Mean Mental Health Scores Research Articles

Linking Physical and Mental Health Summary Scores from the Veterans RAND 12-Item Health Survey (VR-12) to the PROMIS(®) Global Health Scale.

Global health measures represent an attractive option for researchers and clinicians seeking a brief snapshot of a patient's overall perspective on his or her health. Because scores on different global health measures are not comparable, comparative effectiveness research (CER) is challenging. To establish a common reporting metric so that the physical and mental health scores on the Veterans RAND 12-Item Health Survey (VR-12 (©) ) can be converted into scores on the corresponding Patient Reported Outcomes Measurement Information System (PROMIS(®)) Global Health scores. Following a single-sample linking design, participants from an Internet panel completed items from the PROMIS Global Health and VR-12 Health Survey. A common metric was created using analyses based on item response theory (IRT), producing score cross-walk tables for the mental and physical health components of each measure. The linking relationships were evaluated by calculating the standard deviation of differences between the observed and linked PROMIS scores and estimating confidence intervals by sample size. Participants (N = 2025) were 49 % male and 73 % white; mean age was 46 years. Mental and physical health subscales of the PROMIS Global Health and the VR-12. The mean VR-12 physical component and mental component scores were 45.2 and 46.6, respectively; the mean PROMIS physical and mental health scores were 48.3 and 48.5, respectively. We found evidence that the combined set of VR-12 and PROMIS items were relatively unidimensional and that we could proceed with linking. Linking worked better between the physical health than mental health scores using VR-12 item responses (vs. linking based on algorithmic scores). For each of the cross-walks, users can minimize the impact of linking error with modest increases in sample sizes. VR-12 scores can be expressed on the PROMIS Global Health metric to facilitate the evaluation of treatment, including CER. Extending these results to other common measures of global health is encouraged.

The Effect of Stress Management Program Using Cognitive Behavior Approach on Mental Health of the Mothers of the Children With Attention Deficit Hyperactivity Disorder.

Background:Attention deficit hyperactivity disorder is one of the most common psychiatric disorders in children.Objectives:The study aimed to evaluate the effectiveness of stress management program using cognitive behavior approach on mental health of the mothers of the children with attention deficit hyperactivity disorder.Patients and Methods:In this interventional study, 90 mothers of the children with attention deficit hyperactivity disorder were randomly allocated into three intervention, placebo, and control groups. The general health questionnaire was used to measure mental health. Besides, stress was assessed through the depression-anxiety-stress scale. The two instruments were completed at baseline, immediately after, and one month after the intervention by the mothers. Afterwards, within group comparisons were made using one-sample repeated measurement ANOVA. One-way ANOVA was used for inter group comparisons. Mothers in the placebo group only participated in meetings to talk and express feelings without receiving any interventions.Results:At the baseline, no significant difference was found among the three groups regarding the means of stress, anxiety, depression, and mental health. However, a significant difference was observed in the mean score of stress immediately after the intervention (P = 0.033). The results also showed a significant difference among the three groups regarding the mean score of mental health (P < 0.001). One month after the intervention, the mean difference of mental health score remained significant only in the intervention group (P < 0.001).Conclusions:The study findings confirmed the effectiveness of stress management program utilizing cognitive behavior approach in mental health of the mothers of the children with attention deficit hyperactivity disorder.

Vascular chronic Q fever: quality of life.

The aim of this study was to evaluate the quality of life in patients with vascular chronic Q fever at time of diagnosis and during follow-up. Based upon the SF-36 questionnaire, the mean physical and mental health of each patient were assessed at 3-month intervals for up to 18 months. A total of 26 patients were included in the study. At time of diagnosis, the mean physical health and mental health score was 50·6 [95% confidence interval (CI) 46·7-54·4] and 44·6 (95% CI 41·6-47·5), respectively. During treatment, the mean physical health score declined significantly by 1·7 points each 3 months (P < 0·001) to 40·8 (95% CI 34·4-45·1). The mean mental health score significantly and steadily increased towards 51·2 (95% CI 46·9-54·3) during follow-up (P = 0·026). A total of 23% of patients were cured after 18 months of follow-up. In conclusion, quality of life at time of diagnosis for patients with vascular chronic Q fever is lower compared to a similar group of patients, matched for age and gender, with an aortic abdominal aneurysmal disease, and physical health decreases further after starting treatment. Considering the low percentage of cure, the current treatment of vascular chronic Q fever patients may require a separate strategy from that of endocarditis in order to increase survival.

Comorbidities and health-related quality of life in Spanish patients with moderate to severe psoriasis: a cross-sectional study (Arizona study).

Psoriasis is a common, chronic inflammatory immunologically mediated disease of the skin, showing a high prevalence of associated comorbidities, and strongly affecting patients' health-related quality of life (HR-QOL), with profound impact on the psychological aspect. We aimed to establish the correlation between HR-QOL and the associated comorbidities in patients with moderate to severe psoriasis in Spain. A cross-sectional, observational, epidemiological study was conducted at 68 dermatology-based centers across Spain. From October 2010 to June 2011, all adult patients diagnosed with moderate to severe psoriasis at least 6months prior to the study visit and receiving or not receiving treatment for psoriasis were eligible for inclusion. A total of 1022 patients were included. The study population showed mean 36-item short-form (SF-36) physical and mental health scores and Dermatological Life Quality Index (DLQI) of 49.7, 46.2 and 5.3, respectively. The multiple linear regression models showed that patients with moderate to severe psoriasis and a diagnosis of psoriatic arthritis (PsA), hypertension, diabetes mellitus, sleep disturbances or obesity were found to have lower SF-36 health physical scores. Female patients with depression or anxiety disorders had lower SF-36 health mental scores. Patients diagnosed with moderate to severe psoriatic disease and associated anxiety disorder had greater DLQI scores. Moderate to severe psoriasis has a significant burden on the HR-QOL of patients. Regardless of sex, patients with several comorbidities such as PsA, hypertension or obesity were found to have worse scores in the physical component of the QOL questionnaire, whilst women were more affected in the mental health component than men.

Mental health service use: is there a difference between rural and non-rural women in service uptake?

This study examines differences in uptake of the Medicare items rolled out in 2006 under the 'Better Access Scheme' (BAS) between rural and non-rural Australian women. It compares differences in women's uptake of the BAS services by area of residence (ARIA+) across time using the Australian Longitudinal Study of Women's Health (ALSWH) survey data linked to Medicare data. Women aged 28-33 years at the time the BAS was introduced that responded to the self-reported question on depression/anxiety and consented to linkage of their survey data with Medicare data (n=4,316). Participants were grouped by ARIA+ according to BAS use, diagnoses of anxiety/depression but no BAS use and other eligible women. Across all areas, women born 1973-1978 with a self-reported diagnosis of depression/anxiety or having treatment under the BAS had a significantly lower mean mental health score compared to other women. Significantly more women living in non-rural areas had used at least one service provided under the BAS initiative compared to women in outer regional, inner regional or remotes areas (21% versus 18% versus 13% versus 7%, respectively), and across all areas, 12% of women reported having a diagnosis of depression/anxiety but not been treated under the BAS. While there is a gradual uptake of the new BAS services, a large percentage of women who have a diagnosis of depression/anxiety have not been treated under the BAS. The data suggest that women in urban areas have been better able to take up the services compared to non-urban women.

The Effect of Holy Quran Voice on Mental Health

This study was designed to determine the effect of Quran listening without its musical tone (Tartil) on the mental health of personnel in Zahedan University of Medical Sciences, southeast of Iran. The results showed significant differences between the test and control groups in their mean mental health scores after Quran listening (P = 0.037). No significant gender differences in the test group before and after intervention were found (P = 0.806). These results suggest that Quran listening could be recommended by psychologists for improving mental health and achieving greater calm.

Investigating the Relationship between Sleep Quality and Mental Health in Chemical Veterans in Comparison with Their Spouses and a Control Group

Aim: This study was aimed to determine the relationship between sleep quality and mental health of veterans in comparison with that of their spouses and a control group. Methods: Thirty-seven chemical veterans with moderate to severe injury based on the standards of Foundation of Martyrs and Veterans Affairs were selected from Mazandaran province. Then, the spouses of 31 of them were selected and 15 of their close relatives also enrolled in the study as the control group. The three groups were evaluated by GHQ for their mental health and Pittsburg Sleep Quality Index (PSQI) for sleep quality. Collected data were analyzed using SPSS software 16 and descriptive and analytic statistical methods. Results: The mean score of mental health in veterans, their spouses and close relatives were 44.13 ± 14.4, 34.19 ± 15.2 and 21.73 ± 17.32, respectively. The mean scores of PSQI test in veterans, their spouses, and their close relatives were 10.94 ± 5.6, 8.7 ± 5.5 and 4.27 ± 1 that the difference was statistically significant among the three groups (P ≤ 0.0001). A positive relationship was seen between mental health and sleep quality in veterans and their spouses respectively (r = 0.4, P = 0.02) and (r = 0.83, P

A Pilot Study to Assess the Impact of Structured Diet and Exercise Counseling on Obesity and Quality of Life Measures in South Carolina

Purpose: Obesity is a pervasive problem in the U.S., especially in South Carolina, with 33.9% of the population overweight and 32.6% obese. Obesity is associated with a poor quality of life (QOL), as shown by the Medical Outcomes Study Short Form (SF questionnaires). Medicare and Medicaid proposed intensive counseling for all its patients with a body mass index (BMI) over 30kg/m2 in September 2011. Obesity counseling has been used as a Physician Quality Reporting System measure. This study aimed to assess whether structured counseling on healthy diet and exercise choices in patients with a body mass index (BMI) over 25kg/m2 had an impact on their QOL, understanding the benefits of healthy diet and exercise choices (DAEC) and BMI. Methods: In this prospective pilot study, 104 patients were recruited at a gastroenterology center in South Carolina. At the initial consultation, their QOL and knowledge of DAEC were assessed using the SF-12, and a structured ‘diet and exercise' questionnaire (DAEQ). Their BMI was recorded, and categorized according to the World Health Organisation International Classification of Weight According to BMI (Overweight, Obese class I, II or III). They were counseled for 40 minutes on portion sizes, healthy meal choices and the importance of regular exercise. They were shown how to measure serving sizes. Their comprehension was verified by information recall. Written guidelines were supplied, reinforcing this information. These directives were based on guidance from the American Heart Association and Centre for Nutrition Policy and Promotion. The follow-up period was two months, in which patients received two phone calls to monitor their progress, SF-12 and DAEQ scores, and BMI. Results: Obesity class I patients underwent a significant improvement in mean mental health and DAEQ scores. Obesity class II patients experienced significant improvements in mean BMI and mean physical health scores. There were significant improvements in obesity class III patients' mean BMI and mental health scores. Overweight patients demonstrated improvement in all aspects of the SF-12, DAEQ scores, and reduction in BMI. The results before and after structured counseling are summarized in the ‘Summary of Results' table.Table: Table. Summary of resultsConclusion: This study highlights the benefits of regular counseling, even within a short period, as an intervention for obesity management. With further follow-up, there is potential for greater improvement in results. While these results do not evaluate quality of care due to the outcome measures used, there is an opportunity for physicians to motivate patients in clinics to take responsibility for their own physical and mental health, and to prevent future comorbidities through regular counseling and information reinforcement.

Health Effects of Neighborhood Demolition and Housing Improvement: A Prospective Controlled Study of 2 Natural Experiments in Urban Renewal

We took advantage of a 2-intervention natural experiment to investigate the impacts of neighborhood demolition and housing improvement on adult residents' mental and physical health. We identified a longitudinal cohort (n = 1041, including intervention and control participants) by matching participants in 2 randomly sampled cross-sectional surveys conducted in 2006 and 2008 in 14 disadvantaged neighborhoods of Glasgow, United Kingdom. We measured residents' self-reported health with Medical Outcomes Study Short Form Health Survey version 2 mean scores. After adjustment for potential confounders and baseline health, mean mental and physical health scores for residents living in partly demolished neighborhoods were similar to the control group (mental health, b = 2.49; 95% confidence interval [CI] = -1.25, 6.23; P = .185; physical health, b = -0.24; 95% CI = -2.96, 2.48; P = .859). Mean mental health scores for residents experiencing housing improvement were higher than in the control group (b = 2.41; 95% CI = 0.03, 4.80; P = .047); physical health scores were similar between groups (b = -0.66; 95% CI = -2.57, 1.25; P = .486). Our findings suggest that housing improvement may lead to small, short-term mental health benefits. Physical deterioration and demolition of neighborhoods do not appear to adversely affect residents' health.

Effects of Violence Victimization on Mental Health of Children and Adolescents: Analysis of Mediating Effects of Self-concept

Purpose: The purpose of this study is to clarify mediating effects of self-concept on mental health of children and adolescents who fell victim to violence. Methods: A survey was conducted on 4th, 5th, and 6th graders from 2 elementary schools and 1st, 2nd, and 3rd year students from 3 middle schools (n=2,391). Data were analyzed using descriptive statistics and AMOS. Results: The mean scores of mental health and self-concept in the subjects were 4.5 and 184.9 respectively. The rate of poor mental health in students who had fallen victim to violence was more than twice as high as that in students who had never experienced it. The self-concept of students who experienced violence had a tendency to decline. Violence experience and self-concept accounted for 47.7%(43.0% for boys and 53.4% for girls) of the changes in mental health. The indirect mediating effects of self-concept were significant. Conclusion: Based on the findings, the following is suggested. Schools should offer a self-concept improvement program for students with a distorted self-concept caused by falling victim to violence. It could help such adolescents have a positive self image and improve their mental health.

The Effect of a supportive program on mental health of mothers of children with cerebral palsy

Background: The challenges experienced by mothers of children with cerebral palsy usually are multiple and ongoing. These challenges affect the mental health of mothers. Thus they need to be supported with supportive programs. Aim: This study was carried out to determine the effect of a designed- supportive program on mental health of mothers who have children with cerebral palsy. Method: In this quasi-experimental study 60 mothers who had children with cerebral palsy were firstly selected by convenience sampling method and then allocated to two groups of experimental (n=30) and control (n=30). Data collection tools included the demographic and General Health Questionnaires (GHQ-12). Designed supportive program was implemented for experimental group through three steps including assessment of needs, giving support and evaluation. Data were analyzed with SPSS software Version 16 using Chi-square, t student and paired t-test. Results: Chi-square showed no significant difference in terms of demographic variables between two groups. Independent t-test showed that there is a significant difference between two groups in relation to mean scores of mental health after intervention (P<0.001). Based on Paired t-test there was a significant difference between mean scores of mental health before and after intervention in experimental group (P<0.001), but this difference was not seen in control group. Conclusion According to the findings, applying a designed- supportive program could affect positively the mental health status of the mothers who had children with cerebral palsy. So it is suggested that designed- supportive programs to be applied as an effective method to promote mental health of mothers of children with cerebral palsy.

P-1350 - Investigating the relationship between sleep quality and mental health in chemical veterans in comparison with that of their spouses and a control group

In the present study, 37 chemical veterans with injury magnitude of moderate and severe based on the standards of Foundation of Martyrs and Veterans Affairs were selected from Mazandaran province. In addition, the spouses of 31 of them were selected and 15 of their close relatives were also enrolled in the study as the control group. The three groups were evaluated by GHQ for their mental health and Pittsburg Sleep Quality Index (PSQI) for their sleep quality. . The mean score of mental health in veterans, their spouses and close relatives were 44.13 ± 14.4, 34.19 ± 15.2 and 21.73 ± 17.32, respectively, and the mean scores of PSQI test in veterans, their spouses, and their close relatives were 10.94 ± 5.6, 8.7 ± 5.5 and 4.27 ± 1 showing a statistically significant difference between the three groups (P ≤ 0.0001). There was a positive relationship between mental health and sleep quality in veterans and their spouses, that is, (r = 0.4▮P = 0.02) and (r = 0.83, P < 0.0001), respectively. However, no relationship was found between mental health and sleep quality in their close relatives: r = 0.01, P = 0.96). It could be claimed that poor sleep quality in chemical veterans, compared to their spouses and close relatives, could be due to mental health, rather than chemical effects and chronic lung disease; therefore, treatment of mental health might be an important step in improving the sleep quality of veterans.

P-429 - The effect of familiarity with quran on the mental health

Introduction The holy Quran is the curative that after its cure,there is no fear of disease anymore. One of the miracles of Quran is its effect on sevice and medical care duties. Objectives Regarding the key role of nurses in offering health service to patients and the importance of the nurses' mental health, thisc study was conducted. Aims To assess the effect of Quran on the mental health of nurses. Methods This educational trial was done on 55 nurses at educational hospitals of Arak University of Medical Sciences through randomized simple sampling. Intervention was attendance in the workshop of familiarity with Quran. Before and after intervention, the GHQ-28 questionnaire was completed by the participants.Data were analyzed by descriptive statistics, paired t-test, and Chi square. Results The mean age of the nurses was 34.45 ± 6.3 years. 30 participants (68.2%)were married. The mean mental health scores before and after intervention were 27.75 ± 9.76 and 22.34 ± 7.83 respectively which indicated the significant difference (P Conclusions The intervention has been effective in reducing mental health scores and somehow, in improving the nurses' mental health status. On the other hand, participation in the familiarity with Quran workshop can improve the nurses' mental health.

Maternal psychosocial factors around delivery, and the behavior of 2‐year‐old children

The objectives of the present study were to explore whether maternal psychosocial factors, mental health and work stress around delivery, are related to the behavior of 2-year-old children. In a prospective cohort study design, pregnant women attending the National Taiwan University Hospital for delivery and post-partum care from April 2004 to January 2005 were recruited and their children were observed at 24 months. A total of 186 mother-term-born child dyads completed the measurement. The five-item Mental Health Index (MHI-5) self-report data of maternal psychosocial factors were selected from the Taiwanese version of the short form 36 (SF-36). The Child Behavior Checklist for age 1½-5 (CBCL/1½-5) was completed by the parents when the child was 2 years old. The mean score of mental health around delivery was 68.11. The proportion of mothers with work stress seldom and always was 61.8% and 24.7%, respectively. The mean of the total CBCL score, and internalizing, externalizing behavior and sleep problems scores was 45.95, 11.89, 15.59 and 4.23, respectively. After adjusting for the potential confounders, maternal work stress around delivery was found to have a significant effect on the total CBCL and externalizing, attention and aggressive, behavioral problems of 2-year old children. Maternal mental health around delivery, however, did not show significant effects on child behavior. Work stress around delivery seems to aggravate children's externalizing behavior problems at 2 years old. It is therefore important to improve the psychosocial health and reduce the stress of pregnant women.

Health-related quality of life in adults with transfusion-independent thalassaemia intermedia compared to regularly transfused thalassaemia major: new insights

In patients with β thalassaemia intermedia (TI), the milder anaemia and transfusion independence imply better health-related quality of life (HR-QoL). However, the unbalanced pathophysiology of the disease allows for several serious clinical complications to manifest, which may have a negative impact on HR-QoL. This was a cross-sectional study on adult patients with transfusion- and iron chelation-independent TI and β thalassaemia major (TM) attending the Chronic Care Center, Hazmieh, Lebanon. A total of 80 patients agreed to participate in the study [32 TI (median age 24 yr) and 48 TM (median age 23 yr)]. The RAND SF-36 survey was used to assess HR-QoL. Data on patient demographics, clinical complications and socioeconomic status were collected. Patients with TI and TM were comparable with age and gender, but patients with TM had a significantly longer median duration with a known thalassaemia diagnosis. Patients with TI had a higher proportion of multiple complications. Socioeconomic parameters were comparable, except for patients with TI being more commonly married. The mean Total, Physical Health and Mental Health Scores were significantly lower in patients with TI compared to TM, indicating poorer HR-QoL. There was a statistically significant positive correlation between the duration with a known thalassaemia diagnosis and a higher Mental Health Score (r(s) = 0.73, P = 0.020). The mean Physical Health Score was significantly lower in patients with multiple clinical complications compared to patients with single or no complications (P = 0.012). Associations remained independently significant at multivariate analysis. Patients with transfusion-independent TI have lower HR-QoL compared to TM patients. At a comparable age, the shorter duration since diagnosis and the multiplicity of complications may explain these findings.

Patient Preferences and the Ironic Nature of Randomized Trials

Randomized trials are an attractive form of medical research that often contains blemishes when examined carefully. One criticism relates to limited generalizability, because such studies typically include only a fraction of the available patients and often exclude the challenging individuals who have complex comorbidities. Randomized trials can also fail because of practical issues such as insufficient recruitment (inadequate power bias), a limited duration of follow-up (brevity bias), or losses to follow-up (attrition bias). Several other opportunities for misinterpretation arise if the study is not adequately blinded so that outcomes and cointerventions are managed in a slanted manner. Furthermore, the large costs of a randomized trial (both financial and operational) create a potential conflict of interest for investigators and a worrisome reality that the research will not be repeated. This issue of the journal describes a further blemish in randomized trials that is subtle, pervasive, and rarely mentioned. Specifically, such trials randomize the assignment of patients to treatments and thereby require each person to disregard his or her inherent preferences. Such a behavior style is remarkably strange for a sentient adult, does not occur in usual clinical settings, and typically must be maintained for an extended interval. Of course, patients sometimes feel conflicted when facing a choice, and such indecision may take time to resolve before a subsequent commitment. By definition, however, a randomized trial requires each patient to follow a treatment that has been randomly assigned with no basis. Most people who sustain a career, marriage, diet, or other large-stakes effort would have a strong preference or other insight that underlies their specific choice. The article by McCaffery and colleagues provides an empiric demonstration of this discrepancy between self-selection and randomized assignment. Participants underwent a 2-step randomization where eligible patients were first divided into 2 groups; namely, those who were allowed to selfselect their treatment and those who instead received randomized assignment (hence, patients in the latter group were randomized twice). The main test evaluated the observed effects among self-selected patients compared with randomly assigned patients. In this study, the patients were diagnosed with cervical atypia, the medical treatment was a new screening strategy to prevent cervical cancer, and the primary outcome was a measure of mental health. The principal finding was that mean mental health scores were higher if the patient received the new screening strategy by self-selection rather than randomized assignment (47.57 v. 46.16, respectively). These new results corroborate standard intuitions on the importance of choice. For example, consider a trial testing whether chocolate milk leads to more consumer satisfaction than strawberry milk. One way to test such a hypothesis would be to recruit participants, allow each to self-select a flavor, and measure subsequent satisfaction. An alternative approach would be to recruit a second group, serve each participant a flavor by random assignment, and measure subsequent satisfaction. Consider that chocolate is generally popular but not universally enjoyed by all. If so, the randomized trial may still show positive results in favor of chocolate; however, the magnitude of relative benefit would be attenuated by the subgroup of participants who were assigned to chocolate but who would have preferred strawberry. An accurate estimate of flavor preferences requires some studies based on self-selection and not just randomized assignment. From the Department of Medicine, Brigham and Women’s Hospital, Institute for Clinical Evaluative Sciences in Ontario, Canada (JAU) and the Institute for Clinical Evaluative Sciences, Clinical Epidemiology Program, Sunnybrook Health Sciences Centre Department of Medicine, University of Toronto, Canada (DAR).

Use of equipment and respite services and caregiver health among Australian families living with Rett syndrome

This study assessed factors that could influence equipment and respite services use among Australian families caring for a girl/woman with Rett syndrome and examined relationships between use of these resources and the health of female caregivers. Data was sourced from questionnaires completed by families ( n = 170) contributing to the Australian Rett Syndrome Database in 2004 and 2006. Regression analysis was used to assess relationships between child factors (age, mobility, clinical severity and behaviour), family factors (accessibility and socio-economic factors) and the use of equipment and respite services in 2004, and relationships between resource use in 2004 and health of female caregivers as measured by the SF-12 in 2006. In 2004, the majority (88.3%) of families used at least one piece of equipment with more equipment use associated with greater mobility restrictions. Home respite services were used by 54.9% of families and overnight respite services by 47.6% of families. Use of more home respite services was associated with severely restricted levels of mobility and mothers having a vocational or university qualification. Use of more overnight respite services was associated with increasing age of the girl/woman with Rett syndrome and mothers being employed while use of less overnight respite services was associated with increasingly difficult behaviours in the girl/woman. In 2006, female caregivers had a mean mental health score of 41.1 (95% CI 38.9–43.3) and no relationships with previous resource use were identified. The mean physical health score of female caregivers was 48.7 (95% CI 46.8–50.5) and lower scores were associated with the use of equipment and overnight respite services. Equipment was a widely used resource whereas respite services, particularly overnight services, were used less widely. Further investigation of the reasons for this and alternative support strategies is indicated.

Injuries and the Quality of Life of Collegiate Athletes: A Pilot Study

Purpose: To explore the relationship between injury severity and athletes’ quality of life, as well as the role of cognitive appraisal during participation restrictions. Method: A descriptive quantitative survey research design was used. Ten NCAA Division III athletes completed two self-report instruments: the SF-12v2TM Health Survey and a scale that ranked injury severity based on time-loss from sport. Results: Data analysis yielded three main findings: (a) mean mental health scores were lower than mean physical health scores in all injury severity categories; (b) three participants had higher mental than physical health scores; and (c) only four scores were beyond the range of average health by SF-12v2TMstandards. Conclusions: While no definitive relationship between injuries and quality of life was found, results suggested that injuries have greater psychological implications than physical implications, that the recovery process is unique for each individual, and that the SF-12v2TM may not be the most optimal instrument for this context. The findings of this study were consistent with that of the literature, which states cognitive appraisal has a significant role in the experience of injuries and participation restrictions; thus, athletes need to be treated holistically in order for them to achieve full recovery and increase their quality of life.

Specialist nursing interventions for inflammatory bowel disease

The number, type and roles of specialist nurses dedicated to the care and management of patients with inflammatory bowel disease is increasing. Despite this increase, there has been little evidence to date to demonstrate the effectiveness of specialist nursing interventions. This review aims to identify and evaluate the impact of specialist nursing interventions on management of inflammatory bowel disease, access to treatment, remission, morbidity and quality of life. To identify and evaluate the impact of specialist nursing interventions for improving the care and management of patients with inflammatory bowel disease (IBD). A comprehensive search of databases including the Cochrane Library, MEDLINE, and British Nursing Index was carried out to identify trials. References from relevant papers were searched and hand searching was undertaken of relevant publications including gastroenterology conference proceedings to identify additional trials (date of last search 30 September 2008). Randomised controlled trials, controlled before and after studies and interrupted time series studies of gastroenterology and IBD specialist nurses intending to improve access and outcomes for patients with ulcerative colitis and Crohn's disease were considered for inclusion. Two investigators independently extracted data and assessed trial quality. Any discrepancies were resolved by consensus. One randomised controlled trial of 100 IBD patients receiving a specialist nurse delivered counselling package (n = 50) or routine outpatient clinic follow-up (n = 50), with assessments at entry and six and 12 months, was included in this review. This study was of low methodological quality. Disease remission, patient compliance, clinical improvement, utilisation of nurse-led services, patient satisfaction, hospital admission, outpatient attendance, progression to surgery, length of hospital stay and cost effectiveness data were not reported. Pooled mean mental health scores at 6 months were higher in patients who received nurse-led counselling compared to patients who received routine follow-up. However, this difference was not statistically significant (WMD 3.67; 95% CI -0.44 to 7.77; P = 0.08). Other pooled assessments of physical and psychological well-being showed no statistically significant differences. Although specialist nurse counselling interventions might provide benefit for IBD patients the one included study was of low quality and the results of this study should be interpreted with caution. Higher quality trials of gastroenterology and IBD specialist nursing interventions are needed to assess the impact of specialist nursing interventions on the care and management of patients with inflammatory bowel disease.

Long-Term Subjective and Objective Outcome After Primary Repair of Traumatic Facial Nerve Injuries

Although traumatic facial nerve paralysis is a severe handicap, there are no follow-up studies evaluating outcome after primary repair of traumatic facial nerve injuries. From May 1988 to August 2005, 27 patients (mean age, 27 years) were operated for traumatic facial nerve lesions (mean number of affected branches, 2.2). End-to-end facial nerve repair was always performed. All patients were invited to our outpatient clinic for standardized questionnaires (Facial Disability Index, Short Form-36 Health Survey), physical examination (Sunnybrook Facial Grading System), and clinical photographs. Sixteen patients participated in the follow-up study (mean, 9.2 years). Mean Facial Disability Index Physical and Social scores were 86 and 81, respectively, indicating good subjective facial functioning. The mean Sunnybrook Facial Grading System score was 74 indicating adequate facial functioning. Mean physical and mental health scores (Short Form-36 Health Survey) were comparable with normative data. Primary end-to-end repair of traumatic facial nerve injuries results in good long-term objective and subjective functional and emotional outcome.