Irritable bowel syndrome among medical students and its association with anxiety.

Objective: To find out the frequency of Bowel Syndrome (IBS) among medical students according to ROME 111 criteria. To find out the frequency of common subtypes of IBS among the IBS positive medical students. To observe the association between anxiety, depression, and irritable bowel syndrome according to HAD scale. Study Design: Cross Sectional study. Setting: Medical Students of BUMDC. Period: September to November 2020. Material & Methods: The study was conducted among the medical students at a private medical college in Karachi. Ethical approval taken. After taking consent questionnaires were given. The total students with irritable bowel syndrome were presented by their frequencies, then finding were analyzed using ROME 111 and HAD scale. Results: A total of 370 students were included after considering inclusion and exclusion criteria. Out of which 152 students (41%) were found to have irritable bowel syndrome according to ROME 111 criteria. The most common IBS subtypes seen in our study was IBS –D (diarrhea) 80. Among those students diagnosed with IBS, anxiety was positive in 100 students while depression was seen in 5 students according to HAD scale. Conclusion: This study concludes that medical students are more prone to develop IBS which is aggravated by stress related anxiety for having extensive curriculum and pressure from the peers of having good score in exam among intellectual section of the society which is not an easy task to cope up.

Revisiting the Risk Factors for Multiple Symptoms of Temporomandibular Disorders: A structured Cross-sectional Study

Background: The risk factors for Temporomandibular Disorders (TMD) are extensively studied, but the results showed no consistency. Only a small proportion of patients with TMD are likely to seek help and require treatment. Those individuals tend to present with multiple symptoms. This cohort of patients was not well investigated. Objective: The study aimed to examine the association between possible risk factors for presentation with multiple TMD symptoms. Methods: A population-based, cross-sectional study was conducted across 2101 individuals with an age range of 19-60 years. The condition was assessed via a detailed questionnaire comprising symptoms, habits, dental history, general health, sleep patterns, along with the completion of the Hospital Anxiety and Depression (HAD) scale, followed by an examination of the hypothesized clinical signs. The obtained data were tabulated and characterized the study population in a descriptive analysis in forms of percentages and frequencies. The significance level was set at P-value less than or equal to 0.005. The chi-squared test was implemented to assess the relationship between the multiple TMD symptoms reported and the potential risk factors. Results: Most participants reported a variable amount of stress. Moreover, 1528 (72.7 percent) mentioned abnormalities in sleep. About 80 percent had at least one TMD-related symptom. The multiple symptoms of TMD were identified among the 741 individuals. The following risk factors demonstrated association with a robust statistical significance (P=0.00), 1) occupation, 2) sleeping problems, 3) health concerns, 4) traumatic dental treatment, 5) various somatic symptoms, and 6) elevated HAD scale. When the outcomes of the clinical examination were analyzed, the statistical assessment could link soft tissue changes, namely; the cheek ridging and tongue indentations (P 0.00), with multiple symptoms of the condition. Conclusion: Multiple TMD symptoms were prevalent among individuals with elevated stress, abnormal sleep pattern, traumatic dental treatment, elevated HAD scale. The results highlighted the importance of psychological factors in the pathogenesis of TMD.

Olive production in Northern Iran: physical and comparative advantages analysis

ABSTRACT: Olive is one of the strategic products of Guilan province, northern Iran. Hence, it is very important to determine the optimal production pattern of olive, given the resources scarcity and the assessment of physical and Comparative Advantage (CA). In this study, three physical advantage indices for olive production in Guilan province during 2008-2016 were investigated. Also, the CA, protection and competitiveness indicators of olive production at Guilan province for 2016-17 cultivation years were calculated using the Policy Analysis Matrix (PAM). Results showed that Guilan province had scale advantage in olive production. The highest degree of olive plantation concentration was on 2008 with scale advantage index of 2.49. Also, results of efficiency advantage showed that, except for 2008, olive production had efficiency advantage over all under study years at Guilan province. Results of Domestic Resource Costs (DRC) and Social Cost Benefit ratio (SCB) indicators for both traditional and commercial olive plantations revealed the CA of olive production in Guilan province. Also, the competitiveness indices values (UCd and UCx) for both traditional and commercial olive plantations were less than 1. So, the olive production systems in Guilan province had the ability to compete with domestic and international competitors.

High levels of alexithymia in patients with multiple sclerosis

Alexithymia is a personality trait characterized by difficulties identifying and describing feelings. Some researchers describe high levels of alexithymia among patients with multiple sclerosis (MS) but literature data on this subject are scarce. Objective: The objective of the present study was to characterize findings of alexithymia in patients with MS. Methods: This cross-sectional case-control study included 180 patients with MS and a matched control group. Data for patients with MS included disease duration, number of demyelinating relapses and degree of neurological disability, as assessed by the Expanded Disability Scale Score (EDSS). In addition, the Hospital Anxiety and Depression (HAD) scale and the Toronto Alexithymia Scale (TAS) were used. Results: There were 126 women and 54 men in each group, with median age of 37 years and median education of 16 years. Patients with MS had higher degrees of depression (p<0.01), anxiety (p=0.01) and alexithymia (p<0.01) than did control subjects. For individuals with MS, depressive traits (p<0.01), anxious traits (p=0.03), higher age (p=0.02), lower education level (p=0.02), higher degree of disability (p<0.01) and not being actively employed (p=0.03) were associated with higher rates of alexithymia. Conclusion: Alexithymia was a relevant finding in patients with MS.

PREVALENCE AND PSYCHOLOGICAL STRESS IN RECURRENT APHTHOUS STOMATITIS AMONG FEMALE DENTAL STUDENTS IN SAUDI ARABIA

Introduction. Recurrent Aphthous Stomatitis (RAS) is a common oral mucosal disorder which is characterized by recurrent ulcerations mainly confined to non-keratinized oral mucosa. Though the exact etiology is imprecise, stress and anxiety were found to be linked with the onset of RAS. The present study was directed to know the prevalence of RAS among female dental students in King Khalid University, to find out the association between RAS and psychological stress and the effectiveness of Hospital Anxiety and Depression scale (HADS) in finding out the psychological profile of RAS patients.Method. 122 female dental students of age group 17 to 25 years were selected for the study. Subjects with relevant medical problems and deleterious habits were excluded. A questionnaire comprising general stress related questions and HAD scale were used to assess stress. Those who were giving history of ulcer were diagnosed as RAS based on the clinical features. The questionnaire results were used for statistical analysis and processed.Result. 14% of the total students were having RAS. 70% could correlate the onset of ulcer with certain specific factors; stress being the major causative agent (91%). In HAD scale, 88% of students were having anxiety and 65% had depression; all patients with depression had anxiety.Conclusion. The prevalence of RAS in female dental students in KKU was around 14%. There is a strong relationship between psychological stress and RAS, as in most of the other studies. HAD scale alone can be used for detecting the psychological factor in RAS.

Analysis of Psychological Characteristics Impacting Spinal Cord Stimulation Treatment Outcomes: A Prospective Assessment

Background: Psychological factors are recognised as influencing the outcome of spinal cord stimulation (SCS) although there is currently no consensus as to which factors impact upon SCS efficacy. Objective: To identify psychological characteristics that may impact the efficacy of SCS. Study Design: Prospective evaluation. Setting: Single secondary care center in Dudley, United Kingdom. Methods: Patients: Seventy-five patients were initially recruited and 56 patients (31 women and 25 men) were followed-up for 12-months. Intervention: SCS for the management of chronic non-cancer pain. Main Outcome Measures: Outcome measures assessed at baseline, 6 months, and 12 months following SCS implantation included the visual analogue scale (VAS), Oswestry disability index (ODI), hospital anxiety and depression (HAD) scale, and the pain coping strategies questionnaire (PCSQ). Results: Statistically significant improvements were observed for the VAS (P < 0.001), ODI (P = 0.011), anxiety (P = 0.042), and depression (P = 0.010) in the HAD scale and for the subscales reinterpreting pain sensation (P = 0.018), control over pain (P = 0.001), and ability to decrease pain (P < 0.001) of the PCSQ. We observed that depression and autonomous coping (control over pain, ability to reduce pain, and catastrophizing) may impact sensory aspects such as pain intensity and disability scores affecting the outcome of SCS treatment. Age at time of implant and duration of pain prior to implant were also found to impact SCS efficacy. Limitations: It has been reported that loss of analgesia may be experienced within 12 to 24 months following SCS implantation and therefore, it would be of interest to follow patients over a longer period. Conclusions: This study demonstrates that psychological aspects such as depression and autonomous coping may impact SCS treatment. Addressing these issues prior to SCS implantation may improve SCS long-term outcome. Key words: Spinal cord stimulation, chronic pain, psychological characteristics, depression, autonomous coping

HUBUNGAN MEKANISME KOPING DENGAN KEPATUHAN KEMOTERAPI PADA PENDERITA KEGANASAN YANG MENGALAMI ANSIETAS DAN DEPRESI

AbstrakPenderita keganasan mendapat kemoterapi banyak menunjukkan gejala psikologisseperti ansietas dan depresi yang sangat berpengaruh terhadap kepatuhan penderita dalammenjalani kemoterapi. Penelitian ini bertujuan untuk melihat hubungan mekanisme kopingdengan kepatuhan melakukan kemoterapi pada penderita keganasan yang mengalamiansietas dan depresi. Penelitian dilakukan selama 3 bulan pada penderita keganasan yangmenjalani kemoterapi di RSUP M.Djamil dengan metode cross sectional. Jumlah pasienadalah 59 pasien, 38 diantaranya mengalami ansietas dan/atau depresi. Mekanisme kopingdinilai dengan Brief Cope. Kepatuhan dinilai dengan wawancara dan kuesioner. Ansietasdan depresi dinilai dengan HAD Scale. Data di analisa dengan SPSS menggunakan uji Chi-Square dan korelasi koefisien kontingensi dengan tingkat kebermaknaan p<0,05. Kesimpulandari penelitian ini adalah prevalensi depresi lebih tinggi dari pada ansietas pada penderitakeganasan yang menjalani kemoterapi, dan ada hubungan kuat yang bermakna secarastatistik antara mekanisme koping dengan kepatuhan melakukan kemoterapi pada penderitakeganasan yang mengalami ansietas dan depresi.AbstractPatients with malignancies who received chemotherapy show psychological symptomssuch as anxiety and depression that correlated with their adherence to chemotherapy. Thisstudy aims to see the relationship between coping mechanisms with chemotherapy adherencein patients with malignancies who experience anxiety and depression. The study was conductedfor 3 months in patients with malignancies undergoing chemotherapy at Dr M.Djamil usingcross sectional design. The number of patients was 59, 38 of them experienced anxiety and/ordepression. Coping mechanism was assessed using the Brief Cope. Compliance was assessedby interview and questionnaire. Anxiety and depression were assessed by the HAD Scale. Datawas analyzed with SPSS using Chi-Square and coefficient contingency correlation, significancelevel of p <0.05. The final conclusion of this study is that the prevalence of depression washigher than the prevalence of anxiety in patients with malignancies who undergo chemotherapy,and there was a strong relationship between coping mechanism and chemotherapy adherencein patients with malignancies who experienced anxiety and depression.

Psycho-social determinants of antenatal anxiety and depression in Pakistan: Is social support a mediator?

Introduction: Pregnancy is generally viewed as a time of fulfillment and joy, however, for many women, it can be a stressful event. In South Asia, it is associated with cultural stigmas revolving around gender discrimination, abnormal births and genetic abnormalities. It is also associated with several psychiatric problems in women, most notably, depression and anxiety. Methodology: This cross sectional study was undertaken in four teaching hospitals in Lahore from February, 2014 to June, 2014. 500 Pregnant women presenting at the outdoors of obstetrics and gynecology department were interviewed. The questionnaire consisted of three sections: Demographics, Hospital anxiety and depression scale and social provision scale. Data was analyzed in SPSS v.20. Descriptive statistics were analyzed for demographics. Pearson Chi Square, Bivariate Correlations and linear regression were run to analyze associations of independent variables with scores on HAD scale and SPS. Results: There were a total of 500 respondents. Mean age of respondents was 27.41 years (5.65). Anxiety levels of participants were categorized as Normal 145 (29%), borderline 110 (22%) and anxious 245 (49%). Depression levels were categorized as 218 (43.6%) normal, 123 (24.6%) borderline, and 159 (31.8%) depressed. Inferential analysis revealed that higher scores on HAD scale were significantly associated with lower scores on social provisions scale (SPS), rural background, history of harassment, abortion, C-sections and unplanned pregnancies (P < .05). Social support also mediated the relationship between gender of previous offspring and scores on HAD scale. Women reporting higher numbers of female children were significantly associated with higher scores on HAD scale and lower on SPS scale. Whereas increasing number of male progeny were associated with low scores on depression subscale (P < .05). Conclusion: Keeping in context the predominantly patriarchal socio-cultural setting, the predictors of antenatal anxiety and depression in Pakistan may differ from those of the developed countries. Rural women and working women showed higher levels of antenatal anxiety and depression, which contradicts studies from western countries. Our study revealed higher number of female progeny was associated with higher levels of depression and anxiety while male progeny had a protective influence. We, therefore, suggest that interventions designed to reduce antenatal anxiety and depression should take these unique factors, operating in developing countries and patriarchal societies, into account in their design and implementation.

Psycho-social determinants of antenatal anxiety and depression in Pakistan: Is social support a mediator?

Introduction: Pregnancy is generally viewed as a time of fulfillment and joy, however, for many women, it can be a stressful event. In South Asia, it is associated with cultural stigmas revolving around gender discrimination, abnormal births and genetic abnormalities. It is also associated with several psychiatric problems in women, most notably, depression and anxiety. Methodology: This cross sectional study was undertaken in four teaching hospitals in Lahore from February, 2014 to June, 2014. 500 Pregnant women presenting at the outdoors of obstetrics and gynecology department were interviewed. The questionnaire consisted of three sections: Demographics, Hospital anxiety and depression scale and social provision scale. Data was analyzed in SPSS v.20. Descriptive statistics were analyzed for demographics. Pearson Chi Square, Bivariate Correlations and Partial Correlations were run to analyze associations of independent variables with scores on HAD scale and SPS. Results: There were a total of 500 respondents. Mean age of respondents was 27.41 years (5.65). Anxiety levels of participants were categorized as Normal 145 (29%), borderline 110 (22%) and anxious 245 (49%). Depression levels were categorized as 218 (43.6%) normal, 123 (24.6%) borderline, and 159 (31.8%) depressed. Inferential analysis revealed that higher scores on HAD scale were significantly associated with lower scores on SPS, rural background, history of harassment, abortion, C-sections and unplanned pregnancies (P < .05). Social support also mediated the relationship between total numbers of children, gender of previous offspring and scores on HAD and SPS scales. Women reporting higher numbers of female children were significantly associated with higher scores on HAD scale and lower on SPS scale. Whereas increasing number of male progeny were associated with low scores on these scales (P < .05). Conclusion: Keeping in context the predominantly patriarchal socio-cultural setting, the predictors of antenatal anxiety and depression in Pakistan may differ from those of the developed countries. Rural women and working women showed higher levels of antenatal anxiety and depression, which contradicts studies from western countries. Our study revealed higher number of female progeny was associated with higher levels of depression and anxiety while male progeny had a protective influence. We, therefore, suggest that interventions designed to reduce antenatal anxiety and depression should take these unique factors, operating in developing countries and patriarchal societies, into account in their design and implementation.

Depressive disorder among the breast cancer patients in outpatient department of a tertiary care hospital in Pakistan

ObjectivesTo determine the frequency of Depressive Disorder among patients with breast cancer in an outpatient department of a tertiary care hospital in Pakistan.BackgroundCancer not only affects body physically but can also affect the mind in the form of psychiatric disorder. Proper identification and treatment of these conditions can be beneficial and cost-effective.MethodologyThis cross-sectional descriptive study was conducted on patients of breast cancer attending OPD of oncology department of Civil Hospital Karachi. The sample consisted of ninety three diagnosed patients of breast cancer who were screened for psychiatric morbidity through Hospital Anxiety and Depression Scale (HAD Scale). Screened patients were interviewed and diagnosed as depressive disorder according to ICD criteria. The level of depression in these diagnosed patients was quantified through ZUNG'S Depression Rating Scale.ResultsEighty two percent (n = 76) of the sample (n = 93) were found to have psychiatric morbidity on HAD scale. Out of these screened sample sixty percent (n = 46) were found to be depressed on Zung self rating depression scale. Majority of these patients were suffering from mild to moderate depression. Half of the female in this sample were undergone mastectomy that was not found to have any statistically significant impact on psychiatric morbidity of the patient.ConclusionThis study shows high prevalence of depression in patients with breast cancer. The health professional involve in care of breast cancer should screen routinely their patients for symptoms of depression.