Physical activity habits, limitations and predictors in people with inflammatory bowel disease: a large cross-sectional online survey

Background: Limited evidence suggests that physical activity has beneficial effects in people with inflammatory bowel disease (IBD). This study aimed to determine the physical activity habits of adults with IBD, the limitations to physical activity they experience because of their disease, and the extent to which their physical activity is affected by various demographic, clinical, and psychological factors. Methods: Data were collected on 859 adult participants (52% with Crohn's disease, 75% women) through an online survey conducted between May and June 2016. Measures included physical activity (International Physical Activity Questionnaire), psychological symptoms (Hospital Anxiety and Depression Scale), fatigue (subitems of IBD fatigue scale), exercise perceptions (Exercise Benefits/Barriers Scale), and disease activity. Regression analyses were used to identify predictors of physical activity. Results: Only 17% of respondents were categorized as "high active." Self-reported physical activity levels decreased, and fatigue and psychological scores increased, with increasing disease activity. Walking was the most common activity performed (57% of respondents) and running/jogging the most commonly avoided (34%). Many participants (n = 677) reported that IBD limited their physical activity, for reasons including abdominal/joint pain (70%), fatigue/tiredness (69%), disease flare-up (63%), and increased toilet urgency (61%). Physical activity was independently associated with depression, disease activity, and perceived barriers to exercise in people with Crohn's disease, and depression and age in people with ulcerative or indeterminate colitis (all P <= 0.038). Conclusions: This survey highlights several important factors that should be considered by designers of future physical activity interventions for people with IBD

Experience with and attitudes towards psychotherapy and antidepressants among patients with inflammatory bowel disease and functional gastrointestinal disorders : An online patient survey to inform system design

This study aimed to explore and compare experiences with and attitudes toward psychotherapy and antidepressants of patients with inflammatory bowel disease (IBD) and functional gastrointestinal disorders (FGiDs). Patients from gastroenterology clinic databases were invited to an online survey. Student\u27s t test, Mann-Whitney U test, chi-square test, and Fisher\u27s test were used to compare patients with IBD and FGiD on demographics and variables of interest. Of 86 participants, 56 (65%) had IBD and 30 (35%) had FGiDs. Mean levels of anxiety, depressive, and stress symptoms were within the moderate to severe range. Psychological care and antidepressants were offered to significantly more FGiD than to IBD respondents (37% vs. 9%; p = .009). Although the symptoms were generally reduced after the prescription of antidepressants, only 30% of IBD respondents and 21% of FGiD respondents using antidepressants would recommend them to others. In contrast, 53% of IBD respondents and 69% of FGiD respondents who used psychotherapy would recommend it to others. Both these therapies were valued by recipients; however, neither was reported to improve gastrointestinal (GI) symptoms. Given the high desire for and positive experiences of psychological care for these 2 common GI conditions, access to formal psychological support services within GI clinics would appear to be the most efficient model

Doctor communication quality and friends' attitudes influence complementary medicine use in inflammatory bowel disease

AIM: To examine the frequency of regular complementary and alternative therapy (CAM) use in three Australian cohorts of contrasting care setting and geography, and identify independent attitudinal and psychological predictors of CAM use across all cohorts. METHODS: A cross sectional questionnaire was administered to inflammatory bowel disease (IBD) patients in 3 separate cohorts which differed by geographical region and care setting. Demographics and frequency of regular CAM use were assessed, along with attitudes towards IBD medication and psychological parameters such as anxiety, depression, personality traits and quality of life (QOL), and compared across cohorts. Independent attitudinal and psychological predictors of CAM use were determined using binary logistic regression analysis. RESULTS: In 473 respondents (mean age 50.3 years, 60.2% female) regular CAM use was reported by 45.4%, and did not vary between cohorts. Only 54.1% of users disclosed CAM use to their doctor. Independent predictors of CAM use which confirm those reported previously were: covert conventional medication dose reduction (P < 0.001), seeking psychological treatment (P < 0.001), adverse effects of conventional medication (P = 0.043), and higher QOL (P < 0.001). Newly identified predictors were CAM use by family or friends (P < 0.001), dissatisfaction with patient-doctor communication (P < 0.001), and lower depression scores (P < 0.001). CONCLUSION: In addition to previously identified predictors of CAM use, these data show that physician attention to communication and the patient-doctor relationship is important as these factors influence CAM use. Patient reluctance to discuss CAM with physicians may promote greater reliance on social contacts to influence CAM decisions.Réme Mountifield, Jane M Andrews, Antonina Mikocka-Walus and Peter Bampto

Controversies Revisited : A Systematic Review of the Comorbidity of Depression and Anxiety with Inflammatory Bowel Diseases.

BACKGROUND: Although mental health concerns are known to occur commonly for those with inflammatory bowel diseases (IBD), the nature of this comorbid relationship has not been systematically reviewed to date. A review in 2007 identified 5 controversies regarding anxiety/depression rates and various comparators between and within IBD. We aimed to systematically analyze and critique the current evidence regarding this comorbidity, providing an update to the 5 controversies. METHODS: Ebscohost Medline, CINAHL, Embase, and PsychINFO were searched between 2005 and 2014 using systematic review methodology. Controlled quantitative studies examining either symptoms or diagnoses of anxiety and depression in IBD were included in the review, with study quality assessed using a scale developed a priori to evaluate observational research. RESULTS: (1) IBD versus healthy controls (pooled mean proportions) (n = 13 studies): anxiety 19.1% versus 9.6%, depression 21.2% versus 13.4%; (2) IBD inactive versus IBD active disease (n = 26): anxiety 28.2% versus 66.4%, depression 19.9% versus 34.7%; (3) ulcerative colitis versus Crohn's disease (n = 28): anxiety 31% versus 37%, depression 22% versus 24.4%; (4) IBD versus other chronic medical conditions (n = 17): anxiety 41.9% versus 48.2%, depression 14.5% versus 28.4%; (5) onset of anxiety/depression before or after IBD onset (n = 2): adults more likely to develop anxiety/depression before IBD onset, but a substantial proportion develops depression after onset; an increased risk for children of developing anxiety/depression after IBD onset. CONCLUSIONS: The high rates of anxiety and depression for those with IBD, particularly when disease is active, warrant a systemic approach to screening and treatmen

Does Computerized Cognitive Behavioral Therapy Help People with Inflammatory Bowel Disease? : A Randomized Controlled Trial

BACKGROUND: Cognitive behavioral therapy may be useful for improving health-related quality of life (HRQOL) of at least some patients with inflammatory bowel disease (IBD), especially those with psychiatric comorbidities. However, cognitive behavioral therapy can be difficult to access. These difficulties can be overcome by computerized cognitive behavioral therapy (CCBT). This is a randomized controlled trial of a self-administered CCBT intervention for patients with IBD focused on improving HRQOL. It is hypothesized that CCBT completers will have an improved HRQOL relative to people not allocated to CCBT. METHODS: Patients with IBD were randomly allocated to CCBT (n = 113) versus treatment as usual (n = 86). The IBD Questionnaire at 12 weeks after baseline was the primary outcome, while generic HRQOL, anxiety, depression, coping strategies, perceived stress, and IBD symptoms were secondary outcomes. Outcomes were also measured at 6 months after baseline. Predictors of dropout were also determined. RESULTS: Twenty-nine CCBT participants (25.7%) completed the CCBT. The IBD Questionnaire was significantly increased at 12 weeks in CCBT completers compared with treatment-as-usual patients (F = 6.38, P = 0.01). Short Form-12 mental score (F = 5.00, P = 0.03) was also significantly better in CCBT compared with treatment-as-usual patients at 12 weeks. These outcomes were not maintained at 6 months. The predictors of dropout were baseline depression, biological use, lower IBD Questionnaire scores, and not having steroids. CONCLUSIONS: Improvements at 12 weeks after baseline were not maintained at 6 months. Future research should aim to improve adherence rates. Moreover, CCBT may not work for patients with IBD with comorbid depression

Patient satisfaction with treatment for alcohol use disorders: comparing patients with and without severe mental health symptoms

BACKGROUND: Previous studies suggest patients with co-occurring alcohol use disorders (AUDs) and severe mental health symptoms (SMHS) are less satisfied with standard AUD treatment when compared to patients with an AUD alone. This study compared patient satisfaction with standard AUD treatment among patients with and without SMHS and explored how standard treatment might be improved to better address the needs of these patients. METHODS: Eighty-nine patients receiving treatment for an AUD either at an inpatient hospital, outpatient clinic, inpatient detoxification, or residential/therapeutic community services were surveyed. Patient satisfaction with treatment was assessed using the Treatment Perception Questionnaire (range: 0-40). Patients were stratified according to their score on the Depression Anxiety Stress Scale. Forty patients scored in the extremely severe range of depression (score &gt;14) and/or anxiety (score &gt;10) (indicating SMHS) and 49 patients did not. An inductive content analysis was also conducted on qualitative data relating to areas of service improvement. RESULTS: Patients with SMHS were found to be equally satisfied with treatment (mean =25.10, standard deviation =8.12) as patients with an AUD alone (mean =25.43, standard deviation =6.91). Analysis revealed that being an inpatient in hospital was associated with reduced treatment satisfaction. Patients with SMHS were found to be significantly less satisfied with staffs\u27 understanding of the type of help they wanted in treatment, when compared to patients with AUDs alone. Five areas for service improvement were identified, including staff qualities, informed care, treatment access and continuity, issues relating to inpatient stay, and addressing patients\u27 mental health needs. CONCLUSION: While findings suggest that AUD treatment services adequately meet the needs of patients with SMHS in treatment, patients with SMHS do feel that staff lack understanding of their treatment needs. Findings have important implications as to how current health care practice might be improved according to the patient\u27s perspective of care

"My midwife said that having a glass of red wine was actually better for the baby" : A focus group study of women and their partner's knowledge and experiences relating to alcohol consumption in pregnancy

Background: While it is well established that alcohol can cross the placenta to the foetus and can affect an infant's development, many women continue to drink during pregnancy. For this reason it is important to determine what information is being provided, what information may be missing, and the preferred sources of information on this issue. In order to improve prevention strategies, we sought to understand the knowledge and experiences of pregnant women and their partners regarding the effects of alcohol consumption during pregnancy.\ud \ud Methods: The current study utilised a qualitative study design in order to gain insight into the views and experiences of pregnant women, newly delivered mothers and their partners. Focus groups examined the participant’s knowledge about the effects of alcohol consumption during pregnancy, the sources of information on this issue, and the psycho-social influences on their drinking behaviour. Five focus groups were conducted involving a total of 21 participants (17 female). A six-stage thematic analysis framework was used to analyse all focus group discussions in a systematic way.\ud \ud Results: Seven major themes were identified from the focus group data: 1) knowledge of Foetal Alcohol Spectrum Disorders; 2) message content and sources; 3) healthcare system; 4) society and culture; 5) partner role; 6) evaluation of risk; and 7) motivation. The findings indicated that although the majority of participants knew not to drink alcohol in pregnancy they had limited information on the specific harmful effects. In addition, routine enquiry and the provision of information by health care professionals were seen as lacking.\ud \ud Conclusions: The findings of this research provide important insights in to the relationship between pregnant women, their partners, and their healthcare providers. Several recommendations can be made on the basis of these findings. Firstly, public health messages and educational materials need to provide clear and consistent information about the effects of alcohol consumption on the developing baby. Additionally, more thorough and consistent routine enquiry for alcohol consumption in pregnant women needs to occur. Finally, it is important to ensure ongoing education for health professionals on the issue of alcohol consumption during pregnancy

Incidence and outcomes of major trauma assaults: a population-based study in Victoria

OBJECTIVE: To describe the incidence and outcomes of assault resulting in serious injury in Victoria. DESIGN AND SETTING: Analysis of population-based data from the Victorian State Trauma Registry for assaults between 1 July 2001 and 30 June 2007. MAIN OUTCOME MEASURES: Overall trends in the rate of assault-related major trauma, inhospital mortality, and functional outcomes 6 months after injury as measured by the Extended Glasgow Outcome Scale. RESULTS: The rate of assault-related major trauma rose significantly over the 6-year study period (incidence rate ratio [IRR], 1.21 [95% CI, 1.16-1.26]), particularly for blunt assault (IRR, 1.33 [95% CI, 1.26-1.41]). There were 803 admissions for major trauma related to assault: 484 (60%) were for blunt trauma and 319 (40%) for penetrating trauma. Most patients were young men. Compared with penetrating trauma, blunt trauma was associated with more severe injury; 396 patients (82%) with blunt trauma had serious head injuries, and 102 (24%) of these required inpatient rehabilitation. A higher percentage of patients with penetrating trauma died in hospital compared with those with blunt trauma (35 [11%] v 23 [5%]; P = 0.001). Follow-up at 6 months showed that only 19% of respondents (42 patients) had made a complete recovery; outcomes at 6 months were worse for patients with blunt trauma than for those with penetrating trauma. CONCLUSIONS: The incidence of assault resulting in severe trauma rose significantly between 2001-02 and 2006-07, mostly due to a rise in assault resulting in blunt trauma. The increase in incidence, the young age of the victims, and the potential for high burden of injury and poor outcome, combined with the preventable nature of assault, highlight the importance of developing effective assault-prevention strategies