Abstract
Aims
No empirical research on the psychological impact of the coronavirus disease 2019 (COVID-19) pandemic on people living with IBD, a population known to typically present high levels of ...anxiety and depression and to be potentially vulnerable to COVID-19, has yet been conducted. This study aimed to explore the links between contextual variables related to the COVID-19 pandemic and disease and psychological outcomes.
Methods
The sample included 124 Portuguese patients with Crohn’s disease or ulcerative colitis (85.48% women) who completed self-reported measures in an online survey during April 2020.
Results
Fear of contracting COVID-19 and medication adherence were both high and unrelated. About half of the sample presented moderate (37.10%) to severe (14.50%) anxiety. Normal and mild anxiety levels were at 29.80% and 18.50%, respectively. Regarding depressive symptoms, 51.60% of the sample presented normal levels, 27.40% mild severity, 16.10% moderate, and 4.8% severe. No differences were found between Crohn’s disease and ulcerative colitis patients. Regression analyses showed that anxiety explained IBD symptom perception (β = 0.29; P = 0.022); fear of contracting COVID-19 (β = 0.35; P < 0.001) and IBD symptom perception (β = −0.22; P = 0.009) explained depressive symptoms; and fear of contracting COVID-19 (β = 0.41; P < 0.001), IBD symptom perception (β = 0.26, P < 0.001), and being in isolation (β = −0.16, P = 0.041) explained anxiety. Type of medication was not linked to these outcomes.
Conclusions
The COVID-19 pandemic does not seem to be affecting adherence to medication but seems to present relevant effects on psychological well-being. Inflammatory bowel disease health care professionals should be attentive of patients’ psychological response to this pandemic and of its possible consequences on disease expression. This study additionally provided a psychometrically sound measure of fear of contracting COVID-19.
Abstract Purpose To investigate possible associations between recreational cannabis use and bone health in humans. Methods Cross-sectional study of individuals recruited from primary care in the UK ...between 2011 and 2014. Cases were regular smokers of cannabis divided into moderate (n=56) and heavy user (n=144) subgroups depending on whether they reported fewer or more than 5000 cannabis smoking episodes during their lifetime. Controls comprised 114 cigarette smokers. Results Heavy cannabis users had lower total hip bone mineral density (mean ± SD Z-score: -0.20±0.9 vs. +0.2±0.9, p<0.0005), lower spine bone mineral density (-0.5±1.2 vs. 0.0±1.2, p<0.0005) and lower BMI (26.5±6.0 vs 29.0±7.0, p=0.01) than controls. Fracture rate was also increased in heavy users (rate ratio=2.17, 95% confidence interval 1.59 to 2.95; p<0.001). When compared with controls, CTX serum concentrations were raised in heavy cannabis users (0.3±0.1 vs. 0.2±0.1 pg/ml, p=0.045) as were P1NP concentrations (47.1±19.2 vs. 41.2±17.8 pg/ml, p=0.01). Serum 25(OH)D concentrations were reduced in heavy users compared with controls (25.3±16.8 vs. 36.9±26.7 nmol/l, p=0.002). Multiple regression analysis revealed that heavy cannabis use was an independent predictor of spine bone mineral density accounting for 5.4% of the variance (p=0.035) and total hip bone mineral density accounting for 5.8% of the variance (p=0.001) but mediation analysis suggested that the effect on spine bone mineral density was indirect and mediated through low BMI. Conclusion Heavy cannabis use is associated with low bone mineral density, low BMI, high bone turnover and an increased risk of fracture. Heavy cannabis use negatively impacts on bone health both directly and indirectly through an effect on BMI.
This study tested the acceptability and efficacy of an Acceptance and Commitment Therapy and compassion-based intervention (LIFEwithIBD) in people with IBD through a two-arm RCT.
Participants were ...recruited at the Gastroenterology Department of the Coimbra University Hospital between June and September 2019. Of the 355 patients screened, those who accepted to participate were randomly assigned to one of two conditions: experimental group (LIFEwithIBD;
= 25) or control group (waitlist;
= 29). Participants completed self-report measures at baseline (T0), post-intervention (T1), and 3-month (T2) and 12-month (T3) follow-ups. Intervention acceptability was assessed. Efficacy was examined using intent-to-treat ANCOVA at post-intervention after adjusting for baseline values of depressive, anxiety, and stress symptoms (primary outcomes). Linear mixed models for all longitudinal outcomes were also analysed. Inflammatory and disease biomarkers were determined at T0 and T3.
Acceptability results revealed a high level of satisfaction and perceived usefulness regarding the intervention. Both groups experienced a significant decrease in stress symptoms and IBD symptom perception at T1. No significant differences were observed at follow-up for the primary outcomes. The experimental group reported significantly lower Crohn's disease Symptom severity at T2 than the control group. Post-hoc analyses designed to mitigate floor effects revealed substantial treatment effects for the experimental group regarding anxiety symptoms. No significant differences were observed in clinical biomarkers from T0 to T3.
The LIFEwithIBD intervention shows promising, although preliminary, benefits for managing disease activity and reducing anxiety symptoms in IBD patients with high severity of psychological distress.
: https://www.clinicaltrials.gov/ct2/show/NCT03840707, identifier NCT03840707.
There is ample evidence of the high mental health burden caused by Inflammatory Bowel Disease (IBD). Several constructs such as experiential avoidance, cognitive fusion, shame, and self-criticism ...have recently emerged as potential intervention targets to improve mental health in IBD. Psychotherapeutic models such as Acceptance and Commitment Therapy and compassion-based interventions are known to target these constructs. In this protocol, we aim to describe a two-arm Randomized Controlled Trial (RCT) testing the efficacy of an ACT and compassion-focused intervention named Living with Intention, Fullness, and Engagement with Inflammatory Bowel Disease (LIFEwithIBD) intervention + Treatment As Usual (TAU) vs. TAU in improving psychological distress, quality of life, work and social functioning, IBD symptom perception, illness-related shame, psychological flexibility, self-compassion, disease activity, inflammation biomarkers, and gut microbiota diversity.
This trial is registered at ClinicalTrials.gov (Identifier: NCT03840707, date assigned 13/02/2019). The LIFEwithIBD intervention is an adaptation to the IBD population of the Mind programme for people with cancer, an acceptance, mindfulness, and compassion-based intervention designed to be delivered in a group format. The LIFEwithIBD intervention's structure and topics are presented in this protocol. Participants were recruited at the Gastroenterology Service of the Coimbra University Hospital between June and September 2019. Of the 355 patients screened, 61 participants were selected, randomly assigned to one of two conditions experimental group (LIFEwithIBD + TAU) or control group (TAU) and completed the baseline assessment. Outcome measurement took place at baseline, post-intervention, 3- and 12-month follow-ups.
Results from this RCT will support future studies testing the LIFEwithIBD intervention or other acceptance and/or compassion-based interventions for IBD.
The current goal of treatment in irritable bowel syndrome (IBS) focuses primarily on symptom management and attempts to improve quality of life. Several treatments are at the disposal of physicians; ...lifestyle and dietary management, pharmacological treatments and psychological interventions are the most used and recommended. Psychological treatments have been proposed as viable alternatives or compliments to existing care models. Most forms of psychological therapies studied have been shown to be helpful in reducing symptoms and in improving the psychological component of anxiety/depression and health-related quality of life. According to current NICE/NHS guidelines, physicians should consider referral for psychological treatment in patients who do not respond to pharmacotherapy for a period of 12 months and develop a continuing symptom profile (described as refractory irritable bowel syndrome). Cognitive behavioral therapy (CBT) is the best studied treatment and seems to be the most promising therapeutic approach. However, some studies have challenged the effectiveness of this therapy for irritable bowel syndrome. One study concluded that cognitive behavioral therapy is no more effective than placebo attention control condition and another study showed that the beneficial effects wane after six months of follow-up. A review of mind/body approaches to irritable bowel syndrome has therefore suggested that alternate strategies targeting mechanisms other than thought content change might be helpful, specifically mindfulness and acceptance-based approaches. In this article we review these new psychological treatment approaches in an attempt to raise awareness of alternative treatments to gastroenterologists that treat this clinical syndrome.
A robust scale capable of assessing illness-related experiential avoidance (EA) in any given medical condition is currency lacking. Further, there is no available measure that assesses EA related to ...illness behaviours, i.e., actions and/or reactions in relation to feeling unwell that have the purpose of defining one’s state of health and obtaining physical or emotional relief from perceived or actual illness. This study intends to fill this significant gap by presenting the development and psychometric test of a measure of EA related to illness behaviour, the Illness Behaviour Avoidance Scale (IBAS). A total of 370 Portuguese adults with chronic illness participated in the study. The structure and validity of the IBAS was tested through an Exploratory Factor Analysis (EFA; n = 185), a Confirmatory Factor Analysis (CFA; n = 185), and reliability analyses. The IBAS presented a 7-item unifactorial structure, with good global (CMIN/DF = 2.08; CFI = 0.97; TLI = 0.94; SRMR = 0.04; RMSEA = 0.08,
p
= 0.139) and local adjustments (SRWs 0.56–0.73; SMCs 0.31–0.53). It also presented a good internal consistency (with αs = 0.82), and construct and discriminant validity. The IBAS appears to be a significant improvement from the use of previous EA measures in illness contexts. This scale can provide a measurement of whether the behavioural response to any given condition is a manifestation of EA.
Transmission line-based metamaterials are used to realize and model the conjugate-impedance matched superabsorbers. Here, we formulate an analytical-numerical approach for maximizing the effective ...absorption cross section of the metamaterial wormhole superabsorber, under the goal of minimizing the complexity of the structure. Analytical expressions for the gradient of the absorption cross section as a function of the structural parameters are derived. Numerical results showing enhanced absorption are obtained under three different optimization strategies: a ring-by-ring approach, a gradient-based optimization, and a mixed algorithm. The best results are achieved with the mixed algorithm, with which it is demonstrated that the optimal wormhole superabsorber significantly outperforms a black body-type absorber of a similar size. This study is of a particular interest for applications of the conjugate-impedance-matched superabsorbers as efficient harvesters of electromagnetic radiation.
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