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وَقَالَ لَنَا سُلَيْمَانُ حَدَّثَنَا حَمَّادٌ، عَنْ أَيُّوبَ، عَنْ نَافِعٍ، قَالَ مَا رَدَّ ابْنُ عُمَرَ عَلَى أَحَدٍ وَصِيَّةً‏.‏ وَكَانَ ابْنُ سِيرِينَ أَحَبَّ الأَشْيَاءِ إِلَيْهِ فِي مَالِ الْيَتِيمِ أَنْ يَجْتَمِعَ إِلَيْهِ نُصَحَاؤُهُ وَأَوْلِيَاؤُهُ فَيَنْظُرُوا الَّذِي هُوَ خَيْرٌ لَهُ‏.‏ وَكَانَ طَاوُسٌ إِذَا سُئِلَ عَنْ شَىْءٍ مِنْ أَمْرِ الْيَتَامَى قَرَأَ ‏{‏وَاللَّهُ يَعْلَمُ الْمُفْسِدَ مِنَ الْمُصْلِحِ‏}‏‏.‏ وَقَالَ عَطَاءٌ فِي يَتَامَى الصَّغِيرُ وَالْكَبِيرُ يُنْفِقُ الْوَلِيُّ عَلَى كُلِّ إِنْسَانٍ بِقَدْرِهِ مِنْ حِصَّتِهِ‏.‏

Nafi' said:"Ibn 'Umar never refused to be appointed as guardian." The most beloved thing to Ibn Sirin concerning an orphan's wealth was that the orphan's advisor and guardians would assemble to decide what is best for him. When Tawus was asked about something concerning an orphan's affairs, he would recite: '...And Allah knows him who means mischief from him who means good...' (V 2:220). 'Ata said concerning some orphans, "The guardian is to provide for the young and the old orphans according to their needs from their shares

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Treatment-seeking behaviors and attitudes survey among women at risk for perinatal depression or anxiety.

Objective: To identify treatment preferences, help-seeking steps, and responses from social support persons among women at risk for perinatal depression or anxiety. Design: Prospective descriptive survey of women at risk for depression or anxiety. Setting: Private hospital in central Ohio. Participants: From an original sample of 220 women recruited between the third trimester of pregnancy and 2 months postpartum, we selected 36 women reporting clinically significant levels of depressive or anxious symptoms to complete a telephone survey. An additional 17 family members were surveyed as identified social support persons. Methods: Two telephone interviews including survey and open-ended responses were administered to participants approximately 6 weeks apart. Social support persons also received survey interviews assessing their opinions about the participants' mood changes. Results: More participants reported consulting friends and family about symptoms (83%) than consulting health care professionals (50%). However, most participants and their social support persons disagreed about the primary illness cause (66%). Approximately two thirds of participants recalled receipt of depression screening and feedback, but far fewer received referral or treatment via pharmacotherapy (36.1%) or psychotherapy (16.7%). Conclusion: Findings suggest screening and referral can be enhanced through expanding perinatal mental health education to target social support persons as they are often consulted by women when determining whether depression exists or should be treated. Further, a more active, personalized referral processes should be used routinely in addition to screening and education to facilitate appropriate treatment.

Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · cohort or longitudinal · 28 citationsread the source →

Telehealth Home Monitoring and Postcardiac Surgery for Congenital Heart Disease.

Objectives: To test the effect of a 4-month telehealth home monitoring program (REACH), layered on usual care, on postdischarge outcomes in parents of infants recovering from cardiac surgery and their infants. Methods: Randomized trial of infants discharged from the hospital after cardiac surgery for congenital heart disease. Consecutive infants with complex congenital heart disease undergoing cardiac surgery within 21 days of life were enrolled at 3 university-affiliated pediatric cardiac centers. Results: From 2012 to 2016, 219 parent-infant dyads were enrolled; 109 were randomly assigned to the intervention group and 110 to the control group. At 4 months postdischarge, parenting stress was not significantly different between groups (total Parenting Stress Index in the intervention group was 220 and in the control group was 215; P = .61). The percentages of parents who met posttraumatic stress disorder (PTSD) criteria and parent quality of life inventory scores were also not significantly different between the 2 groups (PTSD in the intervention group was 18% and was 18% in the control group; P =.56; the mean Ulm Quality of Life Inventory for Parents in the intervention group was 71 andwas 70 in the control group; P = .88). Infant growth in both groups was suboptimal (the mean weight-for-age z scores were -1.1 in the intervention group and -1.2 in the control group; P = .56), and more infants in the intervention group were readmitted to the hospital (66% in the intervention group versus 57% in the control group; P < .001). Conclusions: When added to usual care, the REACH intervention was not associated with an improvement in parent or infant outcomes. Four months after neonatal heart surgery, ∼20% of parents demonstrate PTSD symptoms. Suboptimal infant growth and hospital readmissions were common.

Pediatrics · randomised controlled trial · 26 citationsread the source →

Evaluation of a Violence-Prevention Programme with Jamaican Primary School Teachers: A Cluster Randomised Trial.

This study investigated the effect of a school-based violence prevention programme implemented in Grade 1 classrooms in Jamaican primary schools. Fourteen primary schools were randomly assigned to receive training in classroom behaviour management (n = 7 schools, 27 teachers/classrooms) or to a control group (n = 7 schools, 28 teachers/classrooms). Four children from each class were randomly selected to participate in the evaluation (n = 220 children). Teachers were trained through a combination of workshop and in-class support sessions, and received a mean of 11.5 h of training (range = 3-20) over 8 months. The primary outcomes were observations of (1) teachers' use of violence against children and (2) class-wide child aggression. Teachers in intervention schools used significantly less violence against children (effect size (ES) = -0.73); benefits to class-wide child aggression were not significant (ES = -0.20). Intervention teachers also provided a more emotionally supportive classroom environment (ES = 1.22). No benefits were found to class-wide prosocial behaviour, teacher wellbeing, or child mental health. The intervention benefited children's early learning skills, especially oral language and self-regulation skills (ES = 0.25), although no benefits were found to achievement in maths calculation, reading and spelling. A relatively brief teacher-training programme reduced violence against children by teachers and increased the quality of the classroom environment.

International journal of environmental research and public health · randomised controlled trial · 19 citationsread the source →

Long-term developmental effects of withholding parenteral nutrition for 1 week in the paediatric intensive care unit: a 2-year follow-up of the PEPaNIC international, randomised, controlled trial.

Background: The paediatric early versus late parenteral nutrition in critical illness (PEPaNIC) multicentre, randomised, controlled trial showed that, compared with early parenteral nutrition, withholding supplemental parenteral nutrition for 1 week in the paediatric intensive care unit (PICU; late parenteral nutrition) reduced infections and accelerated recovery from critical illness in children. We aimed to investigate the long-term impact on physical and neurocognitive development of early versus late parenteral nutrition. Methods: In this preplanned 2-year follow-up study, all patients included in the PEPaNIC trial (which was done in University Hospitals Leuven, Belgium; Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands; and Stollery Children's Hospital, Edmonton, AB, Canada) were approached for possible assessment of physical and neurocognitive development compared with healthy children who were matched for age and sex, and who had never been admitted to a neonatal ICU or a PICU. Assessed outcomes comprised anthropometric data; health status; parent-reported or caregiver-reported executive functions and emotional and behavioural problems; and tests for intelligence, visual-motor integration, alertness, motor coordination, inhibitory control, cognitive flexibility, and memory. To address partial responses among the children tested, we did multiple data imputation by chained equations before univariable and multivariable linear and logistic regression analyses adjusted for risk factors. This trial is registered with ClinicalTrials.gov, number NCT01536275. Findings: At the 2-year follow-up, 60 (8%) of 717 children who received late parenteral nutrition and 63 (9%) of 723 children who received early parenteral nutrition had died (p=0·81). 68 (9%) of 717 children who received late and 91 (13%) of 723 children who received early parenteral nutrition were too disabled for neurocognitive assessment (p=0·059), and 786 patients (395 assigned to late and 391 assigned to early parenteral nutrition) consented for testing. 786 patients and 405 healthy control children underwent long-term outcome testing between Aug 4, 2014, and Jan 19, 2018, and were included in the imputation model for subsequent multivariable analyses. Late parenteral nutrition did not adversely affect anthropometric data, health status, or neurological functioning, and improved parent-reported or caregiver-reported executive functioning (late vs early parenteral nutrition β estimate -2·258, 95% CI -4·012 to -0·504; p=0·011), more specifically inhibition (-3·422, -5·171 to -1·673; p=0·0001), working memory (-2·016, -3·761 to -0·270; p=0·023), and meta-cognition (-1·957, -3·694 to -0·220; p=0·027). Externalising behavioural problems (β estimate -1·715, 95% CI -3·325 to -0·106; p=0·036) and visual-motor integration (0·468, 0·087 to 0·850; p=0·016) were also improved in the late parenteral nutrition group compared with the early parenteral nutrition group. After Bonferroni correction for multiple comparisons, the effect on inhibitory control remained significant (p=0·0001). Interpretation: Withholding early parenteral nutrition for 1 week in the PICU did not negatively affect survival, anthropometrics, health status, and neurocognitive development, and improved inhibitory control 2 years after PICU admission. Funding: European Research Council Advanced Grant, Methusalem programme provided by the Flemish Government, Flemish Agency for Innovation by Science and Technology (IWT), Research Foundation Flanders (FWO), Sophia Children's Hospital Foundation (SSWO), Stichting Agis Zorginnovatie, Erasmus Trustfonds, and European Society for Parenteral and Enteral Nutrition (ESPEN) research grant.

The Lancet. Respiratory medicine · randomised controlled trial · 72 citationsread the source →

Anti-folate drug resistance in Africa: meta-analysis of reported dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) mutant genotype frequencies in African Plasmodium falciparum parasite populations.

Background: Mutations in the dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes of Plasmodium falciparum are associated with resistance to anti-folate drugs, most notably sulphadoxine-pyrimethamine (SP). Molecular studies document the prevalence of these mutations in parasite populations across the African continent. However, there is no systematic review examining the collective epidemiological significance of these studies. This meta-analysis attempts to: 1) summarize genotype frequency data that are critical for molecular surveillance of anti-folate resistance and 2) identify the specific challenges facing the development of future molecular databases. Methods: This review consists of 220 studies published prior to 2009 that report the frequency of select dhfr and dhps mutations in 31 African countries. Maps were created to summarize the location and prevalence of the highly resistant dhfr triple mutant (N51I, C59R, S108N) genotype and dhps double mutant (A437G and K540E) genotype in Africa. A hierarchical mixed effects logistic regression was used to examine the influence of various factors on reported mutant genotype frequency. These factors include: year and location of study, age and clinical status of sampled population, and reporting conventions for mixed genotype data. Results: A database consisting of dhfr and dhps mutant genotype frequencies from all African studies that met selection criteria was created for this analysis. The map illustrates particularly high prevalence of both the dhfr triple and dhps double mutant genotypes along the Kenya-Tanzania border and Malawi. The regression model shows a statistically significant increase in the prevalence of both the dhfr triple and dhps double mutant genotypes in Africa. Conclusion: Increasing prevalence of the dhfr triple mutant and dhps double mutant genotypes in Africa are consistent with the loss of efficacy of SP for treatment of clinical malaria in most parts of this continent. Continued assessment of the effectiveness of SP for the treatment of clinical malaria and intermittent preventive treatment in pregnancy is needed. The creation of a centralized resistance data network, such as the one proposed by the WorldWide Antimalarial Resistance Network (WWARN), will become a valuable resource for planning timely actions to combat drug resistant malaria.

Malaria journal · systematic review · 97 citationsread the source →

The Child and Adolescent Twin Study in Sweden (CATSS).

The Child and Adolescent Twin Study in Sweden (CATSS) is an ongoing longitudinal twin study targeting all twins born in Sweden since July 1, 1992. Since 2004, parents of twins are interviewed regarding the children's somatic and mental health and social environment in connection with their 9th or 12th birthdays (CATSS-9/12). By January 2010, 8,610 parental interviews concerning 17,220 twins had been completed, with an overall response rate of 80%. At age 15 (CATSS-15) and 18 (CATSS-18), twins and parents complete questionnaires that, in addition to assessments of somatic and mental health, include measures of personality development and psychosocial adaptation. Twin pairs in CATSS-9/12 with one or both twins screening positive for autism spectrum disorders, attention deficit/hyperactivity disorder, tic disorders, developmental coordination disorder, learning disorders, oppositional defiant disorder, conduct disorder, obsessive-compulsive disorder, and/or eating problems have been followed with in-depth questionnaires on family, social environment and personality, and subsequently by clinical assessments at age 15 together with randomly selected population controls, including 195 clinically assessed twin pairs from the first 2 year cohorts (CATSS-15/DOGSS). This article describes the cohorts and study groups, data collection, and measures used. Prevalences, distributions, heritability estimates, ages at onset, and sex differences of mental health problems in the CATSS-9/12, that were analyzed and found to be overall comparable to those of other clinical and epidemiological studies. The CATSS study has the potential of answering important questions on the etiology of childhood mental health problems and their role in the development of later adjustment problems.

Twin research and human genetics : the official journal of the International Society for Twin Studies · cohort or longitudinal · 242 citationsread the source →

The relationship between parent attitudes about childhood vaccines survey scores and future child immunization status: a validation study.

Importance: Acceptance of childhood vaccinations is waning, amplifying interest in developing and testing interventions that address parental barriers to immunization acceptance. Objective: To determine the predictive validity and test-retest reliability of the Parent Attitudes About Childhood Vaccines survey (PACV), a recently developed measure of vaccine hesitancy. Design, setting, and participants: Prospective cohort of English-speaking parents of children aged 2 months and born from July 10 through December 10, 2010, who belonged to an integrated health care delivery system based in Seattle and who returned a completed baseline PACV. Parents who completed a follow-up survey 8 weeks later were included in the reliability analysis. Parents who remained continuous members in the delivery system until their child was 19 months old were included in the validity analysis. Exposure: The PACV, scored on a scale of 0 to 100 (100 indicates high vaccine hesitancy). Main outcomes and measures: Child's immunization status as measured by the percentage of days underimmunized from birth to 19 months of age. Results: Four hundred thirty-seven parents completed the baseline PACV (response rate, 50.5%), and 220 (66.5%) completed the follow-up survey. Of the 437 parents who completed a baseline survey, 310 (70.9%) maintained continuous enrollment. Compared with parents who scored less than 50, parents who scored 50 to 69 on the survey had children who were underimmunized for 8.3% (95% CI, 3.6%-12.8%) more days from birth to 19 months of age; those who scored 70 to 100, 46.8% (40.3%-53.3%) more days. Baseline and 8-week follow-up PACV scores were highly concordant (ρ = 0.844). Conclusions and relevance: Scores on the PACV predict childhood immunization status and have high reliability. Our results should be validated in different geographic and demographic samples of parents.

JAMA pediatrics · cohort or longitudinal · 240 citationsread the source →

Late-onset hypogonadism: current concepts and controversies of pathogenesis, diagnosis and treatment.

Although suppressed serum testosterone (T) is common in ageing men, only a small proportion of them develop the genuine syndrome of low T associated with diffuse sexual (e.g., erectile dysfunction), physical (e.g. loss of vigor and frailty) and psychological (e.g., depression) symptoms. This syndrome carries many names, including male menopause or climacterium, andropause and partial androgen deficiency of the ageing male (PADAM). Late-onset hypogonadism (LOH) describes it best and is therefore generally preferred. The decrease of T in LOH is often marginal, and hypogonadism can be either due to primary testicular failure (low T, high luteinizing hormone (LH)) or secondary to a hypothalamic-pituitary failure (low T, low or inappropriately normal LH). The latter form is more common and it is usually associated with overweight/obesity or chronic diseases (e.g., type 2 diabetes mellitus, the metabolic syndrome, cardiovascular and chronic obstructive pulmonary disease, and frailty). A problem with the diagnosis of LOH is that often the symptoms (in 20%-40% of unselected men) and low circulating T (in 20% of men >70 years of age) do not coincide in the same individual. The European Male Ageing Study (EMAS) has recently defined the strict diagnostic criteria for LOH to include the simultaneous presence of reproducibly low serum T (total T <11 nmol l-1 and free T <220 pmol l-1 ) and three sexual symptoms (erectile dysfunction, and reduced frequency of sexual thoughts and morning erections). By these criteria, only 2% of 40- to 80-year-old men have LOH. In particular obesity, but also impaired general health, are more common causes of low T than chronological age per se. Evidence-based information whether, and how, LOH should be treated is sparse. The most logical approach is lifestyle modification, weight reduction and good treatment of comorbid diseases. T replacement is widely used for the treatment, but evidence-based information about its real benefi ts and short- and long-term risks, is not yet available. In this review, we will summarize the current concepts and controversies in the pathogenesis, diagnosis and treatment of LOH.

Asian journal of andrology · review · 124 citationsread the source →

'I felt less alone knowing I could contribute to the forum': psychological distress and use of an online infertility peer support forum.

Background: Feelings of loss, shame and stigmatization, reduced quality of life, isolation and loneliness are common among men and women with infertility. Fertility patients may seek peer mentoring and support, specifically through the use of online forums, to fulfil their needs for shared experience and guidance through the fertility treatment process. Objective: To assess the use and benefits of an online fertility-related peer support forum through two research questions: (1) do socio-demographics, stress, and anxiety differ between posters on the forum, lurkers who read messages but did not post, and people who chose not to use it?; and (2) how did forum users describe their experiences? Design: A sample of 220 male and female fertility patients aged 23-54 years old (M = 35.51, SD = 4.94) were recruited at fertility clinics in Montreal and Toronto, Canada, to test a mobile application called 'Infotility'. They answered questionnaires before and after being given access to Infotility for eight weeks. The peer support forum was accessible through the Infotility dashboard. Main outcome measures: Psychological distress was measured through the 4-item Perceived Stress Scale and the Generalized Anxiety Disorder 7-item Scale. Experiences using the forum were assessed through open-ended questions and in-depth interviews. Results: Participants with heightened psychological distress were more likely to become posters rather than lurkers or non-users and reported less distress after using the forum. Forum users appreciated the opportunity to share their experiences with others in similar situations. Conclusion: The forum reduced loneliness and allowed participants to learn new ways to manage stress. It was particularly beneficial for those with heightened psychological distress.

Health psychology and behavioral medicine · 13 citationsread the source →

Self-Efficacy, Depression, and Self-Care Activities in Adult Jordanians with Type 2 Diabetes: The Role of Illness Perception.

Diabetes mellitus is reaching epidemic levels worldwide. In a developing country like Jordan, type 2 diabetes mellitus (T2DM) has reached a prevalence rate of 17.1%. This cross-sectional study examined the relationship between self-care activities and: illness perception, depression, social support, religiosity and spiritual coping, and self-efficacy among patients with T2DM. A random sample of 220 patients with T2DM, who attended Jordan University Hospital in Jordan were enrolled. The data were collected through a structured interview and the medical files. The instruments consisted of a sociodemographic and clinical standardised questionnaires: Brief Illness Perception Questionnaire, Patients' Health Questionnaire-9; ENRICH Social Support Instrument; Religious and Spiritual Coping Subscale; Diabetes Management Self-Efficacy Scale; and Summary of Diabetes Self-Care Activities. Bivariate analysis investigated the relationship between variables. Structure Equation Modelling (SEM) was performed to test the proposed conceptual model. The study found that approximately 70% of the respondents suffered some form of depressive symptoms. The SEM showed a direct relationship between self-efficacy and self-care activities (β = 0.40; p < 0.001). Depression was indirectly related to self-care activities through self-efficacy (β = -0.20; p = 0.003); nevertheless, it was directly related to perception of: treatment control, consequences, and emotional representations. Overall, the sequence between illness perception and self-efficacy was mediated by depression. Strategies to promote self-efficacy and illness perception are vital in customising a diabetes health plan to meet Arabic cultural expectations.

Issues in mental health nursing · 37 citationsread the source →

Cognitive and psychiatric symptom trajectories 2-3 years after hospital admission for COVID-19: a longitudinal, prospective cohort study in the UK.

Background: COVID-19 is known to be associated with increased risks of cognitive and psychiatric outcomes after the acute phase of disease. We aimed to assess whether these symptoms can emerge or persist more than 1 year after hospitalisation for COVID-19, to identify which early aspects of COVID-19 illness predict longer-term symptoms, and to establish how these symptoms relate to occupational functioning. Methods: The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study of adults (aged ≥18 years) who were hospitalised with a clinical diagnosis of COVID-19 at participating National Health Service hospitals across the UK. In the C-Fog study, a subset of PHOSP-COVID participants who consented to be recontacted for other research were invited to complete a computerised cognitive assessment and clinical scales between 2 years and 3 years after hospital admission. Participants completed eight cognitive tasks, covering eight cognitive domains, from the Cognitron battery, in addition to the 9-item Patient Health Questionnaire for depression, the Generalised Anxiety Disorder 7-item scale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, and the 20-item Cognitive Change Index (CCI-20) questionnaire to assess subjective cognitive decline. We evaluated how the absolute risks of symptoms evolved between follow-ups at 6 months, 12 months, and 2-3 years, and whether symptoms at 2-3 years were predicted by earlier aspects of COVID-19 illness. Participants completed an occupation change questionnaire to establish whether their occupation or working status had changed and, if so, why. We assessed which symptoms at 2-3 years were associated with occupation change. People with lived experience were involved in the study. Findings: 2469 PHOSP-COVID participants were invited to participate in the C-Fog study, and 475 participants (191 [40·2%] females and 284 [59·8%] males; mean age 58·26 [SD 11·13] years) who were discharged from one of 83 hospitals provided data at the 2-3-year follow-up. Participants had worse cognitive scores than would be expected on the basis of their sociodemographic characteristics across all cognitive domains tested (average score 0·71 SD below the mean [IQR 0·16-1·04]; p<0·0001). Most participants reported at least mild depression (263 [74·5%] of 353), anxiety (189 [53·5%] of 353), fatigue (220 [62·3%] of 353), or subjective cognitive decline (184 [52·1%] of 353), and more than a fifth reported severe depression (79 [22·4%] of 353), fatigue (87 [24·6%] of 353), or subjective cognitive decline (88 [24·9%] of 353). Depression, anxiety, and fatigue were worse at 2-3 years than at 6 months or 12 months, with evidence of both worsening of existing symptoms and emergence of new symptoms. Symptoms at 2-3 years were not predicted by the severity of acute COVID-19 illness, but were strongly predicted by the degree of recovery at 6 months (explaining 35·0-48·8% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); by a biocognitive profile linking acutely raised D-dimer relative to C-reactive protein with subjective cognitive deficits at 6 months (explaining 7·0-17·2% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); and by anxiety, depression, fatigue, and subjective cognitive deficit at 6 months. Objective cognitive deficits at 2-3 years were not predicted by any of the factors tested, except for cognitive deficits at 6 months, explaining 10·6% of their variance. 95 of 353 participants (26·9% [95% CI 22·6-31·8]) reported occupational change, with poor health being the most common reason for this change. Occupation change was strongly and specifically associated with objective cognitive deficits (odds ratio [OR] 1·51 [95% CI 1·04-2·22] for every SD decrease in overall cognitive score) and subjective cognitive decline (OR 1·54 [1·21-1·98] for every point increase in CCI-20). Interpretation: Psychiatric and cognitive symptoms appear to increase over the first 2-3 years post-hospitalisation due to both worsening of symptoms already present at 6 months and emergence of new symptoms. New symptoms occur mostly in people with other symptoms already present at 6 months. Early identification and management of symptoms might therefore be an effective strategy to prevent later onset of a complex syndrome. Occupation change is common and associated mainly with objective and subjective cognitive deficits. Interventions to promote cognitive recovery or to prevent cognitive decline are therefore needed to limit the functional and economic impacts of COVID-19. Funding: National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Wolfson Foundation, MQ Mental Health Research, MRC-UK Research and Innovation, and National Institute for Health and Care Research.

The lancet. Psychiatry · 46 citationsread the source →

Improvement of Social Isolation and Loneliness and Excess Mortality Risk in People With Obesity.

Importance: Individuals with obesity experience markedly higher levels of social isolation and loneliness than those without obesity, but little is known about whether improvement of social isolation or loneliness might attenuate obesity-related excess risk of mortality. Objective: To investigate whether improvement of social isolation or loneliness is associated with lower obesity-related excess risk of mortality. Design, setting, and participants: This cohort study included individuals without cancer or cardiovascular disease (CVD) at baseline from the UK Biobank with follow-up beginning in March 2006 and ending in November 2021. Main outcomes and measures: All-cause, cancer-related, and CVD-related mortality were estimated. Results: A total of 398 972 participants were included in this study (mean [SD] age, 55.85 [8.08] years; 220 469 [55.26%] women; 13 734 [3.44%] Asian, 14 179 [3.55%] multiracial, and 363 685 [91.16%] White participants). Overall, 93 357 (23.40%) had obesity, and 305 615 (76.60%) did not. During a median (IQR) follow-up of 12.73 (12.01-13.43) years, a total of 22 872 incident deaths were recorded. Compared with participants with obesity with an index of 2 or greater for social isolation, the multivariable adjusted hazard ratios (HRs) for all-cause mortality were 0.85 (95% CI, 0.79-0.91) and 0.74 (95% CI, 0.69-0.80) for participants with obesity and a social isolation index of 1 and 0, respectively (P for trend < .001); compared with participants with obesity and an index of 2 for loneliness, the HRs and 0.97 (95% CI, 0.89-1.06) and 0.86 (95% CI, 0.79-0.94) for participants with obesity and a loneliness index of 1 and 0, respectively (P for trend < .001). As the index of social isolation and loneliness went from highest to lowest, the HR for all-cause mortality decreased by 36% and 9%, respectively, in people with obesity compared with people without obesity using the multivariable model. Social isolation was ranked higher than loneliness, depression, anxiety, and lifestyle-related risk factors including alcohol, physical activity, and healthy diet for estimating the risks of all-cause mortality, cancer-related mortality, and CVD-related mortality. Conclusions and relevance: In this cohort study of UK Biobank participants, a lower index of social isolation or loneliness was associated with a decreased risk of all-cause mortality among people with obesity, and improvement of social isolation and loneliness attenuated obesity-related excess risk of all-cause mortality.

JAMA network open · 46 citationsread the source →

A network analysis of anger, shame, proposed ICD-11 post-traumatic stress disorder, and different types of childhood trauma in foster care settings in a sample of adult survivors.

Background: Anger and shame are aspects that are specifically associated with psychopathology and maladaptation after childhood abuse and neglect. They are known to influence symptom maintenance and exacerbation; however, their interaction is not fully understood. Objective: To explore with network analysis the association and interaction of prolonged, complex interpersonal childhood abuse and neglect in institutional foster care settings [institutional abuse (IA)] with anger, shame, and the proposed 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) post-traumatic stress disorder (PTSD) symptoms in adult survivors. Method: Adult survivors of IA (N = 220, mean age = 57.95 years) participated in the study and were interviewed using the Childhood Trauma Questionnaire, the International Trauma Questionnaire, the State-Trait Anger Expression Inventory, the Displaced Aggression Questionnaire, and shame-related items. To identify the most central aspects, we used a staged network analysis and centrality analysis approach: (1) on the scale level; (2) on the item/symptom level; and (3) with modularity analysis to find communities within the item-level network. Results: Trait anger, anger rumination, emotional abuse, and PTSD re-experiencing symptoms played the most important roles on a scale level and were then further analyzed on the item/symptom level. The most central symptom on the item level was anger rumination related to meaningful past events. The modularity analysis supported discriminant validity of the included scales. Conclusions: Anger is an important factor in the psychopathological processes following childhood abuse. Anger rumination is closely related to PTSD symptoms; however, anger is not a part of the proposed ICD-11 PTSD in the present study.

European journal of psychotraumatology · 29 citationsread the source →

SOGC Guideline Retirement Notice No. 2.

These documents have been archived because they contain outdated information. They should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines. The Use of Magnetic Resonance Imaging in the Obstetric Patient [J Obstet Gynaecol Can 36 (2014) 349-355] AUTHORS Yves Patenaude, MD, Sherbrooke, QC Denise Pugash, MD, Vancouver, BC Kenneth Lim, MD, Vancouver, BC Lucie Morin, MD, Montreal, QC The Role of Surgery in Endometrial Cancer [J Obstet Gynaecol Can 35 (2013) 370-371] AUTHORS Christopher Giede, MD, Saskatoon, SK Tien Le, MD, Ottawa, ON Patti Power, MD, St John's, NL Female Genital Cutting [J Obstet Gynaecol Can 35 (2013) 1028-1045] AUTHORS Liette Perron, MSW, Ottawa, ON Vyta Senikas, MD, Ottawa, ON Margaret Burnett, MD, Winnipeg, ON Victoria Davis, MD, Scarborough, ON Technical Update on Pessary Use [J Obstet Gynaecol Can 35 (2013) 664-674] AUTHORS Magali Robert, MD, Calgary, AB Jane A. Schulz, MD, Edmonton, AB Marie-Andrée Harvey, MD, Kingston, ON Cancer Chemotherapy and Pregnancy [J Obstet Gynaecol Can 35 (2013) 263-278] AUTHORS Gideon Koren, MD, Toronto, ON Nathalie Carey, BSc, Toronto, ON Robert Gagnon, MD, Montréal, QC Cynthia Maxwell, MD, Toronto, ON Irena Nulman, MD, Toronto, ON Vyta Senikas, MD, Ottawa, ON Current Status in Non-Invasive Prenatal Detection of Down Syndrome, Trisomy 18, and Trisomy 13 Using Cell-Free DNA in Maternal Plasma [J Obstet Gynaecol Can 35 (2013) 177-181] AUTHORS Sylvie Langlois, MD, Vancouver, BC Jo-Ann Brock, MD, Halifax, NS Mifepristone [J Obstet Gynaecol Can 25 (2003) 235] The Presence of a Third Party During Breast and Pelvic Examinations [J Obstet Gynaecol Can 25 (2003) 237] Midwifery [J Obstet Gynaecol Can 25 (2003) 239] Emergency Contraception [J Obstet Gynaecol Can 25 (2003) 673-678] Tension-Free Vaginal Tape (TVT) Procedure [J Obstet Gynaecol Can 25 (2003) 692-694] Uterine Fibroid Embolization (UFE) [J Obstet Gynaecol Can 26 (2004) 899-911] AUTHORS Guylaine G. Lefebvre, MD, Toronto, ON George Vilos, MD, Toronto, ON Murray Asch, MD, Oshawa, ON The Prevention of Early-Onset Neonatal Group B Streptococcal Disease [J Obstet Gynaecol Can 26 (2004) 826-832] AUTHORS Deborah M. Money, MD, FRCSC, Vancouver, BC Simon Dobson, MD, FRCPC, Vancouver, BC Cell-Free Fetal DNA in the Maternal Circulation and its Future Uses in Obstetrics [J Obstet Gynaecol Can 27 (2005) 54-57] AUTHOR R. Douglas Wilson, MD, Philadelphia, PA Cystic Fibrosis Carrier Testing in Pregnancy in Canada [J Obstet Gynaecol Can 24 (2002) 644-647] Amniocentesis and Women with Hepatitis B, Hepatitis C, or Human Immunodeficiency Virus [J Obstet Gynaecol Can 25 (2003) 145-148] Fetal Health Surveillance in Labour [J Obstet Gynaecol Can 24 (2002) 250-262] Management of the Third Stage of Labour to Prevent Postpartum Hemorrhage [J Obstet Gynaecol Can 25 (2003) 952-953] Cervical Cancer Prevention in Low-Resource Settings [J Obstet Gynaecol Can 26 (2004) 205-206] Hirsutism: Evaluation and Treatment [J Obstet Gynaecol Can 24 (2002) 62-67] Breast Cancer, Pregnancy, and Breastfeeding [J Obstet Gynaecol Can 24 (2002) 164-171] Parvovirus B19 Infection in Pregnancy [J Obstet Gynaecol Can 24 (2002) 727-734] Diversity [J Obstet Gynaecol Can 25 (2003) 1042] Conflict of Interest [J Obstet Gynaecol Can 25 (2003) 1044] Canadian Contraception Consensus [J Obstet Gynaecol Can 26 (2004) 347-387] School-Based and School-Linked Sexual Health Education and Promotion in Canada [J Obstet Gynaecol Can 26 (2004) 596-600] Gestational Trophoblastic Disease [J Obstet Gynaecol Can 24 (2002) 434-439] FIGO Professional and Ethical Responsibilities Concerning Sexual and Reproductive Rights [J Obstet Gynaecol Can 26 (2004) 1097-1099] FIGO / ICM Global Initiative to Prevent Post-Partum Hemorrhage [J Obstet Gynaecol Can 26 (2004) 1102] Intimate Partner Violence Consensus Statement [J Obstet Gynaecol Can 27 (2005) 365-388] The Management of Nausea and Vomiting of Pregnancy [J Obstet Gynaecol Can 24 (2002) 817-823] Canadian Contraception Consensus [J Obstet Gynaecol Can 26 (2004) 143-156] Present Role of Stem Cells for Fetal Genetic Therapy [J Obstet Gynaecol Can 27 (2005) 1038-1042] Amended Canadian Guideline for Prenatal Diagnosis (2005) Change to 2005-Techniques for Prenatal Diagnosis [J Obstet Gynaecol Can 27 (2005) 1048-1054] Umbilical Cord Blood Banking: Implications for Perinatal Care Providers [J Obstet Gynaecol Can 27 (2005) 263-274] Breast Cancer and Abortion [J Obstet Gynaecol Can 27 (2005) 491] AUTHOR Robert H. Lea, MD, Halifax, NS Postural Health in Women: The Role of Physiotherapy [J Obstet Gynaecol Can 27 (2005) 493-500] AUTHORS S.J. Britnell, BScPT, Vancouver, BC J.V. Cole, BScPT, Vancouver, BC L. Isherwood, BScPT, Vancouver, BC M.M. Sran, PT, BScPT, Vancouver, BC N. Britnell, BScPT, Vancouver, BC S. Burgi, BScPT, Vancouver, BC G. Candido, BScPT, Vancouver, BC L. Watson, BScPT, Vancouver, BC The Management of Uterine Leiomyomas [J Obstet Gynaecol Can 25 (2003) 396-405] Guidelines for Vaginal Birth after Previous Caesarean Birth [J Obstet Gynaecol Can 26 (2004) 660-670] Fetal Health Surveillance in Labour [J Obstet Gynaecol Can 24 (2002) 342-348] Number of Births to Maintain Competence [J Obstet Gynaecol Can 24 (2002) 359] Sexual Abuse by Physicians [J Obstet Gynaecol Can 25 (2003) 862] The Use of First Trimester Ultrasound [J Obstet Gynaecol Can 25 (2003) 864-869] Use of Hormonal Replacement Therapy After Treatment of Breast Cancer [J Obstet Gynaecol Can 26 (2004) 49-54] Obstetric Ultrasound Biological Effects and Safety [J Obstet Gynaecol Can 27 (2005) 572-575] Fetal Soft Markers in Obstetric Ultrasound [J Obstet Gynaecol Can 27 (2005) 592-612] Maternal Transport Policy [J Obstet Gynaecol Can 27 (2005) 956-959] Choice of Surgery for Stress Incontinence [J Obstet Gynaecol Can 27 (2005) 964-971] The Use of Fetal Doppler in Obstetrics [J Obstet Gynaecol Can 25 (2003) 601-607] Screening for Gestational Diabetes Mellitus [J Obstet Gynaecol Can 24 (2002) 894-903] Hormone Replacement Therapy and Cardiovascular Disease [J Obstet Gynaecol Can 24 (2002) 577-579] Providing Opinion for Medico-Legal Cases [J Obstet Gynaecol Can 24 (2002) 590-592] Antenatal Corticosteroid Therapy for Fetal Maturation [J Obstet Gynaecol Can 25 (2003) 45-48] Mastalgia [J Obstet Gynaecol Can 28 (2006) 49-57] AUTHORS Vera Rosolowich, RN, SCM, IBCLC, Winnipeg, MB Elizabeth Saettler, MD, Winnipeg, MB Beth Szuck, BA, HEc, CACE, RD, Winnipeg, MB Pregnancy Outcomes After Assisted Reproductive Technology [J Obstet Gynaecol Can 28 (2006) 220-233] AUTHORS Victoria M. Allen, MD, MSc, Halifax, NS R. Douglas Wilson, MD, MSc, Philadelphia, PA Canadian Contraception Consensus-Update on Depot Medroxyprogesterone Acetate (DMPA) [J Obstet Gynaecol Can 28 (2006) 305-308] AUTHOR Amanda Black, MD, Ottawa, ON Guidelines for Training Requirements in Colposcopy and its Related Treatment Modalities [J Obstet Gynaecol Can 28 (2006) 314-316] AUTHOR Susan M. McFaul, MD, Ottawa, ON Pelvic Examinations by Medical Trainees [J Obstet Gynaecol Can 28 (2006) 320-321] AUTHORS Kimberly E. Liu, MD, Edmonton, AB Deborah Robertson, MD, Montréal, QC Glenn Posner, MDCM, Ottawa, ON Sukhbir S. Singh, MD, London, ON Lawrence Oppenheimer, MD, Ottawa, ON Stillbirth and Bereavement: Guidelines for Stillbirth Investigation [J Obstet Gynaecol Can 28 (2006) 540-545] AUTHOR Line Leduc, MD, Montréal, QC Progesterone-Only and Non-Hormonal Contraception in the Breast Cancer Survivor: Joint Review and Committee Opinion of the Society of Obstetricians and Gynaecologists of Canada and the Society of Gynecologic Oncologists of Canada [J Obstet Gynaecol Can 28 (2006) 616-626] AUTHORS Jenna McNaught, MD, Winnipeg, MB Robert L. Reid, MD, Kingston, ON Breast Self-Examination [J Obstet Gynaecol Can 28 (2006) 728-730] AUTHOR Vera Rosolowich, RN, SCM, IBCLC, Winnipeg, MB The Physician Expert in Legal Proceedings [J Obstet Gynaecol Can 28 (2006) 913-915] AUTHORS Titus Owolabi, MD, Toronto, ON George Vilos, MD, Toronto, ON Induced Abortion Guidelines [J Obstet Gynaecol Can 28 (2006) 1014-1027] AUTHOR Victoria Jane Davis, MD Health Professionals Working With First Nations, Inuit, and Métis Consensus Guideline [J Obstet Gynaecol Can 35 (2013) S1-S4] AUTHORS Don Wilson, MD, FRCSC (Co-chair), Hellisuk Nation, Comox, BC Sandra de la Ronde, MD, FRCSC (Co-chair), Ottawa, ON Simon Brascoupé, Kitigan Zibi Anishinabeg, Ottawa, ON Alisha Nicole Apale, MSc, Ottawa, ON Lucy Barney, RN, MSN, Lillooet Nation, Vancouver, BC Bing Guthrie, MD, FRCSC, Yellowknife, NT Elizabeth Harrold, RN, Vancouver, BC Ojistoh Horn, MD, CCFP, Mohawk, Kahnawake, QC Robin Johnson, MD, FRCSC, Esdilagh, First Nation, Williams Lake, BC Darrien Rattray, MD, Tahltan, Halifax, NS Nicole Robinson, MA, Ottawa, ON Introduction [J Obstet Gynaecol Can 35 (2013) S5-S6] Chapter 1 Definitions [J Obstet Gynaecol Can 35 (2013) S7-S8] Chapter 2 Demographics [J Obstet Gynaecol Can 35 (2013) S9-S12] Chapter 3 Social Determinants of Health Among First Nations, Inuit, and Métis [J Obstet Gynaecol Can 35 (2013) S13-S23] Chapter 4 Health Systems, Policies, and Services for First Nations, Inuit, and Métis [J Obstet Gynaecol Can 35 (2013) S24-S27] Chapter 5 First Nations, Inuit, and Métis Women's Sexual and Reproductive Health [J Obstet Gynaecol Can 35 (2013) S28-S32] Chapter 6 First Nations, Inuit, and Métis Maternal Health [J Obstet Gynaecol Can 35 (2013) S33-S36] Chapter 7 Mature Women's Health [J Obstet Gynaecol Can 35 (2013) S37] Chapter 8 Changing Outcomes Through Culturally Competent Care [J Obstet Gynaecol Can 35 (2013) S38-S41] Chapter 9 Conclusion [J Obstet Gynaecol Can 35 (2013) S42-S43] Chapter 10 Case Studies [J Obstet Gynaecol Can 35 (2013) S44-S47] Appendix 1. Apology for the Forced Relocation of Inukjuak and Pond Inlet Families [J Obstet Gynaecol Can 35 (2013) S48] Appendix 2. Apology for the Residential School System [J Obstet Gynaecol Can 35 (2013) S49] Appendix 3. Avoiding Re-Traumatization of Sexual Abuse/Assault Victims During the Birthing Process [J Obstet Gynaecol Can 35 (2013) S50].

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC · 3 citationsread the source →

Inflammatory Bowel Diseases at the University of Chicago-Early Experiences: a Personal Historical Account

▪"The Secret of Happiness is Knowledge, and the Secret of Knowledge is an Inquiring Mind; Not to Idly Stand Aside from the Eternal Quest to Heal.” (Adapted from Thucydides, ca. 460–400 BC). Few human illnesses today are more challenging medically, scientifically, and socio-economically than the world-wide “nonspecific” inflammatory bowel diseases (IBDs): ulcerative colitis and Crohn's disease. They did occur several centuries ago, but they are essentially diseases of the 20th century. They affect men and women, children and young adults, and all ethnic groups, and involve virtually all bodily systems in addition to the gastrointestinal tract. Ulcerative colitis and Crohn's disease have emerged as major biomedical problems. Prevailing etiologic concepts, often originating in 20th century clinical observation, today provide exciting opportunities for meaningful research. More physicians and scientists now are involved in the study of IBDs and, like Ariadne of Greek mythology, are endeavoring to negotiate the complex biomedical maze of IBDs. As the story goes, Ariadne, daughter of Pasiphae and King Minos of Crete, fell in love with the Athenian hero Theseus, and with a “thread of glittering jewels” helped him escape the imprisoning Labyrinth after he had slain the evil Minotaur (half bull, half human). Metaphorically, our hope for the 21st century is conquest of the “IBD Minotaur.” This report retraces my initial interest in IBDs and my earliest observations; more details are provided in Kirsner's Origins and Directions of Inflammatory Bowel Disease (published by the Kluwer Academic Press, 2002), including a clarification of the pivotal early Mt. Sinai (New York) experience1 with Crohn's disease. In particular, it recognizes the contributions of Eli Moschowitz and A. O. Wilensky, Surgeons L. Ginzburg and G. Oppenheimer, all of the Mt. Sinai Hospital, and B. B. Crohn and Surgeon A. A. Berg to the 1932 presentation in New Orleans. My interest in IBDs began in January 1936 when I undertook the care of a 40-year-old emaciated woman, who was brought to the University of Chicago Medical Center in desperate condition with severe “ulcerative colitis,” a virtually unknown illness at the time. I had not seen a similar clinical situation during my medical school days (1929-1933) in Boston. Lacking antibacterial drugs, steroids, immunosuppressants, and adequate support measures, she rapidly succumbed to the disease. Having witnessed her daily decline, yet unable to help, the death of this patient challenged me to learn more about IBDs. The 1909 London symposium reviewing 317 patients with ulcerative colitis, collected from 5 local hospitals,2 including instances dating back to the 19th century, indicated that ulcerative colitis was not a new disease. Similarly, a 1901 paper, “A Study of Chronic Hyperplastic Tuberculosis of the Intestine with Report of a Case,” by A. J. Lartigau of Columbia University, reviewing a substantial German and French literature prior to the key 1913 (Dalziel) and the 1932 Mt. Sinai Crohn's disease reports, revealed the early existence of Crohn's disease, initially misdiagnosed as intestinal tuberculosis. My interest in the historical aspects of ulcerative colitis and Crohn's disease has produced several comprehensive reviews.3,–5 Initially, assisted by gastrointestinal fellows, I focused on the clinical nature of ulcerative colitis, its mode of onset, clinical manifestations, nutritional aspects, the complications, including the increased risk of colorectal cancer; and the differentiation of ulcerative colitis and Crohn's colitis. In 1948, with W. L. Palmer and G. Maimon, I described the course of 120 patients with ulcerative colitis6 and in 1951, the course of 40 patients with regional enteritis.7 With M. Sparberg and J. J. Fennessy, a 1966 study reviewed 220 patients with ulcerative proctitis and mild ulcerative colitis.8 An expanded computerized study in 1971, with B.G.H. Rogers and Linda Clark, reviewed the demography and course of 1400 patients with IBD seen at the University of Chicago. All series included children, teenagers, and young adults; some had repeatedly received antibacterial medication for respiratory infections. Several isolated clinical experiences were of interest, but unrevealing. For example, sleep therapy had been recommended for ulcerative colitis by European observers. By chance, one patient in 1937 was receiving larger amounts of sedation than prescribed. She slept almost continuously for 7 days. While asleep, the number of bowel movements diminished, but the colitis persisted. An intriguing clinical experience was the abrupt cessation of diarrhea in a woman with ulcerative colitis who became temporarily psychotic; the diarrhea returned when the psychosis receded. I became aware of the varied clinical and laboratory manifestations and the numerous local and systemic complications, including the nutritional depletion associated with the growth retardation of children with IBD, later studied in detail by colleagues, Drs. Barbara Kirschner and Irwin Rosenberg. I soon learned that the undernourished patient (with iron-deficiency anemia and lowered serum albumin) did not respond fully to otherwise effective medication. Clinical studies revealed a wide variety of IBD-related problems (retardation of growth in children, ocular complications, pyoderma gangrenosum, liver disease, osteoporosis, arthritis). A definitive study of toxic megacolon complicating ulcerative colitis, with Charles Norland, in 1969, provided important clinical information on the early diagnosis and risk factors (undernutrition, electrolyte depletion, morphine for abdominal pain).9 Two studies with AP Klotz and M. van Woert (1951 and 1964) documented the previously unrecognized radiologic reversibility of severe ulcerative colitis, after prolonged clinical quiescence of the disease.10,11 Bleeding from the colon and rectum, a characteristic symptom, often was profuse, requiring blood transfusions, which reflected the hypervascularity of the inflamed bowel, attributed by early observers to the mast cell release of histamine, increasing capillary congestion. Clinical observations suggested various etiologic possibilities; including bacteria (postinfection IBD, overuse of oral antibiotics for respiratory illness in children, and fulminating ulcerative colitis after aureomycin for acne), familial occurrences, especially in Crohn's disease (genetic), and the individually variable course of IBD (immunology, genetics). The association of Crohn's disease with several genetic syndromes suggested a genetic relationship.12 Patients with ulcerative colitis manifested allergic disorders (e.g., hay fever, allergic rhinitis), suggesting an immunologic background. Additional clinical studies disclosed families with combinations of ulcerative colitis and Crohn's disease in married couples and a higher incidence of complications in familial IBD.13,–15 The NOD2 Card 15 gene identified simultaneously by P. Hugot (Paris) and Judy Cho (University of Chicago) stimulated much research on the complex genetics of IBD. The rapid advances in this aspect of IBD have been described recently by Russell et al16 and Vermeire et al.17 The etiologic hypotheses of the 1930s: Allergy to foods (milk, eggs, wheat), tree and grass pollens, “gastrointestinal reactions” to corn flakes or margarine, nutritional (vitamin deficiencies, “intestinal protective factor"), antecedent bacterial infection (dysentery bacillus, lymphopathia venereum, amebic dysentery, mycobacteria), and psychogenic disorders emphasizing “maternal dominance,” and an “ulcerative colitis personality” in “immature, passive, overly dependent individuals"; had little convincing supporting evidence.18 The psychiatric emphasis was supported by papers such as “Emotion and Diarrhea,”19 and “The Psychogenic Origin of Organic Diseases.”20 I soon was made aware of “real life” dependency, when a male patient showed me a map he had made locating public toilets on the route from his home in Highland Park to the University of Chicago.21 Esther M. Sternberg has described the biochemical and molecular basis of emotionally induced stress.22 I initially was interested in the of bacteria as the of ulcerative colitis and especially Crohn's disease, and I was by the of IBD in the of of the intestinal inflammatory diseases with including from of a regional in did not this in this increased after I had patients with gastrointestinal from at The University of Chicago and Crohn's disease in young had studied for in the of this important to the by P. of in This the increased and of to a incidence of diseases and to in the of with the of and IBD A the lowered incidence of disease, has been children on The protective involved early to bacterial of in and I was aware of the intestinal its by as the of disease and by intestinal and by of a as a I to this major key to the IBD later studied by and Charles are in the of IBD, as reviewed by gastrointestinal a for the bacterial in the of IBDs. in the and after of the and I for and with focused on and the with This experience have me that the bacterial in IBD (e.g., the intestinal than in but I was not to With the with the Chicago of amebic dysentery, I a young woman after from the amebic had severe ulcerative colitis. She later of of the infection of the colon had been a risk for ulcerative colitis. young patients the of ulcerative colitis to the oral of antibacterial medication (e.g., oral for and A young aureomycin for a fulminating ulcerative colitis, a and I an in the intestinal the an inflammatory A similar of in a previously who a severe ulcerative colitis after an in to involve a intestinal In an early with the of from patients with ulcerative colitis in by in the In with of ulcerative colitis the of to became at the made by the P. Hugot of has suggested the of and as of in an foods are produced and at the is yet the my IBD studies were by the of and psychogenic concepts, during my medical in the European and of at I with ulcerative colitis. In condition had and they had this information to days after the of in I patients with IBD at a French from at major local after had This was my with IBD I returned to the from in the of I with on the of and factors in the of IBD In I and (University of undertook the of in patients with IBD, in the of the This comprehensive study of new biochemical of in and The of in the bowel in patients with ulcerative colitis and Crohn's disease, had not been fully With the of I the of the colon and to and rapid of the in and colitis In the of amounts of to the colon or in retardation in children, the of of the colon and rectum, and liver disease in ulcerative colitis and the intestinal abdominal and in Crohn's disease were challenging clinical problems. The of in ulcerative colitis and its in Crohn's disease were a when in by of documented by M. of and J. of and in our and the In 1948, I the of a my with Crohn's the I was by disease and as to the increased of to a of the associated with increased for the of intestinal bacteria (e.g., or the induced of an in the bowel et in for the and the of in Crohn's disease in colon This and familial occurrences, including families with to 5 with ulcerative colitis and Crohn's disease, and Crohn's disease in and studies of the familial of IBD with and later In after patients ulcerative colitis after from which had I was of an to IBD, by or A study of ulcerative colitis, with A. Klotz and M. had revealed of of the of the of the colon and in ulcerative colitis, an early of the in to intestinal immunologic the of and the of the et recently documented increased intestinal intestinal described as in an experience in the Allergy (University of I an interest in the of allergic in IBD. from (e.g., and a of ulcerative colitis as an disease in the with of the bowel and as This was supported by of the of the intestinal and I produced in and I colon in ulcerative colitis like O. and P. of not and this aware of immunologic to foods in the gastrointestinal and young children with the of the bowel to in the had not been M. and I documented the of the colon to and In as the B. and produced the complex in the This was in and and (University of Chicago) the of in the colitis In G. and of produced for the of local and in the of ulcerative The of and as the of the the intestinal from an intestinal and the that IBD is by a to of the intestinal as later by Charles had not yet A had documented the and the of of the gastrointestinal that had A with M. reviewed and definitive manifestations of in the gastrointestinal and a with and papers provided and for immunologic studies of IBD. A with G. the increasing immunologic of The of the of the bowel increased immunologic including P. of the protective of and J. soon identified the The of oral had been documented in by at the University of Chicago in it was by and L. New In addition to and identified included the cell cell L. and cell and to the intestinal in the inflammatory I was aware of the biochemical studies of of in the and molecular studies of but I was to this important to and ulcerative colitis the of as the in bowel in were observations on Crohn's disease from the University of 1936 by and of an of the bowel as the of Crohn's disease, my interest, especially after an had been identified in the bowel from one of my from a of the Crohn's the of or with and emerged from this the and of the Crohn's disease bowel to the intestinal in the Crohn's disease have and have to the increased of the of Crohn's disease and ulcerative colitis, as described by O. B. G. and and by G. and W. were in the and including of of liver or (e.g., of an of and of the and of hypotheses had been in of the to an was in but in the did with IBD in the with the nutritional deficiencies, the of nutritional by the increased oral of by was to the support of the had the of who and in the of the IBD were by who helped patients and families with this patients received I a documented to in patients with severe ulcerative colitis. Two clinical experiences are An colitis in a young woman who had been after receiving the patient was to patient with severe ulcerative colitis in the Two later she a and In she her and a In a I had to bowel and prolonged by of daily of as a of in with In the were to and were to of or of I research. from the intestinal in ulcerative colitis, and (University of Chicago) repeatedly the blood were as a support was the of the medical of ulcerative colitis in the early 20th but with and and support The exciting of in in increased of more effective of the disease and a new in the of IBD. in studies of the of the and antibiotics on the the initial in bacterial were and associated with the of was to fully or the and of the was in the of some patients with ulcerative colitis and the bacterial and it became a of especially for the complications of Crohn's disease and ulcerative colitis The of in by and an the and which was for the of effective in the of patients with ulcerative colitis. later was to the of and the of this became the of I to as therapy for ulcerative colitis. became to patients with ulcerative colitis and with Crohn's disease in The of new IBD patients to the University of Chicago increased By the as as new patients were seen and the of IBD patients More antibiotics had initial and clinical in IBD were by The of and in was a in the of human including IBD. In 1951, W. L. Palmer and in showed the of and in this was documented by the Two patients with ulcerative colitis of the at after the of 40 in one patient and in the The and bowel and the The and the of the early days patients and physicians at the of with this medication an of and In our one male patient with ulcerative colitis including of and young with ulcerative colitis a with clinical The was as the of and The early problems and the complications of therapy as learned to in IBD. in the early of the inflammatory are not recommended for A 1966 study our early experience with in ulcerative colitis, of the medication of severe toxic the liver and the with J. A. J. B. and J. in the of in the of ulcerative colitis and especially in Crohn's the of B. and of New was as an effective medication for IBD, including its in the and of M. B. and G. recently have a comprehensive of In the the of ulcerative colitis was in its early was a of the colon on the of the was in the hope of later bowel the colon from its at the to the rectum, the bowel with the in an to bowel became when was for ulcerative colitis, of the colon and and the of an was the effective and of the were to A major in 1951, in London and of the almost simultaneously the the A major early for patients and physicians when the was in and a soon in New in the in support of patients requiring an and information its The support at the was at the University of by and this expanded the The Chicago was as the In the the and with the the of the to ulcerative colitis and, for the of provided a more for disease. In Crohn's disease of the of the bowel with was of bowel and of the this often was by disease, the became as much bowel as to bowel In the of the and to the regional of the bowel and regional of the colon became at the University of Chicago. By the Crohn's disease had more than ulcerative colitis in our patient now were at new patients and were The increasing of patients with ulcerative colitis and especially with Crohn's disease, the of medical and the not for increased the of with physicians and with patients and families as to the nature of IBD and its A of IBD patients was by Linda and B. G. In the B. a more comprehensive IBD I numerous with patients and as to the research in IBD at the time. The of the of a had ulcerative colitis, and the support of the of were especially in the and L. in the early helped the to IBD research at the University of Chicago. the and M. in addition to research became a key in several to IBD, including with me on the of the for and of the of in the of a of and Chicago patients and the of and has provided and now for has been a major to our IBD research for contributions were important to the IBD research of on the of the intestinal and in the support of Judy of the gene in to Crohn's disease The laboratory at the University of Chicago to provide for genetic the increasing of IBD, to research interest in IBD. I in the early to this to the of the Study by me in the to research in IBD, with initially had been by study of the medical and L. of the of and at the University of and with the of to the of the Study of the in to in addition to for this study I J. W. (University of and now reviewed by and the of the Study I a symposium in in January a of interested in IBD, scientists all and by The of this to a at the University of Chicago provided new opportunities for the of and stimulated research on IBD. The Study provided support in the of and in the of to support research in during the of the and with the of of ulcerative colitis and with the of research in the M. supported the of the for in Ulcerative The Medical to this included such as J. A. W. (University of J. M. (University of O. (University of L. G. (University of later at and J. B. and W. L. Palmer (University of M. the of on ulcerative colitis and Crohn's disease from the were to of and were an important of information on IBD. Additional included P. A. and P. The to with patients and families on support for research as to the nature of ulcerative colitis and Crohn's disease increased this M. the of a “The by the the of The to this was by the University of had of severe ulcerative colitis. “The was the on ulcerative colitis to for public and its to increasing of the IBD interest in IBD increased after the illness of the from a later an abdominal of an intestinal from an unrecognized regional An intestinal was the bowel a had intestinal and he succumbed later to The at that became aware of the research in Crohn's disease and made a of for this I received from this a addition to my research More this the of interest in supporting IBD research. As was public or in support of IBD the of the for and in New the of and Irwin M. and and in in the New this with numerous the I as of the during the increased and the for and now the Crohn's and of is the for information on IBD to patients and to research on IBD, and young in IBD, new research and effective with the the the of and By the new clinical and of the IBDs had been to a comprehensive The of Inflammatory Bowel with of the in and was an New have 5 The Kirsner's Inflammatory Bowel by the (University of and J. by in The and of the information on IBD and has been by the The IBD situation today is from the IBD is a of the medical and is a major interest of physicians and medical the and IBD now is as one of the important medical problems of our time. In medical and medical IBD has the disease for biomedical the gastrointestinal tract. As a of the of the now are more IBD of has made important contributions to the of of IBD for the and on IBDs. Clinical including Drs. B. (University of Chicago) and have made clinical and contributions to the of especially Crohn's in the and the of and in IBD. a with IBD, a are to therapy for The is century research has indicated the protective nature of oral gastrointestinal to learn more of this and it to oral is the of Crohn's disease intestinal to the disease after and an intriguing the the the intestinal the and growth and the of In the study of now have been including the important in numerous the of an important in and more is yet to learned of and of the of genetic of IBD, by the and of the human the of genetic therapy for IBD. is a of factors in the of a variety of of various of cell and involved in intestinal have not yet identified the or of IBD, have learned much about the nature of diseases and of the patients and The study of IBD has to important advances in one of the more important is the of the gastrointestinal in our have aware of the of genetic and gastrointestinal the gastrointestinal and aspects of IBD including the of and the of new of the the intestinal the bacteria and and and and In such a complex and the of scientists including and with patients and and the are I have been with the the interest, the and the of patients and I have been to as I have been to with the gastrointestinal and with physicians the of in the and care of the IBD With such the for IBD now than I the of the French and by to involved in the and the of the and of the ethnic and the and of our and the increasing of our the of the of the of and the of this hope in a in a or in a and yet in a I that hope is and by men and like and the of our and the of this hope and this the to IBD.

Inflammatory Bowel Diseases · 4 citationsread the source →

Transactional sex amongst AIDS-orphaned and AIDS-affected adolescents predicted by abuse and extreme poverty.

Objectives: Little is known about impacts of familial AIDS on abuse and sexual health outcomes amongst adolescents. Objectives were to determine whether familial AIDS is: (1) associated with severe physical, emotional, and sexual abuse; (2) associated with transactional sexual exploitation; and (3) explore whether relationships between familial AIDS and transactional sex are mediated by extreme poverty and abuse. Design: Adolescent self-report study in deprived South African communities. Methods: A 2009 follow-up of a 2005 study achieved 71% retention (n = 723). The 2009 sample included AIDS-orphaned (n = 236), other-orphaned (n = 231), and non-orphaned (n = 220) adolescents, whose primary caregivers were AIDS sick (n = 109), other sick (n = 147), and healthy (n = 220). Abuse and transactional sex were measured using widely used and validated self-report measures. Results: AIDS orphanhood and parental AIDS sickness predicted emotional and physical abuse and transactional sexual exploitation. Orphanhood or parental sickness by non-AIDS causes, and having healthy caregivers, did not predict any abuse outcomes. Adolescents "dually" affected by AIDS orphanhood and sickness showed a 3-fold likelihood of severe emotional and physical abuse and, amongst girls, a 6-fold likelihood of transactional sexual exploitation, compared with those in healthy families. Heightened risk of transactional sex amongst adolescents in AIDS-affected families was mediated by extreme poverty and abuse exposure. In combination, the effects of familial AIDS, food insecurity, and exposure to abuse raised prevalence of transactional sex amongst girls from 1% to 57%. Conclusions: Adolescents from AIDS-affected families are highly vulnerable to severe physical and emotional abuse and transactional sex. This has implications for policy and programming in child protection and HIV prevention services.

Journal of acquired immune deficiency syndromes (1999) · 107 citationsread the source →