Emotional Well-being Subscale Research Articles

Joint associations of psychological distress and working conditions with sickness absence in Finland

Abstract Background Psychological distress has increased remarkably, especially among younger age groups, during the last years. Both psychological distress and exposure to strenuous working conditions are known risk factors for sickness absence (SA). We examined whether psychological distress and working conditions are jointly associated with SA periods of 1-7 days and 8+ days among young and midlife Finnish employees. Methods We linked survey data from the Helsinki Health Study cohort from 2017 (response rate 51.5%) with the employer’s SA register for the City of Helsinki, Finland (82% consented to the linkage; n = 3949, 80% women, age 19-39 years). Mean follow-up time was 2.1 years. We calculated rate ratios (RR) and 95% confidence intervals (CI) for SA periods of 1-7 days and 8+ days using negative binomial regression models among participants with and without psychological distress, and with and without exposure to strenuous working conditions. Psychological distress was measured with the emotional wellbeing subscale of RAND-36 (cut-off 60 points). Working conditions included physical and mental strenuousness of work and hours per day spent in heavy physical work. Results Participants with psychological distress and exposure to strenuous working conditions had the highest age- and gender-adjusted RRs for SA periods of ≥ 8 days (physically strenuous work: RR: 2.38, CI: 1.97-2.88; mentally strenuous work: RR: 2.08, CI: 1.72-2.53; ≥3 h per day spent in physical work: RR: 2.48, CI: 2.01-3.06), the interactions being additive. The associations were weaker for SA periods of 1-7 days. Adjusting for marital and employment status, education, alcohol use, smoking and body mass index only slightly attenuated these associations. Conclusions Psychological distress and exposure to strenuous working conditions were additively associated with SA. Both individual- and workplace-related risk factors for SA are important to be considered when planning preventive actions. Key messages • Young and early midlife Finnish employees with simultaneous psychological distress and exposure to strenuous working conditions had the highest rates of SA periods, the interactions being additive. • Both psychological distress and exposure to strenuous physical and mental working conditions should be considered when planning preventive actions to reduce employees’ SA.

An Exploratory Study on the Effects of Souchard Postural Gymnastics in Parkinson's Disease Patients with Camptocormia: A Quasi-Experimental Approach.

Background/Objective: Parkinson's disease (PD), a prevalent neurodegenerative disorder, leads to motor and non-motor impairments, affecting quality of life. Camptocormia can be one of the motor signs of PD, characterized by a severe and abnormal forward flexion of the thoracolumbar spine that typically occurs when walking or standing. The following study aims to verify whether postural gymnastics can be an effective treatment for trunk control, balance, activities of daily living, and general well-being in patients with early-stage PD and camptocormia. Methods: Nine participants (mean age 67.7 ± 7.8) with early PD (Hoehn and Yahr Scale ≤ 2) received 10 biweekly physiotherapy sessions. Outcomes were measured using the Parkinson's Disease Questionnaire (PDQ-39) and Berg Balance Scale (BBS) along with trunk mobility and muscle tests according to the Medical Research Council (MRC) scale. Results: Statistically significant results were noted in the PDQ-39 mobility, ADLs and emotional well-being subscales and in the BBS; statistically significant improvements were also seen in trunk mobility and muscle strength. Conclusions: This study shows that the postural gymnastic treatment, according to Souchard, in patients with PD's camptocormia has obtained good results and has the potential timprove mobility and balance, encouraging and motivating patients in their rehabilitation journeys.

468. CALCULATING THE MINIMAL CLINICALLY IMPORTANT DIFFERENCE FOR THE FACT-E FROM ESOPHAGECTOMY TO RECOVERY USING DISTRIBUTION-BASED METHODS

Abstract Background The Functional Assessment of Cancer Therapy-Esophageal (FACT-E) is a validated patient-reported outcome instrument that measures four subscales of general cancer health and one subscale specific to esophageal cancer. To make the instrument more clinically useful, therapeutic thresholds known as minimal clinically important differences (MCID) are needed. The purpose of this study was to calculate the MCID for the FACT-E and its subscales for patients undergoing an esophagectomy. Methods The study was based on a retrospective analysis of a registry maintained by a high volume North American tertiary care referral centre, which includes the FACT-E collected between August 2004 and September 2023. The FACT-E was administered at nine time points over the course of a patient’s care, ranging from the time of first presentation to 5 years post-esophagectomy. This study used two distribution-based approaches – the standard error (SE) and the standard deviation (SD) – to calculate the MCID for the FACT-E’s total score and its five subscales. Nonparametric bootstrapping was used to generate 95% confidence intervals for each MCID. Results There were 731 participants included in this study but not all of those completed each subscale at each time point. The MCID for physical well-being ranged from 2.2-3.1 using SE and 2.3-3.4 using SD, from 2.1-3.6 using SE and 2.2-3.6 using SD for social well-being, 1.2-1.7 using SE and from 1.4-2.0 using SD for emotional well-being, 2.1-2.4 using SE and 3.2-3.6 using SD for functional well-being, and from 3.2-4.3 using SE and from 4.3-6.4 using SD for the esophagus cancer subscale. The MCID for the total score ranged from 6.7-8.3 using SE and from 8.9-11.2 using SD. Conclusion The MCID thresholds for the FACT-E subscales vary depending on when they are collected and how they are measured. In general, smaller thresholds of change are needed in the social and emotional well-being subscales, while larger ones are needed for the esophagus cancer subscale. Overall, the MCID for the FACT-E total score ranged from 6 to 11. Clinicians should consider these MCID if using the FACT-E to assess changes in patients’ symptom severity before and after esophagectomy.

The Effect of Sleep Habits on Quality of Life in Pediatric Patients With Chronic Kidney Disease.

Sleep disturbance has been studied in adult patients with early and end-stage chronic kidney disease (CKD). However, there are limited publications on the pediatric patient population. This paper evaluated the association between sleep disturbances and quality of life (QoL) inpediatricpatients with CKD. The study included 22 patients and 22 healthy controls from the pediatric nephrology outpatient clinic.All participants completed the Turkish Generic Health-Related Quality of Life Questionnaire for Children and Adolescents (HRQoLQ) and the Child Sleep Habits Questionnaire(CSHQ). Patients diagnosed with CKD were compared in terms of HRQoLQ and CSHQ scores within themselves as kidney replacement therapy (KRT) recipients and non-recipients and with the control group. The mean HRQoLQ total score of the patients was 89.0 ± 12.4 and the mean CSHQ total score was 46.7 ± 5.6; there was no correlation between the total scores (p=0.599). CSHQ total and subgroup scores were similar in patients with and without KRT. The CSHQ total and subgroup median scores were not different in the patient and control groups. According to the HRQoL scale, the total QoL score and the physical and emotional well-being subscale scores were lower in patients receiving KRT than in those not receiving KRT. Sleep problems and HRQoL should not be underestimated in the pediatric CKD population, especially in patients receiving KRT. Large-scale studies with long-term outcomes are needed to understand better and improve QoL.

Association between dental clinical measures and oral health-related quality of life among Iraqi schoolchildren: A cross-sectional study.

The aim of this study was to assess the association between dental clinical measures and oral health-related quality of life (OHRQoL) together with the potential mediating role of sociodemographic factors and oral health behaviours on this association in a group of Iraqi children. The target population for this cross-sectional study consisted of 372 primary school children aged 8-10 years in the city of Kut, Iraq, during the year 2022. The participants were selected using a multi-stage random sampling technique. Detailed information about the children was collected through a comprehensive questionnaire that included demographic characteristics, oral health-related behaviors, the Arabic version of the Child Perceptions Questionnaire for 8-10-year-olds (CPQ8-10), and parental knowledge regarding oral health. Additionally, clinical dental evaluations were conducted, which included assessments of decayed, missing, and filled surfaces (DMFS, dmfs) as well as teeth (DMFT, dmft). Simplified oral hygiene index (OHI-S), bleeding on probing (BOP), and the community periodontal index (CPI) were also recorded for each participant using the recommended methodology by the World Health Organization (WHO). The statistical analysis included the Chi-square test, independent t-test, and simple and multiple linear regressions. The mean age of the children was 9.0 (± 0.82) years. About one-third of children reported brushing at least two times per day and consuming a sweet snack once a day. Visiting a dentist during the past year was reported by 21% of children. Oral health behaviours demonstrated a significant association with the total CPQ8-10 scores (p < 0.001). Based on adjusted effects (β and 95% CI) from the multiple linear regressions, untreated dental caries (dt > 0, DT > 0) had a negative impact on the total CPQ8-10 score (adjusted β = 2.3 (95% CI: 0.67 to 3.91) and 3.4 (95% CI: 2.14 to 4.56), respectively). Decayed surfaces (DS), and teeth (DT) were associated with the total score of the CPQ8-10 and all its subscales (adjusted β range = 0.1 (95% C.I.: 0.03 to 0.19)-1.0 (95% CI: 0.72 to 1.26) and 0.2 (95% CI: 0.004 to 0.40)-1.2 (95% CI: 0.91 to 1.67), respectively). There was an association between oral hygiene index and total CPQ8-10 scores (adjusted β = 1.8 (95% CI: 0.62 to 3.02)), especially the functional limitations and emotional well-being subscales. Findings of this study emphasizes the negative impact of dental caries and poor oral hygiene on children's OHRQoL. This association is highlighted more when considering that over two-thirds of these children do not comply with favourable levels of oral health behaviour. Enhancing the level of OHRQoL among these children, therefore, necessitates comprehensive programs for decreasing the volume of unmet oral health needs and improving children's adherence to recommended oral health behaviours.

A whole food, plant-based randomized controlled trial in metastatic breast cancer: feasibility, nutrient, and patient-reported outcomes

PurposeQuality of life (QOL) is among the most important outcomes for women with metastatic breast cancer (MBC), and it predicts survival. QOL is negatively impacted by cognitive impairment, fatigue, and weight gain. We assessed whether a whole food, plant-based (WFPB) diet-promoting weight loss is feasible and might improve QOL.MethodsWomen with MBC on stable systemic treatments were randomized 2:1 to 1) WFPB dietary intervention (n = 21) or 2) usual care (n = 11) for 8 weeks. Participants attended weekly education visits and consumed an ad libitum WFPB diet (3 prepared meals/day provided). Patient-reported outcomes and 3-day food records were assessed at baseline and 8 weeks. The effects of WFPB diet on changes in outcomes were assessed by analysis of covariance model controlling for baseline.Results20 intervention and 10 control participants completed the trial. Intervention participants were highly adherent to the WFPB diet (94.3 % total calories on-plan). Intervention group nutrient intakes changed significantly including dietary fat (35.8 % to 20.4 % percent calories from fat, p < 0.001) and fiber content (12.7 to 30.8 g fiber/1000 kcal, p < 0.001). Perceived cognitive function (FACT-Cog total + 16.1; 95 % confidence interval [CI] = 0.8–31.7; p = 0.040) and emotional well-being (FACT-B emotional well-being subscale + 2.3; CI = 0.5–4.1; p = 0.016) improved in the WFPB versus the control group. Fatigue, measured by the BFI, improved within the WFPB group for fatigue severity (M = 4.7 ± 2.5[SD] to 3.7 ± 2.3, p = 0.047) and fatigue at its worst (5.8 ± 2.8 to 4.4 ± 2.4, p = 0.011).ConclusionsSignificant dietary changes in this population are feasible and may improve QOL by improving treatment-related symptoms. Additional study is warranted.Trial Registration: ClinicalTrials.gov identifier: NCT03045289. Registered 7 February 2017.

Familism, family cohesion, and health-related quality of life in Hispanic prostate cancer survivors.

Familism, the cultural value that emphasizes feelings of loyalty and dedication to one's family, has been related to both positive and negative outcomes in Hispanic cancer survivors. One potential source of observed inconsistencies may be limited attention to the family environment, as familism may be protective in a cohesive family whereas it can exacerbate distress in a conflictive family. The current study explored the associations of familism with general and disease-specific health-related quality of life (HRQoL) in Hispanic men who completed prostate cancer (PC) treatment, and whether family cohesion may help explain these relationships. Hispanic men treated for localized PC (e.g., radiation, surgery) were enrolled in a randomized controlled stress management trial and assessed prior to randomization. Familism (familial obligation) was assessed using Sabogal's Familism Scale and family cohesion was measured using the Family Environment Scale (ranging from high to low). The sexual, urinary incontinence, and urinary obstructive/irritative domains of the Expanded Prostate Cancer Index Composite - Short Form measured disease-specific HRQoL. The physical, emotional, and functional well-being subscales of the Functional Assessment of Cancer Therapy - General captured general HRQoL. Hierarchical linear regression and the SPSS PROCESS macro were used to conduct moderation analyses, while controlling for relevant covariates. Participants were 202 older men on average 65.7 years of age (SD = 8.0) who had been diagnosed with PC an average of 22 months prior to enrollment. Familism was not directly associated with general and disease-specific HRQoL. Moderation analyses revealed that greater familism was related to poorer urinary functioning in the incontinence (p = .03) and irritative/obstructive domains (p = .01), and lower emotional well-being (p = .02), particularly when family cohesion was low. These findings underscore the importance of considering contextual factors, such as family cohesion, in understanding the influence of familism on general and disease-specific HRQoL among Hispanic PC patients. The combined influence of familism and family cohesion predicts clinically meaningful differences in urinary functioning and emotional well-being during the posttreatment phase. Culturally sensitive psychosocial interventions to boost family cohesion and leverage the positive impact of familistic attitudes are needed to enhance HRQoL outcomes in this population.

The Effects of Resveratrol Supplementation on the Quality of Life of Diabetic Patients with Neuropathy: Small Randomized Clinical Trial

The diabetic neuropathy complication exerts a considerable decline in the level of patient’s well-being. The main approaches to hamper the progression of diabetic complications and improve patient’s life quality are controlling the glycemic levels and amelioration of the hyperglycemia-induced neuroinflammation, oxidative stress and pain. Supplementation of appropriate anti-inflammatory and anti-oxidants such as resveratrol may therefore be effective in the management of diabetic complications. The aim of this trial was to assess resveratrol’s impact on improving life quality of patients with the neuropathic complication of diabetes. Sixty-one patients with diabetic neuropathy were recruited in this double-blinded placebo-controlled trial. Patients were randomized into the resveratrol (n=31) group; who received a 500mg resveratrol capsule once daily concomitantly with the conventional hypoglycemic agents for three months, and the placebo (n=30) group. From each group 25 patients completed the study. The quality of life (QoL) of the patients was estimated utilizing RAND 36-item survey questionnaire. Fasting blood glucose levels were analyzed at the baseline and on the last day of the 3rd month. There was a significant decrement (p&lt; 0.001) in the fasting serum glucose level of the patients supplemented with resveratrol at the end of the 3rd month, in comparison with the patient using the placebo. There was also a significant improvement in patient’s severity of pain (p&lt;0.001) as shown in the bodily pain score of the RAND 36 scale and a remarkable (p &lt; 0.05) improvement in physical functioning, physical health, social functioning, emotional well-being, energy/fatigue, and health change subscales of the questionnaire. The study concluded that resveratrol is the polyphenol that has a positive effect on reducing pain associated with diabetic neuropathy and improving the overall QoL of the patient.

A Pilot Trial of Stepwise Implementation of Virtual Reality Mindfulness and Accelerated Transcranial Magnetic Stimulation Treatments for Dysphoria in Neuropsychiatric Disorders

Dysphoria is a transdiagnostic symptom that causes considerable suffering. Implementation of established self-care and clinical treatment options, such as mindfulness and transcranial magnetic stimulation (TMS), is typically disjointed for conditions involving dysphoria. There is a need for a rapid progression of accessible treatments that can be efficacious across multiple comorbidities. In a pilot stepwise implementation study to assess feasibility and effectiveness, adult participants with dysphoria (depression, anxiety, PTSD, and/or chronic pain) went through a treatment course of VR mindfulness, then accelerated TMS (accel-TMS) over the left dorsolateral prefrontal cortex (left dlPFC), then accel-TMS over the dorsomedial prefrontal cortex (dmPFC). Participants who did not benefit from one treatment phase progressed to the next until remission or study completion. Twenty-four participants were enrolled with 23 in VR mindfulness (phase 1), 19 in accel-TMS left dlPFC (phase 2A), and 13 in accel-TMS dmPFC (phase 2B). For our primary outcome measure of the short form-36 emotional well-being subscale (paired t -test), no significant change was found in phase 1 ( n = 19 , p = .226 ), significant improvement was found in phase 2A ( n = 19 , p = .038 ), and no significant change was found in the smaller sample of phase 2B ( n = 12 , p = .089 ). Symptom improvement was largely supported by clinician-administered scales, with more significant changes found in accel-TMS left dlPFC and dmPFC. The benefits of VR mindfulness were limited; however, both accel-TMS phases showed a significant impact on secondary measures of depression, anxiety, and PTSD. This stepwise protocol shows promise in providing an approach to rapidly improve symptoms of dysphoria in transdiagnostic populations. This trial is registered with NCT05061745.

Comparison of the effects of high-intensity interval and moderate-intensity continuous training on inflammatory markers, cardiorespiratory fitness, and quality of life in breast cancer patients

BackgroundAs the effectiveness of breast cancer treatment has improved, a growing number of long-term breast cancer survivors are seeking help for unique health problems. These patients may be at increased risk of cardiovascular disease due to the side effects of treatment. The positive impact of most types of exercise has been repeatedly reported in people with cancer, but the most effective exercise approaches for maximum beneficial adaptations remain controversial. Thus, this study aimed to compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on inflammatory indices, adipokines, metabolic markers, body composition, cardiorespiratory fitness, and quality of life in breast cancer patients during adjuvant endocrine therapy. MethodsThirty non-metastatic breast cancer patients during adjuvant endocrine therapy who had been treated with chemotherapy and/or radiotherapy were recruited from Iran and randomized to HIIT, MICT, or control groups for a supervised exercise intervention that took place 3 times a week for 12 weeks. The training intensity was determined based on the peak oxygen uptake (VO2peak), and the volume of training was matched in HIIT and MICT based on the VO2peak. Body composition, functional capacity, cardiorespiratory fitness, metabolic indices, sex hormones, adipokines, and inflammatory markers were assessed before and after the intervention. ResultsThe VO2peak increased by 16.8% in the HIIT group in comparison to baseline values (mean difference = 3.61 mL/kg/min). HIIT significantly improved the VO2peak compared to control (mean difference = 3.609 mL/kg/min) and MICT (mean differences = 2.974 mL/kg/min) groups. Both HIIT (mean difference = 9.172 mg/dL) and MICT (mean difference = 7.879 mg/dL) interventions significantly increased high-density lipoprotein cholesterol levels compared to the control group. The analysis of covariance showed that physical well-being significantly improved in MICT compared to control group (mean difference = 3.268). HIIT significantly improved the social well-being compared to the control group (mean difference = 4.412). Emotional well-being subscale was significantly improved in both MICT (mean difference = 4.248) and HIIT (mean difference = 4.412) compared to the control group. Functional well-being scores significantly increased in HIIT group compared with control group (mean difference = 3.35) . Significant increase were also observed in total functional assessment of cancer therapy-General scores in both HIIT (mean difference = 14.204) and MICT groups (mean difference = 10.036) compared with control group. The serum level of suppressor of cytokine signaling 3 increased significantly (mean difference = 0.09 pg/mL) in the HIIT group compared to the baseline. There were no significant differences between groups for body weight, body mass index, fasting blood glucose, insulin resistance, sex hormone binding globulin, total cholesterol, low-density lipoprotein cholesterol, adipokines, interleukin-6, tumor necrosis factor-α, or interleukin-10. ConclusionHIIT can be used as a safe, feasible, and time-efficient intervention to improve cardiovascular fitness in breast cancer patients. Both HIIT and MICT modalities enhance quality of life. Further large-scale studies will help determine whether these promising results translate into improved clinical and oncological outcomes.

Test-Retest Reliability of the Impact of Vision Impairment-Very Low Vision Questionnaire.

Most patient-reported outcome measures used in ophthalmology show floor effects in a very low vision population, which limits their use in vision restoration trials. The Impact of Vision Impairment-Very Low Vision scale (IVI-VLV) was developed to specifically target a very low vision population, but its test-retest reliability has not been investigated yet. The German version of the IVI-VLV was administered twice to patients with stable disease of a low vision clinic. Test and retest person measures of the IVI-VLV subscales were obtained from Rasch analysis. Test-retest reliability was investigated by intraclass correlation coefficients and Bland-Altman plots. We included 134 patients (72 women, 62 men) at a mean age of 62 ± 15 years. The intraclass correlation coefficients were 0.920 (95% confidence interval, 0.888-0.944) for the activities of daily living and mobility subscale of the IVI-VLV and 0.929 (95% confidence interval, 0.899-0.949) for the emotional well-being subscale. Bland-Altman plots did not indicate any systematic bias. In linear regression analysis, test-retest differences were not significantly associated with visual acuity or administration interval. Both subscales of the IVI-VLV showed excellent repeatability independent of visual acuity and length of repeat interval. Further validation steps including an assessment of the patient-reported outcome measure's responsiveness are required for use in vision restoration trials. The results support repeated use of the IVI-VLV as a patient-reported end point in future studies in very low and ultralow vision populations.

Separate and joint associations of chronic pain, multisite pain and mental health with sickness absence among younger employees: a register based longitudinal study

BackgroundPain conditions and poorer mental health are associated with work disability. However, few studies have examined the association of concurrent pain and poorer mental health with sickness absence among younger employees. We examined separate and joint associations of chronic pain, multisite pain, and mental health with total and long-term all-cause sickness absence days among younger Finnish municipal employees.MethodsThe Young Helsinki Health-study data were collected in 2017 from 19–39-year-old employees of the City of Helsinki, Finland. Chronic (≥ 3 months) and multisite (≥ 2 body sites) pain and mental health (RAND-36 emotional wellbeing subscale dichotomized by median score) were self-reported (n = 3911). Chronic pain, multisite pain and mental health were analyzed separately and combined. Register data on total (≥ 1 workdays) and long-term (≥ 11 workdays) sickness absence days during the following year were obtained. Negative binomial regression analyses were performed with sociodemographic, socioeconomic, and health-related factors as confounders. Gender interaction and synergistic indices were examined.ResultsChronic multisite pain was associated with long-term sickness absence days (rate ratio [RR] 2.51, 95% CI 1.17–5.42). Chronic pain (RR 5.04, 95% CI 2.14–11.87) and multisite pain (RR 4.88, 95% CI 2.30–10.33) were associated with long-term sickness absence days among employees with poorer mental health. There was a synergistic interaction between gender and multisite pain for total sickness absence days (synergy index 1.80, 95% CI 1.27–2.54), with stronger associations among women.ConclusionsChronic and multisite pain are associated with long-term sickness absence among younger employees, particularly among women and employees with concurrent poorer mental health. Consideration of this knowledge at workplaces and in healthcare could help to identify and support employees at increased risk of later sickness absence.

The Impact of Nonmotor Symptoms on Health-Related Quality of Life in Parkinson's Disease: A Network Analysis Approach.

Nonmotor symptoms negatively affect health-related quality of life (HRQoL) in patients with Parkinson's disease (PD). However, it is unknown which nonmotor symptoms are most commonly associated with HRQoL. Considering the complex interacting network of various nonmotor symptoms and HRQoL, this study aimed to reveal the network structure, explained HRQoL variance, and identify the nonmotor symptoms that primarily affect HRQoL. We included 689 patients with PD from the Cohort of Patients with Parkinson's Disease in Spain (COPPADIS) study who were rated on the Nonmotor Symptoms Scale in Parkinson's disease (NMSS) and the Parkinson´s Disease Questionnaire 39 (PDQ-39) at baseline. Network analyses were performed for the 30 items of the NMSS and both the PDQ-39 summary index and eight subscales. The nodewise predictability, edge weights, strength centrality, and bridge strength were determined. In PD, nonmotor symptoms are closely associated with the mobility, emotional well-being, cognition, and bodily discomfort subscales of the PDQ-39. The most influential nonmotor symptoms were found to be fatigue, feeling sad, hyperhidrosis, impaired concentration, and daytime sleepiness. Further research is needed to confirm whether influencing these non-motor symptoms can improve HRQoL.

Effects of Panax Ginseng on Health-Related Quality of Life in Patients with Non-Metastatic Breast Cancer: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial Ginseng for HRQOL in Breast Cancer

Being diagnosed with cancer and chemotherapy impose distressing symptoms on patients’ Health-Related Quality of Life (HRQOL). This study evaluated ginseng efficacy on improving multiple aspects of HRQOL in breast cancer patients. Forty women with non-metastatic early breast cancer were enrolled in the study. Participants received ginseng (1 g/day) or placebo with standard chemotherapy. HRQOL was evaluated via in-person interviews at baseline, two weeks after the second and last chemotherapy cycles. The FACT-B, a 37-item questionnaire composed of five subscales including physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), and Breast Cancer Subscale (BCS) was employed to assess HRQOL. A considerable decreasing trend in the mean scores of all subscales, as well as the total score, was observed in the placebo group; nevertheless, the ginseng group experienced a slight decrease in the PWB subscale and a constant or even increasing trend in other subscales and total score. The differences in the mean change of scores during the study period were statistically significant in all domains between the two groups (all p-values < 0.001). Regular ginseng supplementation may provide beneficial effects on enhancing different aspects of HRQOL including PWB, SWB, EWB, FWB, and BCS in breast cancer patients. This study was registered in the Iranian Registry of Clinical Trials (IRCT, IRCT20141227020441N7) in Jan 2020.

Exploring Perception of Terminally Ill Cancer Patients about the Quality of Life in Hospice based and Home based Palliative Care: A Mixed Method Study.

The objectives of the study were to evaluate the perceptions and performance of terminally ill cancer patients regarding the quality of palliative care at different settings and to measure their quality of life (QOL) at the end of life. This comparative, parallel and mixed method study was conducted at the Community Oncology Centre, Ahmedabad, among 68 terminally ill cancer patients as per inclusion criteria; who were receiving hospice (HS)-based and home (HO)-based palliative care under 2 months permitted by the Indian Council of Medical Research. In this parallel and mixed method study, qualitative findings were supplemented by quantitative data with both components executed simultaneously. Interview data were recorded by taking extensive notes during interviews along with an audio recording. Interviews were transcribed verbatim and a thematic approach was adopted. QoL questionnaire ('FACIT© System') was used for the assessment of QOL in terms of four dimensions. Data were analysed using the appropriate statistical test on Microsoft Excel. The qualitative data (primary component) analysed under five themes - staff behaviour, comfort and peace, enough and consistent care, nutrition and moral support, in the present study favours a HS-based setting more than a HO-based setting. Among all four subscale scores, physical well-being and emotional well-being subscale scores were statistically significantly associated with the place of palliative care. Functional Assessment of Cancer Therapy-General (FACT-G) total score was high among patients getting HO-based palliative (mean = 67.64) care than HS-based palliative care (mean = 56.56) and the difference between total FACT-G scores was statistically significant (unpaired t-test = 2.20, P = 0.03). Overall, with the primary component favouring HS care and higher scores obtained in HO-based patients, the present study advocates the necessity for palliative services to expand their coverage regardless of whether they are provided at HS or HO, as it has improved the QOL of cancer patients significantly.

Early integration of palliative care in cervical cancer: Experiences from a pilot study.

Palliative care (PC) has been classically synonymous with end-of-life care offered to patients with advanced incurable cancers with an aim to improve their quality-of-life (QoL). However, there is growing evidence to suggest that early integration of PC (EIPC) along with cancer-directed management improves patient-reported outcomes. In this study, we aim to evaluate the impact of EIPC on QoL of cervical cancer patients treated with curative intent. Patients with locally advanced cervical cancer (stage IB2 to IIIB) having eastern cooperative oncology group (ECOG) performance score 0-2 were randomized into EIPC arm and standard of care arm of concurrent chemoradiation by a computer-generated table of random numbers. QoL was assessed by functional assessment of cancer therapy - general (FACT-G) questionnaire twice in both arms. The first assessment was done prior to starting treatment and second assessment at three months after treatment completion. The mean scores on physical, mental, emotional, social, and functional well-being subscales of FACT-G scale were calculated in both arms, and Wilcoxon test was used to evaluate differences in QoL scores within and in between the arms. This trial was registered with Clinical Trials Registry of India (CTRI) vide CTRI/2017/05/008704. Fifty patients were enrolled in each arm. However, only 42 and 45 patients in EPIC and standard oncological care arm were evaluated in the final analysis. Comparing QoL scores between the two time points in each arm, the mean pre-treatment scores in EIPC arm was significantly higher than post-treatment scores in the domains of physical and emotional well-being, whereas social and functional well-being scores improved significantly after treatment as compared with that as baseline. However, when compared between two arms, the difference of mean scores pre- and post-treatment were almost similar for physical and functional well-being but statistically significant differences were found only in social and emotional well-being scales. Our study is a feasibility study done in an attempt to test the validity of EIPC in cervical cancers. The results are inspiring to conduct robust studies in the future to explore this new domain of integration of palliative services in curable cancers.

Surgeon compassion may mitigate quality of life disparities associated with health literacy

ObjectivesPatients with health literacy (HL) disparities are less likely to comprehend hospital discharge instructions and less satisfied with physician communication. In this prospective cohort study, we sought to examine the...

Pain and mental health - separate and joint associations with sickness absence among young employees

Abstract Background Both pain and mental illness associate with work disability. However, few studies have examined the association of concurrent pain and mental distress with sickness absence (SA). We examined separate and joint associations of chronic pain, multisite pain, and mental distress with total and long-term all-cause SA among young and midlife municipal employees. Methods As part of the Young Helsinki Health study, baseline data were collected in 2017 from 19-39-year-old employees of the City of Helsinki, Finland. Chronic (≥3 months) pain, multisite (≥2 body sites) pain and mental distress (RAND-36 emotional wellbeing subscale below median) were reported by 3911 respondents. Register data on total (&amp;gt;1 day) and long-term ((&amp;gt;11 workdays) SA for the following year were obtained from the employer and the Social Insurance Institute of Finland with respondents’ informed consent. Negative binomial regression analyses were performed with sociodemographic, socioeconomic, and health-related factors as confounders. The interaction of gender was examined. Results Chronic pain, multisite pain, and mental distress were associated with total SA. Chronic multisite pain was associated with long-term SA (rate ratio [RR] 2.51, 95% CI 1.17-5.42), and chronic pain (RR 5.04, 95% CI 2.14-11.87) and multisite pain (RR 4.88, 95% CI 2.30-10.33) with long-term SA among those with mental distress. For women, there was a synergistic interaction of multisite pain to the association with total SA (synergy index 1.80, 95% CI 1.27-2.54). Conclusions Chronic and multisite pain associate with SA among young and midlife employees. The associations are generally stronger among women and particularly among those with concurrent mental distress. Interventional studies are needed to confirm if early symptom recognition and support could reduce sickness absence. Key messages • Chronic pain and pain at multiple body sites associate with sickness absence among young and midlife employees, particularly among women and those with concurrent mental distress. • Interventional studies are needed to confirm if sickness absence could be reduced by early recognizing pain and mental distress among employees and providing preventive and therapeutic services.

The effect of an anti-inflammatory in comparison with a low caloric diet on physical and mental health in overweight and obese women with knee osteoarthritis: a randomized clinical trial.

To evaluate the effect of an anti-inflammatory compared to a low-calorie diet on the physical and mental health of patients with knee OA. In this randomized parallel clinical trial, participants were selected among overweight and obese women aged 40years or older with mild to moderate OA. Sixty women with a ratio of 1:1 were randomly assigned to receive either low-calorie or anti-inflammatory accompanied by a low-calorie diet for two months. The dietary intake and weight of participants were measured. Study variables were assessed using the Western Ontario and McMaster Index (WOMAC), visual analog pain scale (VAS), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI-I), and the Short Form 36 Health Survey Questionnaire (SF-36) to indicate the quality of life (QoL). There was no statistically significant difference between the two groups in demographic and baseline variables except for the emotional well-being subscale of QoL. There was significant difference in anti-inflammatory compared to low-calorie diet in terms of weight (MD (95% CI): -4.02kg (-6.77 to -1.28); p = 0.005), VAS (MD (95% CI): -0.97 (-1.53 to -0.41); p = 0.001), WOMAC-total score (MD (95% CI): -9.91 (-15.05 to -4.78); p < 0.001), WOMAC-pain subscale (MD (95% CI): -3.30 (-5.30 to -1.29); p = 0.002), WOMAC-physical function (MD(95% CI): -5.48 (-9.41 to -1.53); p = 0.007), depression (p = 0.003), anxiety (p = 0.011), QoL-physical functioning (0.041), and QoL-pain (0.010) after the intervention. An anti-inflammatory accompanied by a low-calorie diet resulted in greater weight loss and greater improvement in pain intensity, functional status, depression, anxiety, and some dimension of QoL in overweight and obese women with knee OA compared to the low-calorie diet. Trial registration number and date of registration: IRCT201610220030424N2; 2018-04-23.

CAN A PHYSICAL ACTIVITY PROGRAMME IMPROVE THE QUALITY OF LIFE IN YOUTH WHO LIVE IN AN ORPHANAGE? A MIXED METHODS STUDY

Physical activity (PA) is thought to positively contribute to the improvement of the (poor) Quality of Life (QoL) of youth living in institutions. However, youth’s participation in PA can be affected by the “significant others” in their life. The aim of this study was to (a) investigate the impact of a PA programme on the QoL of youth hosted in an orphanage and (b) understand the role of the relationships formed in this institution in the outcome of the programme objectives. For that purpose, a mixed methods approach was adopted. The study was conducted in an orphanage in Attica, Greece. Twelve of the 13 male orphans (Mage= 13.08 ± 2.43 years) participated in a 10-week PA programme implemented in the institution. The KINDL® questionnaire was completed by the orphans and one caregiver before and after the PA intervention. The qualitative data were collected through observation and semi-structured interviews with 12 orphans and 6 members of the orphanage staff. The results showed that orphans’ QoL levels were poor; whereas a statistically significant decline in their total KINDL® scores (p= .033) and the Emotional Well-Being subscale (p= .013) was identified. Quality data revealed that orphans’ participation in the PA programme was inconsistent, although they estimated that it was valuable. Intra- and inter-personal factors emerged as barriers for PA participation. It seems that living in an institution results in deep deteriorations in youth’s QoL that cannot be surmounted by their participation in a PA programme.