Promoting Healthy Lifestyles with Personalized, APOE Genotype Based Health Information: The Effects on Psychological-, Health Behavioral and Clinical Factors

There is an increasing demand for individualized, genotype-based health advice. The general population-based dietary recommendations do not always motivate people to change their life-style, and partly following this, cardiovascular diseases (CVD) are a major cause of death in worldwide. Using genotype-based nutrition and health information (e.g. nutrigenetics) in health education is a relatively new approach, although genetic variation is known to cause individual differences in response to dietary factors. Response to changes in dietary fat quality varies, for example, among different APOE genotypes. Research in this field is challenging, because several non-modifiable (genetic, age, sex) and modifiable (e.g. lifestyle, dietary, physical activity) factors together and with interaction affect the risk of life-style related diseases (e.g. CVD). The other challenge is the psychological factors (e.g. anxiety, threat, stress, motivation, attitude), which also have an effect on health behavior. The genotype-based information is always a very sensitive topic, because it can also cause some negative consequences and feelings (e.g. depression, increased anxiety). The aim of this series of studies was firstly to study how individual, genotype-based health information affects an individual’s health form three aspects, and secondly whether this could be one method in the future to prevent lifestyle-related diseases, such as CVD. The first study concentrated on the psychological effects; the focus of the second study was on health behavior effects, and the third study concentrated on clinical effects. In the fourth study of this series, the focus was on all these three aspects and their associations with each other. The genetic risk and health information was the APOE gene and its effects on CVD. To study the effect of APOE genotype-based health information in prevention of CVD, a total of 151 volunteers attended the baseline assessments (T0), of which 122 healthy adults (aged 20 – 67 y) passed the inclusion criteria and started the one-year intervention. The participants (n = 122) were randomized into a control group (n = 61) and an intervention group (n = 61). There were 21 participants in the intervention Ɛ4+ group (including APOE genotypes 3/4 and 4/4) and 40 participants in the intervention Ɛ4- group (including APOE genotypes 2/3 and 3/3). The control group included 61 participants (including APOE genotypes 3/4, 4/4, 2/3, 3/3 and 2/2). The baseline (T0) and follow-up assessments (T1, T2, T3) included detailed measurements of psychological (threat and anxiety experience, stage of change), and behavioral (dietary fat quality, consumption of vegetables, - high fat/sugar foods and –alcohol, physical activity and health and taste attitudes) and clinical factors (total-, LDL- HDL cholesterol, triglycerides, blood pressure, blood glucose (0h and 2h), body mass index, waist circumference and body fat percentage). During the intervention six different communication sessions (lectures on healthy lifestyle and nutrigenomics, health messages by mail, and personal discussion with the doctor) were arranged. The intervention groups (Ɛ4+ and Ɛ4-) received their APOE genotype information and health message at the beginning of the intervention. The control group received their APOE genotype information after the intervention. For the analyses in this dissertation, the results for 106/107 participants were analyzed. In the intervention, there were 16 participants in the high-risk (Ɛ4+) group and 35 in the low-risk (Ɛ4-) group. The control group had 55 participants in studies III-IV and 56 participants in studies I-II. The intervention had both short-term (≤ 6 months) and long-term (12 months) effects on health behavior and clinical factors. The short-term effects were found in dietary fat quality and waist circumference. Dietary fat quality improved more in the Ɛ4+ group than the Ɛ4- and the control groups as the personal, genotype-based health information and waist circumference lowered more in the Ɛ4+ group compared with the control group. Both these changes differed significantly between the Ɛ4+ and control groups (p<0.05). A long-term effect was found in triglyceride values (p<0.05), which lowered more in Ɛ4+ compared with the control group during the intervention. Short-term effects were also found in the threat experience, which increased mostly in the Ɛ4+ group after the genetic feedback (p<0.05), but it decreased after 12 months, although remaining at a higher level compared to the baseline (T0). In addition, Study IV found that changes in the psychological factors (anxiety and threat experience, motivation), health and taste attitudes, and health behaviors (dietary, alcohol consumption, and physical activity) did not directly explain the changes in triglyceride values and waist circumference. However, change caused by a threat experience may have affected the change in triglycerides through total- and HDL cholesterol. In conclusion, this dissertation study has given some indications that individual, genotypebased health information could be one potential option in the future to prevent lifestyle-related diseases in public health care. The results of this study imply that personal genetic information, based on APOE, may have positive effects on dietary fat quality and some cardiovascular risk markers (e.g., improvement in triglyceride values and waist circumference). This study also suggests that psychological factors (e.g. anxiety and threat experience) may not be an obstacle for healthy people to use genotype-based health information to promote healthy lifestyles. However, even in the case of very personal health information, in order to achieve a permanent health behavior change, it is important to include attitudes and other psychological factors (e.g. motivation), as well as intensive repetition and a longer intervention duration. This research will serve as a basis for future studies and its information can be used to develop targeted interventions, including health information based on genotyping that would aim at preventing lifestyle diseases. People’s interest in personalized health advices has increased, while also the costs of genetic screening have decreased. Therefore, generally speaking, it can be assumed that genetic screening as a part of the prevention of lifestyle-related diseases may become more common in the future. In consequence, more research is required about how to make genetic screening a practical tool in public health care, and how to efficiently achieve long-term changes.

Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: identification of risk factors, preventive factors and key elements for treatment--a cohort study

Background Chronic localized pain syndromes, especially chronic low back pain (CLBP), are common reasons for consultation in general practice. In some cases chronic localized pain syndromes can appear in combination with chronic widespread pain (CWP). Numerous studies have shown a strong association between CWP and several physical and psychological factors. These studies are population-based cross-sectional and do not allow for assessing chronology. There are very few prospective studies that explore the predictors for the onset of CWP, where the main focus is identifying risk factors for the CWP incidence. Until now there have been no studies focusing on preventive factors keeping patients from developing CWP. Our aim is to perform a cross sectional study on the epidemiology of CLBP and CWP in general practice and to look for distinctive features regarding resources like resilience, self-efficacy and coping strategies. A subsequent cohort study is designed to identify the risk and protective factors of pain generalization (development of CWP) in primary care for CLBP patients. Methods/Design Fifty-nine general practitioners recruit consecutively, during a 5 month period, all patients who are consulting their family doctor because of chronic low back pain (where the pain is lasted for 3 months). Patients are asked to fill out a questionnaire on pain anamnesis, pain-perception, co-morbidities, therapy course, medication, socio demographic data and psychosomatic symptoms. We assess resilience, coping resources, stress management and self-efficacy as potential protective factors for pain generalization. Furthermore, we raise risk factors for pain generalization like anxiety, depression, trauma and critical life events. During a twelve months follow up period a cohort of CLBP patients without CWP will be screened on a regular basis (3 monthly) for pain generalization (outcome: incident CWP). Discussion This cohort study will be the largest study which prospectively analyzes predictors for transition from CLBP to CWP in primary care setting. In contrast to the typically researched risk factors, which increase the probability of pain generalization, this study also focus intensively on protective factors, which decrease the probability of pain generalization.

Investigation of psychological and neuropsychological factors associated with clinical outcome following a group rehabilitation programme

The present study investigated neuropsychological and psychological factors associated with successful treatment outcome following a group intervention for individuals with acquired brain injury (ABI). Participants were classified into two groups (Clinically Improved and Not Improved) based upon the findings of a previous study (Ownsworth, McFarland, & Young, 2000a). A discriminant analysis was used to predict group membership on three outcome measures (Awareness and Strategy Behaviour indices of the Self-Regulation Skills Interview and the Psychosocial Dimension of the Sickness Impact Profile) between pre-assessment and post-assessment, and between pre-assessment and 6 months follow-up. Neuropsychological factors involved measures of executive functioning and psychological factors were assessed using measures of personality-related denial and coping-related denial. Overall, the results indicated that individuals with impaired executive functioning were most likely to be classified as Clinically Improved on measures of awareness, strategy behaviour and psychosocial functioning. Individuals who deny or minimise their ABI symptoms were less likely to improve their psychosocial functioning following the group intervention. Future research needs to evaluate interventions for enhancing self-regulation skills and improving psychosocial functioning for individuals who employ denial as a main strategy for coping following ABI.

Sexual dysfunction in epilepsy: identifying the psychological variables

In order to evaluate the psychological variables that affect sexual dysfunction (SD) in epilepsy, where compared 60 epileptics (Group 1) with 60 healthy individuals (Group 2), through the State-Trait Anxiety Inventory (Spielberger et al., 1970), Beck Depression Inventory (Beck, 1974) and Sexual Behavior Interview (Souza, 1995). Sexual dysfunction (SD), anxiety and depression were found more frequently in Group 1 than in Group 2 and were not related to sex. Variables such as the onset duration and frequency of seizures as well as the use to medication were not associated with SD. Temporal lobe epilepsy was related to SD (p = 0.035) but not to anxiety or depression. Anxiety and depression were related to SD in both groups. Perception in controlling the seizures was closely related to anxiety (p = 0) and depression (p = 0.009). We conclude that psychological factors play an important role in the alteration of sexual behavior in epileptics and that suitable attention must be given to the control of these variables.

Psychological stress and recurrent aphthous stomatitis

INTRODUCTION AND OBJECTIVES: Recurrent aphthous stomatitis (RAS) is the most common type of ulcerative disease of the oral mucosa. Despite its worldwide occurrence and the extensive amount of research that has been devoted to the subject, the etiology of RAS remains unclear. Nevertheless, several hereditary, nutritional, infectious and psychological factors have been associated with RAS. The aim of this case-control study was to assess the influence of psychological stress on the manifestation of RAS. METHOD: Fifty patients were enrolled in the trial. Twenty-five RAS patients constituted the study group and another 25 non-RAS patients who were similarly matched for sex, age and socioeconomic status constituted the control group. Each patient was evaluated in terms of the four domains of stress (emotional, physical, social and cognitive) using an internationally validated questionnaire, which was comprised of 59 items and measured the frequency and intensity of stress symptoms. The RAS group was interviewed during an active RAS episode. Completed questionnaires were submitted to proper analytical software and interpreted by an expert psychologist. RESULTS: There was a higher level of psychological stress among RAS group patients when compared to the control group (P < 0.05). CONCLUSION: Psychological stress may play a role in the manifestation of RAS; it may serve as a trigger or a modifying factor rather than being a cause of the disease.

Common mental disorders during pregnancy: prevalence and associated factors among low-income women in Sao Paulo, Brazil

To estimate the prevalence of common mental disorders (CMD) and factors associated with these disorders among pregnant women of low socio-economic status (SES) in Sao Paulo. We performed a cross-sectional study with 831 women in their 20th to 30th weeks of pregnancy, who were attending antenatal clinics in primary care in Sao Paulo, Brazil. CMD were assessed with the Clinical Interview Schedule-Revised. Crude and adjusted prevalence ratios and 95% CI were calculated to examine the association between CMD and exposure variables. The prevalence of CMD was 20.2% (95% CI 17.5 to 23.0). Age at current pregnancy and at first delivery, current obstetric complications, not having friends in the community, living in a crowded household, lower occupational status and history of previous psychiatric treatment were all independently associated with increased prevalence of CMD. CMD is highly prevalent among pregnant women of low SES seen in primary care settings in Sao Paulo. A combination of distal and proximal psychosocial factors increase the risk for CMD. Primary health care professionals need to be aware of how common CMD in such settings and properly trained to deal with CMD during pregnancy.

The investigation of factors underlying deficits in self-awareness and self-regulation

Primary objective: To examine a theoretical model which suggests that a contribution of both psychological and neuropsychological factors underlie deficits in self-awareness and self-regulation. Research design: Multivariate design including correlations and analysis of variance (ANOVA). Methods: Sixty-one subjects with acquired brain injury (ABI) were administered standardized measures of self-awareness and self-regulation. Psychological factors included measures of coping-related denial, personality-related denial and personality change. Neuropsychological factors included an estimate of IQ and two measures of executive functioning that assess capacity for volition and purposive behaviour. Main outcomes and results: The findings indicated that the relative contribution of neuropsychological factors to an outcome of deficits in self-awareness and self-regulation had a more direct effect than psychological factors. In general, measures of executive functioning had a direct relationship, while measures of coping-related and personality-related denial had an indirect relationship with measures of self-awareness and self-regulation. Conclusion: The findings highlighted the importance of measuring both neuropsychological and psychological factors and demonstrated that the relative contribution of these variables varies according to different levels of self-awareness and self-regulation.

Does participation in a pain course based on the international association for the study of pain's curricula guidelines change student knowledge about pain?

The People in Pain course was set up as a joint initiative of the Departments of Occupational Therapy and Physiotherapy within the School of Health and Rehabilitation Sciences at The University of Queensland. It was instigated in response to the publication of Pain Curricula for Occupational Therapy and Physiotherapy by the International Association for the Study of Pain (IASP) in 1994 (1). The first year it was offered, the "People in Pain" course comprised 14 h of lecture content. It was then expanded to encompass 28 h of lectures and seminar involvement. OBJECTIVES: To evaluate the impact of participation in a university pain course that meets the IASP pain curricula guidelines to increase health professional students' knowledge about pain. METHODS: Students who participated in the People in Pain course over the first three years were invited to complete the Revised Pain Knowledge and Attitudes Questionnaire (R-PKAQ) pre- and postcourse. Data obtained from 22 students in the short course formed a pilot project, and data from 22 students in the longer version of the course were used in the present study. RESULTS: Examination of the correlation matrix indicated substantial correlations between all R-PKAQ subscales except physiological basis of pain and pharmacological management of pain. In both the pilot project during the first year of the course and the expanded course in the following two years, significant improvement was found in the students' knowledge on five of the six subscales of the R-PKAQ: physiological basis of pain, psychological factors of pain perception, assessment and measurement of pain, cognitive-behavioural methods of pain relief, and pharmacological management of pain. Improvements in the developmental aspects of pain perception subscale failed to reach significance. CONCLUSIONS: An integrated pain course developed according to the pain curriculum guidelines developed by the IASP resulted in increased student knowledge regardless of the length of the program attended.

Factors associated to quality of life in active elderly

OBJECTIVE: To analyze whether quality of life in active, healthy elderly individuals is influenced by functional status and sociodemographic characteristics, as well as psychological parameters. METHODS: Study conducted in a sample of 120 active elderly subjects recruited from two open universities of the third age in the cities of São Paulo and São José dos Campos (Southeastern Brazil) between May 2005 and April 2006. Quality of life was measured using the abbreviated Brazilian version of the World Health Organization Quality of Live (WHOQOL-bref) questionnaire. Sociodemographic, clinical and functional variables were measured through crossculturally validated assessments by the Mini Mental State Examination, Geriatric Depression Scale, Functional Reach, One-Leg Balance Test, Timed Up and Go Test, Six-Minute Walk Test, Human Activity Profile and a complementary questionnaire. Simple descriptive analyses, Pearson's correlation coefficient, Student's t-test for non-related samples, analyses of variance, linear regression analyses and variance inflation factor were performed. The significance level for all statistical tests was set at 0.05. RESULTS: Linear regression analysis showed an independent correlation without colinearity between depressive symptoms measured by the Geriatric Depression Scale and four domains of the WHOQOL-bref. Not having a conjugal life implied greater perception in the social domain; developing leisure activities and having an income over five minimum wages implied greater perception in the environment domain. CONCLUSIONS: Functional status had no influence on the Quality of Life variable in the analysis models in active elderly. In contrast, psychological factors, as assessed by the Geriatric Depression Scale, and sociodemographic characteristics, such as marital status, income and leisure activities, had an impact on quality of life.

Relatório de estágio: mestrado em ensino da música

Resumo I - O projecto “Piano e outros Instrumentos/orquestra” consiste na implementação do formato Piano e Orquestra em complemento às aulas individuais e aos ensaios de conjunto. O trabalho foi dirigido a um grupo de três alunos com idades de 9, 12 e 16 anos, do curso de Iniciação, Básico e Secundário da EMNSC (Escola de Música de Nossa Senhora do Cabo). Foram criados momentos distintos em cada fase. Estimulou-se o desenvolvimento de competências musicais e de estratégias metacognitivas visando a evolução dos alunos e a eficácia na realização do estudo individual. O Projecto foi criado com o objectivo de desenvolver as competências musicais, a motivação para realização do estudo individual e de grupo, o espírito e a audição crítica, o controlo dos factores psicológicos, a ansiedade, o aumento da autoconfiança, a aprendizagem, a melhoria da atitude positiva no momento da execução pública e o incremento do interesse pelas actividades relacionadas com a prática musical. A realização deste projecto visou analisar o grau de motivação, o desenvolvimento e a aquisição de competências musicais dos alunos de piano que frequentaram semanalmente aulas individuais, aulas extra de preparação, ensaios com Orquestra “Da Capo”, ensaios com a Orquestra Maior, duos com violoncelo e com canto. Um dos objectivos era comparar o grau de motivação e desenvolvimento dos alunos quando estudam obras nas aulas individuais que constituem o programa curricular e, por outro lado, quando o fazem em peças seleccionadas especificamente para este Projecto. Esta experiência visou proporcionar um conhecimento nos diversos domínios da música, uma visão diferente da funcionalidade do piano em conjunto com os outros instrumentos, a descoberta das sonoridades do piano contrastante e ao mesmo tempo, integrante com outros instrumentos, as formas de funcionamento dos instrumentos de corda, de sopro, dos assuntos relacionados com a afinação e pretendendo-se assim apurar o sentido de fazer parte integrante de um todo.

A determinação dos números de indivíduos mínimos necessários na experimentação genética

The main object of the present paper consists in giving formulas and methods which enable us to determine the minimum number of repetitions or of individuals necessary to garantee some extent the success of an experiment. The theoretical basis of all processes consists essentially in the following. Knowing the frequency of the desired p and of the non desired ovents q we may calculate the frequency of all possi- ble combinations, to be expected in n repetitions, by expanding the binomium (p-+q)n. Determining which of these combinations we want to avoid we calculate their total frequency, selecting the value of the exponent n of the binomium in such a way that this total frequency is equal or smaller than the accepted limit of precision n/pª{ 1/n1 (q/p)n + 1/(n-1)| (q/p)n-1 + 1/ 2!(n-2)| (q/p)n-2 + 1/3(n-3) (q/p)n-3... < Plim - -(1b) There does not exist an absolute limit of precision since its value depends not only upon psychological factors in our judgement, but is at the same sime a function of the number of repetitions For this reasen y have proposed (1,56) two relative values, one equal to 1-5n as the lowest value of probability and the other equal to 1-10n as the highest value of improbability, leaving between them what may be called the "region of doubt However these formulas cannot be applied in our case since this number n is just the unknown quantity. Thus we have to use, instead of the more exact values of these two formulas, the conventional limits of P.lim equal to 0,05 (Precision 5%), equal to 0,01 (Precision 1%, and to 0,001 (Precision P, 1%). The binominal formula as explained above (cf. formula 1, pg. 85), however is of rather limited applicability owing to the excessive calculus necessary, and we have thus to procure approximations as substitutes. We may use, without loss of precision, the following approximations: a) The normal or Gaussean distribution when the expected frequency p has any value between 0,1 and 0,9, and when n is at least superior to ten. b) The Poisson distribution when the expected frequecy p is smaller than 0,1. Tables V to VII show for some special cases that these approximations are very satisfactory. The praticai solution of the following problems, stated in the introduction can now be given: A) What is the minimum number of repititions necessary in order to avoid that any one of a treatments, varieties etc. may be accidentally always the best, on the best and second best, or the first, second, and third best or finally one of the n beat treatments, varieties etc. Using the first term of the binomium, we have the following equation for n: n = log Riim / log (m:) = log Riim / log.m - log a --------------(5) B) What is the minimun number of individuals necessary in 01der that a ceratin type, expected with the frequency p, may appaer at least in one, two, three or a=m+1 individuals. 1) For p between 0,1 and 0,9 and using the Gaussean approximation we have: on - ó. p (1-p) n - a -1.m b= δ. 1-p /p e c = m/p } -------------------(7) n = b + b² + 4 c/ 2 n´ = 1/p n cor = n + n' ---------- (8) We have to use the correction n' when p has a value between 0,25 and 0,75. The greek letters delta represents in the present esse the unilateral limits of the Gaussean distribution for the three conventional limits of precision : 1,64; 2,33; and 3,09 respectively. h we are only interested in having at least one individual, and m becomes equal to zero, the formula reduces to : c= m/p o para a = 1 a = { b + b²}² = b² = δ2 1- p /p }-----------------(9) n = 1/p n (cor) = n + n´ 2) If p is smaller than 0,1 we may use table 1 in order to find the mean m of a Poisson distribution and determine. n = m: p C) Which is the minimun number of individuals necessary for distinguishing two frequencies p1 and p2? 1) When pl and p2 are values between 0,1 and 0,9 we have: n = { δ p1 ( 1-pi) + p2) / p2 (1 - p2) n= 1/p1-p2 }------------ (13) n (cor) We have again to use the unilateral limits of the Gaussean distribution. The correction n' should be used if at least one of the valors pl or p2 has a value between 0,25 and 0,75. A more complicated formula may be used in cases where whe want to increase the precision : n (p1 - p2) δ { p1 (1- p2 ) / n= m δ = δ p1 ( 1 - p1) + p2 ( 1 - p2) c= m / p1 - p2 n = { b2 + 4 4 c }2 }--------- (14) n = 1/ p1 - p2 2) When both pl and p2 are smaller than 0,1 we determine the quocient (pl-r-p2) and procure the corresponding number m2 of a Poisson distribution in table 2. The value n is found by the equation : n = mg /p2 ------------- (15) D) What is the minimun number necessary for distinguishing three or more frequencies, p2 p1 p3. If the frequecies pl p2 p3 are values between 0,1 e 0,9 we have to solve the individual equations and sue the higest value of n thus determined : n 1.2 = {δ p1 (1 - p1) / p1 - p2 }² = Fiim n 1.2 = { δ p1 ( 1 - p1) + p1 ( 1 - p1) }² } -- (16) Delta represents now the bilateral limits of the : Gaussean distrioution : 1,96-2,58-3,29. 2) No table was prepared for the relatively rare cases of a comparison of threes or more frequencies below 0,1 and in such cases extremely high numbers would be required. E) A process is given which serves to solve two problemr of informatory nature : a) if a special type appears in n individuals with a frequency p(obs), what may be the corresponding ideal value of p(esp), or; b) if we study samples of n in diviuals and expect a certain type with a frequency p(esp) what may be the extreme limits of p(obs) in individual farmlies ? I.) If we are dealing with values between 0,1 and 0,9 we may use table 3. To solve the first question we select the respective horizontal line for p(obs) and determine which column corresponds to our value of n and find the respective value of p(esp) by interpolating between columns. In order to solve the second problem we start with the respective column for p(esp) and find the horizontal line for the given value of n either diretly or by approximation and by interpolation. 2) For frequencies smaller than 0,1 we have to use table 4 and transform the fractions p(esp) and p(obs) in numbers of Poisson series by multiplication with n. Tn order to solve the first broblem, we verify in which line the lower Poisson limit is equal to m(obs) and transform the corresponding value of m into frequecy p(esp) by dividing through n. The observed frequency may thus be a chance deviate of any value between 0,0... and the values given by dividing the value of m in the table by n. In the second case we transform first the expectation p(esp) into a value of m and procure in the horizontal line, corresponding to m(esp) the extreme values om m which than must be transformed, by dividing through n into values of p(obs). F) Partial and progressive tests may be recomended in all cases where there is lack of material or where the loss of time is less importent than the cost of large scale experiments since in many cases the minimun number necessary to garantee the results within the limits of precision is rather large. One should not forget that the minimun number really represents at the same time a maximun number, necessary only if one takes into consideration essentially the disfavorable variations, but smaller numbers may frequently already satisfactory results. For instance, by definition, we know that a frequecy of p means that we expect one individual in every total o(f1-p). If there were no chance variations, this number (1- p) will be suficient. and if there were favorable variations a smaller number still may yield one individual of the desired type. r.nus trusting to luck, one may start the experiment with numbers, smaller than the minimun calculated according to the formulas given above, and increase the total untill the desired result is obtained and this may well b ebefore the "minimum number" is reached. Some concrete examples of this partial or progressive procedure are given from our genetical experiments with maize.

Psychological correlates of childhood obesity.

To enhance the prevention and intervention efforts of childhood obesity, there is a strong need for the early detection of psychological factors contributing to its development and maintenance. Rather than a stable condition, childhood obesity represents a dynamic process, in which behavior, cognition and emotional regulation interact mutually with each other. Family structure and context, that is, parental and familial attitudes, activity, nutritional patterns as well as familial stress, have an important role with respect to the onset and maintenance of overweight and obesity. Behavioral and emotional problems are found in many, though not all, obese children, with a higher prevalence in clinical, treatment-seeking samples. The interrelatedness between obesity and psychological problems seems to be twofold, in that clinically meaningful psychological distress might foster weight gain and obesity may lead to psychosocial problems. The most frequently implicated psychosocial factors are externalizing (impulsivity and attention-deficit hyperactivity disorder) and internalizing (depression and anxiety) behavioral problems and uncontrolled eating behavior. These findings strengthen the need to further explore the interrelatedness between psychological problems and childhood obesity.

Mood and nonmood components of perceived stress and exacerbation of Crohn's disease.

BACKGROUND: Diverse psychological factors are involved in the pathophysiology of stress. In order to devise effective intervention strategies, it is important to elucidate which factors play the most important role in the association between psychological stress and exacerbation of Crohn's disease (CD). We hypothesized that the association between perceived stress and exacerbation of CD would remain after removal of mood and anxiety components, which are largely involved in stress perception. METHODS: In all, 468 adults with CD were recruited and followed in different hospitals and private practices of Switzerland for 18 months. At inclusion, patients completed the Perceived Stress Questionnaire and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. During the follow-up, gastroenterologists assessed whether patients presented with a CD exacerbation. By means of binary logistic regression analysis, we estimated the factor by which one standard deviation of perceived stress would increase the odds of exacerbation of CD with and without controlling for anxiety and depression. RESULTS: The odds of exacerbation of CD increased by 1.85 times (95% confidence interval 1.43-2.40, P < 0.001) for 1 standard deviation of perceived stress. After removing the anxiety and depression components, the residuals of perceived stress were no longer associated with exacerbation of CD. CONCLUSIONS: The association between perceived stress and exacerbation of CD was fully attributable to the mood components, specifically anxiety and depression. Future interventional studies should evaluate the treatment of anxiety and depression as a strategy for potential prevention of CD exacerbations.

Sexual dysfunction in obese women is more affected by psychological domains than that of non-obese

Abstract PURPOSE: To compare differences in the occurrence and changed domains of sexual dysfunction in obese and non-obese Brazilian women. METHODS: Female Sexual Function Index, based on six domains, to investigate 31 sexual dysfunction incidence for obese compared to 32 non-obese women, was used. Statistical analysis using ANOVA and MANOVA were performed to compare total scores of Female Sexual Function Index among groups and to identify the differences among domains, Student t -test was used. Statistical significant level was established for all tests for p<0.05. RESULTS: No difference in female sexual dysfunction frequency between obese (25.8%) and non-obese women (22.5%) was found. However, an important distinction in which aspects of sexual life were affected was found. While the obese group was impaired in three domains of sexual life (desire, orgasm, and arousal), in the control group five aspects were dysfunctional (desire, orgasm, arousal, pain and lubrication). Future research exploring psychological outcomes in obese females, such as body image and measures of positive and negative effect, might better characterize the female sexual dysfunction in this group. CONCLUSIONS: Obesity does not appear to be an independent factor for allow quality of female sexual life. However, disturbance associated to obesity indicates a low frequency of disorder in physical domains, suggesting that psychological factors seem to be mainly involved in the sexual dysfunction in obese women.

Psychological stress alters the ultrastructure and increases IL-1β and TNF-α in mandibular condylar cartilage

Psychological factors can be correlated with temporomandibular disorders (TMDs), but the mechanisms are unknown. In the present study, we examined the microstructural changes and expression of proinflammatory cytokines in mandibular condylar cartilage of the temporomandibular joint (TMJ) in a psychological stress animal model. Male Sprague-Dawley rats (8 weeks old, 210 ± 10 g) were randomly divided into 3 groups: psychological stress (PS, N = 48), foot shock (FS, N = 24), and control (N = 48). After inducing psychological stress using a communication box with the FS rats for 1, 3, or 5 weeks, PS rats were sacrificed and compared to their matched control littermates, which received no stress and were killed at the same times as the PS rats. Body and adrenal gland weight were measured and corticosterone and adrenocorticotropic hormone levels were determined by radioimmunoassay. After hematoxylin-eosin staining for histological observation, the ultrastructure of the TMJ was examined by scanning electron microscopy. Transcription and protein levels of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) were evaluated by ELISA and semi-quantitative RT-PCR. The PS group showed a significantly higher adrenal gland weight after 3 weeks of stress and higher hormone levels at weeks 1, 3, and 5. Histopathological changes and thinning cartilage were apparent at weeks 3 and 5. In the PS group, TNF-α increased at 1, 3, and 5 weeks and IL-1β increased significantly after 1 and 3 weeks of stress, and then decreased to normal levels by 5 weeks. Psychological stress increased plasma hormone levels and RT-PCR indicated increased IL-1β and TNF-α expression in the TMJ in a time-dependent manner. These results suggest that cytokine up-regulation was accompanied by stress-induced cartilage degeneration in the mandibular condyle. The proinflammatory cytokines play a potential role in initiating the cartilage destruction that eventually leads to the TMDs.