Positive health: An integrated quantitative approach in patients with chronic gastrointestinal and hepato-pancreatico-biliary disorders.

BACKGROUND: The concept of positive health (PH) supports an integrated approach for patients by taking into account six dimensions of health. This approach is especially relevant for patients with chronic disorders. Chronic gastrointestinal and hepato-pancreatico-biliary (GI-HPB) disorders are among the top-6 of the most prevalent chronically affected organ systems. The impact of chronic GI-HPB disorders on individuals may be disproportionally high because: (1) The affected organ system frequently contributes to a malnourished state; and (2) persons with chronic GI-HPB disorders are often younger than persons with chronic diseases in other organ systems. AIM: To describe and quantify the dimensions of PH in patients with chronic GI-HPB disorders. METHODS: Prospective, observational questionnaire study performed between 2019 and 2021 in 235 patients with a chronic GI-HPB disorder attending the Outpatient Department of the Maastricht University Medical Center. Validated questionnaires and data from patient files were used to quantify the six dimensions of PH. Internal consistency was tested with McDonald's Omega. Zero-order Pearson correlations and t-tests were used to assess associations and differences. A P value < 0.05 was considered significant. RESULTS: The GI-HPB patients scored significantly worse in all dimensions of PH compared to control data or norm scores from the general population. Regarding quality of life, participation and daily functioning, GI-HPB patients scored in the same range as patients with chronic disorders in other organ systems, but depressive symptoms (in 35%) and malnutrition (in 45%) were more frequent in patients with chronic GI-HPB disorders. Intercorrelation scores between the six dimensions were only very weak to weak, forcing us to quantify each domain separately. CONCLUSION: All six dimensions of PH are impaired in the GI-HPB patients. Malnutrition and depressive symptoms are more prevalent compared to patients with chronic disorders in other organ systems.

Public Fear of Pancreatic Diseases: Causes and Clinical Outcomes at a Single Korean Center.

Background/Aims: The public fear of pancreatic diseases including pancreatic cancer (PC) appears to be growing. The aims of this study were to evaluate the causes of fear of pancreatic diseases and assess clinical outcomes of such individuals. Methods: This was a retrospective study of 249 individuals who visited the Pancreatobiliary Diseases Center at Ewha Womans University Seoul Hospital due to the fear of pancreatic diseases between January 2019 and August 2021. Those referred from other departments or external medical facilities were excluded. Collected data included demographic details, comorbidities, causes of fear of pancreatic diseases, and the presence of pancreatic lesions in imaging studies. Results: The median age was 55 years (range, 22 to 82 years). One hundred eleven subjects (44.6%) were male. The causes of fear of pancreatic diseases were abdominal pain (n=144, 57.8%), back pain (n=114, 45.8%), body weight change (n=35, 14.1%), family history of pancreatic diseases (n=32, 12.9%), and others (n=39, 15.7%). Within the group with family history of pancreatic diseases, 25 subjects had a first-degree relative with PC. Of the 200 subjects who underwent imaging, there was no evidence of pancreatic diseases in 182 (91.0%). Pancreatic lesions identified were cystic lesions (n=15, 7.5%), non-specific calcification (n=1, 0.5%), lipoma (n=1, 0.5%), and solid tumor (n=1, 0.5%), later diagnosed as unresectable PC. Conclusions: Abdominal pain and back pain were the major causes of fear of pancreatic diseases. The prevalence of PC among those who underwent imaging was 0.5%. Such characteristics should be considered when consulting individuals with fear of pancreatic diseases.

Trends in the Utilization of Life-Sustaining Procedures and Palliative Care Consultation Among Dying Patients With Advanced Chronic Pancreas Illnesses in US Hospitals: 2005 to 2014.

AIM: Pancreas cancer continues to carry a poor prognosis. Hospitalized patients with advanced chronic pancreatic illnesses increasingly receive palliative care due to its perceived clinical benefits. Meanwhile, a growing proportion of elderly patients are reportedly receiving life-sustaining procedures. Temporal trends in the utilization of life-sustaining procedures and palliative care consultation among dying patients with advanced chronic pancreatic illnesses in US hospitals were examined. METHODS AND MATERIALS: A serial, cross-sectional analysis was carried out using the National Inpatient Sample Database. Decedents 18 years and older with a principal diagnosis of pancreas cancer or other advanced chronic pancreatic illnesses from 2005 through 2014. The compound annual growth rates (CAGRs) and Cochrane-Armitage correction of χ2 statistic were used. The receipt of life-sustaining systemic procedures, intra-abdominal local procedures and surgeries, and palliative care consultation were examined. Multilevel multivariate logistic regressions were performed to examine the association of various procedures with the utilization of palliative care consultation. RESULTS: Among 77 394 183 hospitalizations, 29 515 patients were examined. The CAGRs of systemic procedures, intra-abdominal procedures, surgeries, and palliative care were -4.19% (P = .008), 2.17%, -1.40%, and 14.03% (P < .001), respectively. The receipt of systemic procedures (odds ratio [OR] = 2.40, 95% confidence interval [CI], 2.08-2.74), local intra-abdominal procedures (OR = 1.46, 95% CI, 1.27-1.70), and surgeries (OR = 2.51, 95% CI, 2.07-3.05) was associated with palliative care consultation (Ps < .001). CONCLUSIONS: Among adults with pancreatic cancer or other advanced chronic pancreatic illnesses in the US hospitals from 2005 to 2014, the utilization of life-sustaining systemic procedures decreased while the prevalence of palliative care consultation increased.

Patient-provider relationships and health outcomes among hepatopancreatobiliary patients.

BACKGROUND: The patient-provider relationship (PPR) is an important element of health care delivery and may influence patient outcomes. The objective of the present study was to identify clinical predictors of PPR among patients with hepatopancreatobiliary (HPB) diseases and assess the association of PPR and health care utilization. MATERIALS AND METHODS: The Medical Expenditure Panel Survey database from 2008-2014 was used to identify adult patients with HPB diagnoses. A PPR score of "poor," "average," and "optimal" was calculated from the Consumer Assessment of Healthcare Providers and Systems Survey. Predictors of poor PPR and the association of PPR and health care utilization were assessed. RESULTS: Among 592 patients, PPR was optimal (210, 35.4%), average (270, 45.5%), or poor (114, 19.2%). Patients without insurance (36.3%) or with Medicaid (28.8%) were more likely to report poor PPR versus patients with private insurance (14.0%) or Medicare (15.4%) (P = 0.03). Poor (24.3%)- and low (21.5%)-income patients were more likely to report poor PPR versus middle (12.8%)- or high-income (14.0%) patients (P = 0.03). Poor mental health was also more common among patients with poor PPR (13.4%) versus average (5.4%) or optimal (3.7%) PPR (P = 0.02), and this association between poor PPR and poor mental health remained significant on multivariable analysis (odds ratio [OR] 2.43, 95% confidence interval [CI] 1.20-4.92). Poor PPR was associated with increased emergency room utilization on univariate (OR 2.50, 95% CI 1.21-5.14), but not multivariate (OR 2.18, 95% CI 0.92-5.15) analysis. CONCLUSIONS: Among patients with HPB diseases, PPR was associated with insurance type, socioeconomic status, and mental health scores. Patients reporting poor PPR were more likely to be high utilizers of the emergency room. Efforts to improve the PPR are needed and should be focused on these high-risk populations.

Effect of mobile phone reminder messages on adherence of stent removal or exchange in patients with benign pancreaticobiliary diseases: a prospectively randomized, controlled study.

BACKGROUND: Plastic and covered metal stents need to be removed or exchanged within appropriate time in case of undesirable complications. However, it is not uncommon that patients do not follow the recommendation for further stent management after Endoscopic Retrograde Cholangiopancreatography (ERCP). The effect of short message service (SMS) intervention monthly on the stent removal/exchange adherence in patients after ERCP is unknown at this time. METHODS: A prospective, randomized controlled study was conducted. After receiving regular instructions, patients were randomly assigned to receive SMS reminding monthly (SMS group) for stent removal/exchange or not (control group). The primary outcome was stent removal/exchange adherence within appropriate time (4 months for plastic stent or 7 months for covered stent). Multivariate analysis was performed to assess factors associated with stent removal/exchange adherence within appropriate time. Intention-to-treat analysis was used. RESULTS: A total of 48 patients were randomized, 23 to the SMS group and 25 to the control. Adherence to stent removal/exchange was reported in 78.2 % (18/23) of patients receiving the SMS intervention compared with 40 % (10/25) in the control group (RR 1.98, 95 % CI 1.16-3.31; p = 0 · 010). Among patients with plastic stent insertion, the median interval time from stent implantation to stent removal/exchange were 90 days in the SMS group and 136 days in the control respectively (HR 0.36, 95 % CI 0.16-0.84, p = 0.018). No difference was found between the two groups regarding late-stage stent-related complications. The rate of recurrent abdominal pain tended to be lower in SMS group without significant difference (8.7 vs 28 %, p = 0.144). Multivariate logistic regression analyses revealed that SMS reminding was the only factor associated with adherence of stent removal/exchange (OR 6.73, 95 % CI 1.64-27.54, p = 0.008). CONCLUSION: This first effectiveness trial demonstrated that SMS reminding monthly could significantly increase the patient adherence to stent removal/exchange after ERCP. TRIAL REGISTRATION: The study was respectively registered on July 10 in 2016 at ClinicalTrials.gov ( NCT02831127 ).

Quality of life in patients with long-standing chronic non-pathological pancreatic hyperenzymemia.

BACKGROUND: Chronic non-pathological pancreatic hyperenzymemia is a benign condition characterized by the persistent elevation of serum pancreatic enzymes without morphological alterations of the pancreas. No information is available regarding the quality of life of these subjects. AIM: To evaluate the physical, mental and psychological status of these subjects using SF-12 Health Survey questionnaire and the 12-item General Health Questionnaire. METHODS: Fifty-one consecutive subjects having long-standing chronic non-pathological pancreatic hyperenzymemia (duration: 11.0 years, range 5-21) were studied. The Italian version of the SF-12 questionnaire and the General Health Questionnaire were compiled by the subjects studied. RESULTS: Regarding the SF-12 questionnaire, the physical component scores and the mental component scores were 50.1 ± 8.0 and 44.7 ± 11.7, respectively and these figures were not statistically different from those of reference Italian population. Regarding the psychological status, seven subjects (13.7%) had non-psychotic-psychiatric problems. No statistical differences in the physical component score, mental component score and general health questionnaire were found between patients having non-familial or familial chronic non-pathological pancreatic hyperenzymemia. CONCLUSIONS: Subjects with long-standing chronic non-pathological pancreatic hyperenzymemia had a quality of life no different from that of the Italian population. The explanation provided by the physician regarding the benignity of long-standing chronic non-pathological pancreatic hyperenzymemia is enough to reassure this type of patient.

The association of quality-of-life measures with malignancy and survival in patients with pancreatic pathology.

OBJECTIVES: This study assessed whether pretreatment quality-of-life (QoL) scores could predict the presence of pancreatic malignancy and survival. METHODS: Patients with pancreatic lesions completed the SF-36, containing 8 domains: physical functioning, role-physical, role-emotional, bodily pain, vitality, mental health, social functioning, and general health. Data obtained included age, sex, resectability, additional antineoplastic therapy, stage, pathology, and survival. Patients were categorized by pathology (benign vs malignant), stage (local, regional, or distant), resectability (resected vs not), survival (<1 vs >1 year), and their pretreatment QoL scores. RESULTS: Of the 323 patients assessed, 210 had malignancies. In 6 of the 8 domains, patients with malignancies had lower median QoL scores compared with patients with benign lesions. Of the patients with malignancies, patients surviving at 1 year or less had lower pretreatment scores in all domains. Stage, resection, adjuvant therapy, and vitality score were independent predictors of survival. CONCLUSIONS: Patients with pancreatic malignancies had lower QoL scores than patients with benign pancreatic disease. Patients with malignancies surviving at 1 year or less had lower scores, even after controlling for stage. This suggests that pretreatment QoL scores are associated with pancreatic malignancy and survival.

Clinical and patient-reported outcomes after pancreatoduodenectomy for different diseases: a follow-up study.

OBJECTIVE: The objective of the study was to evaluate clinical features and quality of life (QoL) in a 2-year follow-up study in subjects who underwent pancreatic head resection (PHR). METHODS: One hundred ninety-seven patients with benign and malignant diseases who underwent PHR were studied. A dedicated clinical form and the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire C-30 were administered at evaluation times (immediately before surgery and 6, 12, 18, and 24 months after discharge). A sample of 197 sex- and age-matched norms was also included into the study as reference group. RESULTS: Of the 197 patients studied, 164 (83.2%) had malignant disease, and 33 had benign disease (16.8%). At initial evaluation, global health was significantly lower (P = 0.001) in the study population as compared with the norms. At the end of the study, the QoL was not significantly different from the norms, although the QoL of the 30 patients with benign disease was significantly better than that of the 72 patients with malignant disease. CONCLUSIONS: The QoL before PHR was impaired in study patients before resection as compared with the normative population, whereas in patients who survived resection, it significantly improved in the 24 months after surgery.

Personal and social comparison information about health risk: reaction to information and information search.

This study extended previous research on the impact of personal and social comparison information about health risk by asking respondents what other information they require. A total of 197 students responded to 1 of 12 vignettes describing hypothetical risks of developing pancreatic disease. These vignettes varied in terms of personal risk, comparison group risk and disease severity. Higher threat manipulations elicited higher ratings of negative affect, although perceived ambiguity moderated this effect. When information was more threatening, respondents requested more information, especially about controlling the disease threat. These results indicate the importance of providing unambiguous information, information about how to control a threat and information people want.

Endometriosis of the pancreas presenting as a cystic pancreatic neoplasm with possible metastasis.

The authors report a case of endometriosis that presented as a cystic mass in the tail of the pancreas, leading to extensive evaluation and ultimately a major surgical resection. The diagnosis was made by histopathological evaluation, revealing endometrial glands and stroma in the wall of the mass with hemorrhagic fluid in the cystic lumen, compatible with pancreatic involvement by an endometrial cyst.

The impact of personal and social comparison information about health risk.

OBJECTIVES: To examine the emotional and cognitive impact of personal and social comparison information about health risk. METHODS: A total of 970 adults responded to vignettes describing risk presentation scenarios that varied in terms of having (a) a 'real world' analogue (cardiac event) versus no such analogue (a fictitious pancreatic disease) condition, (b) high versus low levels of personal risk, and (c) no comparison group information given, comparison group risk higher or lower than own risk. RESULTS: For both the cardiac and pancreatic disease vignettes, respondents' emotional responses and estimates of their own risk were influenced by both personal and social comparison risk information. The cardiac event vignettes produced larger effects than the pancreatic disease vignettes. Unfavourable social comparison information had no discernible impact, relative to not providing any social comparison information. Favourable social comparison information resulted in greater reassurance, less worry, and perceptions of lower susceptibility. Lower personal risk generally produced similar effects, relative to higher personal risk. CONCLUSIONS: In contrast to previous theory and research in this area, we found that both personal and (favourable) social comparison risk information have emotional and cognitive consequences. We hypothesize that the perceived clarity of the information may account for the different patterns of findings in the literature.

Body composition, muscle function and psychological changes in patients undergoing operation for hepatic or pancreatic disease.

BACKGROUND: There is currently a dearth of data with respect to changes in body composition, physiological function and pSychological state in patients undergoing operative treatment for pancreatic or hepatic disease although marked changes in these variables have been reported in colorectal surgical patients. METHODS: In 36 patients (37 operations) we have studied the effect of a pancreatic or hepatic operation (with and without nutritional support) on body fat and body protein (assessed by Dual energy X-ray absorptiometry (DEXA) and anthropometry), respiratory function (measured by spirometry and vitalography), voluntary muscle function (measured by hand dynamometry) and psychological state (measured by use of the hospital anxiety and depression score and visual analogue scale for fatigue) over a 1-week period postoperatively. RESULTS: On the 3rd postoperative day there were significant changes in: grip strength 307 (135-499) to 249 (85-461) N; FEV1 2.28 (0.48-3.98) to 1.02 (0-2.42) litres/min; FVC 2.90 (0.75-5.02) to 1.28 (0.22-3.31) litres; anxiety score 7 (0-17) to 6 (1-20); depression score 3 (0-10) to 5 (0-20), and fatigue 3.9 (0.4-10) to 6.8 (1.0-9.7). These persisted on day 7 by which time mid-arm circumference and total body fat (by DEXA) had fallen from 30.1 (21.1-45.0) to 29.5 (20.2-43.2) cm, and 20.7 (5.8-53.7) to 20.4 (6.6-53.5) kg, respectively. CONCLUSION: We conclude that operative treatment for pancreatic or hepatic disease has an adverse effect on body composition, physiological function and psychological state.

Coping with health threat: social influence processes in reactions to medical test results.

In a laboratory experiment, undergraduate subjects tested positive for an enzyme deficiency they believed to be a risk factor for pancreatic disorders. All Ss were tested with a confederate who received a positive or negative test result. For half the Ss, the confederate expressed a minimizing appraisal of the deficiency's seriousness. Although Ss' concern about the test result was significantly reduced by what the confederate said, behavioral intentions were determined by the confederate's diagnostic status. The effect of the confederate's diagnostic status on intentions was mediated by Ss' perceptions of the deficiency's prevalence. The results support Leventhal's self-regulation theory and demonstrate that the opinions and health characteristics of comparison others have differential effects on cognitive, emotional, and behavioral aspects of coping with a health threat.

Illness cognition and behavior: an experimental approach.

The study of illness cognition and behavior has relied primarily on nonexperimental research designs. In this paper we review the results of a program of experimental investigations of psychological reactions to health threats. Most of the studies employ a new experimental paradigm developed to study illness cognition and behavior in the laboratory. The paradigm has been used in several experiments to examine the cognitive and motivational processes underlying reactions to medical test results. A converging series of studies has shown that denial, manifested in a variety of ways, is a common initial reaction to threatening information. In addition, the studies demonstrate that the perceived prevalence of a health disorder is an important determinant of its perceived seriousness. The insights gained from these studies illustrate the complementary roles of basic experimental research and more naturalistic observational research in the formulation of comprehensive theories of health and illness behavior.

The relationship of psychiatric disorder to gastrointestinal illness.

The definition of psychiatric illness by specific criteria has provided a new method for examining the relationship of certain gastrointestinal (GI) diseases to psychiatric disorder. Using this technique, researchers have found that rates of psychiatric diagnosis in patients with certain functional GI syndromes and Crohn's disease exceed those found in the general population and in comparably ill control groups. Timing of onset of both sets of symptoms (GI and psychiatric) suggests that the functional syndromes generally follow or coincide with the onset of psychiatric symptoms, whereas the onset of Crohn's disease is more independent. A relationship of psychiatric illness to other GI disease is suspected based on results of psychometric testing or on less structured attempts at psychiatric diagnosis employed in earlier studies. Psychiatric diagnosis by criteria definition may play an important role in more clearly understanding any relationship of psychiatric disorder to somatic GI disease as the applications of this scientific technique are expanded.

Clinical effectiveness of a pancreatic enzyme supplement.

In 23 adult patients with pancreatic insufficiency, we evaluated the efficacy of a pancreatic enzyme delivered as pH-sensitive enteric-coated pancreatic lipase microspheres, and compared it with placebo and other available enzyme supplements. In a short-term study, fecal fat was 23.5 +/- 7 g/day with the microspheres, compared with 29.9 +/- 8 with other supplements, providing fat utilization of 76 +/- 7% versus 63 +/- 10% (p less than 0.05). Microspheres reduced daily stool frequency to 1.9 movements from 4.3 on other enzymes (p less than 0.01). These results were obtained with an average intake of 10 microsphere capsules/day. In a year-long study of 22 patients, an average weight gain of 4.0 +/- 1.1 kg was observed associated with return of near-normal social and work life-style in previously housebound patients.