Psychosocial Morbidity Research Articles

Evaluation of fatigue and its correlation with quality of life index, anxiety symptoms, depression and activity of disease in patients with psoriatic arthritis.

BackgroundPsoriatic arthritis is associated with psychosocial morbidity and decrease in quality of life. Psychiatric comorbidity also plays an important role in the impairment of quality of life and onset of fatigue.ObjectivesThis study aimed to assess the prevalence of fatigue in psoriatic arthritis patients and to correlate it to quality of life indexes, functional capacity, anxiety, depression and disease activity.Patients and methodsThis cross-sectional study was performed on outpatients with psoriatic arthritis. Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F; version 4) was used to measure fatigue; 36-Item Short Form Health Survey (SF-36) and Psoriasis Disability Index (PDI) to measure quality of life; Health Assessment Questionnaire (HAQ) to assess functional capacity; Hospital Anxiety and Depression (HAD) scale to measure anxiety and depression symptoms; Psoriasis Area and Severity Index (PASI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Clinical Disease Activity Index (CDAI) to evaluate clinical activity.ResultsIn all, 101 patients with mean age of 50.77 years were included. The mean PDI score was 8.01; PASI score, 9.88; BASDAI score, 3.59; HAQ score, 0.85; HAD – Anxiety (HAD A) score, 7.39; HAD Depression (HAD D) score, 5.93; FACIT–Fatigue Scale (FACIT-FS) score, 38.3 and CDAI score, 2.65. FACIT-FS was statistically associated with PASI (rs −0.345, p<0.001), PDI (rs −0.299, p<0.002), HAQ (rs −0.460, p<0.001), HAD A (rs −0.306, p=0.002) and HAD D (rs −0.339, p<0.001). The correlations with CDAI and BASDAI were not confirmed. There was statistically significant correlation with all of the domains of SF-36 and FACIT-F (version 4).ConclusionPrevalence of fatigue was moderate to intense in <25% of patients with psoriatic arthritis. Fatigue seems to be more related to the emotional and social aspects of the disease than to joint inflammatory aspects, confirming that the disease’s visibility is the most disturbing aspect for the patient and that “skin pain” is more intense than the joint pain.

Disease burden for patients with primary immunodeficiency diseases identified at reference hospitals in Guanajuato, Mexico.

BackgroundIn addition to the deleterious effect on health, there is considerable economic and psychosocial morbidity associated with primary immunodeficiency diseases (PID). Also, the cost of a late diagnosis frequently results in a heavy disease burden on the patient. The objective of this study was to collect and analyze data on patients with PID in the state of Guanajuato in Mexico, to indirectly estimate the burden of the disease.MethodsAn observational, longitudinal, and comparative study was conducted. A total of 44 patients were included and grouped according to the updated classification of PID.ResultsThe median time elapsed from the onset of symptoms to the reference and diagnosis by a tertiary hospital was of 2.17 (IQR = 6.44) years. Before diagnosis, the number of hospitalizations/year per patient was 0.86 (IQR = 2.28), the number of visit to emergency room/year per patient was 0.92 (IQR = 1.77), the number of doctor’s visits/year per patient was 15 (IQR = 11.25), whereas the school/work absence days per patient were reported in 52.72 (IQR = 56.35) days per year. After diagnosis, 20 patients (45.45%) received IVIG replacement therapy, and all of them presented a significant improvement (p <0.05) in all the mentioned variables. Characteristically, even when patients with PID received IVIG, there was still an important disease burden when comparing them against healthy controls. Complications secondary to PID were detected in 19 patients (43.18%). The reported overall mortality rate was 6.82% (n = 3).ConclusionsWe were able to indirectly estimate an important disease burden in patients with PID; which is considered to be preventable, at least in part, with effective interventions like health planning, research, collaboration with primary care providers, and generation of policies and practices, in order to improve the quality of life and care of families with PID.

The role of fillers in the management of acne scars.

Acne scars are present in 95% of patients with acne, and can cause profound psychosocial morbidity. Fillers are commonly used for facial soft tissue augmentation, and there is increasing interest in their use for the treatment of acne scars, particularly for the atrophic subtype. We review the evidence for the use of temporary, semi-permanent and permanent fillers for acne scars. The use of permanent methylmethacrylate fillers for acne scarring is supported by a randomized controlled trial, and is approved by the United States Food and Drug Administration. There is initial evidence supporting the use of poly-L-lactic acid and hyaluronic acid fillers, but evidence is still lacking about the use of polyacrylamide and polyalkylimide fillers.

A clinical update on posttraumatic stress disorder in burn injury survivors.

Burn injuries are complex traumatic events carrying high risks of acute physical and psychosocial morbidity. With greater survival, clinical and research attention has turned to psychosocial recovery outcomes and risk factors. It is timely to summarise current issues in posttraumatic disorders after burn injury for mental health and integrative care clinicians. Posttraumatic stress disorder (PTSD) is a common outcome of severe burn injury. There are difficulties in delivering current best practice treatments to many survivors especially those in rural and remote areas and those with comorbidities. Vicarious traumatization of clinicians, families and carers requires attention and internationally there are moves to psychosocial screening and outcome tracking. The role of the multidisciplinary treatment, integrated and trauma-informed care is essential. While level 1 evidence for PTSD treatments theoretically applies, adaptations that consider comorbidities and treatment contexts are often essential with further research required.

Aligning Mental Health Treatments with the Developmental Stage and Needs of Late Adolescents and Young Adults.

Transitional age youth (TAY) are in a discrete developmental stage, different from both adolescents and mature adults. Serious mental illness can result in their delayed psychosocial development and morbidity. Systemic, provider, and individual barriers result in poor access to care for these youth, potentially impeding their transition to mature adulthood. Current strategies for TAY treatment include patient centered care, vocational and educational support, and shared decision making. There is a paucity of evidence-based practices to effectively treat this population or provide practice guidelines. The research required to do so should be a priority.

They know it's safe - they know what to expect from that face: perceptions towards a cognitive-behavioural counselling programme among caregivers of children with cystic fibrosis.

To explore the experiences of eight caregivers who provide care to children with cystic fibrosis in an eight-week cognitive-behavioural counselling programme at a children's hospital in Winnipeg, Canada. Youth with cystic fibrosis experience significant behavioural and psychosocial challenges, such as depression, anxiety and poor treatment adherence. Caregivers are critical to the provision of care and treatment to young people living with cystic fibrosis. Caregivers of youth with cystic fibrosis experience psychosocial morbidity. Thus, the development of counselling interventions is required to enhance psychosocial well-being among the caregivers of youth with cystic fibrosis. This study was informed by the thematic analytic qualitative research tradition. In-depth, semistructured interviews were conducted with eight caregivers who participated in our programme. The audiotaped interviews were then subject to thematic analysis. The counselling sessions were experienced as 'distinctly different' from routine appointments at the hospital and were characterised by a sense of listening and bidirectional communication. In addition to acquiring a sense of trust and accountability through the programme, counselling appeared to enhance caregivers' perception of their time use, leading to greater temporal agency. From this evidence-based cognitive-behavioural counselling programme, insights about the complex psychosocial lives of the cystic fibrosis community are discussed within the context of the literature. Integrating cognitive-behavioural counselling into routine clinical CF care should be considered as a method to enhance caregiving capacity in the CF community and should be championed by nurses.

A prospective study of changes in anxiety, depression, and problems in living during chemotherapy treatments: effects of age and gender.

Monitoring distress assessment in cancer patients during the treatment phase is a component of good quality care practice. Yet, there is a dearth of prospective studies examining distress. In an attempt to begin filling this gap and inform clinical practice, we conducted a prospective, longitudinal study examining changes in distress (anxiety, depression, and problems in living) by age and gender and the roles of age and gender in predicting distress. Newly diagnosed Brazilian cancer patients (N=548) were assessed at three time points during chemotherapy. Age and gender were identified on the first day of chemotherapy (T1); anxiety, depression, and problems in living were self-reported at T1, the planned midway point (T2), and the last day of chemotherapy (T3). At T1, 37 and 17% of patients reported clinically significant levels of anxiety and depression, respectively. At T3, the prevalence was reduced to 4.6% for anxiety and 5.1% for depression (p<.001). Patients 40-55years, across all time points, reported greater anxiety and practical problems than patients >70years (p<.03). Female patients reported greater emotional, physical, and family problems than their male counterparts (p<.04). For most patients, elevated levels of distress noted in the beginning of treatment subsided by the time of treatment completion. However, middle-aged and female patients continued to report heightened distress. Evidence-based psychosocial intervention offered to at risk patients during early phases of the treatment may provide distress relief and improve outcomes over the illness trajectory while preventing psychosocial and physical morbidity due to untreated chronic distress.

Suicide in patients with genitourinary malignancies.

Genitourinary cancers are significant causes of morbidity and mortality around the world. The present review summarises the current literature on suicide and its risk factors among patients with genitourinary cancers. The review was based on relevant articles published in MEDLINE, ProQuest, PsycINFO, Science Direct and Scopus databases. Patients with prostate cancer represented the most important risk group for suicide, among patients with urogenital cancers. Other risk factors are male gender, older age, white race, advanced disease, living alone and co-existing psychological comorbidities. Findings from the review call for a greater caregiver awareness on psychosocial morbidity and suicidality among genitourinary cancer patients pre- and post-treatment and their early identification, adoption of risk-reduction strategies and prompt referral for expert mental health care.

Optimizing Care and Outcomes for Late Preterm Neonates

The goal of this review is to define gestational age categories and discuss the epidemiology, complications, strategies for prevention, and management of late preterm infants. Late preterm (i.e., 34 to 36 weeks of gestation) birth is prevalent (8.0% of all live births in the USA in 2013) and is associated with increased infant mortality and morbidity. Although most late preterm births are medically indicated, elective early delivery plays a role. Policies limiting elective births at gestations less than 39 weeks and guidance for timing of indicated late preterm birth have reduced late preterm births. Late preterm neonates frequently require neonatal intensive care and should be monitored throughout life for developmental, educational, psychosocial, and medical morbidities. Prevention of late preterm births is key to reduction in mortality and morbidity. Continued prevention efforts and implementation of best practices may decrease acute and long-term complications of late preterm birth.

Is it time to reconsider lobectomy in low-risk paediatric thyroid cancer?

Current guidelines recommend total thyroidectomy for nearly all children with well-differentiated thyroid cancer (WDTC). These guidelines, however, derive from older data accrued prior to current high-resolution imaging. We speculate that there is a subpopulation of children who may be adequately treated with lobectomy. Retrospective analysis of prospectively maintained database. Seventy-three children with WDTC treated between 2004 and 2015. We applied two different risk-stratification criteria to this population. First, we determined the number of patients meeting American Thyroid Association (ATA) 'low-risk' criteria, defined as disease grossly confined to the thyroid with either N0/Nx or incidental microscopic N1a disease. Second, we defined a set of 'very-low-risk' histopathological criteria, comprising unifocal tumours ≤4 cm without predefined high-risk factors, and determined the proportion of patients that met these criteria. Twenty-seven (37%) males and 46 (63%) females were included in this study, with a mean age of 13·4 years. Ipsilateral- and contralateral multifocality were identified in 27 (37·0%) and 19 (26·0%) of specimens. Thirty-seven (51%) patients had lymph node metastasis (N1a = 18/N1b = 19). Pre-operative ultrasound identified all cases with clinically significant nodal disease. Of the 73 patients, 39 (53·4%) met ATA low-risk criteria and 16 (21·9%) met 'very-low-risk' criteria. All 'very-low-risk' patients demonstrated excellent response to initial therapy without persistence/recurrence after a mean follow-up of 36·4 months. Ultrasound and histopathology identify a substantial population that may be candidates for lobectomy, avoiding the risks and potential medical and psychosocial morbidity associated with total thyroidectomy. We propose a clinical framework to stimulate discussion of lobectomy as an option for low-risk patients.

Adherence to treatment in men with hypogonadotrophic hypogonadism.

Men with congenital hypogonadotrophic hypogonadism (CHH) typically require lifelong hormonal therapy, and discontinuing treatment can have negative health consequences. Little is known about adherence to treatment or the psychosocial impact of CHH. A sequential, multiple methods approach was used. A quantitative online survey assessed adherence to treatment, depressive symptoms and illness perceptions. Subsequently, qualitative focus groups explored patient-reported factors for adherence. Adult men with CHH on at least 1 year of treatment were recruited internationally. Adherence (Morisky medication adherence scale), depressive symptoms (Zung self-rating depression scale) and patient perception of CHH (revised illness perception questionnaire) were assessed in an online survey, and comparisons were made to reference groups. Patient focus group discussions were conducted and thematic analysis was employed to identify patient-reported factors for adherence. In total, 101 men on long-term treatment were included (mean age 37 ± 11 years). Forty three percent (43/101) exhibited low medication adherence and a significantly elevated prevalence of mild, moderate or severe depressive symptoms (27%, 17%, 20%, respectively, all P < 0·001 vs reference population). Patients reported negative illness perceptions and significant psychosocial consequences. Focus group discussions (n = 3, 26 total patients) identified patient-, health professional- and healthcare system-related barriers as targets for improving adherence. Congenital hypogonadotrophic hypogonadism men are challenged to adhere to long-term treatment. Poor adherence may contribute to adverse effects on bone, sexual and psychological health. The psychosocial morbidity of CHH is significant and appears to be underappreciated by healthcare providers.

Attention Deficit/Hyperactivity Disorder in Adults with Multiple Sclerosis

AbstractObjectives: To determine symptoms and their effects of attentiondeficit/ hyperactivity disorder (ADHD) in adult patients with multiple sclerosis. Studies of psychiatric comorbidities in patients with multiple sclerosis (MS) have reported greater rates in MS patients than the general population. Methods: Subjects consisted of 72 relapsing remitting multiple sclerosis patients and 57 controls. Demographic characteristics including age, gender, education level, duration of disease and Expanded Disability Symptom Scale (EDSS) were recorded. ADHD symptoms were assessed by Adult Attention Deficit/HyperactivityDisorder Self-Report Scale (ASRS). Furthermore, Hospital Anxiety and Depression Scale (HADS) and Short Form-36 (SF-36) were also applied. Results: MS patients had statistically significant higher the rate of ADHD mean scores compared to controls. Patients with MS had statistically significant higher rate of clinical elevation in ASRS scores. There were 26 MS patients and 4 controls with ADHD symptoms. ASRS scores in MS patients were associated with SF- 36 mental and physical component scores and depression and anxiety scores. Conclusion: ADHD symptoms may develop in adults MS patients and are associated with lowered quality of life and increased psychosocial morbidity. In the future, more comprehensive investigations could clarify origins of ADHD symptoms in adult MS patients.

Adolescent fibroadenoma (Breast &amp;quot;Mouse&amp;quot;) - role of Radiology in assisting diagnosis: a case report

Background: Fibroadenomas are quite common benign lesions in the adolescent age group but it is a cause of concern for the individual and the family. These may remain asymptomatic or may present with pain. Aesthetic distortion of the breast symmetry may lead to psychosocial morbidity in adolescent females. The diagnosis is initially made by the ultra sound. Magnetic Resonance Imaging is done in some cases where the underlying pathology is in doubt. Case presentation: We present a 21 years old young female, university student who reported with complaints of a tender mass in the left breast. Ultrasound (US) of breast showed well circumscribed focus indicating benign nature of the lump. Patient was very anxious. Magnetic resonance imaging (MRI) examinations proved the lesions as fibroadenomas. Conclusion: There is always dilemma for the correct evaluation of the breast lumps but with the help of available cross sectional radiological armamentarium, it is possible to come closer to the diagnosis.

Social networks, social support and social negativity: A qualitative study of head and neck cancer caregivers' experiences.

Head and neck cancer is a serious form of cancer that can generate substantial physical and psychosocial morbidity. Informal caregivers can help patients to manage head and neck cancer and its emotional impacts, both during and after treatment. Caregivers, however, can experience considerable stress as a result of their caring activities. Supportive relationships can protect caregivers from psychosocial strain. Thirty-one head and neck cancer caregivers were interviewed about their experiences of accessing social support from their social networks; difficulties that they experienced accessing this support; and strategies that they used to address these difficulties. Results suggest that head and neck cancer caregivers strongly value social support, but can find it difficult to obtain, and a number of them experience socially negative responses from their networks. Some carers attempt to answer or supplement support deficiencies by turning to non-human coping supports, such as pets, spiritual figures or medication. Implications for theory and practice are discussed.

Comprehensive Structured Transition Program with Dedicated Transition Navigator Reduced Lost to Follow-up and Improved Medication Adherence in Sickle Cell Disease and Thalassemia Adolescents and Young Adults

Introduction: Adolescents and young adults (AYA) with sickle cell disease (SCD) and thalassemia transitioning from pediatric to adult health care experience a lack of engagement with adult care providers, are at high risk of loss to follow-up, emergence of psychosocial issues, morbidity and mortality. The shift from a pediatric to an adult setting can be challenging for AYA who are coping with multiple life transitions and are expected to acquire the necessary skills to manage their own care.Hypothesis: implementation of a comprehensive structured transition program with dedicated transition navigator (TN) in a pediatric and adult hemoglobinopathy comprehensive care center will reduce loss to follow-up and hospitalization, improve adherence to medication and attendance to appointments compared to an unstructured transfer from pediatric to adult program.Methods: A structured comprehensive transition program with a dedicated TN, based on a quality improvement framework with an iterative design to refine the intervention over time, was developed and deployed across a pediatric and adult hemoglobinopathy comprehensive care center (Hospital for Sick Children (HSC) and Toronto General Hospital (TGH) respectively) starting August 1, 2014. Prior to this, patients at age 18 were transferred without preparation. With the TN model, adolescents, from age 12 were followed at each visit by the TN and up to one year after transitioning. Prior to transition to the adult center, adolescents were seen jointly by pediatric and adult care providers and TN in a transition clinic. Patients were assessed for transition readiness and provided with tailored education at each appointment. This observational study compared all AYA with SCD or thalassemia who turned 18 years between August 1, 2013 and August 1, 2015. Patients in the cohort prior to the comprehensive transition program were compared to patients who transitioned through the formal program. Data from one year prior to last appointment at HSC and one year after the first appointment at TGH were collected. The effects of covariates on imaging/clinic/transfusion/subspecialist appointment attendance, medication adherence and hospitalizations were analyzed by multivariable regression.Results: 112 patients met the criteria for transfer/transition, of which 51 transferred prior to August 1, 2014 and 61 transitioned through the comprehensive transition program. No significant differences were observed in baseline demographics including age at transfer/transition, phenotype, distance from the center, medications, parental/guardian appointment attendance, immigration status, family structure, first language spoken or documented cognitive impairment. The youngest patient to undergo transition in the observation period was 16.6 years. The transition process significantly reduced the proportion of patients lost to follow-up from 29% (11/38) to 7% (4/57) (P = 0.0335, Figure 1). In patients who were on hydroxyurea or iron chelation, significant increase in the proportion of patients who maintained or improved their medication adherence to 4 or more days a week was observed in the transition cohort (P = 0.047, LR 4.668) and the presence of the transition program was independently associated with the improvement. A trend towards improvement or maintenance of ≥ 90% attendance to appointments was observed (P = 0.096, OR 2.254). Variations in appointment attendance can be explained by patient’s age, distance from the comprehensive hemoglobinopathy center, and English as patient’s first language. No independent predictor was found in frequency of hospitalization. No new overt strokes or deaths occurred in the year after moving to the adult center.Conclusions: Comprehensive structured transition program with dedicated transition navigator significantly reduced the number of AYA lost to follow-up, and significantly improved and maintained fair to good medication adherence. Further analysis of economic benefit and patient satisfaction will be conducted. A clustered randomized-controlled trial will be forthcoming to determine the effectiveness of this transition model of care on AYA patients with sickle cell disease on patient-important outcomes. [Display omitted] DisclosuresAllemang:Novartis: Other: Funding for the transition navigator program; ApoPharma: Other: Funding for the transition navigator program; Sickkids Foundation: Other: Funding for the transition navigator program. Kuo:Apotex: Other: Unrestricted education grant; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Agios Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Alexion Pharmaceuticals, Inc: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

Mindfulness-Based Cognitive Therapy in Advanced Prostate Cancer: A Randomized Controlled Trial.

Purpose Advanced prostate cancer (PC) is associated with substantial psychosocial morbidity. We sought to determine whether mindfulness-based cognitive therapy (MBCT) reduces distress in men with advanced PC. Methods Men with advanced PC (proven metastatic and/or castration-resistant biochemical progression) were randomly assigned to an 8-week, group-based MBCT intervention delivered by telephone (n = 94) or to minimally enhanced usual care (n = 95). Primary intervention outcomes were psychological distress, cancer-specific distress, and prostate-specific antigen anxiety. Mindfulness skills were assessed as potential mediators of effect. Participants were assessed at baseline and were followed up at 3, 6, and 9 months. Main statistical analyses were conducted on the basis of intention to treat. Results Fourteen MBCT groups were conducted in the intervention arm. Facilitator adherence ratings were high (> 93%). Using random-effects mixed-regression models, intention-to-treat analyses indicated no significant changes in intervention outcomes or in engagement with mindfulness for men in MBCT compared with those receiving minimally enhanced usual care. Per-protocol analyses also found no differences between arms in outcomes or engagement, with the exception of the mindfulness skill of observing, which increased over time for men in MBCT compared with usual care ( P = .032). Conclusion MBCT in this format was not more effective than minimally enhanced usual care in reducing distress in men with advanced PC. Future intervention research for these men should consider approaches that map more closely to masculinity.

Palliative Care in Heart Failure: Results of a Randomized, Controlled Clinical Trial

Background: Despite medical advances and robust data for guideline-directed medical therapy (GDMT), heart failure (HF) remains a progressive disease associated with significant physical and psychosocial morbidity and high mortality. Palliative care approaches, effectively used in other chronic illnesses, are in early stage evaluation and validation in the HF population. Methods: The Palliative Care in Heart Failure Trial (PAL-HF) was an NIH-funded, single-center, randomized, controlled clinical trial of a patient-centered, multidisciplinary intervention targeted in HF patients at high risk for 6-month hospitalization and mortality. The nurse practitioner-delivered intervention focused on relieving physical and psychosocial symptoms, addressing spiritual concerns and advanced care planning. The primary end-point was health-related quality of life assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Palliative Care Subscale of the Functional Assessment of Chronic Illness Therapy (FACIT-PAL) at 6 months. Secondary endpoints include changes in depression, anxiety, spiritual well-being, caregiver satisfaction, resource utilization and a composite of death, HF hospitalization and quality of life. Results: Overall, 150 patients were randomized to GDMT or GDMT+ palliative care intervention (75 patients per study arm). The mean age was 71 years, 47% were women and 41% were African-American. The mean HF duration was 66.9 months and there was an average of 2.2 hospitalizations in the 12 months prior to enrollment. 45% of the patients had an ejection fraction >40% and the mean baseline NT-pro-BNP was 11,576 pmol/L. Most participants (82%) were sedentary >50% of the time, and 85% rated their overall health as poor/fair. The trial was successful on meeting the primary endpoint. Results including primary endpoint and key secondary endpoints will be presented. Conclusions: The results of PAL-HF demonstrate successful enrollment of a critically ill HF patient cohort. The addition of a palliative care intervention focused on symptom relief, spiritual well-being and advanced care planning improved domain-specific quality of life. PAL-HF should be used as pilot data for larger, multi-center clinical trials evaluating strategies to improve care in this vulnerable population.

Transition to adult care for pediatric liver transplant recipients: the Western Australian experience.

Transition to adult care is a vulnerable period for pediatric transplant recipients and is associated with reduced medication compliance, graft loss, and increased mortality. Psychosocial outcomes in young adults differ between pediatric transplant recipients and their healthy peers. We conducted a single-center, retrospective cohort study of all pediatric liver transplant recipients who were transitioned through our center. This study aimed to assess the outcomes of transitioned pediatric liver transplant recipients at an Australian center, including mortality, adherence, and psychosocial morbidity. The 1- and 5-year survival rates following transition were 100% and 92%, respectively. There were no episodes of late rejection. In total, 66.7% of patients were compliant with immunosuppression and 61.1% of patients were compliant with clinic attendance. There was a significant relationship between medication compliance and clinic attendance, as well as presence of psychological issues with clinic non-attendance. Psychosocial outcomes were in keeping with age-matched data from the general population. All patients were employed or studying following transition. This is the first study of its kind in the Australian population, and outcomes were superior to published international data. Despite the demonstrated good outcomes, transition programs may improve healthcare engagement in this cohort.

The evaluation and management of recurrent abdominal pain in childhood

Abstract Recurrent abdominal pain (RAP) is a common complaint in children. Previously considered a single entity, RAP is now used as a descriptive term and sub-classified in the recently published Rome IV criteria, into four functional abdominal pain disorders (FAPD), including functional dyspepsia and irritable bowel syndrome. All share common pathogenic mechanisms of visceral hypersensitivity and central hypervigilance, resulting from disruption of the microbiota–gut–brain axis and abnormal enteric neuro–immune interactions. Although FAPDs are benign in nature, the persistence of symptoms and effects on everyday life can have significant secondary effects including psychosocial morbidity. The diagnosis of FAPDs is based on careful history and examination looking for ‘alarm signs', although a limited battery of laboratory investigations to screen for organic disease may be of value. The management of FAPDs should be multidisciplinary and based on the bio-psychosocial model of care with careful education and engagement of patients/parents. There is currently little evidence to support the routine use of pharmacotherapy, probiotics or diet and a significant placebo effect should be considered when assessing treatment effect. Hypnotherapy has been shown to be an effective therapy. Approximately 50% of FAPDs cases will achieve resolution, especially those that have engaged with the appropriate model of management.

The efficacy of interventions to improve psychosocial outcomes following surgical treatment for breast cancer: a systematic review and meta-analysis.

Breast cancer is the most commonly diagnosed cancer in women across the world. The majority of women diagnosed with the disease undergo surgery, which is often associated with significant psychosocial morbidity. The aim of this meta-analysis was to identify the efficacy of psychosocial interventions for women following breast cancer surgery. A comprehensive literature search was undertaken using keyword and subject headings within 7 databases. Included studies employed a quantitative methodology presenting empirical findings focusing on interventions for female breast cancer patients following surgery. Thirty-two studies were included and based on conventional values of effect sizes. Small effects emerged for the efficacy of psychosocial interventions in relation to anxiety (Hedges g=0.31), depression (0.38), quality of life (0.40), mood disturbance (0.31), distress (0.27), body image (0.40), self-esteem (0.35), and sexual functioning (0.22). A moderate to large effect emerged for the efficacy of interventions in promoting improvements in sleep disturbance (0.67). Clear evidence emerged for the efficacy of cognitive behavioral therapy in promoting improvements in anxiety, depression, and quality of life. This is the first meta-analysis to demonstrate the efficacy of interventions on a range of psychosocial outcomes following breast cancer surgery. The meta-analysis highlighted that cognitive behavioral therapy was consistently the most effective psychosocial intervention promoting improvements in anxiety, depression, and quality of life. However, there are shortcomings in existing studies; the length of the follow-up period is typically short and the generalizability of findings was limited by small samples, both of which should be addressed in future studies.