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Background Methods Results Conclusion Early onset rectal cancer (EORC) is increasing internationally. While EORC cancer presents with some distinct clinical features, there is currently insufficient evidence that age of onset should alter treatment. This study examines treatment patterns for EO versus late‐onset (LO) metastatic rectal cancer in Canterbury, New Zealand, to better understand appropriate treatment strategies and there effect on patient outcomes.A retrospective study on all patients diagnosed with stage 4 rectal adenocarcinoma in Canterbury from 2010 to 2021 was undertaken. Patients under 50 were compared to a control group aged 60–74, analysing treatment patterns, hospital stays, and survival outcomes.Between 2010 and 2021, there were 949 rectal cancer diagnoses in Canterbury, of which 23 were EO and 64 were LO with stage 4 cancer. Survival analysis revealed a significant difference in median survival times between EORC (47.9 months) and LORC patients (26.5 months; P = 0.03). There was no significant difference in the surgical or oncological management between age groups (P > 0.05). Mean admissions per 100 days of life was 0.45 in LORC and 0.44 in EORC (P = 0.9119). There was no significant difference in the median proportion of time spent in hospital between EO and LO groups (2.5 vs. 2.2 days for every 100 days of life, P = 0.88).Surgical and oncological treatments were similar for both EORC and LORC groups. The EO group exhibited better survival, with hospitalization burdens comparable for both. These findings underline the importance of maintaining an approach to metastatic RC balancing survival and quality of life. [ABSTRACT FROM AUTHOR]

Objective: To describe mental health presentations to a tertiary ED in New Zealand during a national COVID‐19 lockdown. Methods: A retrospective, comparative cohort study in Christchurch Hospital, New Zealand. Results: There was a 3510 (37%)‐patient decrease in all presentations to Christchurch Hospital ED during the 5‐week COVID‐19 lockdown period from 26 March 2020 to 28 April 2020, compared to a 111 (1.2%)‐patient decrease in the same time period in the previous year (P < 0.00001). There is usually a seasonal reduction in mental health attendances at this time of year compared to the weeks before. In 2019, there was a 49 (9.8%)‐patient reduction in mental health presentations, whereas in 2020 there was a 193 (34%)‐patient reduction (P < 0.001). In 2020, the proportion of mental health attendances compared to all ED attendances during the 5‐week lockdown period was similar to the 5‐week pre‐lockdown period (564/9460 vs 371/5950, P = 0.48). The proportion of mental health patients presenting due to overdose increased by 6.5% (158/564 vs 128/371, P = 0.035); those due to self‐harm increased by 3.5% (35/564 vs 36/371, P = 0.049). The proportion of mental health presentations due to anxiety, depression and other non‐self‐harm/overdose complaints decreased by 10% (371/564 vs 207/371, P = 0.002). The proportion of overdoses of paracetamol and ibuprofen increased by 13.4% during lockdown (22/158 vs 35/128, P = 0.005). Conclusions: During the COVID‐19 lockdown, both overall ED presentations as well as mental health‐related presentations decreased. There was a relative increase in overdoses and self‐harm, particularly involving paracetamol and ibuprofen. A retrospective, comparative cohort study in Christchurch Hospital, New Zealand, of mental health presentations to the ED during COVID‐19 lockdown. During the COVID‐19 lockdown, both overall ED presentations as well as mental health‐related presentations decreased. There was a relative increase in overdoses and self‐harm, particularly involving paracetamol and ibuprofen. [ABSTRACT FROM AUTHOR]

Background and Aim: The Inflammatory Bowel Disease Disability Index (IBD‐DI) is a measure of disability in inflammatory bowel disease (IBD). The IBD‐DI is validated for use as a clinical interview but not for use as a self‐report questionnaire. We aimed to validate the IBD‐DI for self‐report (IBD‐DI‐SR) and to reduce the number of items, using IBD patients from two centers. Methods: Between April and August 2017, ambulatory IBD patients were recruited from Christchurch Hospital, New Zealand and Concord Hospital, Australia. The IBD‐DI clinical interview version was compared with a self‐report version. Participants were randomized to do the clinical interview or self‐report first. Validation of the IBD‐DI‐SR involved calculating the correlation coefficient between the clinician completed and self‐reported version of the IBD‐DI and Cronbach's α of internal consistency of the IBD‐DI‐SR. To create an item‐reduced version, multiple linear regression was used. The R2 of the model described the overall association between the item‐reduced IBD‐DI‐SR and the IBD‐DI. Results: One hundred fourteen patients (57 from Christchurch and 57 from Sydney) completed the IBD‐DI‐SR validation phase, of whom 63 had Crohn's disease and 51 had ulcerative colitis. The Pearson correlation coefficient between the IBD‐DI‐SR and IBD‐DI is 0.90 (P < 0.001), and Cronbach's α of the IBD‐DI‐SR was 0.86. The item‐reduced version of the IBD‐DI‐SR consisted of eight questions instead of 28, explaining 77% of the variance. Conclusions: The IBD‐DI‐SR has demonstrated reliability and validity. The item‐reduced IBD‐DI‐SR is a concise self‐report instrument for measuring IBD disability, which makes the IBD‐DI more widely usable. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate the factors that make inflammatory bowel disease (IBD) patients more or less likely to be willing to take corticosteroids. Methods: Respondents completed a questionnaire. The primary outcome was whether the respondents would or would not use corticosteroids again to treat their IBD. Three separate univariate and multivariate analyses were performed to examine which variables predicted willingness to take steroids, including specific side effects. Results: Four hundred fifty three respondents (321 with Crohn's disease, 115 with ulcerative colitis; mean age 40 years, 297 [66%] female) completed the questionnaire. Corticosteroid efficacy (OR 6.83, 95% CI 3.67-12.7), lack of previous negative side effects (OR 0.11, 95% CI 0.04-0.32), and positive side effects (OR 2.96, 95% CI 1.63-5.40) were associated with a willingness to use corticosteroids in the future. In multivariate analysis, weight gain (OR 0.53, 95% CI 0.29-0.98) and hallucinations (OR 0.28, CI 0.09-0.89) were associated with an unwillingness to use corticosteroids again, whereas increased energy (OR 2.30, 95% CI 1.20-4.42) was the only significant positive side effect in a multivariate model. Conclusions: Past experiences with corticosteroids influence whether patients will take corticosteroids again. Clinicians should enquire about side effects and positive psychological symptoms associated with corticosteroid use. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate the factors that make inflammatory bowel disease (IBD) patients more or less likely to be willing to take corticosteroids. Methods: Respondents completed a questionnaire. The primary outcome was whether the respondents would or would not use corticosteroids again to treat their IBD. Three separate univariate and multivariate analyses were performed to examine which variables predicted willingness to take steroids, including specific side effects. Results: Four hundred fifty three respondents (321 with Crohn's disease, 115 with ulcerative colitis; mean age 40 years, 297 [66%] female) completed the questionnaire. Corticosteroid efficacy (OR 6.83, 95% CI 3.67-12.7), lack of previous negative side effects (OR 0.11, 95% CI 0.04-0.32), and positive side effects (OR 2.96, 95% CI 1.63-5.40) were associated with a willingness to use corticosteroids in the future. In multivariate analysis, weight gain (OR 0.53, 95% CI 0.29-0.98) and hallucinations (OR 0.28, CI 0.09-0.89) were associated with an unwillingness to use corticosteroids again, whereas increased energy (OR 2.30, 95% CI 1.20-4.42) was the only significant positive side effect in a multivariate model. Conclusions: Past experiences with corticosteroids influence whether patients will take corticosteroids again. Clinicians should enquire about side effects and positive psychological symptoms associated with corticosteroid use. [ABSTRACT FROM AUTHOR]

Introduction: The bidirectional relationship between disease activity and mental health in inflammatory bowel disease (IBD) has prompted investigations into the efficacy of psychotherapeutic interventions such as acceptance and commitment therapy (ACT) on biopsychosocial outcomes. We aimed to examine the efficacy of an ACT program (intervention) in comparison with a cognitive behavioral therapy-informed psychoeducation program (active control) for individuals with IBD and coexistent psychological distress. Both programs were delivered online through a hybrid format (i.e., therapist-led and participant-led sessions)., Methods: A total of 120 adults with IBD were randomized to either the intervention (N = 61) or active control groups (N = 59). Efficacy was determined using linear mixed models for group differences, in rate of changes in study outcomes, between baseline, postintervention, and 3-month follow-up., Results: The primary outcome health-related quality of life significantly improved in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to postintervention ( t [190] = 2.15, P = 0.033) in favor of the intervention group with a medium effect size (β = 0.41, mean difference = 0.07, 95% confidence interval 0.01-0.12, P = 0.014). Similarly, the secondary outcome Crohn's disease activity significantly reduced in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to 3-month follow-up ( t [90] = -2.40, P = 0.018) in favor of the intervention group with a large effect size (β = -0.77, mean difference = -9.43, 95% confidence interval -13.72 to -5.13, P < 0.001) ( P = 0.014). Furthermore, when observing the rate of change in outcomes over time for the groups separately, anxiety symptoms and pain significantly improved in the intervention group only, and conversely, ulcerative colitis activity and stress symptoms significantly improved in the active control group only. All other outcomes (N = 14) significantly improved over time in both groups including IBD activity, gastrointestinal unhelpful thinking patterns, visceral anxiety, fatigue interference, fatigue severity, fatigue frequency, psychological inflexibility, self-efficacy, resilience, current health status, depression symptoms, IBD control, and pain catastrophizing; however, these changes were not significantly different between the groups., Discussion: Both programs were of benefit to people with IBD and distress. However, ACT offers a significant added benefit for health-related quality of life and self-reported Crohn's disease activity and may be a useful adjuvant therapy in integrated IBD care., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)