Sustained sleep restriction reduces emotional and physical well-being

BACKGROUND: Chronic insufficient sleep is a common finding in many pain-related and other medical diseases and is frequently experienced in the general population. Prolonged curtailment of nocturnal sleep has been studied for its adverse effect on cognitive functioning and subjective tiredness, but relatively little is known about its effect on mood and physical symptoms. OBJECTIVE: In order to test whether sleep restriction to 50% of the habitual time over 12 days affects diurnal and day-to-day variation of subjective ratings of mood and physical symptoms, 108 adjectives and statements were self-rated using visual analog scales every 2h during the waking period. DESIGN: Randomized, 16-day controlled in-laboratory study. SETTING: General Clinical Research Center (GCRC). PARTICIPANTS: Forty healthy subjects aged 21-40 years (14 females, 26 males). INTERVENTION: Subjects were randomized to either 4h of sleep per night (11 pm-3 am, N=22) or 8h of sleep per night (11 pm-7 am, N=18) for 12 consecutive days. Main Outcome Measure: Changes in the factor-derived variables optimism-sociability, tiredness-fatigue, anger-aggression, bodily discomfort, and items constituting bodily discomfort were compared between groups. RESULTS: Optimism-sociability progressively declined over consecutive days of sleep restriction by 15%. Bodily discomfort showed a slight, but significant interindividual increase of 3% across days of sleep restriction due to significant increases of generalized body pain, back pain, and stomach pain. Optimism-sociability and tiredness-fatigue showed diurnal variations with a quadratic function period within each day in both conditions. CONCLUSION: The data suggest that chronic insufficient sleep may contribute to the onset and amplification of pain and affect health by compromising optimistic outlook and psychosocial functioning.     

Predictors of postsurgical subacute emotional and physical well-being among women with breast cancer

Breast cancer is the leading type of cancer among women, and surgery is the primary treatment. The subacute phase of care after surgery has a significant impact on quality of life. This article explores the physical and psychological risk profiles of 240 women with early-stage cancer. Although several statistical models were designed for these data, the conclusions are based on the adjusted logistic regression model controlling for presurgical outcomes scores and all other demographics. Findings indicated that the physical risk profile included younger women (<55 years), unmarried, with a caregiver, and a college education. The psychological risk profile includes younger women (<55 years), unmarried, and with annual incomes under $75,000. These profiles will help practitioners anticipate the postsurgical supportive care needs of women with early-stage breast cancer.     

Long-term effects of heart transplantation: the gap between physical performance and emotional well-being

The purpose of our study was to assess physical and emotional factors in heart transplant patients. A prospective design was used to compare patients' physical symptoms, emotional complaints, and restrictions at admission to the waiting list, immediately after, and 1 and 5 years after heart transplantation. Thirty-three patients were included (30 male, 3 female) in the study. Their mean age at admission was 48 +/- 10.2 years. Of these, 23 suffered from cardiomyopathy, 8 from coronary heart disease, and 2 from valvular insufficiency. At admission, the patients suffered from symptoms of cardiac insufficiency, and were restricted in sports, gardening, hobbies, sexual life, job, food-intake, and mobility. More than three-fourths rated their physical and emotional status as moderate to poor. Emotionally, they suffered from irritability, restlessness, depression, psychic lability, lowered drive, lack of social contact, low self-esteem, and anxiety. At the end of rehabilitation (4-8 weeks after the operation), all physical and emotional complaints, as well as restrictions had significantly decreased (p < 0.0001 to p < 0.001), except for trembling, numbness of hands/feet, and food-intake. One year postoperatively, patients reported even fewer physical complaints (p < 0.01). Three-fourths rated their physical and emotional status good or excellent. Five years postoperatively--in contrast to physical status, restrictions, and physical complaints--the emotional complaints had increased significantly (p < 0.0001). Patients reported excellent physical performance up to 5 years postoperatively. On the other hand, the study revealed that their emotional well-being had significantly deteriorated from 1 to 5 years postoperatively. Attention should, therefore, not only be paid to the good physical health of the survivors, but also to the worsening of their emotional status.     

Chronic pain--assessment of orthopedic physical therapists' knowledge and attitudes

Orthopedic physical therapists' knowledge of pain mechanisms and methods of pain management and their attitudes toward working with patients with benign chronic pain were studied. A random sample of 500 members of the American Physical Therapy Association's Section on Orthopaedics received by mail a 36-item questionnaire. Statistical analysis of scores, using frequencies, means, and correlations was performed on the 119 (23.8%) usable returns. All but 4% of the respondents preferred to work with patients who are not likely to have chronic pain. Seventy-two percent believed their entry-level education in pain management and theory was very inadequate or less than adequate to deal with an orthopedic patient population. Pain knowledge scores were low (35.8 out of 46 points), and the scores on positive attitudes toward treating patients with benign chronic pain were lower (20.5 out of 36 points). The study suggests specific deficiencies in orthopedic physical therapists' knowledge of clinical pain mechanisms and management and potentially undesirable attitudes toward treating patients with chronic pain.     

Variables influencing physical therapists' perceptions of continuing education

BACKGROUND AND PURPOSE: As of October 1, 2002, physical therapy continuing education (CE) in Illinois was mandated. Research examining the recent mandate for physical therapists to engage in CE is limited. The purposes of this study were to examine the perceptions of physical therapist clinicians and managers concerning the barriers to and facilitators of CE and to identify how physical therapists perceive the role of their department in the CE process. SUBJECTS: Participants were 23 physical therapists at 6 hospitals. METHODS: Qualitative methodology was used to analyze data. RESULTS: Four themes were identified: negotiating and managing the variables associated with CE, providing and promoting opportunities that meet physical therapists' CE needs, identifying the elements of employment environments that foster CE, and perceived implications of mandating CE. DISCUSSION AND CONCLUSION: This investigation highlights the need to identify the core set of variables associated with engaging in CE and to promote the elements of employment environments that foster CE.     

Cultural affirmation and the protection of emotional well-being

This article examines the impact of the Balkan conflict on the culture and emotional health of a community of Serbian Australians. It discusses how an intimate reconnection with their cultural identity, Serbian Australians, without formal mental health service supports, managed the complex and dynamic interplay between homeland events, mainstream media reports, ethnonational bonds, and mental health issues in Australia. Ethnographic techniques revealed that although the Balkan conflict bared a multitude of potent health and emotional concerns for Serbian Australians, their coping was enhanced by an intimate sense of belonging and reassociation with their historical, religious, cultural, and national identities. By engaging in spiritual connections with their culture and ethnicity, the transglobal effects of the Balkan war on Serbians in Australia revealed that mental health and healing could no longer be seen as a localized phenomenon. It must also be seen as something that transcends the nations and communities in which people live.     

Canadian physical therapists' interest in web-based and computer-assisted continuing education

BACKGROUND AND PURPOSE: Distance education via computer-assisted learning (CAL), including Web-based and CD-ROM learning, confers a number of advantages compared with traditional learning methods. The purposes of this study were (1) to determine the interest of Canadian physical therapists in participating in continuing education using CAL methods and (2) to determine whether interest in CAL was related to type of employment, area of practice, education, computer skill and access, and other demographic variables. SUBJECTS AND METHODS: A random sample of Canadian physical therapists and all members of cardiopulmonary interest groups were surveyed. RESULTS: Of 1,426 survey questionnaires mailed, 69 were returned (58 were unopened and 11 were duplicates). From the remaining 1,357 potential survey responses, 757 responses were received, for an overall response rate of 56%. Seventy-eight percent of the respondents indicated their interest in participating in CAL. Factors associated with interest in CAL included 2 or more hours of Internet access per week, Internet access at both home and work, computer skill, education level, practice area, and belonging to a cardiopulmonary interest group. DISCUSSION AND CONCLUSION: The findings indicate a large positive interest in CAL. Increasing CAL continuing education opportunities could increase options for physical therapists to meet professional expectations for continuing competency.     

Influence of a merger on nurses' emotional well-being: the importance of self-efficacy and emotional reactivity

The influence of the merger of two major medical centres on the emotional well-being of nurses was investigated by use of a questionnaire on emotional distress, perception of threat, self-efficacy and emotional reactivity. Evaluations were carried out 1 month prior to the merger at the official announcement, and again half a year after the merger took place. Before the merger, threat perception was higher in the transferring nurses, but the difference was of borderline significance (P = 0.05). There was a significant positive correlation between threat perception and both emotional reactivity and emotional distress, and a significant negative correlation between self-efficacy and both threat perception and emotional distress (P < 0.001 for all). After the merger, the transferring nurses showed more emotional distress (P = 0.009). There was a significant positive correlation between threat perception, emotional distress and negative outcome variables such as burnout and stress (P < 0.001), and a significant negative correlation between threat perception and positive outcome variables such as growth (P < 0.01). This study identifies some personal characteristics that can affect the way nurses deal with hospital mergers and need to be considered during organizational changes in order to maintain job satisfaction.     

觉知压力在护理实习生情绪智力与职业认同感间的中介效应

目的:了解护理实习生职业认同感现状及其影响因素,分析情绪智力、觉知压力与职业认同感之间的关系。方法:采用情绪智力量表(Wong and Law Emotional Intelligence Scale,WLEIS)、觉知压力量表(Chinese Perceived Stress Scale,CPSS)和护士职业认同评定量表(Nursing Professional Identify Scale)对河南省某三级甲等医院的824名护理实习生进行调查。结果:824名护理实习生情绪智力得分为(84.24±16.66)分,觉知压力得分为(22.10±6.62)分,职业认同感得分为(117.22±18.50)分;不同性别、学历以及是否担任学生干部职务的护理实习生职业认同感得分比较差异均有统计学意义(P<0.05);护理实习生情绪智力与职业认同感呈正相关(P<0.05),觉知压力与情绪智力、职业认同感均呈负相关(P<0.05);觉知压力在护理实习生情绪智力与职业认同感之间存在中介效应,中介效应值占总效应值的9.33%。结论:护理实习生职业认同感处于中等水平,受多种因素的影响,护理管理者可通过提升护理实习生的情绪智力、降低觉知压力来提高其职业认同感。     

Impact of a workplace stress reduction program on blood pressure and emotional health in hypertensive employees

OBJECTIVES: This study examined the impact of a workplace-based stress management program on blood pressure (BP), emotional health, and workplace-related measures in hypertensive employees of a global information technology company. DESIGN: Thirty-eight (38) employees with hypertension were randomly assigned to a treatment group that received the stress-reduction intervention or a waiting control group that received no intervention during the study period. The treatment group participated in a 16-hour program, which included instruction in positive emotion refocusing and emotional restructuring techniques intended to reduce sympathetic nervous system arousal, stress, and negative affect, increase positive affect, and improve performance. Learning and practice of the techniques was enhanced by heart rate variability feedback, which helped participants learn to self-generate physiological coherence, a beneficial physiologic mode associated with increased heart rhythm coherence, physiologic entrainment, parasympathetic activity, and vascular resonance. BP, emotional health, and workplace-related measures were assessed before and 3 months after the program. RESULTS: Three months post-intervention, the treatment group exhibited a mean adjusted reduction of 10.6 mm Hg in systolic BP and of 6.3 mm Hg in diastolic BP. The reduction in systolic BP was significant in relation to the control group. The treatment group also demonstrated improvements in emotional health, including significant reductions in stress symptoms, depression, and global psychological distress and significant increases in peacefulness and positive outlook. Reduced systolic BP was correlated with reduced stress symptoms. Furthermore, the trained employees demonstrated significant increases in the work-related scales of workplace satisfaction and value of contribution. CONCLUSIONS: Results suggest that a brief workplace stress management intervention can produce clinically significant reductions in BP and improve emotional health among hypertensive employees. Implications are that such interventions may produce a healthier and more productive workforce, enhancing performance and reducing losses to the organization resulting from cognitive decline, illness, and premature mortality.     

Motor and functional recovery after stroke: accuracy of physical therapists' predictions

The degree to which physical therapists correctly predicted motor and functional outcome for stroke patients was investigated. Therapists used an adapted form of the physical therapy portion of the Patient Evaluation Conference System (PECSc)--a 14-item assessment measured on an 8-point scale. At admission to a rehabilitation hospital, therapists performed initial assessments of seven motor and functional items on 204 patients and assigned goal scores; before discharge the patients were reevaluated and their final scores determined. The accuracy by which therapists correctly predicted the final score ranged from 53% to 67%; therapists were accurate to within one score for 80% to 83% of patients. The only determinant of accuracy was initial score; neither patient characteristics (age, side of lesion) nor staff experience were found to be associated with correctly predicting final score. Sensitivity and specificity of the goals for predicting independence were examined for three items: lying to sitting, ambulation, and stairs. The sensitivity of a goal of independence was high (96% to 100%), indicating that those patients who were independent at discharge were correctly identified by therapists at admission. The predictive value of a goal of dependence was also very high (91% to 100%), indicating that patients predicted to remain dependent did so. These results suggest that therapists' predictions could prove useful in screening patients for rehabilitation and in planning treatment strategies.     

Hospice role in alleviating the emotional stress of terminal patients and their families

Terminally ill cancer patients in a Veterans Administration hospital were randomly assigned to receive hospice care. Follow-up evaluation through the time of death revealed no significant differences in anxiety or depression between hospice or control patients, but hospice patients exhibited significantly greater improvement in two of three measures of satisfaction (interpersonal care and involvement in care decisions). Hospice patients' significant others (SOs) showed some decrease in anxiety and greater satisfaction with involvement in care than did control SOs. The differences were attributable in part to hospice staff better meeting SOs' perceived needs.     

Social role quality,physical health,and psychological well-being in women after heart surgery

Women's social role quality may be an important factor in their adaptation after heart surgery. Relationships among different dimensions of role quality, physical health, and psychological well-being were examined in 157 midlife and older women who had undergone heart surgery. Overall, older women (n = 89) were similar to younger women (n=68) in physical recovery from heart surgery. Poorer health outcomes were associated with number of health problems, not age. Women with more health problems and lower subjective health perceptions had lower role quality. Multiple regression analyses indicated that, in general, role quality mediated the effects of physical health on psychological well-being. Regardless of the extent of physical health problems, women with higher role quality had higher levels of psychological well-being.     

Relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of therapists' behaviors during early intervention

BACKGROUND AND PURPOSE: Federal law mandates family-centered care as the service delivery model in early intervention programs for children from birth to 36 months of age. This study investigated the relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of physical therapists' family-centered behaviors during early intervention. SUBJECTS AND METHODS: Twenty-five physical therapists and 75 mother-child dyads (3 from each therapist's caseload) participated. The mean chronological age for the children was 21.2 months (SD=7.3, range=6-35). Mothers participated in a structured interview using the Measures of Processes of Care (MPOC-56), and they completed the Parenting Stress Index-Short Form (PSI-SF) and a questionnaire. The Bayley-II Motor Scale was administered to the children. Therapists completed a modified version of the Measures of Processes of Care for Service Providers (MPOC-SP) and a questionnaire. RESULTS: Scores for mothers on the MPOC-56 and for therapists on the MPOC-SP indicated strong positive perceptions and attitudes toward family-centered behaviors. Hierarchical multiple regression analyses indicated that parenting stress explained a considerable amount of the variance in mothers' perceptions of family-centered behaviors, whereas therapists' attitudes explained a considerable amount of the variance in mothers' perceptions of respectful and supportive care. Children's motor ability was inversely related to parenting stress. DISCUSSION AND CONCLUSION: Findings suggest that mothers perceive that physical therapists are using family-centered behaviors in early intervention. Findings from the questionnaires suggest that some early intervention policies may be barriers for therapists and prevent them from actualizing attitudes toward family-centered behaviors.     

QWB在临床健康体检中的调查研究

目的评估临床健康体检者的生命质量及其影响因素研究。方法每一位同意进行调查的临床健康体检者由受过训练的医务工作人员面对面的完成QWB调查,并按要求记录健康体检者的一般情况,包括：性别、年龄、婚姻状况、职业和居住地。根据QWB各部分的权重分别计算各部分的权重分。选择性别、年龄、婚姻状况、文化程度、职业和居住地作为变量,作临床健康体检者生命质量的单因素的影响因子研究。结果临床健康体检者的QWB的总分、移动(MOD)、生理活动(PAC)、社会活动(SAC)和症状/复合健康问题(CPX)等5个纬度的得分为：总分0．8766000±0．1240000、移动(MOD)-0．0007920±-0．009720、生理活动(PAC) -0．0007012±-0．006586、社会活动(SAC)-0．0004268±-0．005493和症状/复合健康问题(CPX)- 0．1215000±-0．121500。临床健康体检者QWB量表得分的单因素的影响因子分析：结果显示：①性别：男性与女性的MOB、PAC、SAC、CPX、W得分比较,差异都无统计学意义(P＞0．05);②年龄：PAC、SAC、CPX、W得分随着年龄段的上升而下降,其中CPX、W得分的差异有统计学意义(P＜0．05);③)婚姻：MOB、PAC、SAC、W得分“在婚”高于“离异/丧偶/分居”,其中PAC得分差异有统计学意义(P＜0．05);④文化程度：CPX、W得分随着文化程度的提高而增加,差异有统计学意义(P＜0．05);⑤居住地：SAC、CPX、W得分“城市(镇)”显著高于“农村”(P＜0．05)。结论QWB量表总得分0．8766000,比国外的常模高,年龄、婚姻状况、文化程度、职业和居住地是QWB评分的影响变量。     

Effect of diabetes education on self-care, metabolic control, and emotional well-being

Participants (n=165) entering a week-long outpatient education program completed a protocol measuring self-care patterns, glycosylated hemoglobin levels, and emotional well-being. Emotional well-being was reassessed at the end of the program, and the entire protocol was completed again at 6 mo (n=124). At the program's end, participants improved on all measures of emotional well-being (P less than .01). Self-esteem and diabetes self-efficacy rose, whereas anxiety and depression fell. At 6 mo, improvement in emotional well-being continued, and important self-care behaviors improved from preprogram levels. Self-monitoring of blood glucose and exercise rose (both P less than .001), and bringing (P less than .01) and glycosylated hemoglobin levels (P less than .001) fell. Program effects were unrelated to demographic or disease characteristics but strongly related to initial status. Participants who entered the program with high levels of emotional well-being or good self-care patterns or glycemic control tended to change little, if at all, at later measurements. On the other hand, people who entered the program with low levels of emotional well-being or with poor self-care patterns or glycemic control improved substantially. Our findings suggest that diabetes education can promote long-term benefits in self-care, metabolic control, and emotional status if the program is specifically designed to provide these benefits. Aspects of the program that contribute to its efficacy are discussed.