Background The non-alcoholic fatty liver disease (NAFLD) is the new epidemics in Northern hemisphere. This condition is associated with anxiety and depression, but data on their impact on the ...cardiovascular risk is elusive. We looked to anxiety and depression in NAFLD in correlation with echocardiography parameters. Methods 77 subjects (39 NAFLD patients, 38 controls); Liver steatosis was assessed by hepatic ultrasonography and SteatoTestTM; cardiovascular parameters by echocardiography. Anxiety was evaluated using Lehrer Woolfolk Anxiety Symptom Questionnaire (LWASQ),and depression using Beck depression inventory (BDI). Results NAFLD patients presented higher BDI scores (p: 0.009) and LWASQ global scores (p: 0.045), vs. controls. LWASQ somatic factor was significantly associated with global longitudinal strain (GLS) in linear analysis (-0.0404, p: 0.0021), while lost significance following multivariate analysis (-0.0166, p-value = 0.124). Although group (NAFLD vs. controls) predicted BDI (6.0378, p:0.005), LWASQ global score (27.5661, p: 0.016), and LWASQ somatic factor (17.5088, p: 0.004) in linear regression, they lost significance in multivariate analysis. Moreover, the relationship between interventricular septal wall thickness (IVSWT) and BDI, LWASQ global score and LWASQ somatic factor was significant in linear analysis, but statistical significance disappeared after multivariate analysis. Conclusions Although NAFLD patients presented increased anxiety and depression risk in univariate analysis, this association lost significance in multivariate analysis. A significant association between GLS levels and LWASQ somatic factor, in addition to IVSWT in anxiety and depression in univariate analysis was observed, but was lost after multivariate analysis.
The gastrointestinal (GI) motility, which is important for the digestion and absorption, may be altered in obesity. The aim of this review is to present the GI motility changes occurring in obesity, ...as well as their underlying mechanisms. We have conducted a systematic review of the published literature concerning GI motility and obesity and have described recent published data on the changes throughout the entire GI tract. Most recent discoveries include evidence supporting the increase of gastroesophageal reflux disease in obesity and inhibition of gastric motility. Intestinal transit of the distal small bowel generally slows down, ensuring enough time for digestion and absorption. Constipation is more frequent in obese patients than in those with a normal weight. The gut-brain axis plays an important role in the pathophysiology of GI motility disorders in obesity. This bidirectional communication is achieved by way of neurons, hormones, metabolites derived from intestinal microbiota and cytokines. The molecular mechanisms of GI motility changes in obesity are complex. Current data offer a starting point for further research needed to clarify the association of obesity with GI motility disorders.
Nonalcoholic fatty liver disease (NAFLD) represents one of the most common chronic liver diseases worldwide. So far, the pathogenesis of NAFLD and its more severe variant nonalcoholic steatohepatitis ...(NASH) is yet unclear, with many mechanisms being proposed as possible causes. This article aims to review the psychological factors associated with NAFLD/NASH.
Three main categories of factors have been investigated: emotional, cognitive and behavioral. Five electronic databases were searched, limited to studies published in the English language, during the period 2005-2015: PubMed, Thomson ISI - Web of Science, Scopus, ProQuest, and ScienceDirect.
Results indicated the most relevant emotional factors to be depression and anxiety. The areas of investigation for cognitive functioning concern those contents and processes related to the ability to initiate and maintain lifestyle changes. The most important behavioral factors identified are physical activity, nutrition/food intake and substance consumption: coffee, alcohol, cigarettes.
Some of the factors identified act as protective factors, other as vulnerability factors. NAFLD/NASH may be considered a cognitive-behavioral disease, the most effective management being lifestyle changes, with emphasis on diet and exercise.
Differences in the composition of the species of microorganisms in the gut may predict the evolution toward obesity and diabetes mellitus. We carried out a systematic review of the studies dedicated ...to the role of gut microbiota in diabetes mellitus and obesity.
A systematic literature search of electronic databases was performed, using the search syntax: "Gut microbiota and diabetes and obesity"; abstracts in English, with data about mechanisms of pathogenesis and treatment options by changing the gut composition were included (259 articles). Studies were excluded if they did not have an abstract, or they contained no data about the exact implication mechanism of microbiota.
There are differences regarding the composition of the gut microbiota in healthy people and type 2 diabetes mellitus patients; the later proved to have significantly decreased Clostridium components, and increased Lactobacillus and Bifidobacterium populations.The intestines of obese subjects are less rich in microbial genes, have a reduced amount of Bacteroidetes and an increased amount of Firmicutes. Fecal microbiota transplantation from obese subjects resulted in adoption of the donor somatotype. Early differences in gut microbiota composition (higher number of Bifidobacteria) function as diagnostic markers for the development of type 2 diabetes mellitus in high-risk patients.The gut endotoxins contribute to metabolic syndrome manifestation. Experimental studies with prebiotic showed lower levels of cytokines and antiobesity potential.
Microbiota composition and its changes since childhood have an important role in the metabolic syndrome. Any intervention in order to prevent or treat obesity and diabetes mellitus should have as target the gut immune system.
Objective To assess if very elderly people with hypertension obtain early benefit from antihypertensive treatment.Design One year open label active treatment extension of randomised controlled trial ...(Hypertension in the Very Elderly Trial (HYVET)).Setting Hospital and general practice based centres mainly in eastern and western Europe, China, and Tunisia.Participants People on double blind treatment at the end of HYVET were eligible to enter the extension.Interventions Participants on active blood pressure lowering treatment continued taking active drug; those on placebo were given active blood pressure lowering treatment. The treatment regimen was as used in the main trial—indapamide SR 1.5 mg (plus perindopril 2-4 mg if required)—with the same target blood pressure of less than 150/80 mm Hg.Main outcome measures The primary outcome was all stroke; other outcomes included total mortality, cardiovascular mortality, and cardiovascular events.Results Of 1882 people eligible for entry to the extension, 1712 (91%) agreed to participate. During the extension period, 1682 patient years were accrued. By six months, the difference in blood pressure between the two groups was 1.2/0.7 mm Hg. Comparing people previously treated with active drug and those previously on placebo, no significant differences were seen for stroke (n=13; hazard ratio 1.92, 95% confidence interval 0.59 to 6.22) or cardiovascular events (n=25; 0.78, 0.36 to 1.72). Differences were seen for total mortality (47 deaths; hazard ratio 0.48, 0.26 to 0.87; P=0.02) and cardiovascular mortality (11 deaths; 0.19, 0.04 to 0.87; P=0.03).Conclusion Very elderly patients with hypertension may gain immediate benefit from treatment. Sustained differences in reductions of total mortality and cardiovascular mortality reinforce the benefits and support the need for early and long term treatment.Trial registration Clinical trials NCT00122811.
Summary
Background
Cross‐cultural, multinational research can advance the field of functional gastrointestinal disorders (FGIDs). Cross‐cultural comparative research can make a significant ...contribution in areas such as epidemiology, genetics, psychosocial modulators, symptom reporting and interpretation, extra‐intestinal co‐morbidity, diagnosis and treatment, determinants of disease severity, health care utilisation, and health‐related quality of life, all issues that can be affected by geographical region, culture, ethnicity and race.
Aims
To identify methodological challenges for cross‐cultural, multinational research, and suggest possible solutions.
Methods
This report, which summarises the full report of a working team established by the Rome Foundation that is available on the Internet, reflects an effort by an international committee of FGID clinicians and researchers. It is based on comprehensive literature reviews and expert opinion.
Results
Cross‐cultural, multinational research is important and feasible, but has barriers to successful implementation. This report contains recommendations for future research relating to study design, subject recruitment, availability of appropriate study instruments, translation and validation of study instruments, documenting confounders, statistical analyses and reporting of results.
Conclusions
Advances in study design and methodology, as well as cross‐cultural research competence, have not matched technological advancements. The development of multinational research networks and cross‐cultural research collaboration is still in its early stages. This report is intended to be aspirational rather than prescriptive, so we present recommendations, not guidelines. We aim to raise awareness of these issues and to pose higher standards, but not to discourage investigators from doing what is feasible in any particular setting.
Deprescribing is part of ensuring appropriate medication use and may reduce medication-related harm. Capturing the beliefs and attitudes of patients towards deprescribing by using a validated tool ...may support optimizing medication use in practice.
To translate, culturally adapt and validate the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire in Romanian and to investigate the attitudes and beliefs of older adults towards deprescribing.
The rPATD questionnaire was translated using forward-backward translation into Romanian and culturally adapted. The psychometric properties were evaluated in older adults ≥65 years of age. Structural validity was assessed by item load on factors using an exploratory factor analysis (EFA) which was compared to the original English version and the internal consistency by Cronbach's alpha. Construct validity was evaluated by calculating the Spearman's rank correlation coefficients between the factor scores obtained using the revised version of the Romanian rPATD and scores on the Beliefs about Medicines Questionnaire (BMQ) Specific Concerns Romanian version. Floor and ceiling effect were also examined.
We translated the questionnaire and administered it to 224 participants (median age 72 years interquartile range: 68.0; 77.0). In the EFA individual items loaded onto 4 factors, grouped similarly to the English version (Involvement, Burden, Appropriateness, Concerns about Stopping factors). Two items from each of the Involvement and Appropriateness factors were removed to improve factor loading and avoid cross-loading. The Cronbach's alpha values for the 4 factors ranged between 0.522 and 0.773. The scores for Burden and Concerns about Stopping factors were found to be positively correlated with BMQ Specific Concerns score. We identified a ceiling effect for one of the four factors (Involvement) and no floor effects.
The Romanian rPATD was validated in 4 factor structure similar to the original English questionnaire. The Romanian version of the questionnaire may support the health care professionals in Romania to initiate and support patient-centered deprescribing.
Background
Irritable bowel syndrome (IBS) is a complex condition with multiple factors contributing to its aetiology and pathophysiology. Aetiologically these include genetics, life‐time events and ...environment, and physiologically, changes in motility, central processing, visceral sensitivity, immunity, epithelial permeability and gastrointestinal microflora. Such complexity means there is currently no specific reliable biomarker for IBS, and thus IBS continues to be diagnosed and classified according to symptom based criteria, the Rome Criteria. Carefully phenotyping and characterisation of a ‘large’ pool of IBS patients across Europe and even the world however, might help identify sub‐populations with accuracy and consistency. This will not only aid future research but improve tailoring of treatment and health care of IBS patients.
Purpose
The aim of this position paper is to discuss the requirements necessary to standardize the process of selecting and phenotyping IBS patients and how to organise the collection and storage of patient information/samples in such a large multi‐centre pan European/global study. We include information on general demographics, gastrointestinal symptom assessment, psychological factors, quality of life, physiological evaluation, genetic/epigenetic and microbiota analysis, biopsy/blood sampling, together with discussion on the organisational, ethical and language issues associated with implementing such a study. The proposed approach and documents selected to be used in such a study was the result of a thoughtful and thorough four‐year dialogue amongst experts associated with the European COST action BM1106 GENIEUR (www.GENIEUR.eu).
PDF
