SF-36 Emotional Well-being Research Articles

Relationship between Physical Activity Levels, Quality of Life, and Sociodemographic Attributes among Adults in Tabuk, Saudi Arabia: A Direction toward Sustainable Health

Physical activity (PA) improves quality of life (QOL), yet the relationship between PA, QOL, and sociodemographic factors in Saudi Arabia remains underexplored. This study examined this relationship among 369 adults from Tabuk City, Saudi Arabia. The questionnaire measured PA levels and QOL using the Arabic versions of the International Physical Activity Questionnaire and the 36-item Short-Form Health Survey (SF-36), respectively. Data analyses included chi-square, Mann–Whitney U, and Kruskal–Wallis H tests alongside a multivariate regression analysis. Among the SF-36 scores, marital status (p = 0.005), history of chronic diseases (p = 0.004), and medication use (p = 0.001) showed significant differences; pain (80.6 ± 21.5) and energy/fatigue (63.0 ± 18.5) scored highest and lowest, respectively; and sex was significantly associated with PA levels (p = 0.001). The average total SF-36 score was 69.5 ± 15.7, and 42.5% of participants reported low PA. Participants with moderate PA had significantly higher SF-36 scores (p = 0.003), energy/fatigue (p < 0.0001), emotional wellbeing (p = 0.009), and general health (p = 0.004) scores compared with those with low PA. The significant association between PA and QOL underscores the need for sustainable health programs to enhance and maintain PA in alignment with the Saudi Vision 2030 QOL program. It can also inform the development of targeted interventions to enhance PA levels and improve QOL aspects within communities, considering specific sociodemographic attributes to ensure effectiveness and inclusivity.

LOWER INCOME IN CAREGIVERS PREDICTS LESS EMOTIONAL WELL-BEING IMPROVEMENT AFTER CAREGIVING ENDS

Abstract Lower income in familial caregivers has been shown to associate with increased distress, depression, and burden during active caregiving. However, findings are less clear on whether lower income associates with changes in well-being that occur after caregiving ends. To investigate this question further, we recruited familial caregivers (CGs) of people with neurodegenerative diseases (PWD; N=36). Emotional well-being was assessed using the SF-36 Emotional Well-being and Energy scales both during active caregiving and after caregiving had ended (predominantly due to the PWD’s death or transition to institutional care, ~10 years later). Household income was measured after active caregiving had ended. Overall, CG’s emotional well-being and energy improved between active caregiving and after caregiving had ended (emotional well-being change: t(35) = 2.22, p = .033; energy change: t(35) = 2.88, p = .007). However, this improvement associated with household income, such that when controlling for levels during active caregiving, income associated with worse emotional well-being (B = -6.72, t(33) = -4.56, p < .001) and energy (B = -8.07, t(33) = -4.99, p < .001) in caregivers after caregiving had ended. During the adjustment period after caregiving ends, lower income may limit opportunities for caregivers to take time away from work to mourn the loss of their loved one or address their own health concerns adequately. Thus, low-income caregivers may experience fewer of the benefits associated with these activities. These findings underscore the importance of providing support for lower income caregivers during the critical period after caregiving ends.

The development of the Therapeutic Group Context Questionnaire: Reliability and validity measures based on telehealth Group-based Pain Management Programs

Introduction In 2016, the Centers for Disease Control and Prevention analyzed the National Health Interview Survey data and found that the occurrence of chronic pain and high-impact chronic pain in the USA was 20.4% and 8%, respectively. Group-based Pain Management Programs have been viewed as significant treatments aiding patients with self-management of chronic pain. The onset of coronavirus disease 2019 (COVID-19) at the beginning of 2020, widely eliminated the in-person Group-based Pain Management Programs. The exploration of therapeutic contextual factors such as the therapeutic alliance and group dynamics in telehealth Group-based Pain Management Programs appears warranted for which reason the Therapeutic Group Context Questionnaire was developed. Methods The therapeutic alliance and group dynamics items in the Therapeutic Group Context Questionnaire were developed from an extensive literature review and underwent examination of content validity, internal consistency, reliability, and validity through telehealth Group-based Pain Management Programs. Results Content validity of the Therapeutic Group Context Questionnaire was established in five separate stages and the psychometrics of the Therapeutic Group Context Questionnaire was found to be very good with high internal consistency and reliability (r = 0.85–0.97) and the ability of the Therapeutic Group Context Questionnaire to differentiate between high and low scorers on the SF-36 emotional well-being measure. Discussion The examination of therapeutic contextual factors via telehealth Group-based Pain Management Programs using the Therapeutic Group Context Questionnaire appears possible in view of the very good psychometric properties described above. Investigation of therapeutic contextual factors through the Therapeutic Group Context Questionnaire may provide greater insight into the role that these factors may have in telehealth programs and their impact on pain outcomes. Future investigation of the Therapeutic Group Context Questionnaire in non-telehealth Group-based Pain Management Programs, as well as, other disorders being addressed via telehealth appears warranted.

The CARESSES Randomised Controlled Trial: Exploring the Health-Related Impact of Culturally Competent Artificial Intelligence Embedded Into Socially Assistive Robots and Tested in Older Adult Care Homes

This trial represents the final stage of the CARESSES project which aimed to develop and evaluate a culturally competent artificial intelligent system embedded into social robots to support older adult wellbeing. A parallel group, single-blind randomised controlled trial was conducted across older adult care homes in England and Japan. Participants randomly allocated to the Experimental Group or Control Group 1 received a Pepper robot for up 18 h across 2 weeks. Two versions of the CARESSES artificial intelligence were tested: a fully culturally competent system (Experimental Group) and a more limited version (Control Group 1). Control Group 2 (Care As Usual) participants did not receive a robot. Quantitative outcomes of interest reported in the current paper were health-related quality of life (SF-36), loneliness (ULS-8), and perceptions of robotic cultural competence (CCATool-Robotics). Thirty-three residents completed all procedures. The difference in SF-36 Emotional Wellbeing scores between Experimental Group and Care As Usual participants over time was significant (F[1] = 6.614, sig = .019, ηp2 = .258), as was the comparison between Any Robot used and Care As Usual (F[1] = 5.128, sig = .031, ηp2 = .146). There were no significant changes in SF-36 physical health subscales. ULS-8 loneliness scores slightly improved among Experimental and Control Group 1 participants compared to Care As Usual participants, but this was not significant. This study brings new evidence which cautiously supports the value of culturally competent socially assistive robots in improving the psychological wellbeing of older adults residing in care settings.

Comparison of low level laser therapy and extracorporeal shock wave in treatment of chronic lateral epicondylitis.

The aim of this study was to compare the efficacy of extracorporeal shock wave therapy (ESWT) ver-sus low-level laser therapy (LLLT) in treating chronic lateral epicondylitis (CLE). In this prospective study, 52 patients (24 males, 28 females; mean age=48 years; age range=30-70 years) with a diagnosis of CLE were included and randomized into two groups (26 in each group): ESWT group (14 males, 12 females; mean age=48±10 years) or LLLT group (10 males, 16 females; mean age=48±11 years). ESWT was applied for 5 weeks with one session per week, while LLLT was applied with 15 sessions on consecutive days. All patients were evaluated using Disability of the Arm, Shoulder and Hand Questionnaire (DASH), Patient-Related Lateral Epicondy-litis Evaluation (PRTEE), and the 36-Item Short-Form Health Survey (SF-36) before and after the treatments. In the comparison of baseline data between treatment groups, significant differences were observed only in SF-Physical functioning and SF-Energy/fatigue scores (p=0.035 and p=0.038, re-spectively), which were 77.1±17.2 and 56.3±17.2 in ESWT group and 66.5±18.0 and 44.8±21.5 in LLLT group, respectively. In the comparison of post-treatment data between groups, there were sig-nificant differences in all scores (p<0.05) except two subscales of SF-36, which were SF-role limita-tions due to emotional problems (p=0.092) and physical health (p=0.147), respectively. The other subscales of SF-36, PRTEE and DASH scores obtained after the treatments were better in ESWT group than in LLLT group. The comparison of pre-and post-treatment scores in each group revealed significant improvements in all scores (p<0.05), except SF-36 subscales, including energy/fatigue, emotional well-being, social functioning, and general health scores (p>0.05). Evidence from this study revealed that although both treatment modalities were effective in the treatment of CLE, ESWT seemed to more effective in pain relief and functional recovery than LLLT. Level II, Therapeutic study.

Association between pet ownership and physical activity levels, atopic conditions, and mental health in Singapore: a propensity score-matched analysis

Although existing literature increasingly suggests a positive influence of pet ownership on human physical activity levels, results from many European, American, and Japanese studies have been inconsistent. How pet ownership impacts mental health and atopy is likewise controversial and whether distinct demographic subgroups experience differential effects is unclear. This cross-sectional study surveyed participants (n = 823) via a self-administered online questionnaire. Comparisons of outcomes between pet owners and non-pet owners with subgroup analyses were performed within a propensity score-matched subset (n = 566) of respondents. There were no differences in physical activity levels or mental health scores between pet owners and non-pet owners. In subgroup analyses, compared to non-pet owners, main pet caregivers reported 14.1 (95% CI 2.79–25.3) and 19.0 (95% CI 4.70–33.3) more minutes per week of moderate- and vigorous-intensity physical activity respectively and higher SF-36 emotional well-being (β = 2.7, 95% CI 0.100–5.32) and energy scores (β = 3.8, 95% CI 0.410–7.27). Age was a significant effect modifier of the association between pet ownership and emotional well-being, energy and social functioning scores, with greater scores above the ages of 39, 35 and 39 years old respectively (interaction p = 0.043, 0.044, 0.042). Finally, pet acquisition was associated with worsening of allergic rhinitis, while pet ownership cessation was associated with improvement of allergic rhinitis and eczema symptoms. To our knowledge, this is the first study addressing the public health impact of pet ownership in Southeast Asia and its findings add contextual nuance to suggest potential benefits derived from pet ownership.

MP67-17 ASSOCIATION BETWEEN TREATMENT FOR LOCALIZED PROSTATE CANCER AND MENTAL HEALTH OUTCOMES

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP67)1 Apr 2020MP67-17 ASSOCIATION BETWEEN TREATMENT FOR LOCALIZED PROSTATE CANCER AND MENTAL HEALTH OUTCOMES Amy Luckenbaugh*, Daniela Wittmann, Ann Arbor, MI, Zighuo Zhao, Tatsuki Koyama, Li-Ching Huang, Aaron Laviana, Christopher Wallis, Karen Hoffman, David Penson, and Daniel Barocas Amy Luckenbaugh*Amy Luckenbaugh* More articles by this author , Daniela WittmannDaniela Wittmann More articles by this author , Ann Arbor, MIAnn Arbor, MI More articles by this author , Zighuo ZhaoZighuo Zhao More articles by this author , Tatsuki KoyamaTatsuki Koyama More articles by this author , Li-Ching HuangLi-Ching Huang More articles by this author , Aaron LavianaAaron Laviana More articles by this author , Christopher WallisChristopher Wallis More articles by this author , Karen HoffmanKaren Hoffman More articles by this author , David PensonDavid Penson More articles by this author , and Daniel BarocasDaniel Barocas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000947.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management options for localized prostate cancer are similar with respect to intermediate-term survival outcomes and differ with respect to disease-specific functional outcomes. However, little is known about the impact of prostate cancer treatment on mental health. In this context, we evaluated the association between prostate cancer treatment choice and patient-reported mental health outcomes over time. METHODS: We enrolled a population-based cohort of men who underwent active surveillance, surgery or radiation therapy as part of the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study. Depression (using the CES-D score, range 0-27, higher score indicating worse depression) and emotional well-being, energy and vitality (using the SF-36, range 0-100, higher scores indicating better function) were evaluated longitudinally through five years. Patients who did not complete at least one CES-D or SF-36 follow-up survey were excluded from the analysis. Univariate and multivariate analysis were performed to assess factors associated with CES-D and SF-36 scores. RESULTS: Among 1509 (52.4%) patients undergoing radical prostatectomy, 961 (33.4%) undergoing radiation therapy and 409 (14.2%) undergoing active surveillance there were no significant differences in CES-D or SF-36 scores between treated patients and those undergoing active surveillance (Table 1). The most significant predictors of decline in CES-D score included: older age (p=0.0075), poor overall health (p<0.0001), being unmarried (p<0.0195) and lower baseline CES-D score (p<0.0001). Baseline sexual function and urinary control were not correlated with longitudinal CES-D scores. Similar factors were found to be correlated with SF-36 emotional well-being, energy and vitality scores. CONCLUSIONS: Treatment with surgery or radiation was not associated with depression symptoms, or emotional well-being, energy, and vitality scores when compared to active surveillance through five years. Factors associated with development of declining mental health included: older age, being unmarried, poor overall health and lower baseline scores. Further analysis is warranted to determine if post-treatment sexual, urinary and bowel function are associated with longitudinal changes in mental health. Source of Funding: Grants (1R01HS019356 and 1R01HS022640) from the Agency for Healthcare Research and Quality and an award (CE12-11- 4667) from the Patient-Centered Outcomes Research Institute. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1031-e1032 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amy Luckenbaugh* More articles by this author Daniela Wittmann More articles by this author Ann Arbor, MI More articles by this author Zighuo Zhao More articles by this author Tatsuki Koyama More articles by this author Li-Ching Huang More articles by this author Aaron Laviana More articles by this author Christopher Wallis More articles by this author Karen Hoffman More articles by this author David Penson More articles by this author Daniel Barocas More articles by this author Expand All Advertisement PDF downloadLoading ...

The ostomy leak impact tool: development and validation of a new patient-reported tool to measure the burden of leakage in ostomy device users

BackgroundLeakage is a major concern for people who use a stoma, but people’s experience and its impact is not well understood. This study aimed to establish a definition of leakage through clinical and user input. This information was used to develop and validate a new measurement tool to understand the impact of leakage for people using a stoma appliance, in the UK, US, France, and Denmark.MethodsParticipants were recruited from a panel of users, hosted by Coloplast, that includes people who currently use Coloplast products. Six clinicians and 41 users took part in concept elicitation interviews. The qualitative findings were used to draft items. A panel of clinical experts was organized to develop and validate items (N = 6). Cognitive debrief interviews were conducted with five users in each country, which resulted in removing some items and revising the measure. A psychometric validation was conducted with 340 people in four countries whereby participants were asked to complete a series of measures online. Full psychometric analyses including validity and reliability were conducted.ResultsA final tool was established consisting of three domains related to the burden of leakage: “Emotional impact,” “Usual and social activities,” and “Coping and control.” Convergent validity was evaluated by benchmarking to existing health-related quality of life instruments (domains of SF-36 and Ostomy-Q). This showed high correlation between domains of the leakage tool and other measures, in particular for the Emotional impact domain when compared with SF-36 Emotional well-being and Ostomy-Q Confidence domain (p < 0.001). Coping and control correlated moderately well with most PROs tested for except the physical functioning domains, which showed only modest correlation (p < 0.001). Usual and social activities correlated equally well with all domains. Internal consistency was high for Emotional impact and Usual and social activities (> 0.92).ConclusionThe study highlights how users define leakage and its impact in a way that is meaningful to them. This information has been used to develop an instrument to measure leakage which can potentially be used by clinicians and researchers. The instrument demonstrated evidence supporting its reliability and validity as an outcome measure to assess the impact of leakage in stoma care.

Contributors to disease-specific health knowledge in adults with congenital heart disease: A correlational study.

Growth in the adults with congenital heart disease (ACHD) population represents a challenge to the health care infrastructure. As patients with chronic disease are increasingly held accountable for their own care, contributors to disease-specific health knowledge, which are known to correlate with patients' participation in care, merit investigation to design patient-focused interventions. We conducted a single-site, cross-sectional study of ACHD patients. Investigators retrospectively gathered clinical data as well as psychometric and health status assessments completed at the time of enrollment. We investigated the impact of clinical and psychological variables on Leuven Knowledge Questionnaire for Congenital Heart Diseases health knowledge composite scores (HKCS). Variables with significant associations were considered in a stepwise multivariable regression model to determine which combination of variables jointly explained variability in HKCS. Overall HKCS was associated with the number of prior cardiac surgeries (r=0.273; 95% CI: 0.050-0.467; P=.016), perceived stress (r=0.260; 95% CI: 0.033-0.458; P=.024), SF-36 emotional well-being (r = -0.251; 95% CI: -0.451, -0.024; P=.030), history of noncardiac surgery (P=.037), cirrhosis (P=.048), and presence of implantable cardioverter-defibrillator (P=.028). On multivariable modeling, only the number of cardiac surgeries was found to correlate with HKCS. While univariate correlations were found between HCKS and several other clinical and psychological variables, only number of prior cardiac surgeries independently correlated with disease-specific health knowledge in ACHD patients. These results suggest that clinical and psychological variables are not impediments to disease-specific health knowledge.

Gender differences confirmed in cardiac surgery patients in cardiac rehabilitation

The leading cause of death in Europe is cardiovascular diseases (CVD), it causes 4 million deaths a year. Lithuania is classified as a high risk group of CVD. Many studies have shown that there are gender related differences in the way cardiac symptoms and diseases are perceived the incidence and course of coronary disease, cardiac treatments, and cardiac surgery. One hundred and twenty-five patients after cardiac surgery: valve surgery 37.8% ( n = 48), coronary artery bypass graft surgery (CABG) 52.8% ( n = 67), combined 9.4% ( n = 10) undergoing exercise training inpatient CR were studied in order to evaluate the effect of a CR programme on the quality of life. Functional capacity was assessed by a 6 minutes walking test and quality of life was assess by using the Short-Form (36) General Health Survey (assess patient's health and emotional well-being) scale from 1 to 100, on admission and at the end of 3 weeks programme. In the study participated 89 men (71.2%) and 36 women (28.8%). Men average age was 62.53 ± 1.85; women - 67.78 ± 1.6 ( P = 0.017). The prevalence of risk factors was not statistically significantly different between men and women ( P > 0.05). The physical capacity according to 6MWT was statistically significantly lower in women before and after CR (before 341.2 ± 24.1 vs. 246.2 ± 21.2 m., P = 0,004 after 417,1 ±13.29 vs. 341.2 ± 24.1, P = 0.009). Results of SF-36 general health assessment (45.9 ± 1.9% vs. 47.41 ± 3.5%) and emotional well-being (59.17 ± 2.81% vs. 62.4 ± 2.9%) at the beginning of CR did not differ (> 0.05). After CR women rated their general health (45.72 ± 2.36% vs. 54.4 ± 2.77%, P = 0.037) and emotional well-being (82.35 ± 2.65% vs. 71.2 ± 2.57%, P = 0.012) statistically significantly higher. In the female group, general health and emotional well-being assessment after CR were better evaluated, although women were older and their physical capacity was lower.

Investigation of the effects of connective tissue mobilisation on quality of life and emotional status in healthy subjects.

Connective Tissue Massage (CTM) or Manipulation is a bodywork technique which lies at the interface between alternative approaches. The autonomic balancing responses to CTM can be useful in the treatment of anxiety. This study was planned to investigate the effects of connective tissue mobilization (CTM) on quality of life and emotional status in healthy subjects. Design; Prospective trial, Setting; Treatment and Population. The study was conducted on 100 volunteers (students). Students in second class were in CTM group (20,49±1,37 years) and students (19,50±1,15 years) educating in class 1 were in control group. Participants were assessed before and after CTM according to flexibility of trunk flexion, hamstring muscles, trunk hyperextension and lateral flexion. It was used The SF-36 Health-Related Quality of Life Inventory (SF-36) to assess general health status and Beck Depression Scale was used for assessing emotional status. It was observed a significant increase at lateral flexion to the right of trunk (p=0,03) in CTM group after application. It was found a significant difference (p=0,009) in emotional status between groups. It was found differences at general health level (p=0,001), limitations in emotional role (p=0,016) in SF-36. It was some differences in depression status and some subscales of SF-36 (general health, social status, emotional well-being, pain and energy levels) in favour of control group before application. It was no difference between groups after application. CTM could be used for minimizing depressive symptoms, improving quality of life in healthy young subjects.

Predictors of health-related quality of life in neurosurgical brain tumor patients: focus on patient-centered perspective

In brain tumor (BT) patients, the association between health-related quality of life (HRQoL) and psychological characteristics remains largely unknown. We evaluated the association of personality traits, clinical factors, psychological distress symptoms, and cognitive state with HRQoL in BT patients. On admission for BT surgery, 200 patients (69 % women; age 55.8 ± 14.5 years) were evaluated for HRQoL (SF-36 scale), Big-Five personality traits (Ten-Item Personality Inventory), psychological distress symptoms (Hospital Anxiety and Depression Scale or HADS), cognitive function (Mini-Mental State Examination or MMSE) and clinical characteristics, including functional status (Barthel index or BI). The most common BT diagnoses were meningioma (39 %) and high-grade glioma (18 %). Only factors significantly associated with SF-36 domains in univariable regression analyses were included in their respective multivariable models and predicted from 6 %-49 % of the total variance of SF-36 scores. Greater TIPI emotional stability score was independently associated with greater SF-36 emotional well-being (β = 0.23, p < 0.001) and general health (β = 0.18, p = 0.01) scores, and greater TIPI consciousness score, with greater SF-36 emotional well-being score (β = 0.13, p = 0.02). HADS-anxiety and HADS-depression scores were the strongest independent determinants of all, except physical functioning, SF-36 scores (β-values range from 0.14 to 0.56; p values ≤ 0.03). BI score was the strongest independent determinant of SF-36 physical functioning score (β = 0.36, p < 0.001). MMSE score was associated with all but emotional well-being and social functioning SF-36 scores. Consciousness and emotional stability should be considered important personality-related determinants of HRQoL in BT patients. Psychological distress, functional disability, and cognitive impairment are also important predictors of HRQoL.

Health-related quality of life in individuals with spinal cord injury in Colombia, South America

To assess health-related quality of life (HRQOL) of individuals with Spinal Cord Injury (SCI) in Neiva, Colombia. Cross-sectional. 40 Colombians with SCI and 42 age- and gender-matched controls completed the SF-36, a self-report measure composed of eight component areas (physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions). Compared to healthy controls, individuals with SCI had significantly lower means on five SF-36 subscales: physical functioning (22.5 vs. 94.0; p < 0.001), role limitations due to physical problems (54.4 vs. 77.4; p < 0.01), social functioning (67.5 vs. 80.1; p < 0.05), pain (65.4 vs. 79.5; p < 0.01), and general health (54.9 vs. 69.4; p < 0.01). Both groups scored similarly on the SF-36 emotional well-being subscale. Individuals with SCI from Neiva, Colombia report having poorer quality of life across various domains than healthy controls, primarily in the area of physical functioning. These findings suggest the need for rehabilitation health professionals to develop and implement interventions to improve HRQOL in individuals with SCI.

M2024 Ghrelin Stimulates Gastric Contraction in a Specific Physiological Condition In Vivo and In Vitro in the House Musk Shrew ( Suncus Murinus), a Ghrelin-And Motilin-Producing Laboratory Animal

Background: While gastroparesis usually presents with nausea or vomiting, abdominal pain also may be part of the presenting illness. The importance of pain in gastroparesis and its associated factors are largely unexplored. Aims: Define abdominal pain prevalence in gastroparesis and relate to demography, etiology, severity, quality of life, gastric retention, and analgesic vs. prokinetic/antiemetic drug use. Methods: 339 gastroparesis patients were enrolled from 6 centers of the NIDDK Gastroparesis Clinical Research Consortium from 1/ 07-11/09. Survey, exam, and gastric emptying data were compared in those with pain vs. no pain and pain as the predominant symptom vs. predominant nausea or vomiting. Results: 243 patients (72%) noted abdominal pain; pain was the predominant symptom in 65 (19%) vs. nausea or vomiting in 194 (57%). On Patient Assessment of GI Symptoms surveys, upper abdominal pain scores were higher in those with pain (3.5±1.4) vs. no pain (1.9±1.8, P<0.0001). Lower abdominal pain scores also were higher with (2.3±1.7) vs. no pain (1.4±1.5, P<0.0001). Higher percentages of those with pain were women (86 vs. 76%, P= 0.04) and had idiopathic etiology (70 vs. 54%, P=0.007). Infection-like prodromes were similar with (17%) vs. no pain (19%, P=0.75). Investigator-rated gastroparesis severity was similar with vs. no pain (P=0.25). Patient Assessment of GI Quality of Life (PAGI-QOL) scores were lower with pain (2.3±1.1 vs. 2.8±1.1, P<0.0007). SF-36 physical function (P<0.0001), energy/fatigue (P=0.004), emotional wellbeing (P=0.02), social function (P= 0.0004), pain (P<0.0001), and general health (P=0.02) scores were lower with pain. 4 hr gastric retention (normal <10%) was similar with (32±24%) vs. no pain (33±22%, P=0.91). Opiate use was higher with pain (P<0.0001), while antidepressant (P=0.22), neuropathic pain modulator (P=0.10), prokinetic (P=0.40), and antiemetic (P=0.13) use did not significantly differ. Compared to those with predominant nausea or vomiting, patients with predominant pain had higher upper abdominal pain scores (P<0.0001), but similar severity (P= 0.91), lower abdominal pain scores (P=0.21), 4 hr gastric retention (P=0.96), PAGI-QOL and SF-36 scores (P=NS). Conclusions: Abdominal pain is prevalent in gastroparesis and is predominant in 1 in 5 patients. Pain, like nausea and vomiting, impairs quality of life. Pain is associated with female gender and idiopathic etiology but not gastric retention. Increased opiate use reflects its health care impact and underscores a need to investigate new treatment options for pain. Our findings provide insight into this important symptom and emphasize its negative influence in gastroparesis.

Impact of hemochromatosis screening in patients with indeterminate results: The hemochromatosis and iron overload screening study

Purpose: Assess the quality of life impact of receiving indeterminate test results for hemochromatosis, a disorder involving HFE genetic mutations and/or elevated serum transferrin saturation and ferritin.Methods: The study sample was from the Hemochromatosis and Iron Overload Screening Study, a large observational study of hemochromatosis among primary care patients in the US and Canada using HFE genotype and serum transferrin saturation and ferritin screening. Study subjects included 2,304 patients found with hemochromatosis risk of uncertain clinical significance. Assessed was SF-36 general health and emotional well-being before screening and six weeks after participants received their test results. Health worries were assessed after screening.Results: Of the study subjects, 1,268 participants (51.5%) completed both assessments. Compared to normal controls, those with HFE mutations or elevated serum transferrin saturation and ferritin levels of uncertain significance were more likely to report diminished general health and mental well-being, and more health worries. These effects were associated with participants' belief of having tested positive for hemochromatosis or iron overload.Conclusion: Notification of indeterminate results from screening may be associated with mild negative effects on well-being, and might be a potential participant risk in screening programs for disorders with uncertain genotype-phenotype.

A Randomized Controlled Trial of Tai Chi for Tension Headaches

This study examined whether a traditional low-impact mind–body exercise, Tai Chi, affects health-related quality-of-life (HRQOL) and headache impact in an adult population suffering from tension-type headaches. Forty-seven participants were randomly assigned to either a 15 week intervention program of Tai Chi instruction or a wait-list control group. HRQOL (SF-36v2) and headache status (HIT-6™) were obtained at baseline and at 5, 10 and 15 weeks post-baseline during the intervention period. Statistically significant (P < 0.05) improvements in favor of the intervention were present for the HIT score and the SF-36 pain, energy/fatigue, social functioning, emotional well-being and mental health summary scores. A 15 week intervention of Tai Chi practice was effective in reducing headache impact and also effective in improving perceptions of some aspects of physical and mental health.

Chronic Disease Self-Management Program for Low Back Pain in the Elderly

Objective To evaluate the effectiveness of Stanford's Chronic Disease Self-Management Program (CDSMP) for chronic low back pain (LBP) in older Americans. Design Randomized controlled trial. Setting Community-based program offered at 12 locations. Subjects Community-dwelling seniors (n = 109) aged 60 and older with chronic LBP of mechanical origin. Methods Patients were randomly allocated to the CDSMP or to a 6-month, wait-list control group. The program included one 2.5-hour session per week for 6 weeks. Outcomes evaluated at 6 months included 100-point modified Von Korff pain and disability scales; days with pain and disability; SF-36 general health, energy-fatigue, and emotional well-being scales; 2 scales from the Arthritis Self-Efficacy Scale, self-care attitudes/behaviors, and health services utilization. Results For pain at 6 months, the primary outcome, the adjusted mean difference between the program and control, was −1.0 ( P = .835). There was a sizable advantage for the program in disability averaged over the course of the entire 6-month study (−9.2, P = .027), but not at the 6-month follow-up (−5.8, P = .278). There was an interaction between intervention and baseline disability days favoring the program for higher baseline values ( P = .007). The CDSMP affected emotional well-being (7.6, P = .037) and energy-fatigue (5.1, P = .274). There were no differences for self-efficacy, pain days, and general health. Conclusion There was no advantage for the CDSMP over a wait-list control for improving pain, general health, self-efficacy, and self-care attitudes in older Americans with chronic LBP. A benefit was suggested for emotional well-being, fatigue, functional disability, and days with disability.

Eating disorders and emotional and physical well-being: Associations between student self-reports of eating disorders and quality of life as measured by the SF-36

To assess health-related quality of life (HRQoL) in subjects with eating disorders in terms of eating disorder type and in relation to self-reports of longstanding illness, depression and self-harming behaviours. Data on eating disorder history, SF-36 health status, longstanding illness, and self-reported frequencies of depression, self-harming behaviour, and suicidal thoughts or acts were collected during 1996 as part of a UK postal survey of students' health. Completed questionnaires were returned by 1439 of 3750 students (response rate 42%). Eighty-three respondents (5.8%; 8.9% of females) reported a probable eating disorder history: 54 (3.8%) bulimia nervosa, 22 (1.6%) binge eating disorder, and 7 (0.5%) anorexia nervosa. Eating disorder subjects reported more impairment in SF-36 emotional than physical well-being, with significantly lower mental (p < 0.001) but not physical (p = 0.21) component summary scores. This was most evident in bulimia nervosa and binge eating disorder subjects. Anorexia nervosa subjects reported fewer SF-36 emotional limitations although they were significantly more likely to report depression, self-harming behaviour, and suicidal ideation. An eating disorder history is accompanied by HRQoL impairment primarily in emotional well-being. Anorexia nervosa subjects perceive fewer limitations than subjects with other eating disorders. While this is consistent with previous reports of better SF-36 emotional well-being in those with restrictive eating behaviours, it may also suggest that the SF-36 is insensitive to emotional distress in anorexia nervosa.

Health-related quality of life in patients with human immunodeficiency virus infection in the United States: results from the HIV cost and services utilization study

PURPOSE: To measure health-related quality of life among adult patients with human immunodeficiency virus (HIV) disease; to compare the health-related quality of life of adults with HIV with that of the general population and with patients with other chronic conditions; and to determine the associations of demographic variables and disease severity with health-related quality of life. SUBJECTS AND METHODS: We studied 2,864 HIV-infected adults participating in the HIV Cost and Services Utilization Study, a probability sample of adults with HIV receiving health care in the contiguous United States (excluding military hospitals, prisons, or emergency rooms). A battery of 28 items covering eight domains of health (physical functioning, emotional well-being, role functioning, pain, general health perceptions, social functioning, energy, disability days) was administered. The eight domains were combined into physical and mental health summary scores. SF-36 physical functioning and emotional well-being scales were compared with the US general population and patients with other chronic diseases on a 0 to 100 scale. RESULTS: Physical functioning was about the same for adults with asymptomatic HIV disease as for the US population [mean (± SD) of 92 ± 16 versus 90 ± 17) but was much worse for those with symptomatic HIV disease (76 ± 28) or who met criteria for the acquired immunodeficiency syndrome (AIDS; 58 ± 31). Patients with AIDS had worse physical functioning than those with other chronic diseases (epilepsy, gastroesophageal reflux disease, clinically localized prostate cancer, clinical depression, diabetes) for which comparable data were available. Emotional well-being was comparable among patients with various stages of HIV disease (asymptomatic, 62 ± 9; symptomatic, 59 ± 11; AIDS, 59 ± 11), but was significantly worse than the general population and patients with other chronic diseases except depression. In multivariate analyses, HIV-related symptoms were strongly associated with physical and mental health, whereas race, sex, health insurance status, disease stage, and CD4 count were at most weakly associated with physical and mental health. CONCLUSIONS: There is substantial morbidity associated with HIV disease in adults. The variability in health-related quality of life according to disease progression is relevant for health policy and allocation of resources, and merits the attention of clinicians who treat patients with HIV disease.