There were no significant differences between patients with positive and negative clinical, endoscopic and histological outcomes concerning their IFX trough levels (TLs), area under the IFX concentration vs. time curve (AUC), clearance and antibodies to infliximab (ATI) levels. However, the need to undergo therapeutic escalation later in disease development was significantly associated with higher ATI levels (2.62µg/mL vs. 1.15µg/mL, p=0.028). Moreover, and after adjusting for disease severity, the HR (hazard ratio) for therapeutic escalation was significantly decreased for patients with an ATI concentration below 3µg/mL (HR=0.119, p=0.010), and increased for patients with fecal calprotectin (FC) level above 250µg/g (HR=9.309, p=0.018). In clinically-stable UC patients, IFX pharmacokinetic features cannot predict therapeutic response on a short-term basis. However, high levels of ATIs or FC may be indicative of a future therapeutic escalation.

Development and Validation of Risk Matrices for Crohn's Disease Outcomes in Patients Who Underwent Early Therapeutic Interventions.

INTRODUCTION: The establishment of prognostic models for Crohn's disease [CD] is highly desirable, as they have the potential to guide physicians in the decision-making process concerning therapeutic choices, thus improving patients' health and quality of life. Our aim was to derive models for disabling CD and reoperation based solely on clinical/demographic data. METHODS: A multicentric and retrospectively enrolled cohort of CD patients, subject to early surgery or immunosuppression, was analysed in order to build Bayesian network models and risk matrices. The final results were validated internally and with a multicentric and prospectively enrolled cohort. RESULTS: The derivation cohort included a total of 489 CD patients [64% with disabling disease and 18% who needed reoperation], while the validation cohort included 129 CD patients with similar outcome proportions. The Bayesian models achieved an area under the curve of 78% for disabling disease and 86% for reoperation. Age at diagnosis, perianal disease, disease aggressiveness and early therapeutic decisions were found to be significant factors, and were used to construct user-friendly matrices depicting the probability of each outcome in patients with various combinations of these factors. The matrices exhibit good performance for the most important criteria: disabling disease positive post-test odds = 8.00 [2.72-23.44] and reoperation negative post-test odds = 0.02 [0.00-0.11]. CONCLUSIONS: Clinical and demographical risk factors for disabling CD and reoperation were determined and their impact was quantified by means of risk matrices, which are applicable as bedside clinical tools that can help physicians during therapeutic decisions in early disease management.