The physiological nature of post-surgical changes and the mental stamina required of positive eating habits contribute to postoperative adherence difficulties. Many patients likely exhibit poor habits pre-surgery, and without added help to change these behaviors may regain weight. Participants in this study indicated that convenient access to an RDN was helpful. Bariatric facilities should include staff well-trained in the specific nutritional barriers patients face and provide availability of staff beyond the initial postoperative phase.
Objective: The role of psychosocial stress in the onset and course of atopic dermatitis is widely accepted. However, validation of pathological models that integrate psychosomatic aspects and biochemical mediators is still missing. Longitudinal single case studies offer a possibility to examine the effects of psychosocial stressors on biochemical as well as on dermatological variables under naturalistic conditions. Patient and Methods: A 42-year-old patient suffering from life-long atopic dermatitis was observed for a period of 77 days in an integrated single case design. Psychosocial stressors and disease activity were measured daily by diary recordings and additionally with standardized weekly interviews (Incidents and Hassles Inventory). Cortisol, neopterin, and catecholamines were gauged on a daily basis by overnight (8 hour) urine samples. Intervening factors, such as medication and lifestyle, were controlled. Longitudinal data were studied with combined time-series (ARIMA modeling) and regression analysis. Results: Psychosocial variables explained up to nearly 50% of variance in skin condition and also nearly 50% of immunoendocrinological dynamics. The relationship between biochemical patterns and skin condition is weak (explained variance <25%). We also found differential effects dependent on different characteristics of psychosocial stressors (i.e., predictability vs. nonpredictability). Identical stressors showed variations in their effects on different dependent variables (i.e., a positive influence on arm skin but a negative influence on neck skin). Conclusions: The results confirm the assumed relationship between psychosocial stressors and disease activity in atopic dermatitis in the patient under study. The broad spectrum of differential effects found in only one single case underlines the complexity of psychobiological mechanisms and the necessity of further (single case) research.
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