Social Functioning Research Articles

Somatisation differentiates fibromyalgia from low back pain: a comparative, cross-sectional cohort study

Abstract Objectives To examine whether somatisation, depression, anxiety, fatigue, coping dimensions, pain, physical and social function, or sociodemographic characteristics can differentiate fibromyalgia from low back pain in a cross-sectional cohort setting of our Zurzach Interdisciplinary Pain Programme. Methods Fibromyalgia and low back pain (not fulfilling the diagnostic criteria for fibromyalgia) were compared using the Symptom Checklist-90R (SCL-90R) Somatisation scale, the Quantification Inventory for Somatoform Syndromes (QUISS) Number of somatoform symptoms, and other standardised instruments. Standardised mean differences (SMDs) quantified the score differences, and binomial logistic regression modelling with various co-variates differentiated fibromyalgia from low back pain. Results The largest differences indicating worse health in fibromyalgia (n = 131) were in somatisation (SCL-90R: SMD=-0.971, QUISS: SMD=-0.960), followed by affective health, pain and coping (SMDs between -0.632 and -0.280). Physical and social functioning were comparable in the two conditions (n = 262 low back pain). The two somatisation scales both with odds ratios (OR)=0.966 (p≤ 0.002) plus female sex (OR = 3.396, p< 0.001) predicted 74.3% of the cases correctly (accuracy) with a positive predictive value of 65.3% and a specificity of 87.0% for fibromyalgia. In the female subsample (n = 280), the model remained stable with an accuracy of 71.9%. Conclusion Somatisation stood out from all other somatic, psychosocial, and coping dimensions and sociodemographics as the one significant specific predictor distinguishing fibromyalgia from low back pain. The fibromyalgia phenotype is characterised by the generalisation of painful loci but equally prominently by generalised somatoform symptoms. Assessment of somatisation is recommended to ensure accurate identification and understanding of the multifaceted syndrome of fibromyalgia.

Testing the Effectiveness of a Mobile Smartphone App Designed to Improve the Mental Health of Junior Physicians: Protocol for a Randomized Controlled Trial.

Shift (Black Dog Institute) is the first mobile health smartphone appcreated to support the mental health of junior physicians. Junior physicians experience demanding work conditions, leading to high levels of psychological distress and burnout. However, they are often concerned about the potential career impacts of seeking mental health support. The confidentiality and ease of access of digital interventions may be particularly suited to address these concerns. The Shift app provides therapeutic and psychoeducational content and strategies contextualized for the specific needs of physicians in training. App content includes information on mental health, help seeking, mindfulness, and common workplace-related concerns of junior physicians. This study aims to test, at scale, the effectiveness of Shift among junior physicians working in Australia using a randomized controlled trial design. The primary aim is to examine whether junior physicians using Shift experience a reduction in depressive symptoms compared with a waitlist control group. The secondary aim is to examine whether the app intervention group experiences improvements in anxiety, work and social functioning, help seeking, quality of life, and burnout compared with the control group. A total of 778 junior physicians were recruited over the internet through government and nongovernment medical organizations across Australia, as well as through paid social media advertisements. They were randomly allocated to one of 2 groups: (1) the intervention group, who were asked to use the Shift app for a period of 30 days, or(2) the waitlist control group, who were placed on a waitlist and were asked to use the app after 3 months.Participants completed psychometric measures for self-assessing mental health and wellbeing outcomes, with assessments occurring at baseline, 1 month after completing the baseline period, and 3 months after completing the baseline period. Participants in the waitlist control group were asked to complete an additional web-based questionnaire 1 month after receiving access to the app or 4 months after completing the baseline survey. Participants took part in the study on the internet; the study was completely automated. The study was funded from November 2022 to December 2024 by the New South Wales Ministry of Health. Data collection for the study occurred between January and August 2024, with 780 participants enrolling in the study during this time. Data analysis is underway; the effectiveness of the intervention will be estimated on an intention-to-treat basis using a mixed-model, repeated measures analysis. Results are expected to be submitted for publication in 2025. To the best of our knowledge, this is the first randomized controlled trial to examine the effectiveness of a mobile health smartphone app specifically designed to support the mental health of junior physicians. Australia and New Zealand Clinical Trials Registry ACTRN12623000664640; https://tinyurl.com/7xt24dhk. DERR1-10.2196/58288.

Suicidality among clients in a network of coordinated specialty care (CSC) programs for first-episode psychosis: Rates, changes in rates, and their predictors

BackgroundPeople experiencing their first episode of psychosis have high risk of suicide, and programs specializing in early psychosis have not always achieved reduced risk. The present study analyzes patterns of suicide ideation, self-harm, and suicide attempts within the Connection Learning Healthcare System of 23 early psychosis programs in Pennsylvania and Maryland that follow the Coordinated Specialty Care treatment model. MethodPeople with first episode psychosis (n = 1101) were assessed at admission and every six months using a standardized battery that included self-reported past-month ideation and clinician-reported past-six-month ideation, self-harm, and suicide attempts. ResultsAt admission, there were 28 % rates of self-reported past-month suicide ideation and 52 % rates clinician-reported past-six-month suicide ideation, 23 % rate of clinician-reported self-harm, and 15 % rate of attempts. After the first six months of treatment there were significantly lower rates of clinician-reported suicidality (with reductions of at least 77 %), and after the first year of treatment there was significantly lower self-reported ideation (with approximately 54 % reporting lower past-month ideation). Changes were not accounted for by differential early discharge. A range of psychosocial variables predicted within- and between-subject variability in suicidality. Social and role functioning, depressive symptom severity, and a sense of recovery were significant within-subject predictors of all four measures of suicidality. ConclusionsCompared to admission, we observed substantially lower rates of suicidality within the first year of treatment for clients with first episode psychosis in Coordinated Specialty Care. Reductions were predicted by some of the variables targeted by the treatment model.

Social odors drive hippocampal CA2 place cell responses to social stimuli.

Hippocampal region CA2 is essential for social memory processing. Interaction with social stimuli induces changes in CA2 place cell firing during active exploration and sharp wave-ripples during rest following a social interaction. However, it is unknown whether these changes in firing patterns are caused by integration of multimodal social stimuli or by a specific sensory modality associated with a social interaction. Rodents rely heavily on chemosensory cues in the form of olfactory signals for social recognition processes. To determine the extent to which social olfactory signals contribute to CA2 place cell responses to social stimuli, we recorded CA2 place cells in rats freely exploring environments containing stimuli that included or lacked olfactory content. We found that CA2 place cell firing patterns significantly changed only when social odors were prominent. Also, place cells that increased their firing in the presence of social odors alone preferentially increased their firing during subsequent sharp wave-ripples. Our results suggest that social olfactory cues are essential for changing CA2 place cell firing patterns during and after social interactions. These results support prior work suggesting CA2 performs social functions and shed light on processes underlying CA2 responses to social stimuli.

Why do some Mexicans with psychosis risk symptoms seek mental health care and others do not?

Help-seeking barriers differ according to the sociocultural context and country-specific mental healthcare system. More research is needed in low-middle-income countries, where early psychosis programs are still scarce, and the mental health care gap is wide. This study aims to explore predisposing, enabling, and need factors associated with mental health service utilization in 481 Mexicans self-reporting psychosis risk symptoms, as well as differences between those who were currently mental health service users (MHSU) and those who were not (non-MHSU). Participants responded to self-reported measures through an online survey. The factors associated with an increased probability of using mental health services were having an occupation, having a medium/high socioeconomic status, an intention to seek help from a mental health professional, fewer help-seeking barriers, moderate/severe anxious symptoms, higher distress associated with psychosis risk symptoms and social functioning impairment. Findings provide relevant information for designing more effective strategies to improve help-seeking, early identification, and timely treatment delivery in Mexico. The need to generate strategies focused on reducing stigma, enhancing psychosis literacy in the community, and increasing the identification of emerging signs of psychosis in primary healthcare professionals is highlighted, mainly when co-occurring with other psychiatric symptoms.

The impact of the COVID-19 pandemic on individuals with pre-existing diabetes mellitus.

To examine the psychosocial impact of the COVID-19 pandemic on patients with a diagnosis of diabetes mellitus (DM). Semi-structured interviews were conducted with 31 individuals with DM attending a diabetes clinic to determine the impact of the COVID-19 restrictions on anxiety and depressive symptoms, social and occupational functioning and quality of life. Anxiety symptoms were correlated with functioning, quality of life and diabetes self-management. Likert data demonstrated that social functioning (mean = 5.5, SD = 3.7) and quality of life (mean = 4.1, SD = 3.1) were most impacted by the COVID-19 pandemic. Anxiety symptoms were prevalent with 13 individuals (41.9%) scoring above cut-off scores for the presence of anxiety symptoms based on the Beck Anxiety Inventory. Diabetes self-management was significantly correlated with functioning (r = 0.51, p = 0.006) and inversely correlated with anxiety symptoms (r = -0.51, p = 0.007). A prior history of a depressive or anxiety disorder was associated with significantlyincreased anxiety symptoms, as well as impaired global functioning (p < 0.01), poorer self-care of diabetes (p = 0.014) and satisfaction with diabetes treatment (p = 0.03). The psychological and social impact of COVID-19 restrictions on individuals with DM was significant, with poorer management of diabetes correlated with anxiety symptom severity.

Grief on pain and quality of life in combat veterans with PTSD

ABSTRACT Background: Persistent Complex Bereavement Disorder (PCBD) comprises a set of grief symptoms that are often linked to other psychological conditions such as PTSD and depression, may be prevalent in Veterans with combat experience, and may also impact general health. Objective: This study investigated the association between grief and sleep, pain, PTSD, and depression, among Veterans participating in a clinical trial for PCBD treatment. Method: Data from 155 Veterans receiving treatments for PCBD were analysed to explore the association between PCBD and symptoms of sleep pain, PTSD, and depression. Veterans experiencing grief reported symptoms related to physical health, emotional problems, energy, and fatigue, emotional well-being, social functioning, presence of pain, and general health. PCBD appeared to have a specific association with pain and physical functioning, independent of other variables. Conclusions: This study examined the potential independent association of PCBD on physical and mental health in Veterans with PTSD. PCBD appeared to have a very specific and significant association with pain and physical functioning. In other words, the pain of grief was related to ratings of physical pain. Future research on PCBD should address the potentially bidirectional association with bodily pain, particularly chronic pain, in relation to loss, with specific attention to potential mechanisms underlying this relationship.

Impact of COVID-19 on myalgic encephalomyelitis/chronic fatigue syndrome-like illness prevalence: A cross-sectional survey.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) can be triggered by infectious agents including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the impact of the coronavirus disease 2019 (COVID-19) pandemic on ME/CFS prevalence is not well characterized. In this population-based cross-sectional study, we enrolled a stratified random sample of 9,825 adult participants in the Kaiser Permanente Northern California (KPNC) integrated health system from July to October 2022 to assess overall ME/CFS-like illness prevalence and the proportion that were identified following COVID-19 illness. We used medical record and survey data to estimate the prevalence of ME/CFS-like illness based on self-reported symptoms congruent with the 2015 Institute of Medicine ME/CFS criteria. History of COVID-19 was based on a positive SARS-CoV-2 nucleic acid amplification test or ICD-10 diagnosis code in the medical record, or self-report of prior COVID-19 on a survey. Of 2,745,374 adults in the eligible population, an estimated 45,892 (95% confidence interval [CI]: 32,869, 58,914) or 1.67% (CI 1.20%, 2.15%) had ME/CFS-like illness. Among those with ME/CFS-like illness, an estimated 14.12% (CI 3.64%, 24.6%) developed the illness after COVID-19. Among persons who had COVID-19, those with ME/CFS-like illness after COVID-19 were more likely to be unvaccinated and to have had COVID-19 before June 1, 2021. All persons with ME/CFS-like illness had significant impairment in physical, mental, emotional, social, and occupational functioning compared to persons without ME/CFS-like illness. In a large, integrated health system, 1.67% of adults had ME/CFS-like illness and 14.12% of all persons with ME/CFS-like illness developed it after COVID-19. Though COVID-19 did not substantially increase ME/CFS-like illness in the KPNC population during the study time period, ME/CFS-like illness nevertheless affects a notable portion of this population and is consistent with estimates of ME/CFS prevalence in other populations. Additional attention is needed to improve awareness, diagnosis, and treatment of ME/CFS.

Recasting technocracy theory and analysis: Avenues for a critical-qualitative research framework

Technocracy strongly marks contemporary transformations of political and institutional regimes. Such increasing relevance triggered an exponential growth of dedicated research. Yet, this research often features a quantitative approach based on a reified conception of technocracy, resulting in a rationalist and functionalist perspective neglecting the political dimension. Technocracy is thus implicitly conceived as a depoliticised phenomenon deterministically set to ever-expand in democratic regimes. In contrast, this article proposes a recast of technocracy theory and analysis. First, we rethink the phenomenon of technocracy by exploring the agency of technocratic politics. Second, in epistemological and methodological terms, we lay the foundations for a systematic and robust qualitative research framework capable of tackling this form of politics by other – technocratic – means. To this end, we propose Critical Discourse Analysis as a main candidate to fulfil our theoretical-epistemic purposes, offering a detailed roadmap of a critical-qualitative approach to technocrats’ agency and discourse.

Psychological and social difficulties in young non-help-seeking adolescents at risk for psychosis: insights from a large cohort study.

This study used data from the Norwegian Mother, Father, and Child Cohort Study (MoBa), and explored the psychological and social challenges of 14-year-olds who report psychotic symptoms. Research on help-seeking youths indicates comorbid symptoms of depression, anxiety, and social deterioration, but less is known about non-help-seeking individuals who may not use healthcare services, possibly skewing comorbidity profiles. Also, findings suggest that adolescents manifesting psychotic symptoms refrain from pursuing help. This gap underscores the necessity of studying non-help-seeking adolescents to better understand their needs and the risks they face without intervention. We analyzed responses from adolescents who completed the 14-year questionnaire in MoBa (N = 127), identifying those as at risk by their high scores on psychosis-risk items, within the top 0.4% (N = 58). Comparative analyses were conducted against matched controls to assess differences in psychological and social functioning (N = 69). Results indicated that the at-risk adolescents experience significantly more depression and anxiety and have lower self-esteem and poorer social functioning than controls. Social functioning parameters, including leisure activities, social competence, quality of parental relationship, and sense of school belonging, were significantly worse than those observed in controls. The results indicate a pronounced vulnerability among non-help-seeking adolescents at-risk, similar to issues seen in help-seeking youths. These findings highlight the importance of early identification and intervention strategies that reach beyond traditional clinical settings, suggesting the efficacy of population or community-based screenings to prevent long-term adverse outcomes. The study proposes a broader understanding of psychosis risk, stressing the importance of inclusive approaches to support at-risk adolescents effectively.

Health-related quality of life among women diagnosed with in situ or invasive breast cancer and age-matched controls: a population-based study

PurposeA breast cancer (BC) diagnosis may negatively affect health-related quality of life (HRQoL). However, there are few comparisons of HRQoL at several time points for women with BC, and particular when subdivided into invasive and in situ tumors. The purpose of this study was to investigate various aspects of HRQoL in women recently diagnosed with invasive BC or ductal carcinoma in situ (in situ) compared to age-matched BC free controls in a population-wide sample recruited through the Cancer Registry of Norway.MethodsThis cross-sectional study utilized HRQoL data collected in 2020–2022 from a digital survey including 4117 cases (3867 women with invasive BC and 430 with in situ) and 2911 controls. HRQoL was assessed ≥ 21 days after diagnosis, using EORTC QLQ-C30. This includes scores assessing global quality of life (gHRQoL) and HRQoL functions and symptoms. Multivariable regression analyses were used to compare HRQoL between cases and controls and to identify factors associated with gHRQoL and fatigue. Additionally, HRQoL 14 months after diagnosis was analyzed in 1989 of the included cases and in 1212 of the controls. Score differences of ≥ 10 points were considered clinically relevant and thus presented in the results.ResultsInvasive BC cases had lower gHRQoL, role- and social functioning in addition to more fatigue than controls. In situ cases had lower role—and social functioning than controls. Invasive BC cases scored worse than in situ on all domains, but the differences were not considered clinically relevant. Physical activity was associated with better gHRQoL and less fatigue in invasive BC, in situ and controls. Both invasive BC and in situ cases improved their role- and social functioning scores from diagnosis to 14 months follow-up, however no improvement was seen for fatigue.ConclusionWomen with invasive BC and in situ reported lower role- and social functioning scores than controls right after diagnosis with improvements 14 months after diagnosis. Physical activity was associated with better gHRQoL and less fatigue and should, whenever possible, play a key role in the care for BC patients.

The Influence of Colonial Trauma on the Masculine Characteristics of Georgian Identity

The present paper explores two Georgian literary texts written at the beginning of the twentieth century, at the early stage of Sovietization: Sanavardo by Demna Shengelaia, and Jaqo’s Dispossessed by Mikheil Javakhishvili. I aim to explore the traumatic effects of colonization on Georgian national consciousness and analyze its influence on the masculine characteristics of the Georgian identity. The issue of national self-identification has been raised, with all its sharpness, at every stage of fundamental historical and political changes in Georgia. The permanency of the issue is an indication of the fact that the national self-identification process has been associated with certain historical facts and events that have not been fully realized and existed as not overcome trauma, by society. Such an event is the Russian occupation of Georgia at the end of the nineteenth century. Based on trauma theory, the research shows that in both novels, the writers describe the lives of the main characters who lost their abilities and were unable to make purposeful use of their potential. Therefore, their political and social functions were represented by disregarding reality and distancing themselves from the present. The reasons for the negation of the present refer to the so-called existential fear of reality, which has caused a weakening or disappearance of masculine characteristics of identity such as power, assertiveness, desire to own and control, and individual initiative.

How social media exposure constructs social confidence: An empirical study on impact, mechanisms, and multilateral relationships.

Social confidence functions as a vital spiritual force in fostering the positive and healthy evolution of society. This paper explores how social media exposure contributes to the construction of social confidence within the framework of Media-system Dependency Theory. The research unveils the following key findings: (1) Social media exposure positively facilitates social confidence; (2) Group efficacy and group cohesion, perceived as manifestations of cognitive divergence between "efficacy" and "collective" within collective efficacy, both serve as mediating mechanisms influencing the impact of social media exposure on social confidence. The Channel Testing of Causality confirms that group cohesion plays a significantly more crucial role as a pathway compared to group efficacy; (3) The differentiated impact of social media exposure, encompassing Tencent WeChat and Sina Weibo, materializes in distinct components of social confidence and follows different influence pathways.

Patient Consent and The Right to Notice and Explanation of AI Systems Used in Health Care

Given the need for enforceable guardrails for artificial intelligence (AI) that protect the public and allow for innovation, the U.S. Government recently issued a Blueprint for an AI Bill of Rights which outlines five principles of safe AI design, use, and implementation. One in particular, the right to notice and explanation, requires accurately informing the public about the use of AI that impacts them in ways that are easy to understand. Yet, in the healthcare setting, it is unclear what goal the right to notice and explanation serves, and the moral importance of patient-level disclosure. We propose three normative functions of this right: (1) to notify patients about their care, (2) to educate patients and promote trust, and (3) to meet standards for informed consent. Additional clarity is needed to guide practices that respect the right to notice and explanation of AI in healthcare while providing meaningful benefits to patients.

Quality of Life After Abdomioperineal Resection for Rectal Carcinoma

Background: Abdominoperineal resection (APR) has long been a standard treatment for rectal cancer, particularly for tumors located very distally or in patients with poor sphincter function. Despite the rise of sphincter-sparing techniques, APR remains essential in certain cases. This study aims to evaluate the impact of APR on the quality of life (QoL) in rectal cancer patients. Objective: To assess the quality of life in rectal cancer patients following APR, focusing on physical, psychological, sexual, and social functioning. Method: This prospective observational study was conducted at Sher-e-Bangla Medical College &amp; Hospital, Barisal, over six months (July-December 2015). Patients who underwent APR for rectal cancer and were at least three months post-surgery were included. QoL was evaluated based on patients' self-assessments across four dimensions: physical, psychological, sexual, and social functioning. Result: The study included patients with a mean age of 48 years (range: 23-75 years), with 40% being early middle-aged (31-40 years). Stoma-related issues were reported by 56% of patients, while 64% experienced odor problems. Psychological distress was prevalent, with 52% feeling discomfort, 44% experiencing depression or anxiety, and 12% reporting suicidal tendencies. Sexual dysfunction was significant, affecting 55% of men, with 83.8% completely impotent. Social functioning was compromised, with 42% reducing social activities. Overall, 24% of patients rated their QoL as poor, 14% as extremely poor, 26% as average, and 36% as good. Conclusion: Rectal cancer patients post-APR experience considerable limitations across all QoL dimensions, underscoring the need for targeted interventions to improve their overall well-being.

The Effect of Spiritual Care Development to Reduce the Level of Depression in the Families of Intensive Care Patients

Depression is a mental condition that affects a person's physical, psychological and social functioning. Depression occurs when problems in life arise, such as feeling disappointed, lost, depression is also a form of feeling sad, which can cause unhappiness and hopelessness. This study aimed was to analyze the effect of spiritual care development to reduce the level of depression in the families of intensive care patients. This research design uses Quasy experiment pre and posttest. The population is all families of patients in the Intensive Care ward at RSUD Haji Surabaya, totaling 108 respondents. The sample size was 85 respondents who met the inclusion criteria. The independent variable from the research is spiritual care with the intervention medium being a spiritual kit and the dependent variable is the level of depression in the family who keeps the patient in the intensive care room. Data was collected using the Beck's Depression Inventory questionnaire and then analyzed using the Wilcoxon Signed rank test. The Z score value for the pre-post variable for the incidence of depression is -5.940 with a p value of Asymp. Sig. (2-tailed) of .000 &lt; 0.05, it can be seen that there is a significant influence between the results of the level of depression before and after the spiritual therapy kit. Developing spiritual care using the spiritual kit method can reduce the level of depression in the families of intensive care patients.

WELFARE ANALYSIS VIA MARGINAL TREATMENT EFFECTS

We consider a causal structure with endogeneity, i.e., unobserved confoundedness, where an instrumental variable is available. In this setting, we show that the mean social welfare function can be identified and represented via the marginal treatment effect as the operator kernel. This representation result can be applied to a variety of statistical decision rules for treatment choice, including plug-in rules, Bayes rules, and empirical welfare maximization rules. Focusing on the application of the empirical welfare maximization framework, we provide convergence rates of the worst-case average welfare loss (regret).

The Social Intervention Function of Chinese Pop Music Performance and Its Macro Sociological Analysis

Pop music is a product of human consciousness and widely exists in all known human cultures. Music is not a necessity for human survival, why is it so important to humans? For a long time, social connections have been considered an important function of music and a major factor influencing the evolution of human musicality. The recent hypothesis of music social connection provides a framework for understanding the biological and cultural evolution of music. It suggests that music can coordinate emotions, behaviors, and ideological perspectives among individuals, strengthen intimate relationships between individuals, and thus enhance social cohesion. Pro social behavior is a manifestation of human social connections, which refers to the beneficial behavior of individuals towards others, groups, and society, such as helping behavior. Although studies have shown that listening to prosocial songs and their associated prosocial emotions can promote individual prosocial behavior, it remains unclear whether the music itself and its corresponding emotional experiences are sufficient to influence prosocial behavior after excluding the influence of lyrics. In addition, although some studies suggest that prosocial behavior is related to factors such as individual psychological theory ability and cognitive ability, the mediating effect of music on prosocial behavior through psychological theory ability and cognitive ability has not been verified. Therefore, based on the classic two-dimensional emotional model, this study systematically examines whether music and its induced emotional experiences affect individual prosocial behavior decisions, and further explores the mediating role of psychological theory and cognitive ability.

Augmented Reality as an Aid to Behavior Therapy for Anxiety Disorders: A Narrative Review.

Anxiety disorders are among the most common mental disorders worldwide. These conditions are characterized by excessive anxiety that is difficult to control. In most anxiety disorders, symptoms are triggered by exposure to specific objects or situations. This leads sufferers to avoid such exposures, leading to impaired social and occupational functioning and reduced quality of life. Therapies based on behavioral principles, either alone or in combination with cognitive techniques, are the most effective psychological interventions for anxiety disorders. However, the effectiveness of these therapies may be limited due to a lack of generalization from clinic to real-world settings. Augmented reality (AR) is a technology that provides an interactive experience by superimposing computer-generated content, often in multiple sensory modalities, on the real world. Emerging evidence suggests that AR may be useful in treating a broad range of mental disorders, including anxiety disorders. This review examines the evidence for the use of AR-based techniques as an aid to behavioral or cognitive-behavioral therapies for anxiety disorders. The available evidence suggests that this method may offer significant advantages over conventional therapies, particularly in the case of specific phobias, but also in social anxiety disorder. AR can also be combined with other novel technologies to monitor psychophysiological markers of anxiety and its reduction over the course of treatment. The advantages of AR could be related to its combination of real and simulated content, allowing for better generalization of the benefits of conventional exposure-based therapy. Though the safety, efficacy, and cost-effectiveness of this method need to be confirmed in larger samples, it could lead to a paradigm shift in the way behavioral therapies for anxiety disorders are conceptualized and delivered.

The bowel function instrument for rectal cancer survivors with anastomosis and ostomy

ObjectiveRectal cancer is often treated with surgery such as ostomy or anastomosis. The Bowel Function Instrument (BFI) is a valid and reliable 18-item measure of physical bowel symptoms. Some items on the BFI do not apply to those with ostomies. We reanalyzed data from a previous validation study to inform the best method for scoring the BFI for both people with ostomies and anastomosis. MethodsPeople (n = 575) with rectal cancer treated with ostomy (n = 181, 31 %) or anastomosis (n = 394, 69 %) completed the BFI and Short Form 12 (SF12) measure on a mailed survey. The full BFI has three subscales and a total score based on 14 items: soilage/urgency (4 items); frequency of bowel movements (6 items); and dietary changes (4 items). We used confirmatory factor analysis (CFA) to examine two versions (8-item, 11-item) of the BFI adapted for use with both ostomy and anastomosis. We also examined reliability and validity of the version supported by the CFA. ResultsCFA results supported the 8-item BFI that included only the soilage/urgency items and dietary changes items but not the frequency items. The 8-item BFI was reliable (Cronbach's alpha of 0.788). The 8-item BFI score significantly correlated with all SF12 subscales with Pearson correlations ranging from 0.115 (Vitality) to 0.318 (social function). ConclusionsThe 8-item version of the BFI was valid and reliable as a total score for people with ostomy or anastomosis. The 8-item BFI may be useful for monitoring bowel function during and after treatment for rectal cancer.