MOS 36-Item Short-Form Health Research Articles

Teaching ethics and medical conduct in developing countries under unstable political conditions

This study examined the association of various clinical features of obsessive-compulsive disorder (OCD) with quality of life (QoL) in 102 adults with a principal diagnosis of OCD. Participants were assessed by trained clinicians using the Anxiety Disorders Interview Schedule 4th edition, the Yale-Brown Obsessive-Compulsive Scale, and an unstructured clinical interview. Subjects completed the MOS-36 Item Short Form Health Survey, and Beck Depression Inventory-II. Obsessive-compulsive symptom severity was negatively correlated with emotional health, social functioning and general health QoL. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Additionally, interference of obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Resistance against obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and social functioning QoL. Diminished QoL is present in persons with OCD and is essential in understanding the complete clinical picture of OCD.

Integrated treatment of male and female desire disorders

This study examined the association of various clinical features of obsessive-compulsive disorder (OCD) with quality of life (QoL) in 102 adults with a principal diagnosis of OCD. Participants were assessed by trained clinicians using the Anxiety Disorders Interview Schedule 4th edition, the Yale-Brown Obsessive-Compulsive Scale, and an unstructured clinical interview. Subjects completed the MOS-36 Item Short Form Health Survey, and Beck Depression Inventory-II. Obsessive-compulsive symptom severity was negatively correlated with emotional health, social functioning and general health QoL. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Additionally, interference of obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Resistance against obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and social functioning QoL. Diminished QoL is present in persons with OCD and is essential in understanding the complete clinical picture of OCD.

Neurobiology and treatment of cocaine dependence

This study examined the association of various clinical features of obsessive-compulsive disorder (OCD) with quality of life (QoL) in 102 adults with a principal diagnosis of OCD. Participants were assessed by trained clinicians using the Anxiety Disorders Interview Schedule 4th edition, the Yale-Brown Obsessive-Compulsive Scale, and an unstructured clinical interview. Subjects completed the MOS-36 Item Short Form Health Survey, and Beck Depression Inventory-II. Obsessive-compulsive symptom severity was negatively correlated with emotional health, social functioning and general health QoL. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Additionally, interference of obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Resistance against obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and social functioning QoL. Diminished QoL is present in persons with OCD and is essential in understanding the complete clinical picture of OCD.

The Effect of Auditory Stress on Perception of Intraesophageal Acid in Patients With Gastroesophageal Reflux Disease

Most patients with gastroesophageal reflux disease (GERD) report that stress exacerbates their symptoms, yet mechanisms underlying this association remain unknown. We sought to determine the effect of an acute laboratory stressor on perceptual and emotional responses to intraesophageal acid perfusion in healthy controls and patients with GERD. Forty-six patients with heartburn and 10 healthy controls underwent upper endoscopy and, if negative, pH monitoring. Assessment of psychologic factors and health-related quality of life was done by a questionnaire. Perceptual and emotional responses to intraesophageal acid at baseline, during auditory stress, and during an auditory control condition were determined using a randomized crossover design. Plasma levels of norepinephrine, adrenocorticotropic hormone, and cortisol were assessed. Twenty-nine subjects were identified as nonerosive reflux disease and 17 as erosive esophagitis. Quality of life, psychologic profile, and personality assessment variables were similar among the 2 patient groups and the controls. There was a significant reduction in mean lag time to initial symptom perception and an increase in mean intensity rating and mean acid perfusion sensitivity score in the 2 patient groups during the stress period, which was not seen during the control condition. Healthy controls demonstrated lack of a significant change in all parameters of stimulus response functions to acid, regardless of condition. Acute auditory stress can exacerbate heartburn symptoms in GERD patients by enhancing perceptual response to intraesophageal acid exposure. This greater perceptual response is associated with greater emotional responses to the stressor.

Factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women

Objectives The aim of this study was to investigate factors associated with menopausal symptoms and their relationship with the quality of life among Turkish women. Methods This is a cross-sectional study and included 886 women. Data were collected with a questionnaire including questions about demographics and independent variables tested, the Menopause Symptom Checklist and The MOS 36-Item Short Form Health Survey. Results The mean age of the women included in the study was 48.62 years (standard deviation (S.D.) = 5.75, range: 40–60 years). Of all women, 32.1% were premenopausal, 23.9% perimenopausal and 44.2% postmenopausal. Stepwise multiple regression analyses, performed to determine factors associated with menopausal symptom score, revealed 12 statistically significant variables which increased the strength of the model. These variables were as follows in the order of their contribution to the strength of the model: health problems, recent life stresses, being a primary school graduate, absence of relaxation methods, number of pregnancy, financial problems, tea consumption, inadequate and unbalanced nutrition, coffee consumption, age, being a secondary school graduate and dissatisfaction in marriage. Besides, there was a significant and moderately negative relation between total menopausal symptom scores and quality of life scores. Conclusions A large number of factors were associated with experiencing menopausal symptoms and menopausal symptoms had negative effects on the quality of life among Turkish women. Stress management and health promoting practices should be incorporated into menopausal care programs to improve health and quality of life of middle-aged women.

The perceived burden among Chinese family caregivers of people with schizophrenia

The aim of this study was to examine the level of perceived burden of the Chinese families caring for a relative with schizophrenia and to test its associations with their demographic characteristics, social and family factors and health condition. Despite the increased demands on family members to provide care for patients with schizophrenia in community care, little is known about the level of family burden among these family caregivers and its relationship with their demographic, social and cultural backgrounds. This was a cross-sectional descriptive study. A total of 203 family caregivers were recruited from three regional psychiatric outpatient clinics in Hong Kong. They were asked to complete a set of well-validated questionnaires, consisting of the Chinese version of four instruments - Family Burden Interview Schedule, Family Assessment Device, Six-item Social Support Questionnaire and MOS 36-Item Short Form Health Survey and a socio-demographic data sheet. Statistical analyses were conducted to test the differences in mean burden scores between subgroups, the inter-relationships among the mean scores of the scales and socio-demographic variables and the predictors of family burden. The families who perceived a higher level of caregiver burden were those who lived in a family with poorer functioning, worse health status and less satisfaction of social support. The caregivers' burden score was positively correlated with their age; conversely, it was negatively correlated with their monthly household income and number of family members living with patient. Social support was the best predictor of caregiver burden. These findings increase our understanding about the socio-demographic and cultural variables influencing the well being of family caregivers of a relative with schizophrenia. Helping families to maintain and enhance a supportive social network may represent a useful means to reduce family burden in schizophrenia. This understanding helps health professionals and researchers to identify different sources and domains of burden from a Chinese cultural perspective and take into account of these factors when planning interventions for family caregivers.

Burnout in health care providers of dialysis service in Northern Italy a multicentre study

Few data are available regarding the prevalence of burnout among dialysis health care workers. Aims of the present study were to assess and compare burnout levels in a sample of nurses and physicians working in dialysis units, and to investigate their relationships with quality of life, in a cross-sectional observational study. A total of 344 workers from 10 dialysis centres in Northern Italy completed a battery of questionnaires including the Maslach Burnout Inventory, the MOS-36 Item Short Form Health Survey [SF36: physical (PCS) and mental (MCS) component scores] and the 30-item General Health Questionnaire (GHQ30). Data on social and demographic characteristics and working conditions were also collected. General Estimating Equations models were used for the analysis. Overall, burnout scores were lower than the Italian normative sample, with no significant differences between physicians and nurses. However, 30% of nurses had high emotional exhaustion vs 18% of physicians (adjusted OR 2.38, P = 0.003). Emotional exhaustion was also predicted by number of worked hours and months worked in dialysis in the previous 2 years. Depersonalisation was predicted by male gender and bad relationship with coworkers. Having no children and having a permanent hospital position predicted low personal accomplishment. PCS was lower in nurses (50.0 vs 53.3, P < 0.001), while no significant difference was found for MCS and GHQ30. Lower PCS was associated with emotional exhaustion (P = 0.007) and GHQ30 > 5 with depersonalization (P = 0.032). Although burnout is not a general problem in dialysis health care providers, a subgroup of them may be identified, who would benefit from supportive measures to prevent this condition. Nurses appeared more burned-out in the emotional exhaustion scale than physicians.

Effects of insulin vs. glibenclamide in recently diagnosed patients with type 2 diabetes: a 4‐year follow‐up

To compare effects of early insulin vs. glibenclamide treatment on beta-cell function, metabolic control and quality of life (QL) in recently diagnosed patients with type 2 diabetes. Forty-nine patients with type 2 diabetes diagnosed 0-2 years before inclusion were randomized to two daily injections of premixed 30% soluble and 70% NPH insulin or glibenclamide at six diabetic clinics in Sweden. C-peptide-glucagon tests were performed yearly after 3 days of withdrawal of treatment. Thirty-four patients completed 4 years of study. Daily dose of insulin was increased from 20.4 +/- 1.8 U at year 1 to 26.1 +/- 2.9 U at year 4 (p = 0.005). Glibenclamide dosage increased from 2.7 +/- 0.4 mg at year 1 to 4.5 +/- 0.8 mg at year 4 (p = 0.02). Weight increased more in insulin than in glibenclamide treated (+4.4 +/- 0.8 vs. +0.3 +/- 1.0 kg, p < 0.005). Following short-term withdrawal of treatment, the C-peptide responses to glucagon were significantly higher in the insulin vs. glibenclamide group at years 1 (p < 0.01) and 2 (p < 0.02). HbA1c improved identical during the first year but thereafter deteriorated in the glibenclamide group (p < 0.005 for difference at year 4). Ratios of proinsulin to insulin were higher during treatment in glibenclamide- vs. insulin-treated patients after year 2. QL after 4 years as measured by the MOS 36-item Short-Form Health Survey (SF-36) form was not significantly altered. In a 4-year perspective, beta-cell function deteriorated in both groups. However, deterioration occurred faster in the glibenclamide group, indicating that alleviating demands on secretion by insulin treatment is beneficial.

太極拳運動実施高齢者の健康関連QOL―同年代国民標準値との比較―

We assessed health-related quality of life (HRQOL) of community-dwelling older people who practiced Tai Chi in a cross-sectional study using the MOS 36-item short-form health survey (SF-36, Japanese version). SF-36 and another questionnaire about age, sex, experience with Tai Chi, were distributed to 903 people who were above 65 years old and belonged to the Japan Health Tai Chi Association. Of these, 804 people responded (89.04%). From the SF-36, we used the sub-scores for physical functioning (PF), physical role (PR), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). These sub-scores were compared with those obtained from age-matched national standards for groups 60 to 69 years old and 70 to 80 years old respectively (n=1.040). The 60- to 69-year-old subjects had significantly higher PF (p<0.01), GH (p<0.05), and MH (p<0.01) than the national averages. For the 70- to 80-year old subjects, PF (p<0.01), PR (p<0.01), BP (p<0.05), GH (p<0.01), VT (p<0.01), RE (p<0.01), and MH (p<0.01) were significantly higher than the national averages. The number of years and the frequency of practicing Tai Chi statistically significantly correlated with MH and PF, and GH and PF, respectively. The HRQOL of the people who practiced Tai Chi was better than age-matched national standards. Although the number of years and the frequency of practicing Tai chi statistically significantly correlated with the sub-scores of the HRQOL, the adjusted (R(2)) were low.

Multidisciplinary Congestive Heart Failure Clinic for Older Women: A Randomized Controlled Trial

Objectives: To determine whether a multidisciplinary clinical pathway, a blueprint of the patient care processes for female patients over age 65, will improve patients' quality of life and functional capacities in comparison to usual care for CHF. Design: A randomized controlled trial. The intervention consisted of a series of 12 visits over 6 weeks to optimize medical care, and to engage in an exercise program with strong educational, counseling and dietary management, involving physician, nursing, dietary, physiotherapy, pharmacy, occupational therapy and social work. Setting: Patients were referred from the Ottawa Hospital and the community with a diagnosis of CHF and were screened to ensure they met the eligibility criteria. Participants: Ninety-one community dwelling women aged 63 to 89 with the diagnosis of CHF were enrolled in this study. Measurements: The primary outcome measure was the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The secondary outcome measures included the MOS 36-Item Short-Form Health Survey (SF-36), the Folstein Mini-mental State Examination (MMSE), the 15 item Geriatric Depression Scale (GDS), the Physical Self-Maintenance Scale (PSMS), and survival and health service utilization over 6 months. Results: There was no difference between the two groups in MMSE or GDS scores by the end of six weeks cycle. Comparison of change from baseline MLHFQ score, including physical and emotional components, did not show a difference (P < 0.470). There was also no difference between the two groups in functional outcome as measured by change from baseline PSMS score (P < 0.321). The treatment group had a tendency to more ER visits (for all reasons and for CHF) and hospitalizations. The treatment group had significantly more cardiologist visits during the study period (P < 0.0001). Conclusion: It is feasible to conduct a randomized study in a frail community-based older female population and to test a complex multidisciplinary pathway. Future studies should provide further insight into the optimal intensity and duration of heart failure management programs, and which patients derive the greatest benefit.

Impact of chronic disease on quality of life in the Bella Coola Valley

North American rural residents have higher rates of chronic disease and they report being ill more frequently compared to their urban counterparts. We recently studied health-related quality in residents living in the isolated, rural community of Bella Coola, Canada. To assess health-related quality of life parameters in adults suffering from chronic disease and living in the rural, remote community of Bella Coola. Design, mixed methods: (1) mailed health-related survey; (2) retrospective chart review. people aged 17 years and older living in the Bella Coola Valley and having a chart at the Bella Coola Medical Clinic as of September 2001 were asked to complete a detailed health-related quality of life survey during the period August to December 2001. demographics (age, sex, weight [BMI], ethnicity). Health-related quality of life was measured using the MOS 36-item Short Form Health Survey (SF-36), and the US Centers for Disease Control healthy day's items. Chronic diseases studied included diabetes mellitus, hypertension, chronic obstructive lung disease, coronary artery disease, hyperlipidemia, depression/anxiety, cancer, osteoarthritis, inflammatory arthritis and chronic back/neck pain. Response rate to the survey was 38% (675/1770). Compared to total clinic population relatively more female (57% vs 49%), non-Aboriginal (63% vs 57%) and older people (48.9 vs 43.5 years) answered the survey. The most prevalent chronic diseases among the survey respondents were hypertension (17%), depression/anxiety (13%), hyperlipidemia (11%), chronic back/neck pain (11%), and osteoarthritis (9%). Linear regression analysis was performed for each of the SF-36 domains and CDC healthy day items. The presence of chronic disease is associated with significant differences in HRQOL item scores and the greater the number chronic diseases present the worse the HRQOL item scores. People living in the rural remote community of Bella Coola who have chronic disease experience significant impairment in their health-related quality of life. The greater the number of coexisting chronic diseases a person has, the more likely that poor HRQOL scores will be reported.

Estudo da qualidade de vida em pessoas com lesão medular traumática

Centers of research all over the world are accomplishing studies about quality of life in several chronic conditions, for promoting interventions that promote improvement. This fact extends to spinal cord injury patients. This is a study with the aim of evaluating the quality of life of traumatic spinal cord injury people in the city of Fortaleza, Ceará, Brazil. Participating in the study, 32 paraplegic adult patients with complete traumatic spinal cord injury; most were male, aged 20 to 47 years old and 5 to 10 years of lesion. The instrument used for collection of data was The MOS 36-item Short-Form Health Survey. As results we found that the traumatic spinal cord injury patient possesses great compromising of the quality of life, in all your domains, mainly in what it refers to the "social aspects".

HEALTH-RELATED QUALITY OF LIFE IN MYOTONIC DYSTROPHY TYPE 1 AND ITS RELATIONSHIP WITH COGNITIVE AND EMOTIONAL FUNCTIONING

To evaluate the health-related quality of life in myotonic dystrophy type 1 and its relationships with clinical, genetic, neuropsychological and emotional factors. Case-control study of a continuous series of patients with myotonic dystrophy type 1. Twenty patients, and 20 age-, sex- and education-matched healthy controls underwent the MOS 36-Item Short-Form Health Survey (SF-36), an extensive neuropsychological battery and emotional functioning tests. Patients' SF-36 mean scores were lower than those of controls in all dimensions. The neuropsychological study showed a significant impairment in visuospatial and verbal abstract reasoning (p=0.001), visuospatial memory (p=0.002) and attentive functions (p=0.03) in patients with myotonic dystrophy type 1. The emotional assessment showed significantly high scores in anxiety (p=0.002) and depression (p=0.001), which occurred in approximately 50% of patients. Both physical and mental SF-36 areas were inversely correlated with age, duration and grade of disease, depression and anxiety and positively correlated with attentive control. SF-36 areas were not correlated with cytosine thymine guanidine expansion. Health-related quality of life is severely impaired in myotonic dystrophy type 1 and it is negatively influenced by severity and duration of disease as well as by specific cognitive deficits and changes in emotional functioning. Therapeutic intervention in this field could contribute to ameliorate health-related quality of life in myotonic dystrophy type 1.

Dolor neuropático central y su relación con la calidad de vida de una persona portadora de una lesión medular traumática

To conduct an exploratory cross-sectional study carried out in the city of Fortaleza (Ceara, Brazil) with the aim of evaluating the relation between central neuropathic pain and the quality of life in individuals with central neuropathic pain due to traumatic injury. The study examined the cases of 17 adult paraplegic patients with complete traumatic injuries, mainly due to perforations caused by gunshot wounds. The sample was divided into two groups: 1) those with pain, and 2) those with intense pain (more than 20 points according to McGill and eight on the numerical visual scale). The instruments used were the following: the MOS 36-item Short-Form Health Survey (SF-36) and the McGill pain questionnaire, oriented towards the descriptors and the numerical visual scale. The quality of life of patients with central neuropathic pain due to a spinal cord injury is greatly compromised and when the pain is intense the quality of life is even more effected, especially in the following areas: "functional capacity" (p = 0.005), "general state of health" (p = 0.003), "mental health" (p = 0.035), "social aspects" (p = 0.006) and "pain" (p = 0.003). The quality of life in patients with neuropathic pain due to a traumatic spinal cord injury is severely compromised and the more intense this pain is, the greater its effect on the quality of life will be. It can also be stated that the instruments used were valid for this type of patients (in spite of certain shortcomings) given the complexity and subjectivity of the matter.

Understanding relationships between diabetes mellitus and health-related quality of life in a rural community

There is a lack of information on health-related quality of life (HRQOL) for Aboriginal diabetic people. To investigate HRQOL among aboriginal diabetics living in an isolated, rural Canadian community. Mixed methods: (1) A mailed health-related survey; and (2) a population based retrospective chart review. People aged 17 years and older living in the Bella Coola Valley, British Columbia, Canada, and having a chart at the Bella Coola Medical Clinic as of September 2001 were asked to complete a detailed HRQOL survey during the period August to December 2001. Demographics (age, sex, ethnicity). Health-related quality of life was measured using the MOS 36-item Short Form Health Survey (SF-36), and the US Centers for Disease Control healthy day's items. Relatively greater percentages of diabetic people (n = 72 [57%]) completed the survey than did non-diabetics (n = 675 [37%]). Mean scores for Aboriginal people were lower/poorer than mean scores for non-Aboriginal people in all the quality of life questions. Mean scores for diabetic people were lower than mean scores for non-diabetics in all the quality of life questions. Aboriginal diabetics reported the worst scores on almost all of our quality of life questions. Rural diabetics experience significant impairment in their health-related quality of life. Among rural diabetics, Aboriginals report the worst HRQOL scores. Compared with other people, Aboriginals fare worse in HRQOL, which may explain the difference.

Survey on the quality of life of married child-bearing age women

目的 探讨已婚育龄妇女生命质量状况.方法应用MOS SF-36健康调查量表对550名已婚育龄妇女进行问卷调查.结果文化程度不同的已婚育龄妇女生理机能和生理职能差异具有统计学意义,小学文化程度者生理机能分值较高(95.8±10.0)分,而生理职能得分较低为(73.5±40.3)分(P＜0.05);丧偶者生理职能、精力、精神健康状况较差(P＜0.05)分别为(75.0±25.0)分,(52.1±20.9)分,(59.4±28.3)分;干部身份的已婚育龄妇女生理机能状况较差(P=0.00),而情感职能、生理职能两维度状况较好(P＜0.05).已婚育龄妇女的生命质量与其对生活现状的满意程度及自身年龄密切相关.结论年龄、职业、文化程度、婚姻状况、对生活的主观感受均是育龄妇女生命质量的影响因素。

Incorporation of Fasting Therapy in an Integrative Medicine Ward: Evaluation of Outcome, Safety, and Effects on Lifestyle Adherence in a Large Prospective Cohort Study

The aim of this study was to implement fasting therapy in an inpatient integrative medicine ward and to evaluate safety, acceptance, and effects on health-related outcomes and lifestyle adherence. This was a prospective observational study with consecutive inpatients over 3 [corrected] years. Inclusion and exclusion criteria for fasting therapy were checked by treating physicians and recommendations given. After receiving full information patients decided whether they would participate in fasting. Outcomes were assessed on admission, at discharge, and 3 and 6 months after discharge. The study took place in an integrative medicine department of an academic teaching hospital. Subjects were newly admitted inpatients with chronic internal diseases and chronic pain syndromes, with lengths of hospital stay of >3 days. All patients received intensive integrative treatments including Mind/Body Medicine, acupuncture, nutritional/lifestyle education, and hydrotherapy. Fasting patients participated in a 7-day juice fast (intake <350 kcal/day) with accompanying bowel cleansing, 2 prefasting relief days, and 3 days with stepwise reintroduction of food. Outcomes were assessed based on rate of participation in fasting, severity of main complaint, quality of life (QOL, MOS 36-Item Short-Form Health Survey), safety, lifestyle adherence to recommendations given (relaxation, diet, exercise). Of 2121 patients with complete discharge questionnaires, 952 patients participated in fasting, 873 had a normocaloric vegetarian diet, and 296 patients had other diets and were excluded. Response rates were 71% and 56% at 3- and 6-month follow-up. The main disease-related complaint at discharge was significantly greater improved in fasters versus nonfasters (p < 0.01). Patient QOL increased significantly and comparably from baseline to discharge in both groups. Fasting was well tolerated and no serious fasting-related adverse effects were reported. In all, 743 (78%) of fasting patients reported improvement of their health through fasting. Descriptors of lifestyle adherence showed higher levels of related activities in the 3 and 6 months of follow-up. Fasting can safely and successfully be implemented in an inpatient integrative medicine concept and is perceived as a health-promoting method by the majority of patients. Potential effects on disease-related complaints and lifestyle adherence should be further evaluated in randomized trials.

Treating Radiculopathy with an Indwelling Epidural Catheter and Infusion Pump

For the purpose of reducing inflammation causing radiculopathy, lumbar transforaminal and interlaminar epidural injections deliver corticosteroid to the vicinity of the spinal nerve, nerve roots, and intervertebral disc. Although acceptable, the efficacy of transforaminal injections is limited and variable. An indwelling epidural catheter offers the distinct advantages of delivering greater concentrations of corticosteroid directly to the site of pathology, over an extended duration. This extended exposure to corticosteroid may benefit the site of pathology. To evaluate the safety and efficacy of corticosteroid administered through a disposable indwelling epidural catheter and infusion pump to treat pain and dysfunction caused by lumbosacral radiculopathy. A pilot investigation consisting of a prospective consecutive series of 10 patients, conducted in a specialty hospital. An indwelling epidural catheter dispensed corticosteroid into the epidural space at the suspect level of pathology. The catheter was attached to an external, lightweight, spring-pressurized, and disposable reservoir pump holding 8.0 mg dexamethasone diluted with bacteriostatic normal saline to a total volume of 72 ml. After each patient's hospital discharge, the medication was administered into the epidural space at a rate of 1 ml per hour over a 72-hour period. Follow-up at six weeks was achieved in 100% of the patients. The outcome measures, recorded at pre-treatment and six weeks post-treatment were assessed using: the Visual Analog Scale (VAS); MOS 36-Item Short-Form Health Survey (SF-36); Pain Symptoms Survey; Oswestry Disability Index; Beck Inventory; Work History Survey; Work Index; Expectations Met Survey; Activities of Daily Living Form; and the Satisfaction With Treatment Form. There was no patient morbidity or mortality associated with this treatment, and patients, on average, experienced decreased pain levels after treatment. Mean delta VAS improvement was 4.1 (SD = 2.6, R =-9.6 to +1.5). The mean percent improvement was 46.7%. Safe and effective treatment of lower extremity radiculopathy symptoms may be obtained with this new method.

The role of pre‐operative state‐anxiety in the determination of intra‐operative neuroendocrine responses and recovery

The psychophysiological model of adjustment to surgery predicts associations between (1) heightened pre-operative state-anxiety and intra-operative neuroendocrine responses, (2) neuroendocrine responses and complications; and (3) heightened pre-operative state-anxiety and post-operative recovery. The present study examined these associations. Participants were 39 patients (mean age 71.9+/-6.1 years) undergoing elective carotid endarterectomy surgery under local anaesthesia. In the week prior to surgery, patients completed baseline measures of physical and mental functioning using the MOS 36-item Short-Form Health Survey (SF-36). In addition to this, they undertook a 24-hour urine save to measure cortisol and catecholamines. Measures of state-anxiety were completed on the evening prior to surgery. A second 24-hour urine save was started at the time of anaesthetic induction. Follow-up measures of physical and mental functioning were completed 1 month following surgery. All complications were recorded during hospitalization. There was a significant negative association between pre-operative state-anxiety and intra-operative cortisol (r=-.52, p<or=.001). Using hierarchical regression analysis, pre-operative state-anxiety accounted for 10% of the variance in intra-operative cortisol responses after controlling for medical and demographic factors. There were no significant associations between neuroendocrine responses and complications. Pre-operative state-anxiety was a significant determinant of poorer mental functioning following surgery, explaining 10% of the variance in scores after adjusting for baseline mental functioning. Results from this study show increasing pre-operative anxiety to be associated with lower intra-operative cortisol responses and poorer mental functioning 1 month following surgery.

Health-related quality of life (HRQOL) in Japanese osteoporotic patients and its improvement by elcatonin treatment

Health-related quality of life (HRQOL; "QOL" hereafter) was evaluated in Japanese osteoporotic patients using three questionnaires; the SF-36 (MOS 36-Item Short-Form Health Survey; generic, profile-type), the EQ-5D (Euro Qol-5 Dimensions; generic, preference-based), and the JOQOL (Japanese Osteoporosis Quality of Life 1999; disease-targeted). The eight subscales and two summary scores of the SF-36 were impaired in these patients even after correction for age and sex. The scores on the EQ-5D and JOQOL correlated well with the subscales of the SF-36 that represent the physical aspects of physical function and bodily pain, which suggests that physical aspects are important determinants of overall QOL status in osteoporotic patients. Although the QOL scores did not correlate with bone mineral density, they were markedly influenced by the presence of vertebral fractures. In particular, the presence of two or more vertebral fractures greatly decreased the QOL scores. We then evaluated the QOL scores before and after treatment. The patients were either given calcium supplementation alone or calcium plus once-weekly elcatonin (Elcitonin, Asahi Kasei Pharma, Tokyo, Japan) injection. Elcatonin treatment markedly improved diverse aspects of the QOL, whereas calcium alone did not. The current data suggest that osteoporosis, especially in the presence of vertebral fracture, is associated with compromised QOL, and therapeutic intervention for osteoporosis should be evaluated in terms of QOL, as well as in terms of increases in bone mineral density and fracture prevention.