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Obesity is a chronic disease that is linked to the presence of numerous chronic illnesses, including venous disease. Venous disease can lead to chronic wounds, which may be exacerbated by vitamin, mineral, and macro-nutritional deficiencies. A cross-sectional observational design was used to examine the nutritional status of patients with chronic venous leg ulcers (VLUs) who are overweight or obese and to explore the relationship between nutritional status and severity of venous ulceration. Nutritional status was evaluated using anthropometric measurements, nutrient analysis from a 3-day dietary intake log, serum albumin, vitamins A and C, and zinc levels. Wound severity was assessed using the Leg Ulcer Measurement Tool (LUMT). Eight patients participated; six patients were men, and all eight patients were more than 50 years of age. Patients had an average daily caloric intake below their estimated caloric need. When compared with recommended daily intake levels, dietary nutrient intake was suboptimal for protein, vitamin C, and zinc. Serum levels were below normal for at least one of these nutrients in six patients. A positive correlation was found only between serum albumin, average daily intake, and percent recommended daily intake of protein (r s = 0.93, P = .003). An inverse relationship was found between LUMT score and serum vitamin A levels (r s = −0.83, P = .01), and a positive correlation was observed between LUMT score and serum vitamin C (r s = 0.74, P = .04). No clear relationships were shown among serum zinc, albumin, and LUMT scores. Overweight and obese patients with VLU show nutritional deficits that are similar to those of the broader population of patients with leg ulcers. The relationships found between vitamins A and C and leg ulcer severity warrant further exploration. The nutritional differences in the study need to be examined in a larger sample of overweight and normal-weight patients to determine whether overweight patients are at greater risk for prolonged VLU because of poor nutrition than non-overweight patients.

Objective. Determine the effectiveness of a comprehensive self-management (CSM) intervention delivered via telephone (T-CSM) or in-person (IP-CSM) as compared to usual care (UC) for adults with IBS. Methods. Potential participants were recruited through community advertisements and screened for eligibility criteria during the baseline period. 188 participants were randomized to T-CSM, IP-CSM or UC. Both CSM interventions were delivered weekly over 9 weeks, and addressed nutritional, cognitive and behavioral strategies for managing IBS symptoms. Outcomes were measured at baseline and 3, 6, and 12 months follow-up times. Two primary outcome variables were analyzed: a) IBS symptom severity (IBS-SS) from a daily diary, measured as the percent of days with at least one IBS symptom (abdominal pain, bloating, constipation, diarrhea, intestinal gas, urgency) being moderate or worse, and b) IBS-specific quality of life (QOL) measured on a 0-100 scale. Mixed-model analyses were used to analyze data from the three follow-up times, controlling for baseline values of IBS symptom severity, QOL, and psychological distress as covariates. Results. The two primary outcome variables showed highly significant treatment differences with both T-CSM and IP-CSM having better outcomes than UC (p

The purpose of this preliminary report is describe how an orientation towards social desirability responses affects the reporting of gastrointestinal (GI) and psychological symptoms in women with Irritable Bowel Syndrome (IBS) compared to nonsymptomatic controls. Methods: Women with medically diagnosed IBS (n = 40) and healthy controls (n = 19) ages 21-45 were interviewed and completed questionnaires including the Marlowe-Crowne Social Desirability scale (M-C SDS, 20 items) and Symptom Checklist-90 (SCL-90). They were then followed for one menstrual cycle with a symptom diary. Summary measures included: the mean M-C SDS score, the mean score over the menstrual cycle for G! (abdominal pain, bloating, constipation, and diarrhea) and psychological distress (SCL-90 subscale; daily anxiety, depression, and anger). Results: The mean level for the M-C SDS did not differ significantly between groups (IBS, M = 8.7 -+ 4.3; Control 9.6 + 4.2). However the higher the M-C SDS the higher mean daily GI symptom (abdominal pain, r s = 297, p = .13; bloating, r s = .470 p = .01; and constipation, r s = 463 p = .02; but not diarrhea, r s = -.067, p = .74) in the IBS group (n = 27). The M-C SDS was negatively correlated with SCL-90 subscales scores (IBS (n = 40) anxiety, r s = -.305 p = .05; depression, r s = -.377 p --.02, hostility, q = -.304 p = .05; interpersonal sensitivity, r s = -.364 p = .02) although less so in the daily measures (1BS (n =27), anxiety, r s = -.278 p = .16; depression, r s = -.049 p = .81, anger, r s = -.149 p = .46). Conclusions: Even though the women with IBS in this sample did not differ from controls in their mean score on a social desirability scale, their reports of GI symptoms and psychological distress were influenced by their need to respond in a socially appropriate manner. These results are consistent with the findings in patients being evaluated for intractable pain. This type of self reporting bias may reflect either a personality style that is influenced by social context, e.g., the legitimacy of physical but not psychological symptoms or an awareness that health care systems are more responsive to somatic symptoms or both. Funded by National Institute of Nursing Research, NR04101.

A two-part experimental design was used to study the effects of ovarian hormone cessation, hormone supplementation, and dietary fiber composition on body weight, appetite, and intestinal transit. In Part 1, effects of ovarian hormone status on body weight and baseline and stimulated intestinal transit were measured in chow-fed rats. Sprague-Dawley rats were ovariectomized (OVX), then injected daily (22 days) with estrogen (E), progesterone (P), the combination (E + P), or placebo. Controls were sham operated and placebo injected. Among OVX rats, E and E + P had the least body weight gain (9%, 6%); placebo and P had the greatest (36%, 34%). In OVX-P, baseline intestinal transit (measured in anesthetized rats as distance traveled by a charcoal marker) was relatively low, but vagal stimulation via centrally administered thyrotropin-releasing hormone evoked an increase significantly larger than that in other groups. In Part 2, experiments probed the interacting effects of ovarian hormone cessation and dietary fiber composition on body weight and baseline intestinal transit. Caloric intake was measured to determine the contribution of altered appetite. Rats were OVX or sham operated, then fed liquid diets with or without dietary fiber (25 days). OVX fiber-fed rats had significantly higher caloric intake, weight gain, and baseline intestinal transit than other groups. Caloric intake did not fully account for group differences. These results demonstrate modulation of GI function by ovarian hormones and dietary fiber.

In a previous study, gastrointestinal (GI) symptoms and stool characteristics were found to be influenced by menstrual cycle phase. The current study was designed to replicate initial work regarding GI symptoms and stool characteristics and to explore the relationships between GI symptoms, stool characteristics, ovarian hormone levels, and indicators of psychophysiological arousal. Fifty women (dysmenorrheic, N = 22; nondysmenorrheic, N = 28) maintained a daily dairy for recording stool characteristics, GI symptoms, and daily anxiety level. First morning void urine specimens for catecholamine assays and serum samples for ovarian hormone and cortisol determinations were obtained at menses, follicular, and luteal phases. Results showed menstrual cycle-related differences in stool characteristics and report of GI symptoms, with the greatest changes occurring at menses in the total sample. Dysmenorrheic women reported higher levels of all GI symptoms at menses as compared to nondysmenorrheic women. In addition, cycle-related differences in serum cortisol, urine catecholamines, and report of anxiety were also noted, particularly in dysmenorrheic women. However, looser stools and GI symptoms at menses were not correlated with absolute levels of ovarian hormones or indicators of psychophysiological arousal.

For those women who have not been contraceptively sterilized, midlife is a period of waning fertility. However, the occurrence of anovulatory menstrual cycles is unpredictable. Contraceptive methods also become increasingly contraindicated, both medically and physiologically. This article reviews the physiology of waning fertility and midlife contraceptive options, and discusses implications for helping women meet their contraceptive needs throughout the perimenopausal period.

The purpose of this study was to determine which borderline hypertension subjects could succeed in self-regulating blood pressure, and to distinguish the psychologic and physiologic variables that predicted success. Thirty-four white, male, unmedicated, borderline hypertensive subjects participated in a 14-session biofeedback/cognitive self-management training program. Of these, 22 exited with diastolic pressure below 90 mm Hg; 12 exited equal to or above 90 mm Hg. Both groups exited with scores markedly lower on the Symptoms Checklist-90 (SCL-90). The successful group began and ended on all cognitive/affective subscales at a lower level than the unsuccessful group. A discriminant analysis revealed that lower scores on the SCL-90, lower systolic blood pressures, and higher heart rates during a mental task at the beginning of treatment distinguished those who succeeded in self-regulation from those who could not succeed. The possible mechanisms for blood pressure control/change as a consequence of biofeedback are discussed.

Previous research has yielded inconsistent results in the control of essential hypertension. One explanation for response to drug or behavioral therapy may be the patient's psychological status upon entering treatment. Thirty-five borderline hypertensive males entered into a self-management program with biofeedback and cognitive restructuring components. The SCL-90 (Symptom Checklist-90) and the Holmes' Schedule of Recent Events were used to determine if responders and nonresponders could be distinguished prior to treatment on the basis of psychological status. Patients whose hypertension was resistant to treatment (diastolic greater than or equal to 90 mm Hg) reported significantly greater levels of psychological distress and greater life changes than did controlled patients. Pretreatment differences could not be explained by compliance or expectation of success. This study suggests that a relationship exists between psychological distress, life changes and the subsequent control of hypertension; this has implications for treatment selection and design for psychologically distressed individuals.