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1.  Psychobiological Subtypes of Ulcerative Colitis: pANCA Status Moderates the Relationship between Disease Activity and Psychological Distress 
Introduction
Studies of psychological factors in ulcerative colitis (UC) have produced inconsistent findings. This study sought to determine whether perinuclear antineutrophil cytoplasmic antibody (pANCA) demarcates subtypes which differ with respect to psychobiological interactions.
Methods
In 148 outpatients with UC, the strength of the relationship between current UC disease activity and psychological distress was assessed. pANCA was determined by ELISA and immunofluorescence, disease activity was determined by symptoms, physical examination and endoscopy using the St. Mark’s index, and depressive symptoms and health anxiety were measured with self report scales. Pearson correlations between disease activity and depressive symptoms and between disease activity and health anxiety were calculated.
Results
In 74 pANCA negative subjects, the relationship between disease activity and measures of psychological distress was significant for disease activity-depression (partial correlation= 0.48, p < 0.001) and for disease activity-health anxiety (partial correlation= 0.64, p < 0.001), whereas in 74 pANCA positive subjects, no relationships were found (disease activity-depression: partial correlation= 0.18, p = 0.14; disease activity-health anxiety: partial correlation= 0.20, p = 0.09). The differences in the strength of correlation between pANCA positive and pANCA negative subjects were statistically significant for both disease activity-depression (z = 2.0, p = 0.02) and for activity-health anxiety (z = 3.3, p < 0.001).
Conclusions
pANCA status demarcates psychobiologically distinct subtypes of UC, such that the absence of pANCA is associated with greater psychobiological interaction. These findings have implications for clinical care and understanding the pathophysiology of intestinal inflammation.
doi:10.1111/j.1572-0241.2006.00798.x
PMCID: PMC2923655  PMID: 17029612 CAMSID: cams1454
2.  Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training 
Background
Working in a hospital during an extraordinary infectious disease outbreak can cause significant stress and contribute to healthcare workers choosing to reduce patient contact. Psychological training of healthcare workers prior to an influenza pandemic may reduce stress-related absenteeism, however, established training methods that change behavior and attitudes are too resource-intensive for widespread use. This study tests the feasibility and effectiveness of a less expensive alternative - an interactive, computer-assisted training course designed to build resilience to the stresses of working during a pandemic.
Methods
A "dose-finding" study compared pre-post changes in three different durations of training. We measured variables that are likely to mediate stress-responses in a pandemic before and after training: confidence in support and training, pandemic-related self-efficacy, coping style and interpersonal problems.
Results
158 hospital workers took the course and were randomly assigned to the short (7 sessions, median cumulative duration 111 minutes), medium (12 sessions, 158 minutes) or long (17 sessions, 223 minutes) version. Using an intention-to-treat analysis, the course was associated with significant improvements in confidence in support and training, pandemic self-efficacy and interpersonal problems. Participants who under-utilized coping via problem-solving or seeking support or over-utilized escape-avoidance experienced improved coping. Comparison of doses showed improved interpersonal problems in the medium and long course but not in the short course. There was a trend towards higher drop-out rates with longer duration of training.
Conclusions
Computer-assisted resilience training in healthcare workers appears to be of significant benefit and merits further study under pandemic conditions. Comparing three "doses" of the course suggested that the medium course was optimal.
doi:10.1186/1472-6963-10-72
PMCID: PMC2851711  PMID: 20307302
3.  Insecure attachment is associated with the α-EEG anomaly during sleep 
Background
The α-EEG anomaly during sleep, originally associated with chronic pain, is noted in several psychiatric and medical conditions and is also present in some normal subjects. The exact significance of the α-EEG anomaly is uncertain, but it has been suggested to be a nonspecific response to a variety of noxious stimuli. We propose that attachment insecurity, which is often associated with a state of hypervigilance during wakefulness, may be associated with the α-EEG anomaly during sleep.
Methods
Thirty one consecutive patients referred to a Sleep Disorders Clinic for clinical assessment of sleep complaints underwent standard polysomnographic recording. The degree of alpha activity in polysomnographs was scored visually according to standard criteria. Attachment insecurity was measured with the Experience in Close Relationships – Revised questionnaire.
Results
Attachment anxiety was significantly associated with the proportion of sleep in which α waves were present (df = 1, F = 5.01, p = 0.03). The relationship between the α-EEG anomaly and attachment anxiety was not explained by the distribution of sleep and mood diagnoses, medications, anxiety symptoms or depression symptoms.
Conclusion
Interpersonal style in close relationships may be related to sleep physiology. Further research to determine the nature of the relationship between attachment, sleep and other factors that are related to each of these, such as a history of personal adversity, is warranted.
doi:10.1186/1751-0759-1-20
PMCID: PMC2186352  PMID: 17976231
4.  Long-term Psychological and Occupational Effects of Providing Hospital Healthcare during SARS Outbreak 
Emerging Infectious Diseases  2006;12(12):1924-1932.
TOC Summary Line: Healthcare workers in hospitals affected by SARS experience increased psychological stress 1–2 years after the outbreak.
Healthcare workers (HCWs) found the 2003 outbreak of severe acute respiratory syndrome (SARS) to be stressful, but the long-term impact is not known. From 13 to 26 months after the SARS outbreak, 769 HCWs at 9 Toronto hospitals that treated SARS patients and 4 Hamilton hospitals that did not treat SARS patients completed a survey of several adverse outcomes. Toronto HCWs reported significantly higher levels of burnout (p = 0.019), psychological distress (p<0.001), and posttraumatic stress (p<0.001). Toronto workers were more likely to have reduced patient contact and work hours and to report behavioral consequences of stress. Variance in adverse outcomes was explained by a protective effect of the perceived adequacy of training and support and by a provocative effect of maladaptive coping style and other individual factors. The results reinforce the value of effective staff support and training in preparation for future outbreaks.
doi:10.3201/eid1212.060584
PMCID: PMC3291360  PMID: 17326946
Severe Acute Respiratory Syndrome; Stress, Psychological; Health Personnel; Stress, Traumatic; Burnout, Professional, research

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