Celiac Disease and Inflammatory Bowel Disease are Associated with Increased Risk of Eating Disorders: An Ontario Health Administrative Database Study.

BACKGROUND: Previous national registry studies have reported an increased risk of eating disorders in immune-mediated conditions (inflammatory bowel disease [IBD] and celiac disease). Our objective was to examine the association between immune-mediated GI diseases and incident eating disorders in Ontario. METHODS: This was a retrospective matched cohort study of individuals <50 years of age with a diagnosis of an immune-mediated GI disease between 2002 and 2020 ("cases"). Those with a pre-existing eating disorder were excluded. Cases (n=83,920) were matched with controls (n=167,776) based on birth year, sex, and region of residence. Incidence rate ratio and hazard ratio were estimated using Poisson regression model and adjusted Cox proportional models, respectively. RESULTS: Over the follow-up period (up to January 31, 2022), 161 cases and 160 controls were identified with eating disorders. The overall incidence rate ratio (95% CI, p-value) of eating disorders in immune-mediated GI disease was 1.99 (1.6-2.5, p<0.001). The adjusted hazard ratios for eating disorder in cases with immune-mediated GI diseases was 1.98 (1.6-2.5, p<0.001). In the pediatric group of incident cases (≤18 years of age), overall adjusted hazard ratio was 2.62 (1.9-3.7, p<0.001)) compared to 1.56 (1.02-2.4, p=0.041) for adults (>18 years of age). The largest hazard ratio of 4.11 (1.6-10.3, p=0.003) was observed for pediatric incident cases of ulcerative colitis. CONCLUSION: IBD and celiac disease are associated with the development of eating disorders. The magnitude of the association was stronger in the pediatric age group, underscoring the need for early screening and detection.

Individual predictors of tactical planning performance in junior military officers.

This exploratory study examined the influence of personal and psycholinguistic factors on tactical planning performance in a convenience sample of Australian Army personnel. Sixty male junior officers undertaking a tactical training course completed self-report measures of decision-making style, problem-solving appraisal, personality, and tactical planning expertise. A measure of general cognitive ability was sourced from participants' military records. During the course, officers completed several tactical planning exercises that were assessed by course instructors, and an overall measure of tactical planning performance was derived. Psycholinguistic data was derived from participants' thought processes elicited during an analogous planning exercise using a written think-aloud protocol. Automatic linear modeling analyses identified the combination of greater expertise and intuitive decision-making style, less spontaneous decision-making style and problem-solving confidence, younger age, and greater use of words relating to risk and past-focused concepts in their thought records, as significant predictors of better tactical planning, accounting for 55% of the variance in performance. Additionally, general cognitive ability, conscientiousness, and rational decision-making style shared moderate positive bivariate correlations with planning performance. This research has identified individual factors that contribute to tactical mission planning, along with future research avenues, which may inform the training of military commanders at the tactical level.

Self-Expanding Metallic Stents for the Management of Emergency Malignant Large Bowel Obstruction: a Systematic Review.

OBJECTIVES: This paper evaluates the safety and effectiveness of self-expanding metallic stents (SEMS) for the management of emergency malignant colorectal obstruction in patients otherwise requiring multi-stage surgery. No systematic review has been conducted comparing SEMS to only multi-stage surgery. METHODS: Bibliographic databases, including Cochrane, PubMed, EMBASE, and CINAHL, were searched in September 2011 and repeated in November 2013. A pre-determined protocol outlined the study inclusion and appraisal. RESULTS: Forty articles were included, seven compared SEMS to multi-stage surgery. Included studies were of low to moderate quality. Bowel perforation was the most severe stent-related complication, while tumor- and stent-related events occurred most frequently. No significant differences in rates of obstruction relief were reported between treatments, and results regarding relative quality of life were inconclusive. SEMS recipients progressed to elective surgery sooner and required shorter post-procedural hospital stays, but commonly required re-intervention. SEMS provided enduring palliative relief of obstruction, with comparable survival longevity between treatments. Conclusion: SEMS placement is a viable alternative to multi-stage surgery, providing patients with benefits as a bridge-to-surgery and relief of obstruction in a palliative context, with minimal differences in clinical success and safety compared to multi-stage surgery.

Systematic review of hyperbaric oxygen therapy for the treatment of non-neurological soft tissue radiation-related injuries.

PURPOSE: The purpose of this paper was to provide an evidence-based evaluation of the safety and effectiveness of hyperbaric oxygen therapy (HBOT) for the treatment of non-neurological soft tissue radiation-related injuries (STRI). METHODS: Systematic searches of medical bibliographic databases, the Internet, and lists of references were conducted in December 2010 and April 2013 to identify relevant primary studies. Inclusion and classification of papers was resolved through the application of a predetermined protocol. Information on both the safety and effectiveness of HBOT was analyzed. RESULTS: Forty-one articles were included, with 11 comparing HBOT to a regimen without HBOT. Comparative evidence varied considerably in methodological quality, and numerous limitations were identified. Absolute data showed that serious adverse events after HBOT were rare, while more common adverse events were minor and self-limiting. Compared to observation, conventional, or sham therapies, evidence of benefit in clinical outcomes was shown for HBOT for radiation proctitis and wounds in irradiated soft tissue of the head and neck, but not for postirradiation soft tissue edema or radiation cystitis. Clinical outcomes differed little between HBOT and argon plasma coagulation for radiation proctitis and between HBOT and hyaluronic acid for radiation cystitis. CONCLUSIONS: HBOT is a safe intervention which may offer clinical benefits to patients suffering from radiation proctitis and non-neurological STRI of the head and neck. However, differing clinical responses across STRI demonstrate a need for further well-designed clinical trials to validate the use of HBOT for individual STRI, both as an adjunct to conventional treatments and relative to definitive treatments.

Effort-reward imbalance at work and driving anger in an Australian community sample: is there a link between work stress and road rage?

Both workplace stress and road rage are reported to be on the increase. This study examined the effort-reward imbalance (ERI) model of work stress and its relationship with general anger and driving anger in a community sample of 130 Australian workers. It also examined international differences in driving anger, with Australian motorists reporting lower levels of driving anger than American motorists but higher levels than British motorists. Hierarchical multiple regressions confirmed ERI increased driving anger via the mediating variables of general anger and overcommitment; individuals suffering ERI may develop increased general anger or overcommitment, in turn increasing propensity to experience driving anger. Regressions also showed that overcommitment (but not general anger) moderated the effect of ERI on driving anger; ERI has a greater influence on increasing driving anger in individuals with high overcommitment at work. The results have considerable implications for the safety and emotional health of individuals who perceive an imbalance between their efforts and rewards at work, and overcommitted individuals may be at greater risk. The wider implications of the relationship between work stress, emotional well-being and driving anger in employees, along with the potential of driver education interventions, are discussed as public health issues.