This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome (IBS), discusses the rational use of antidepressants as well as non-pharmacological ...This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome (IBS), discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of [BS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. bones and joints (fibromyalgia, temporomandibular joint syndrome), heart (non-cardiac chest pain), vascular (post-menopausal syndrome), and brain (anxiety, depression). Host IBS patients do not have psychiatric illness per se, but a range of psychoform (psychological complaints in the absence of psychiatric disorder) symptoms that accompany their somatoform (physical symptoms in the absence of medical disorder) complaints. It is not correct to label IBS patients as psychiatric patients (except those more difficult patients with true somatization disorder). One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness. Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions. Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in IBS, because the psychoform symptoms that sound similar to those seen in psychiatric disorders may not have the same significance in patients with IBS.展开更多
AIM:To explore age-related changes in symptoms and quality of life(QoL) of women with irritable bowel syndrome(IBS).METHODS:Two-hundred and fifty-four female adult outpatients with IBS attending the Department of Gast...AIM:To explore age-related changes in symptoms and quality of life(QoL) of women with irritable bowel syndrome(IBS).METHODS:Two-hundred and fifty-four female adult outpatients with IBS attending the Department of Gastroenterology at the First Affiliated Hospital of Nanjing Medical University between January,2008 and October,2008 were approached.Patients with a history of abdominal surgery,mental illness or those who had recently taken psychotropic drugs were excluded.A physician obtained demographic and abdominal symptom data.All patients were asked to complete the Zung Self-Rated Anxiety and Depression Scale(SDS/SAS) and the IBS-specific QoL questionnaire.The patients were divided into six groups according to age,in 10-year increments:18-27 years,28-37 years,38-47 years,48-57 years,58-67 years and 68-75 years(maximum 75 years).Age-related differences of abdominal pain or discomfort were analyzed using ranksum tests.Differences in SDS/SAS and IBS-QoL scores between age groups were analyzed using one-way analysis of variance.Pearson's correlations evaluated potential associations between IBS symptoms,psychological factors and QoL in each age group.RESULTS:There were no differences in the distribution of IBS subtypes between age groups(χ2 = 20.516,P = 0.153).Differences in the severity of abdominal pain/discomfort with age were statistically significant(χ2 = 25.638,P < 0.001);patients aged 48-57 years,58-67 years or 68-75 years had milder abdominal pain/discomfort than those in the younger age groups.The severity of anxiety or depressive symptoms did not differ between age groups(SDS,χ2 = 390.845,P = 0.110;SAS,χ 2 = 360.071,P = 0.220).Differences of IBSQoL scores were statistically significant between age groups(χ2 = 1098.458,P = 0.011).The scores of patients in the 48-57-year group were lower than those in the 18-27-year and 28-37-year groups(48-57-year group vs 18-27-year group,74.88 ± 8.76 vs 79.76 ± 8.63,P = 0.021;48-57-year group vs 28-37-year group,74.88 ± 8.76 vs 79.04 ± 8.32,P = 0.014).The scores in the 68-75-year group were lower than those in the 18-27-year,28-37-year and 38-47-year groups(68-75-year group vs 18-27-year group,71.98 ± 9.83 vs 79.76 ± 8.63,P = 0.003;68-75-year group vs 28-37-year group,71.98 ± 9.83 vs 79.04 ± 8.32,P = 0.002;68-75-year group vs 38-47-year group,71.98 ± 9.83 vs 76.44 ± 8.15,P = 0.039).Anxiety and depression were negatively correlated with QoL in all age groups(SDS and QoL:18-27-year group,r =-0.562,P = 0.005;28-37-year group,r =-0.540,P < 0.001;38-47-year group,r =-0.775,P < 0.001;48-57-year group,r =-0.445,P = 0.001;58-67-year group,r =-0.692,P < 0.001;68-75-year group,r =-0.732,P < 0.001.SAS and QoL:18-27-year group,r =-0.600,P = 0.002;28-37-year group,r =-0.511,P < 0.001;38-47-year group,r =-0.675,P < 0.001;48-57-year group,r =-0.558,58-67-year group,P = 0.001;r =-0.588,P < 0.001;68-75-year group,r =-0.811,P < 0.001).A negative correlation between abdominal pain severity and QoL was found in patients aged more than 58 years(58-67-year group,r =-0.366,P = 0.017;68-75-year group,r =-0.448,P = 0.048),but not in younger patients(18-27-year group,r = 0.080,P = 0.716;28-37-year group,r =-0.063,P = 0.679;38-47-year group,r =-0.029,P = 0.812;48-57-year group,r =-0.022,P = 0.876).CONCLUSION:Factors affecting QoL should always be treated in IBS,especially emotional problems in young adults.Even mild abdominal pain should be controlled in elderly patients.展开更多
Edna O'Brien (1930-), an Irish novelist, poet, and short story writer, is considered as a pioneer for her frank portrayals of women and the most gifted woman writing in English at her time. Her first novel, The Cou...Edna O'Brien (1930-), an Irish novelist, poet, and short story writer, is considered as a pioneer for her frank portrayals of women and the most gifted woman writing in English at her time. Her first novel, The Country Girls (1960), was an immediate success. Her writing is lyrical and intense with passions and aspirations. Set in Britain, the short story Cord describes a story about how the mother and the daughter got along in the short reunion after a long separation. The paper mainly explores different religious values, cultural values, and social values between them which caused irreconcilable conflicts. The present paper concludes that the "Cord", the blood tie, can never get rid of the spiritual barrier. Only mutual understanding can eliminate the gap and acquire a harmonious relation between parents and children.展开更多
This paper mainly discusses leadership soft skills, which comprise of collaboration or teamwork, communication skills, initiative, leadership ability, people development or coaching, personal effectiveness or personal...This paper mainly discusses leadership soft skills, which comprise of collaboration or teamwork, communication skills, initiative, leadership ability, people development or coaching, personal effectiveness or personal mastery, planning and organizing, and presentation skills. Leaders need to be masters of soft skills because leadership is determined by those who can demonstrate their ability to drive an organization toward excellence and results. The aim of this paper is to contribute to the body of knowledge and literature in leadership soft skills for educational leaders in higher education institutions. In addition, this paper also provides exposure to administrators to understand the importance of leadership soft skills besides highlighting the two relevant models. Furthermore, it also provides an advantage to administrators in developing high quality interpersonal relationships with the people who they associate with in promoting positive working environment. Leadership soft skills can be seen as providing a vital contribution for organizations and administrators in the process of developing of quality human resource.展开更多
The Merchant of Venice (1914), as one of the greatest works by Shakespeare, is a comedy. It addresses various themes. It is much more than a study of the struggles between Christians and Jews; it also deals with lov...The Merchant of Venice (1914), as one of the greatest works by Shakespeare, is a comedy. It addresses various themes. It is much more than a study of the struggles between Christians and Jews; it also deals with love and self-sacrifice, hatred and revenge, and friendship and marriage. It is a victory of Christians against Jews. But, at a more profound level, the play is ultimately a tragedy which functions as a cautionary exposure on the social problems of prejudice, hypocrisy and the family relationships. The paper begins by addressing the prejudice that is a dominant theme throughout the play. It also contends that the hypocrisy is prevalent in Venetian society. Then, Shylock, as the tragic hero in the play is analyzed. The final part deals with the problem of family relationships. By exposing grave deficiencies in Venetian Society, the play obliges us to make a critical moral judgment on humanity and establish correct philosophy of life and values展开更多
Genome-wide association study(GWAS) can be used to identify genes that increase the risk of psychiatric diseases.However,much of the disease heritability is still unexplained,suggesting that there are genes to be di...Genome-wide association study(GWAS) can be used to identify genes that increase the risk of psychiatric diseases.However,much of the disease heritability is still unexplained,suggesting that there are genes to be discovered.Functional annotation of the genetic variants may increase the power of GWAS to identify disease genes,by providing prior information that can be used in Bayesian analysis or in reducing the number of tests.Expression quantitative trait loci(eQTLs) are genomic loci that regulate gene expression.Genetic mapping of eQTLs can help reveal novel functional effects of thousands of single nucleotide polymorphisms(SNPs).The present review mainly focused on the current knowledge on brain eQTL mapping,and discussed some major methodological issues and their possible solutions.The frequently ignored problems of batch effects,covariates,and multiple testing were emphasized,since they can lead to false positives and false negatives.The future application of eQTL data in GWAS analysis was also discussed.展开更多
文摘This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome (IBS), discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of [BS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. bones and joints (fibromyalgia, temporomandibular joint syndrome), heart (non-cardiac chest pain), vascular (post-menopausal syndrome), and brain (anxiety, depression). Host IBS patients do not have psychiatric illness per se, but a range of psychoform (psychological complaints in the absence of psychiatric disorder) symptoms that accompany their somatoform (physical symptoms in the absence of medical disorder) complaints. It is not correct to label IBS patients as psychiatric patients (except those more difficult patients with true somatization disorder). One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness. Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions. Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in IBS, because the psychoform symptoms that sound similar to those seen in psychiatric disorders may not have the same significance in patients with IBS.
基金Supported by Open Project Program of the Jiangsu Key Laboratory of Molecular and Functional Imaging,No. PYZX 2011016the Medical Science and Technology Development Foundation of Nanjing Department of Health,No. YKK11199
文摘AIM:To explore age-related changes in symptoms and quality of life(QoL) of women with irritable bowel syndrome(IBS).METHODS:Two-hundred and fifty-four female adult outpatients with IBS attending the Department of Gastroenterology at the First Affiliated Hospital of Nanjing Medical University between January,2008 and October,2008 were approached.Patients with a history of abdominal surgery,mental illness or those who had recently taken psychotropic drugs were excluded.A physician obtained demographic and abdominal symptom data.All patients were asked to complete the Zung Self-Rated Anxiety and Depression Scale(SDS/SAS) and the IBS-specific QoL questionnaire.The patients were divided into six groups according to age,in 10-year increments:18-27 years,28-37 years,38-47 years,48-57 years,58-67 years and 68-75 years(maximum 75 years).Age-related differences of abdominal pain or discomfort were analyzed using ranksum tests.Differences in SDS/SAS and IBS-QoL scores between age groups were analyzed using one-way analysis of variance.Pearson's correlations evaluated potential associations between IBS symptoms,psychological factors and QoL in each age group.RESULTS:There were no differences in the distribution of IBS subtypes between age groups(χ2 = 20.516,P = 0.153).Differences in the severity of abdominal pain/discomfort with age were statistically significant(χ2 = 25.638,P < 0.001);patients aged 48-57 years,58-67 years or 68-75 years had milder abdominal pain/discomfort than those in the younger age groups.The severity of anxiety or depressive symptoms did not differ between age groups(SDS,χ2 = 390.845,P = 0.110;SAS,χ 2 = 360.071,P = 0.220).Differences of IBSQoL scores were statistically significant between age groups(χ2 = 1098.458,P = 0.011).The scores of patients in the 48-57-year group were lower than those in the 18-27-year and 28-37-year groups(48-57-year group vs 18-27-year group,74.88 ± 8.76 vs 79.76 ± 8.63,P = 0.021;48-57-year group vs 28-37-year group,74.88 ± 8.76 vs 79.04 ± 8.32,P = 0.014).The scores in the 68-75-year group were lower than those in the 18-27-year,28-37-year and 38-47-year groups(68-75-year group vs 18-27-year group,71.98 ± 9.83 vs 79.76 ± 8.63,P = 0.003;68-75-year group vs 28-37-year group,71.98 ± 9.83 vs 79.04 ± 8.32,P = 0.002;68-75-year group vs 38-47-year group,71.98 ± 9.83 vs 76.44 ± 8.15,P = 0.039).Anxiety and depression were negatively correlated with QoL in all age groups(SDS and QoL:18-27-year group,r =-0.562,P = 0.005;28-37-year group,r =-0.540,P < 0.001;38-47-year group,r =-0.775,P < 0.001;48-57-year group,r =-0.445,P = 0.001;58-67-year group,r =-0.692,P < 0.001;68-75-year group,r =-0.732,P < 0.001.SAS and QoL:18-27-year group,r =-0.600,P = 0.002;28-37-year group,r =-0.511,P < 0.001;38-47-year group,r =-0.675,P < 0.001;48-57-year group,r =-0.558,58-67-year group,P = 0.001;r =-0.588,P < 0.001;68-75-year group,r =-0.811,P < 0.001).A negative correlation between abdominal pain severity and QoL was found in patients aged more than 58 years(58-67-year group,r =-0.366,P = 0.017;68-75-year group,r =-0.448,P = 0.048),but not in younger patients(18-27-year group,r = 0.080,P = 0.716;28-37-year group,r =-0.063,P = 0.679;38-47-year group,r =-0.029,P = 0.812;48-57-year group,r =-0.022,P = 0.876).CONCLUSION:Factors affecting QoL should always be treated in IBS,especially emotional problems in young adults.Even mild abdominal pain should be controlled in elderly patients.
文摘Edna O'Brien (1930-), an Irish novelist, poet, and short story writer, is considered as a pioneer for her frank portrayals of women and the most gifted woman writing in English at her time. Her first novel, The Country Girls (1960), was an immediate success. Her writing is lyrical and intense with passions and aspirations. Set in Britain, the short story Cord describes a story about how the mother and the daughter got along in the short reunion after a long separation. The paper mainly explores different religious values, cultural values, and social values between them which caused irreconcilable conflicts. The present paper concludes that the "Cord", the blood tie, can never get rid of the spiritual barrier. Only mutual understanding can eliminate the gap and acquire a harmonious relation between parents and children.
文摘This paper mainly discusses leadership soft skills, which comprise of collaboration or teamwork, communication skills, initiative, leadership ability, people development or coaching, personal effectiveness or personal mastery, planning and organizing, and presentation skills. Leaders need to be masters of soft skills because leadership is determined by those who can demonstrate their ability to drive an organization toward excellence and results. The aim of this paper is to contribute to the body of knowledge and literature in leadership soft skills for educational leaders in higher education institutions. In addition, this paper also provides exposure to administrators to understand the importance of leadership soft skills besides highlighting the two relevant models. Furthermore, it also provides an advantage to administrators in developing high quality interpersonal relationships with the people who they associate with in promoting positive working environment. Leadership soft skills can be seen as providing a vital contribution for organizations and administrators in the process of developing of quality human resource.
文摘The Merchant of Venice (1914), as one of the greatest works by Shakespeare, is a comedy. It addresses various themes. It is much more than a study of the struggles between Christians and Jews; it also deals with love and self-sacrifice, hatred and revenge, and friendship and marriage. It is a victory of Christians against Jews. But, at a more profound level, the play is ultimately a tragedy which functions as a cautionary exposure on the social problems of prejudice, hypocrisy and the family relationships. The paper begins by addressing the prejudice that is a dominant theme throughout the play. It also contends that the hypocrisy is prevalent in Venetian society. Then, Shylock, as the tragic hero in the play is analyzed. The final part deals with the problem of family relationships. By exposing grave deficiencies in Venetian Society, the play obliges us to make a critical moral judgment on humanity and establish correct philosophy of life and values
文摘Genome-wide association study(GWAS) can be used to identify genes that increase the risk of psychiatric diseases.However,much of the disease heritability is still unexplained,suggesting that there are genes to be discovered.Functional annotation of the genetic variants may increase the power of GWAS to identify disease genes,by providing prior information that can be used in Bayesian analysis or in reducing the number of tests.Expression quantitative trait loci(eQTLs) are genomic loci that regulate gene expression.Genetic mapping of eQTLs can help reveal novel functional effects of thousands of single nucleotide polymorphisms(SNPs).The present review mainly focused on the current knowledge on brain eQTL mapping,and discussed some major methodological issues and their possible solutions.The frequently ignored problems of batch effects,covariates,and multiple testing were emphasized,since they can lead to false positives and false negatives.The future application of eQTL data in GWAS analysis was also discussed.