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1.  Intra- and extra-familial adverse childhood experiences and a history of childhood psychosomatic disorders among Japanese university students 
Background
Japan has been witnessing a considerable increase in the number of children with psychosomatic disorders. The purpose of this study is to examine the relationship between the risk of psychosomatic disorder in adolescents and intra- and extra-familial adverse childhood experiences (ACEs).
Methods
A retrospective cohort study of 1592 Japanese university students (52% male, mean age 19.9 years) who completed a survey about intra- and extra-familial ACEs and the incidence of childhood psychosomatic disorders. Intra-familial ACEs included domestic violence, physical violence, emotional abuse, illness in household, parental divorce, no parental affection, and dysfunctional family. Extra-familial ACEs included physical violence or negative recognition by teachers, being bullied in elementary or junior high school, or sexual violence.
Results
The frequency of psychosomatic disorders among the respondents was 14.8%. Among the 7 intra-familial ACEs, emotional abuse (relative risk, RR = 1.9) and illness in household (RR = 1.7) increased the risk of psychosomatic disorders. Estimates of the relative risk for the 5 extra-familial ACEs were statistically significant and ranged from 1.5 for being bullied in elementary school or physical violence from teachers to 2.4. Students who had 3 or more intra-familial ACEs and 2 or more extra-familial ACEs had a 3.0 relative risk for psychosomatic disorder.
Conclusion
These results suggest that intra- and extra-familial ACEs are associated with the development of psychosomatic disorders. Therefore, sufficient evaluation of ACEs should be performed in adolescent patients with psychosomatic disorder.
doi:10.1186/1751-0759-1-9
PMCID: PMC1852322  PMID: 17407551
2.  Associations between scores of psychosomatic health symptoms and health-related quality of life in children and adolescents 
Background
The aims of the present study are to investigate whether there are differences in health-related quality of life (HRQoL) between girls and boys in two different age groups, to study how much of children’s variance in HRQoL can be explained by common psychosomatic health symptoms, and to examine whether the same set of psychosomatic symptoms can explain differences in HRQoL, both between girls and boys and between older and younger school children.
Methods
A cross-sectional study was conducted of 253 children, 99 of ages 11–12 years (n=51 girls, n=48 boys) and 154 of ages 15–16 years (n=82 girls, n=72 boys), in Swedish schools. The KIDSCREEN-52 instrument, which covers 10 dimensions of HRQoL and additional questions about psychosomatic health symptoms, were used. Analyses of variance were conducted to investigate differences between the genders and age groups, and in interaction effects on the KIDSCREEN-52 dimensions. Regression analyses were used to investigate the impacts of psychosomatic symptoms on gender and age group differences in HRQoL.
Results
Boys rated themselves higher than girls on the KIDSCREEN dimensions: physical and psychological well-being, moods and emotions, self-perception, and autonomy. Main effects of age group were found for physical well-being, psychological well-being, moods and emotions, self-perception, autonomy, and school environment, where younger children rated their HRQoL more highly than those aged 15–16 years. Girls rated their moods and emotions dramatically lower than boys in the older age group, but the ratings of emotional status were more similar between genders at younger ages. Psychosomatic symptoms explained between 27% and 50% of the variance in the children’s HRQoL. Sleeping difficulties were a common problem for both girls and boys. Depression and concentration difficulties were particularly associated with HRQoL among girls whereas stomach aches were associated with HRQoL among boys.
Conclusions
Girls and adolescents experience poorer HRQoL than boys and younger children, but having psychosomatic symptoms seem to explain a substantial part of the variation. Strategies to promote health among school children, in particular to alleviate sleep problems among all children, depression and concentration difficulties among girls, and stomach aches among boys, are of great importance.
doi:10.1186/1477-7525-11-176
PMCID: PMC3831247  PMID: 24148880
Health; Quality of life; Gender; School; Children; Adolescents; Psychosomatic symptoms; Sleep problems; KIDSCREEN
3.  Problematic Internet use in Chinese adolescents and its relation to psychosomatic symptoms and life satisfaction 
BMC Public Health  2011;11:802.
Background
Problematic Internet use (PIU) is a growing problem in Chinese adolescents. Little is known about associations of PIU with physical and psychological health. This study was designed to investigate the prevalence of PIU and to test the relationships between PIU and psychosomatic symptoms and life satisfaction among adolescents in mainland China.
Methods
A cross-sectional survey was conducted comprising a large representative sample of 17 599 students in eight cities of China. PIU was assessed by the 20-item Young Internet Addiction Test (YIAT). The Multidimensional Sub-health Questionnaire of Adolescents and the Multidimensional Students' Life Satisfaction Scale were administered to obtain information on psychosomatic symptoms and life satisfaction. Demographics and Internet usage patterns were also collected. Logistic regression was used to assess the effects of PIU on psychosomatic symptoms and life satisfaction.
Results
Approximately 8.1% of subjects showed PIU. Adolescents with PIU were associated with males, high school students, urban, eastern and western areas, upper self-report family economy, service type mostly used for entertainment and relieving loneliness and more frequency of Internet use. Compared with normal Internet users, adolescents with PIU were more likely to suffer from psychosomatic symptoms (P < 0.001), including lack of physical energy (P < 0.001), physiological dysfunction (P < 0.001), weakened immunity (P < 0.001), emotional symptoms (P < 0.001), behavioural symptoms (P < 0.001) and social adaptation problems (P < 0.001). Adolescents with PIU had lower scores on total and all dimensions of life satisfaction (all P < 0.001). Adjusted for the demographic and Internet-related factors, there was positive significant relationship between PIU and psychosomatic symptoms, but negatively related to life satisfaction.
Conclusions
PIU is common among Chinese students, and PIU was significantly associated with psychosomatic symptoms and life satisfaction. Effective measures are needed to prevent the spread of this problem and interventions to prevent the effects of PIU on psychosomatic symptoms and life satisfaction should be conducted as early as possible.
doi:10.1186/1471-2458-11-802
PMCID: PMC3214169  PMID: 21995654
4.  Age and gender differences of psychogenic fever: a review of the Japanese literature 
Background
Psychogenic fever is one of the most common psychosomatic diseases. Patients with psychogenic fever have acute or persistent body temperature above normal range in psychologically stressful situations. In spite of numerous case reports on psychogenic fever, there are few epidemiological studies. Therefore, our goal was to investigate the age distribution and gender differences of psychogenic fever in Japan.
Methods
To achieve this goal, we searched Medline and Ichushi WEB, a Japanese medical database, and added other publications that were not included in these databases. Thus, we reviewed 195 Japanese cases of psychogenic fever published in 62 papers.
Results
Psychogenic fever patients ranged from 3 to 56 years old, with the highest number of cases occurring in 13 year-olds in both sexes. The male: female ratio of 1: 1.19 suggested a slight predominance of female cases. Psychogenic fever accounted for 18% of fever cases of unknown origin in children and 2–6% of the psychosomatic diseases of pediatric patients. Patients with psychogenic fever were not only found in pediatrics departments, but also in psychosomatic medicine, psychiatry, internal medicine, anesthesiology, dentistry, and obstetrics/gynecology departments.
Conclusion
The age of psychogenic fever patients ranged from 3 to 56 years old and the male: female ratio was 1:1.19. Psychogenic fever is seen especially in adolescence in Japan.
doi:10.1186/1751-0759-1-11
PMCID: PMC1888691  PMID: 17511878
5.  Bullying involvement in primary school and common health problems 
Archives of Disease in Childhood  2001;85(3):197-201.
AIMS—To examine the association of direct (e.g. hitting) and relational (e.g. hurtful manipulation of peer relationships) bullying experience with common health problems.
METHODS—A total of 1639 children (aged 6-9 years) in 31 primary schools were studied in a cross sectional study that assessed bullying with a structured child interview and common health problems using parent reports. Main outcome measures were common physical (e.g. colds/coughs) and psychosomatic (e.g. night waking) health problems and school absenteeism.
RESULTS—Of the children studied, 4.3% were found to be direct bullies, 10.2% bully/victims (i.e. both bully and become victims), and 39.8% victims. Direct bully/victims, victims, and girls were most likely to have physical health symptoms (e.g. repeated sore throats, colds, and coughs). Direct bully/victims, direct victims, and year 2 children were most likely to have high psychosomatic health problems (e.g. poor appetite, worries about going to school). Pure bullies (who never got victimised) had the least physical or psychosomatic health problems. No association between relational bullying and health problems was found.
CONCLUSIONS—Direct bullying (e.g. hitting) has only low to moderate associations with common health problems in primary school children. Nevertheless, health professionals seeing children with repeated sore throat, colds, breathing problems, nausea, poor appetite, or school worries should consider bullying as contributory factor.

doi:10.1136/adc.85.3.197
PMCID: PMC1718894  PMID: 11517098
6.  Results of a psychosomatic training program in China, Vietnam and Laos: successful cross-cultural transfer of a postgraduate training program for medical doctors 
Background
With the “ASIA-LINK” program, the European Community has supported the development and implementation of a curriculum of postgraduate psychosomatic training for medical doctors in China, Vietnam and Laos. Currently, these three countries are undergoing great social, economic and cultural changes. The associated psychosocial stress has led to increases in psychological and psychosomatic problems, as well as disorders for which no adequate medical or psychological care is available, even in cities. Health care in these three countries is characterized by the coexistence of Western medicine and traditional medicine. Psychological and psychosomatic disorders and problems are insufficiently recognized and treated, and there is a need for biopsychosocially orientated medical care. Little is known about the transferability of Western-oriented psychosomatic training programs in the Southeast Asian cultural context.
Methods
The curriculum was developed and implemented in three steps: 1) an experimental phase to build a future teacher group; 2) a joint training program for future teachers and German teachers; and 3) training by Asian trainers that was supervised by German teachers. The didactic elements included live patient interviews, lectures, communication skills training and Balint groups. The training was evaluated using questionnaires for the participants and interviews of the German teachers and the future teachers.
Results
Regional training centers were formed in China (Shanghai), Vietnam (Ho Chi Minh City and Hue) and Laos (Vientiane). A total of 200 physicians completed the training, and 30 physicians acquired the status of future teacher. The acceptance of the training was high, and feelings of competence increased during the courses. The interactive training methods were greatly appreciated, with the skills training and self-experience ranked as the most important topics. Adaptations to the cultural background of the participants were necessary for the topics of “breaking bad news,” the handling of negative emotions, discontinuities in participation, the hierarchical doctor-patient relationship, culture-specific syndromes and language barriers. In addition to practical skills for daily clinical practice, the participants wanted to learn more about didactic teaching methods. Half a year after the completion of the training program, the participants stated that the program had a great impact on their daily medical practice.
Conclusions
The training in psychosomatic medicine for postgraduate medical doctors resulted in a positive response and is an important step in addressing the barriers in providing psychosomatic primary care. The transferability of western concepts should be tested locally, and adaptations should be undertaken where necessary. The revised curriculum forms the basis of training in psychosomatic medicine and psychotherapy for medical students and postgraduate doctors in China, Vietnam and Laos.
doi:10.1186/1751-0759-6-17
PMCID: PMC3546304  PMID: 22929520
Psychosomatic medicine; Curriculum; Teaching of teachers; China; Vietnam; Laos
7.  Work-related stress and psychosomatic medicine 
This article introduces key concepts of work-related stress relevant to the clinical and research fields of psychosomatic medicine. Stress is a term used to describe the body's physiological and/or psychological reaction to circumstances that require behavioral adjustment. According to the Japanese National Survey of Health, the most frequent stressors are work-related problems, followed by health-related and then financial problems. Conceptually, work-related stress includes a variety of conditions, such as overwork, unemployment or job insecurity, and lack of work-family balance. Job stress has been linked to a range of adverse physical and mental health outcomes, such as cardiovascular disease, insomnia, depression, and anxiety. Stressful working conditions can also impact employee well-being indirectly by directly contributing to negative health behaviors or by limiting an individual's ability to make positive changes to lifestyle behaviors, such as smoking and sedentary behavior. Over the past two decades, two major job stress models have dominated the occupational health literature: the job demand-control-support model and the effort-reward imbalance model. In both models, standardized questionnaires have been developed and frequently used to assess job stress. Unemployment has also been reported to be associated with increased mortality and morbidity, such as by cardiovascular disease, stroke, and suicide. During the past two decades, a trend toward more flexible labor markets has emerged in the private and public sectors of developed countries, and temporary employment arrangements have increased. Temporary workers often complain that they are more productive but receive less compensation than permanent workers. A significant body of research reveals that temporary workers have reported chronic work-related stress for years. The Japanese government has urged all employers to implement four approaches to comprehensive mind/body health care for stress management in the workplace: focusing on individuals, utilizing supervisory lines, enlisting company health care staff, and referring to medical resources outside the company. Good communications between occupational health practitioners and physicians in charge in hospitals/clinics help employees with psychosomatic distress to return to work, and it is critical for psychosomatic practitioners and researchers to understand the basic ideas of work-related stress from the viewpoint of occupational health.
doi:10.1186/1751-0759-4-4
PMCID: PMC2882896  PMID: 20504368
8.  Functional near-infrared spectroscopy studies in children 
Psychosomatic and developmental behavioral medicine in pediatrics has been the subject of significant recent attention, with infants, school-age children, and adolescents frequently presenting with psychosomatic, behavioral, and psychiatric symptoms. These may be a consequence of insecurity of attachment, reduced self-confidence, and peer -relationship conflicts during their developmental stages. Developmental cognitive neuroscience has revealed significant associations between specific brain lesions and particular cognitive dysfunctions. Thus, identifying the biological deficits underlying such cognitive dysfunction may provide new insights into therapeutic prospects for the management of those symptoms in children. Recent advances in noninvasive neuroimaging techniques, and especially functional near-infrared spectroscopy (NIRS), have contributed significant findings to the field of developmental cognitive neuroscience in pediatrics. We present here a comprehensive review of functional NIRS studies of children who have developed normally and of children with psychosomatic and behavioral disorders.
doi:10.1186/1751-0759-6-7
PMCID: PMC3337812  PMID: 22433235
Development; Children; Cognitive neuroscience; Near-infrared spectroscopy
9.  A possible connection between psychosomatic symptoms and daily rhythmicity in growth hormone secretion in healthy Japanese students 
Background
Students suffering from psychosomatic symptoms, including drowsiness and feelings of melancholy, often have basic lifestyle problems. The aim of this study was to investigate whether psychosomatic complaints may be related to circadian dysfunction.
Methods
We examined 15 healthy students (4 men and 11 women) between 21 and 22 years old. To assess the presence of psychosomatic symptoms among the subjects, we developed a self-assessment psychosomatic complaints questionnaire consisting of five items pertaining to physical symptoms and five items concerning mental symptoms. The subjects rated their psychosomatic symptoms twice a day (08:00 and 20:00 h). We also assessed growth hormone secretion patterns by fluorescence enzyme immunoassay (FEIA). Salivary samples were collected from the subjects at home five times a day (20:00, 24:00, 04:00, 08:00, and 12:00 h) in Salivette tubes.
Results
The results indicated a relationship between the self-assessment scores and the salivary levels of growth hormone. Subjects with high self-assessment scores showed significant variability in growth hormone secretion over the day, whereas subjects with low self-assessment scores did not.
Conclusion
Psychosomatic symptoms may be associated with circadian dysfunction, as inferred from blunted rhythmicity in growth hormone secretion.
doi:10.1186/1740-3391-7-10
PMCID: PMC2731727  PMID: 19656410
10.  The role of perceived well-being in the family, school and peer context in adolescents’ subjective health complaints: evidence from a Greek cross-sectional study 
Background
During adolescence children are usually confronted with an expanding social arena. Apart from families, schools and neighbourhoods, peers, classmates, teachers, and other adult figures gain increasing importance for adolescent socio-emotional adjustment. The aim of the present study was to investigate the extent to which Greek adolescents’ perceived well-being in three main social contexts (family, school and peers) predicted self-reported Subjective Health Complaints.
Methods
Questionnaires were administered to a Greek nation-wide, random, school-based sample of children aged 12–18 years in 2003. Data from 1.087 adolescents were analyzed. A hierarchical regression model with Subjective Health Complaints as the outcome variable was employed in order to i) control for the effects of previously well-established demographic factors (sex, age and subjective economic status) and ii) to identify the unique proportion of variance attributed to each context. Bivariate correlations and multicollinearity were also explored.
Results
As hypothesized, adolescents’ perceived well-being in each of the three social contexts appeared to hold unique proportions of variance in self-reported Subjective Health Complaints, after controlling for the effects of sex, age and subjective economic status. In addition, our final model confirmed that the explained variance in SHC was accumulated from each social context studied. The regression models were statistically significant and explained a total of approximately 24% of the variance in Subjective Health Complaints.
Conclusions
Our study delineated the unique and cumulative contributions of adolescents’ perceived well-being in the family, school and peer setting in the explanation of Subjective Health Complaints. Apart from families, schools, teachers and peers appear to have a salient role in adolescent psychosomatic adjustment. A thorough understanding of the relationship between adolescents’ Subjective Health Complaints and perceived well-being in their social contexts could not only lead to more effective tailored initiatives, but also to promote a multi- and inter-disciplinary culture in adolescent psychosomatic health.
doi:10.1186/1751-0759-7-17
PMCID: PMC4175490  PMID: 24283390
Subjective Health Complaints (SHC); Adolescence; Family; School; Peers; Well-being; Psychosomatic health; Subjective perceptions; Subjective economic status
11.  Validity issues in the assessment of alexithymia related to the developmental stages of emotional cognition and language 
Objective
We examined developmental aspects of the emotional awareness of adolescents by evaluating their responses to a self-reported questionnaire based on the Toronto Alexithymia Scale-20 (TAS-20).
Methods
The items of the TAS-20 were modified to make them more understandable by adolescents, and nine new items related to a limited capacity for imagination were added. The Japanese Linguistic Ability Test and the multi-dimensional empathy scale for adolescents were administered to examine concurrent validity. Two hundred and two normative young adolescents and thirty-two adolescent patients with psychosomatic and/or behavioral problems participated in the study. Eighty junior high school students also participated in a separate examination of test-retest reliability.
Results
Thirteen items were extracted after exploratory and confirmatory factor analyses, and four core factors were identified in the resulting scale: Difficulty Identifying Feelings (DIF), Difficulty Describing Feelings (DDF), Externally-Oriented Thinking (EOT) and Constricted Imaginal Capacities (CIC). Interestingly, scores on the multi-dimensional empathy scale correlated positively with DIF and DDF, but negatively with EOT and CIC. Higher DDF scores were associated with higher Japanese linguistic abilities. DIF/DDF scores were higher for females than males, irrespective of linguistic ability. Test-retest reliability coefficients were significant. The patient group showed significantly higher DIF scores than the normative students.
Conclusion
The present findings indicated that subjective difficulties in identifying and describing feelings are associated with empathetic and linguistic abilities. The developmental aspect to emotional awareness herein described suggests that self-reported questionnaires for alexithymia must be carefully constructed and examined, even for adults.
doi:10.1186/1751-0759-3-12
PMCID: PMC2777913  PMID: 19886981
12.  Psychosomatic complaints and sense of coherence among adolescents in a county in Sweden: a cross-sectional school survey 
Background
Over the last five to ten years there has been an increase in psychosomatic complaints (PSC) in Swedish children. The objective of the study was to examine the relation between PSC and sense of coherence (SOC).
Methods
A cross-sectional school survey in the county of Västmanland, Sweden. All 16- and 19-year old adolescents present at school on the day of the survey were asked to complete a questionnaire in their classrooms during a one-lesson hour session under the supervision of their teachers. Totally 3,998 students in both private and public schools, studying in ninth grade elementary school or third grade secondary school participated.
Results
The results from our study show that there is a statistically significant relation between PSC and SOC among adolescents. It also shows that adolescents with a weak SOC score have more symptoms of PSC.
Conclusion
Our study indicates that SOC can help the adolescents to choose a coping strategy that is appropriate for the situation and thereby may prevent them from developing PSC. However, additional studies are needed to confirm our findings.
doi:10.1186/1751-0759-2-4
PMCID: PMC2265297  PMID: 18261203
13.  The History, present state, and future prospects of the Asian College of Psychosomatic Medicine (ACPM) 
The Asian College of Psychosomatic Medicine (ACPM) was founded as the Asian Chapter of the International College of Psychosomatic Medicine (ICPM-AC) in Tokyo on April 12, 1982.
The first president was Hitoshi ISHIKAWA (Japan), the vice-presidents were Mahalingam MAHADEVAN (Malaysia) and Burton G.BURTON-BRADLEY (Papua- New Guinea), and the general secretary was Sueharu TSUTSUI (Japan).
Five years previously, preparation for creation of the ICPM-AC was started at the 4th World Congress of the International College of Psychosomatic Medicine (ICPM) held in Kyoto, Japan, September 5-9, 1977.
The First Congress of the ICPM-AC was held by the President Yujiro IKEMI in Tokyo on May 19-20, 1984. The main members in the early stage were Y. IKEMI, H. ISHIKAWA, S. TSUTSUI, Taisaku KATSURA, Tetsuya NAKAGAWA. Hiroyuki SUEMATSU and others from Japan and Hsien RIN (Taiwan), Seock Young KANG (Korea), M. MAHADEVAN. B.G. BURTON-BRADLEY and others from other Asian countries.
Thereafter, academic congresses of the ICPM-AC, the 2nd to the 9th, were held approximately every two years, in Japan, India, Malaysia, Taiwan, Korea, and China. The name was changed to the Asian College of Psychosomatic Medicine (ACPM), and the 10th to 14th congresses were held in Taiwan, Okinawa (Japan), Australia, Korea, and China.
The current president of the Executive Board of ACPM is Chiharu KUBO, the Director of Kyushu University Hospital.
The next academic congress is the 15th ACPM and will be hosted by Tserenkhuugyin LKHAGVASUREN in Ulaanbaatar, Mongolia from August 24-26, 2012.
Participating countries have expanded to include Asian-Oceanic countries such as Mongolia, Micronesia, Australia and Sri Lanka.
The main themes of the congresses have focused on psychosomatic disorders, culture - bound syndromes, oriental medicine, etc... To date,"Health promotion"by raising the level of mental health based on psychoneuroendocrinoimmunomodulation has been very important. Prevention is also important in the Asia - Oceana area, from the viewpoints of both psychosomatics and culture.
Above all, an awareness of existential, authentic health is a sure way to promote healthy longevity and psychosomatic well - being.
To pursue happiness and well-being subjectively, objectively, and ecologically will be the most important purposes of ACPM in the future.
doi:10.1186/1751-0759-6-1
PMCID: PMC3317857  PMID: 22260201
The Asian College of Psychosomatic Medicine (ACPM); The Asian Chapter of the International College of Psychosomatic Medicine (ICPM-AC); history; perspective
14.  Lifestyles and psychosomatic symptoms among elementary school students and junior high school students 
Objectives
To examine the relationship between lifestyles and psychosomatic symptoms in children, we conducted a self-administered questionnaire survey of elementary school students and junior high school students in Japan.
Methods
We designed an original questionnaire to investigate the lifestyles and psychosomatic symptoms of children. In 1997, responses to the questionnaires were elicited from public elementary school fourth grade students (then aged 9–10) and public junior high school seventh grade students (then aged 12–13). The survey was repeated annually for three years as the students advanced through school.
Results
For both boys and girls, each cross-sectional analysis revealed a strong relationship between lifestyle behaviors and psychosomatic symptoms. Psychosomatic, symptoms scores varied according to daily hours of sleep, eating of breakfast, having strong likes and dislikes of food, bowel habits, and daily hours of television watching. Both boys and girls with “good” lifestyle, behaviors evaluated by the HPI (Health Practice Index) showed lower scores for psychosomatic symptoms.
Conclusions
These findings show that the lifestyle behaviors of children are significantly associated with psychosomatic symptoms and suggest that poor lifestyle behaviors are likely to increase physical and psychological health risks.
doi:10.1007/BF02898067
PMCID: PMC2723516  PMID: 21432317
lifestyles; psychosomatic symptoms; elementary school; junior high school; health practice index
15.  Somatic comorbidity in anorexia nervosa: First results of a 21-year follow-up study on female inpatients 
Background
Anorexia nervosa is a severe psychosomatic disease with somatic complications in the long-term course and a high mortality rate. Somatic comorbidities independent of anorexia nervosa have rarely been studied, but pose a challenge to clinical practitioners. We investigated somatic comorbidities in an inpatient cohort and compared somatically ill anorexic patients and patients without a somatic comorbidity. In order to evaluate the impact of somatic comorbidity for the long-term course of anorexia nervosa, we monitored survival in a long-term follow-up.
Method
One hundred and sixty-nine female inpatients with anorexia nervosa were treated at the Charité University Medical Centre, Campus Benjamin Franklin, Berlin, between 1979 and 2011. We conducted retrospective analyses using patient's medical and psychological records. Information on survival and mortality were required through the local registration office and was available for one hundred patients. The mean follow-up interval for this subgroup was m = 20.9 years (sd = 4.7, min = 13.3, max = 31.6, range = 18.3). We conducted survival analysis using cox regression and included somatic comorbidity in a multivariate model.
Results
N = 41 patients (24.3%) showed a somatic comorbidity, n = 13 patients (7.7%) showed somatic comorbidities related to anorexia nervosa and n = 26 patients (15.4%) showed somatic comorbidities independent of anorexia nervosa, n = 2 patients showed somatic complications related to other psychiatric disorders. Patients with a somatic comorbidity were significantly older (m = 29.5, sd = 10.3 vs m = 25.0, sd = 8.7; p = .006), showed a later anorexia nervosa onset (m = 24.8, sd = 9.9 vs. m = 18.6, sd = 5.1; p < .000) and a longer duration of treatment in our clinic (m = 66.6, sd = 50.3 vs. m = 50.0, sd = 47; p = .05) than inpatients without somatic comorbidity. Out of 100 patients, 9 patients (9%) had died, on average at age of m = 37 years (sd = 9.5). Mortality was more common among inpatients with somatic comorbidity (n = 6, 66.7%) than among inpatients without a somatic disease (n = 3, 33.3%; p = .03). Somatic comorbidity was a significant coefficient in a multivariate survival model (B = 2.32, p = .04).
Conclusion
Somatic comorbidity seems to be an important factor for anorexia nervosa outcome and should be included in multivariate analyses on the long-term course of anorexia nervosa as an independent variable. Further investigations are needed in order to understand in which way anorexia nervosa and a somatic disease can interact.
doi:10.1186/1751-0759-6-4
PMCID: PMC3299644  PMID: 22300749
anorexia nervosa; long-term course; somatic comorbidity; mortality
16.  PA01.61. Vrishya dravya- tool in shaping the corner stones of healthy society 
Ancient Science of Life  2012;32(Suppl 1):S111.
Purpose:
The principle aim of Ayurvedic aphrodisiac therapy Vrishya chikitsa is the birth of mentally and physically healthy children as they are the corner stones of a healthy future society. Modern life style is full of stress and competition thus interferes with physical mechanism of body creating psychosomatic impact leading to sexual inefficiency. Ayurvedic aphrodisiacs that enhance the vitality and give sexual power to couples, which enable them to give birth to healthy children. Western medicine relies on aggressive prescription of drugs and surgery to deal with many problems related to sexual dysfunction which in turn have unwanted and even dangerous side effects. In regards to this Scientists are searching for a safe and effective phytomedicine from Ayurveda.
Method:
Review of classical text and research data reported in various journals and monographs.
Result:
Vrishya chikitsa described in Ashtang Ayurveda mentions the reasons for sexual inefficiency and directs the use of several aphrodisiac herbs and minerals to enhance the vitality. Charaka has prescribed the use of aphrodisiacs that enhance the potency of a person. Ex. Ashwagandha, Mushali, Shatavari, Kapikacchu etc. Researches prove that, they enhance the reproductive capabilities and vigor of men while strengthening the body and overall well-being. In Ashwagandha main contain is withanolides, which are steroid lactones and have a quick and pronounced hormonal effect, which stimulate the development of testicular cells. Kapikacchu has been shown to increase sperm count. L dopa, a precursor of the neurotransmitter dopamine, isolated from Kapikacchu, has been shown to increase sperm production. The Vrishya chikitsa resorts to herb preparations and minerals, including nonpharmacological measures mentioned by Charaka like Sadvrutta palana and Aacharrasayana, also attain to enhance reproductive capabilities and vigor of men.
Conclusion:
The herbs mentioned above and Sadavrutta, Achararasayana stands as an answer to solve problem of sexual inefficiency and enhance the potency of a person.
PMCID: PMC3800865
17.  Psychosomatic syndromes and anorexia nervosa 
BMC Psychiatry  2013;13:14.
Background
In spite of the role of some psychosomatic factors as alexithymia, mood intolerance, and somatization in both pathogenesis and maintenance of anorexia nervosa (AN), few studies have investigated the prevalence of psychosomatic syndromes in AN. The aim of this study was to use the Diagnostic Criteria for Psychosomatic Research (DCPR) to assess psychosomatic syndromes in AN and to evaluate if psychosomatic syndromes could identify subgroups of AN patients.
Methods
108 AN inpatients (76 AN restricting subtype, AN-R, and 32 AN binge-purging subtype, AN-BP) were consecutively recruited and psychosomatic syndromes were diagnosed with the Structured Interview for DCPR. Participants were asked to complete psychometric tests: Body Shape Questionnaire, Beck Depression Inventory, Eating Disorder Inventory–2, and Temperament and Character Inventory. Data were submitted to cluster analysis.
Results
Illness denial (63%) and alexithymia (54.6%) resulted to be the most common syndromes in our sample. Cluster analysis identified three groups: moderate psychosomatic group (49%), somatization group (26%), and severe psychosomatic group (25%). The first group was mainly represented by AN-R patients reporting often only illness denial and alexithymia as DCPR syndromes. The second group showed more severe eating and depressive symptomatology and frequently DCPR syndromes of the somatization cluster. Thanatophobia DCPR syndrome was also represented in this group. The third group reported longer duration of illness and DCPR syndromes were highly represented; in particular, all patients were found to show the alexithymia DCPR syndrome.
Conclusions
These results highlight the need of a deep assessment of psychosomatic syndromes in AN. Psychosomatic syndromes correlated differently with both severity of eating symptomatology and duration of illness: therefore, DCPR could be effective to achieve tailored treatments.
doi:10.1186/1471-244X-13-14
PMCID: PMC3556145  PMID: 23302180
Anorexia nervosa; Eating disorders; Psychosomatic syndromes; Illness denial; Alexithymia
18.  Stress causing psychosomatic illness among nurses 
Stress in nurses is an endemic problem. It contributes to health problems in nurses and decreases their efficiency. Documenting the causes and extent of stress in any healthcare unit is essential for successful interventions
Aim:
Establishing the existence and extent of work stress in nurses in a hospital setting, identifying the major sources of stress, and finding the incidence of psychosomatic illness related to stress.
Materials and Methods:
This study used a questionnaire relating to stressors and a list of psychosomatic ailments. One hundred and six nurses responded and they were all included in the study. Stressors were based on four main factors: work related, work interactions, job satisfaction, and home stress. The factors relating to stress were given weights according to the severity. The total score of 50 was divided into mild, moderate, severe, and burnout.
Results:
Most important causes of stress were jobs not finishing in time because of shortage of staff, conflict with patient relatives, overtime, and insufficient pay. Psychosomatic disorders like acidity, back pain, stiffness in neck and shoulders, forgetfulness, anger, and worry significantly increased in nurses having higher stress scores. Increase in age or seniority did not significantly decrease stress.
Conclusion:
Moderate levels of stress are seen in a majority of the nurses. Incidence of psychosomatic illness increases with the level of stress. Healthcare organizations need to urgently take preemptive steps to counter this problem.
doi:10.4103/0019-5278.50721
PMCID: PMC2822165  PMID: 20165610
Burnout; nursing shortage; nursing stress; psychosomatic illness; shift work
19.  Explanations for female excess psychosomatic symptoms in adolescence: evidence from a school-based cohort in the West of Scotland 
BMC Public Health  2007;7:298.
Background
By mid adolescence there is an excess in female physical and/or psychosomatic, as well as psychological morbidity. This paper examines the contribution of a range of factors (self-esteem, body image, gender-role orientation, body mass index, smoking and physical activity) to explaining the female excess in three psychosomatic symptoms (headaches, stomach ache/sickness, and dizziness) and depressive mood at age 15.
Methods
A cohort of 2,196 school pupils (analyses restricted to 2,005 with complete data) surveyed at age 15. All measures were obtained via self-completion questionnaires, apart from body mass index, derived from measured height and weight. Analyses examined (a) sex differences in each potential explanatory factor; (b) their associations with the health measures; (c) the effect of adjustment for these factors on sex differences in the health measures; and (d) the existence of interactive effects between sex and the explanatory factors on the health measures
Results
Each potential explanatory factor was significantly differentiated by sex. Self-esteem, body image (represented by weight-related worries), smoking and physical activity were related to the health measures. These factors accounted for one third of the female excess in headaches and stomach problems, half the excess in dizziness and almost all that in respect of depressive mood. Self-esteem and body image were the factors most consistently related to health, and adjustment for these resulted in the largest reductions in the odds of a female excess in both the psychosomatic symptoms and depressive mood.
Conclusion
Adjustment for a range of potential psychosocial and behavioural factors largely explains (statistically) excess female depressive mood. These factors also partially explain the female excess in certain psychosomatic symptoms.
doi:10.1186/1471-2458-7-298
PMCID: PMC2233615  PMID: 17953744
20.  Mental health of immigrants from the former Soviet Bloc: a future problem for primary health care in the enlarged European Union? A cross-sectional study 
BMC Public Health  2007;7:27.
Background
Enlargement of the European Union has caused worries about the possibility of increased migration from its new members, the former Soviet countries, and consequently increased demands on the health care systems of the host countries. This study investigated whether or not earlier immigrants from the former Soviet Bloc have poorer self-reported mental health, measured as self-reported psychiatric illness and psychosomatic complaints, than the host population in Sweden. It also examined the particular factors which might determine the self-reported mental health of these immigrants.
Methods
The cross-sectional national sample included 25–84-year-old Swedish-born persons (n = 35,459) and immigrants from Poland (n = 161), other East European countries (n = 164), and the former Soviet Union (n = 60) who arrived in Sweden after 1944 and were interviewed during 1994–2001. Unconditional multivariate logistic regression was used in the analyses.
Results
The findings indicated that the country of birth had a profound influence on self-reported mental health. Polish and other East European immigrants in general had a twofold higher odds ratio of reporting psychiatric illness and psychosomatic complaints, which fact could not be explained by adjustments for the demographic and socioeconomic variables. However, immigrants from the former Soviet Union had odds similar to those of the Swedish-born reference group. Adjustments for migration-related variables (language spoken at home and years in Sweden) changed the association between the country of birth and the outcomes only to a limited extent.
Conclusion
Since poor mental health may hinder acculturation, the mental health of immigrants from Poland and other East European countries should be acknowledged, particularly with the expansion of the European Union and inclusion of nine former Soviet Bloc countries by 2007.
doi:10.1186/1471-2458-7-27
PMCID: PMC1828724  PMID: 17328817
21.  Estimation of Influenza Incidence by Age in the 2011/12 Seasons in Japan using SASSy 
Objective
So far, it is difficult to show the incidence rate of influenza in the official sentinel surveillance in Japan. Hence we construct the system which record infectious diseases at schools, kindergartens, and nursery schools, and then can show the accurate incidence rate of influenza in children by age/grade.
Introduction
So as to develop more effective countermeasures against influenza, timely and precise information about influenza activity at schools, kindergartens, and nursery schools may be helpful. At the Infectious Diseases Surveillance Center of the National Institute of Infectious Diseases, a School Absenteeism Surveillance System (SASSy) has been in operation since 2009. SASSy monitors the activity of varicella, mumps, mycoplasma pneumonia, pharyngoconjunctival fever, hand-foot-mouth disease, influenza, and many other infectious diseases in schools. In 2010, SASSy was extended to the Nursery School Absenteeism Surveillance System (NSASSy). These systems record the number of absentees due to infectious diseases in each class of all grades of schools every day. As a powerful countermeasure to the pandemic flu of 2009, SASSy was activated in 9 prefectures, in which included more than 6000 schools, and it is gradually being adopted in other prefectures. As of February 2012, 18 prefectures and 4 big cities, which together comprised 15,700 schools (about 35% of all schools in Japan), utilized SASSy. NSASSy is used in more than 4100 nursery schools, which is about 18% of all nursery schools in Japan. Some studies of similar systems were performed in the UK (1), Hong Kong (2), and the USA (3,4), examined surveillance systems for monitoring infectious disease incidence, but the systems to construct in those studies do not operate nationwide like SASSy or NSASSy, and they cannot provide influenza incidence rates in children.
Methods
All schools, kindergartens, and nursery schools in the community, enter data of the absentees due to infectious diseases into the system every day, thereby providing real-time data regarding infectious diseases prevalent in schools, to the schools around, school boards, public health centers, local governments, and medical professionals. It analyzed data for the 2011/2012 season (from September 1, 2011 to March 31, 2012) mainly, but also two seasons (2010/2011 and 2011/2012) were compared in some prefectures. In total, 12 prefectures, which comprised 2,352,839 children, were participated in 2011/2012 season. In the 2010/2011 season, 1,795,766 children of 9 prefectures were analyzed.
Results
The incidence rate in the first grade of elementary schools is the highest both in the two seasons. The highest incidence rate in this grade distributes from 17.8% to 40.3% in 2011/2012 season, and from 11.0% to 30.7% in 2010/2011 season.
Conclusions
This study proved SASSy and NSASSy are quite useful for monitoring of influenza outbreak in schools and it will be gold standard of surveillance for school children in Japan. The present study also showed incidence rate of influenza in children at schools, kindergartens, and nursery schools, and proved the highest incidence was in the first grade of the elementary school. This is the first finding using such the huge number of subjects, which is more than 2 million. The intervention targeting to the weak age/grade is necessary for effective countermeasure and control of influenza and other infectious diseases.
PMCID: PMC3692790
Surveillance; Influenza; School Absenteeism
22.  ‘Girls need to strengthen each other as a group’: experiences from a gender-sensitive stress management intervention by youth-friendly Swedish health services – a qualitative study 
BMC Public Health  2013;13:907.
Background
Mental health problems among young people, and girls and young women in particular, are a well-known health problem. Such gendered mental health patterns are also seen in conjunction with stress-related problems, such as anxiety and depression and psychosomatic complaints. Thus, intervention models tailored to the health care situation experienced by young women within a gendered and sociocultural context are needed. This qualitative study aims to illuminate young women’s experiences of participating in a body-based, gender-sensitive stress management group intervention by youth-friendly health services in northern Sweden.
Methods
A physiotherapeutic body-based, health-promoting, gender-sensitive stress management intervention was created by youth-friendly Swedish health services. The stress management courses (n = 7) consisted of eight sessions, each lasting about two hours, and were led by the physiotherapist at the youth centre. The content in the intervention had a gender-sensitive approach, combining reflective discussions; short general lectures on, for example, stress and pressures related to body ideals; and physiotherapeutic methods, including body awareness and relaxation. Follow-up interviews were carried out with 32 young women (17–25 years of age) after they had completed the intervention. The data were analysed with qualitative content analysis.
Results
The overall results of our interview analysis suggest that the stress management course we evaluated facilitated ‘a space for gendered and embodied empowerment in a hectic life’, implying that it both contributed to a sense of individual growth and allowed participants to unburden themselves of stress problems within a trustful and supportive context. Participants’ narrated experiences of ‘finding a social oasis to challenge gendered expectations’, ‘being bodily empowered’, and ‘altering gendered positions and stance to life’ point to empowering processes of change that allowed them to cope with distress, despite sometimes continuously stressful life situations. This intervention also decreased stress-related symptoms such as anxiousness, restlessness, muscle tension, aches and pains, fatigue, and impaired sleep.
Conclusions
The participants’ experiences of the intervention as a safe and exploratory space for gendered collective understanding and embodied empowerment further indicates the need to develop gender-sensitive interventions to reduce individualisation of health problems and instead encourage spaces for collective support, action, and change.
doi:10.1186/1471-2458-13-907
PMCID: PMC3850732  PMID: 24083344
Sweden; Young women; Adolescents; Youth mental health; Stress management; Intervention; Gender; Embodiment; Qualitative interviews; Physiotherapy
23.  Clinician-rated mental health in outpatient child and adolescent mental health services: associations with parent, teacher and adolescent ratings 
Background
Clinician-rated measures are used extensively in child and adolescent mental health services (CAMHS). The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) is a short clinician-rated measure developed for ordinary clinical practice, with increasing use internationally. Several studies have investigated its psychometric properties, but there are few data on its correspondence with other methods, rated by other informants. We compared the HoNOSCA with the well-established Achenbach System of Empirically Based Assessment (ASEBA) questionnaires: the Child Behavior Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self-Report (YSR).
Methods
Data on 153 patients aged 6-17 years at seven outpatient CAMHS clinics in Norway were analysed. Clinicians completed the HoNOSCA, whereas parents, teachers, and adolescents filled in the ASEBA forms. HoNOSCA total score and nine of its scales were compared with similar ASEBA scales. With a multiple regression model, we investigated how the ASEBA ratings predicted the clinician-rated HoNOSCA and whether the different informants' scores made any unique contribution to the prediction of the HoNOSCA scales.
Results
We found moderate correlations between the total problems rated by the clinicians (HoNOSCA) and by the other informants (ASEBA) and good correspondence between eight of the nine HoNOSCA scales and the similar ASEBA scales. The exception was HoNOSCA scale 8 psychosomatic symptoms compared with the ASEBA somatic problems scale. In the regression analyses, the CBCL and TRF total problems scores together explained 27% of the variance in the HoNOSCA total scores (23% for the age group 11-17 years, also including the YSR). The CBCL provided unique information for the prediction of the HoNOSCA total score, HoNOSCA scale 1 aggressive behaviour, HoNOSCA scale 2 overactivity or attention problems, HoNOSCA scale 9 emotional symptoms, and HoNOSCA scale 10 peer problems; the TRF for all these except HoNOSCA scale 9 emotional symptoms; and the YSR for HoNOSCA scale 9 emotional symptoms only.
Conclusion
This study supports the concurrent validity of the HoNOSCA. It also demonstrates that parents, teachers and adolescents all contribute unique information in relation to the clinician-rated HoNOSCA, indicating that the HoNOSCA ratings reflect unique perspectives from multiple informants.
doi:10.1186/1753-2000-4-29
PMCID: PMC3003627  PMID: 21108776
24.  Social capital in relation to depression, musculoskeletal pain, and psychosomatic symptoms: a cross-sectional study of a large population-based cohort of Swedish adolescents 
BMC Public Health  2010;10:715.
Background
Social capital has lately received much attention in health research. The present study investigated whether two measures of subjective social capital were related to psychosomatic symptoms, musculoskeletal pain, and depression in a large population of Swedish adolescents.
Methods
A total of 7757 13-18 year old students anonymously completed the Survey of Adolescent Life in Vestmanland 2008 which included questions on sociodemographic background, neighbourhood social capital, general social trust, and ill health.
Results
Low neighbourhood social capital and low general social trust were associated with higher rates of psychosomatic symptoms, musculoskeletal pain, and depression. Individuals with low general social trust had more than three times increased odds of being depressed, three times increased odds of having many psychosomatic symptoms, and double the odds of having many symptoms of musculoskeletal pain.
Conclusions
The findings make an important contribution to the social capital - health debate by demonstrating relations between social capital factors and self-reported ill health in a young population.
doi:10.1186/1471-2458-10-715
PMCID: PMC3091587  PMID: 21092130
25.  Association Between Sleep Disordered Breathing and Behavior in School-Aged Children: The Tucson Children’s Assessment of Sleep Apnea Study 
Study Objectives
This study analyzed the association between the Respiratory Disturbance Index (RDI) and two behavior measures, the Conners’ Parent Rating Scale (CPRS-R) and the Child Behavior Checklist (CBCL) in school-aged children to determine whether there is an optimal threshold of Sleep-disordered Breathing (SDB) associated with increased risk of behavior problems.
Methods
The Tucson Children’s Assessment of Sleep Apnea Study (TuCASA) is an observational cohort study of 6–11 year old Caucasian and Hispanic children designed to assess the anatomic, physiologic and neurocognitive correlates of SDB. 403 children with both polysomnography (PSG) and behavioral data were included in this analysis. Three definitions of SDB were used: RDI independent of oxygen desaturation (RDI0), RDI with 2% oxygen desaturation (RDI2) and RDI with 3% oxygen desaturation (RDI3). T-scored behavioral data were dichotomized at a cutoff point of 65, a score indicative of moderate to severe clinical impairment. Logistic regression was used to access the risk associated with SDB.
Results
The analyses conducted using three different definitions of RDI suggest that the likelihood of having a clinically significant CPRS-R or CBCL subscale score was not necessarily progressive or linear across RDI categories. Cutoff points and prevalences for each definition of RDI proposed to be indicators of clinically significant SDB were RDI0 ≥ 7 (19.38%), RDI2 ≥ 2 (29.38%) and RDI3 ≥ 0.5 (23.96%) events per hour of sleep. Behaviors such as CPRS oppositional, social problems, psychosomatic and CBCL somatic complaints, social problems and aggressive behaviors were found to be significantly associated with SDB.
Conclusions
This analysis found an increased risk of behavior problems such as somatic complaints, oppositional or aggressive behaviors and social problems associated with sleep-disordered breathing in school-aged children. RDI cut points for three definitions of SDB are proposed: 7 for RDI0, 2 for RDI2, and 0.5 for RDI3 respectively.
doi:10.2174/1874297100801010001
PMCID: PMC2435049  PMID: 18568089
Sleep disordered breathing; children; behavior problems

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