The impact role of childhood traumas and life events in patients with alopecia aerate and psoriasis

© 2014, Ismail Volkan Şahiner et al.Background: Alopecia areata (AA) and psoriasis are common dermatological diseases which may be associated with psychosomatic origin. Close relationship with stressful life events has been shown both AA and psoriasis in previous studies. Dermatologic diseases which are thought to be psychosomatic origin are not examined about childhood traumas except AA. In the literature there is no study that investigates both stressful life events with childhood trauma in healthy indiviudals and dermatological diseases with psychosomatic origin such as AA and psoriasis. Objective: To determine whether stressful life events and childhood traumas play a role in AA is the first aim of this study. If it is, will this role specific for AA as a second aim? The patients with psoriasis and healthy individuals were also investigated too. Methods: Patients (range: 18-70 years of age) with a diagnosis of AA and psoriasis who admitted to Dermatology Outpatient Department of Baskent University Medical Faculty between August 2009 and July 2010 were recorded and analyzed for our study. Healthy individuals without past or present psychiatric symptoms proven by the Composite International Diagnostic Interview (CIDI) as control group were selected randomize. Forty patients with AA, 30 patients with psoriasis, and 50 healthy subjects as controls were stratified as three individual groups. The Childhood Trauma Questionnaire, the Life Events Checklist, The Beck Depression Inventory, and the Beck Anxiety Inventory and socio demographic data questionnaire were administered to the participants. Informed consent was obtained from all participants. Results: The rate of childhood traumatic events, the stressful life events, anxiety and depression scores were significantly higher in both AA and psoriasis group than healthy controls. Significant difference was not found between AA and psoriasis patients. Conclusion: Childhood traumas and stressful life events may play a role in the pathogenesis of AA. In addition, this role may also apply to other psychosomatic diseases as psoriasis. This result may let us understand the role of past and present psychological stressors in the etiology of dermatologic psychosomatic diseases. Psycho dermatologic new approaches are needed to evaluate stressful life events and childhood traumas

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)