Differences in Physical and Psychosocial Characteristics Between CFS and Fatigued Non-CFS Patients, a Case-Control Study.

PURPOSE: The main research question is: "Do CFS patients differ from fatigued non-CFS patients with respect to physical, cognitive, behavioral, social, and emotional determinants?" In addition, group differences in relevant outcomes were explored. METHOD: Patients who met the Centers for Disease Control (CDC) criteria for CFS were categorized as CFS; these patients were mainly recruited via a large Dutch patient organization. Primary care patients who were fatigued for at least 1 month and up to 2 years but did not meet the CDC criteria were classified as fatigued non-CFS patients. Both groups were matched by age and gender (N = 192 for each group). RESULTS: CFS patients attributed their fatigue more frequently to external causes, reported a worse physical functioning, more medical visits, and a lower employment rate. The results of a multiple logistic regression analysis showed that patients who believe that their fatigue is associated with more severe consequences, that their fatigue will last longer and is responsible for more additional symptoms are more likely to be classified as CFS, while patients who are more physically active and have higher levels of "all or nothing behavior" are less likely to be classified as having CFS. CONCLUSION: A longitudinal study should explore the predictive value of the above factors for the transition from medically unexplained fatigue to CFS in order to develop targeted interventions for primary care patients with short-term fatigue complaints.

Illness perceptions determine psychological distress and quality of life in youngsters with epilepsy.

The aim of this cross-sectional study was to explore the extent to which gender, epilepsy severity, and self-regulation concepts (illness perceptions, autonomous treatment regulation, perceived autonomy support by parents) predict psychological distress and quality of life (QoL) in young patients with epilepsy. Structured interviews were conducted in 100 patients (Mage=13.9, SD=2.21, 41% girls), and data were analyzed by means of multiple hierarchical regression analyses. Seizures of most patients (91%) were well controlled by antiepileptics, 3% of the patients had infrequent seizures, and seizures in 6% were pharmacoresistant. At a multivariate level, it appeared that youngsters with epilepsy who expect that their disease will last for a long time, who believe that they have less personal control over their illness, and who expect the illness to have a high emotional impact reported higher levels of distress. In addition, a better QoL was reported by youngsters who believed that treatment did not control their illness and who thought that their epilepsy would not affect them emotionally. Findings indicate the importance of illness perceptions, and it is suggested that they should be targeted in future interventions in youngsters with epilepsy.

Causes and consequences of occupational stress in emergency nurses, a longitudinal study.

AIM: This longitudinal study examines the influence of changes over time in work and organisational characteristics on job satisfaction, work engagement, emotional exhaustion, turnover intention and psychosomatic distress in emergency room nurses. BACKGROUND: Organisational and job characteristics of nurses are important predictors of stress-health outcomes. Emergency room nurses are particularly exposed to stressful work-related events and unpredictable work conditions. METHOD: The study was carried out in 15 emergency departments of Belgian general hospitals in 2008 (T1) and 18 months later (T2) (n = 170). RESULTS: Turnover rates between T1 and T2 were high. Important changes over time were found in predictors and outcomes. Changes in job demand, control and social support predicted job satisfaction, work engagement and emotional exhaustion. In addition, changes in reward, social harassment and work agreements predicted work engagement, emotional exhaustion and intention to leave, respectively. CONCLUSIONS: Work-related interventions are important to improve occupational health in emergency room nurses and should focus on lowering job demands, increasing job control, improving social support and a well-balanced reward system. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should be aware of the causes and consequences of occupational stress in emergency room nurses in order to enable preventive interventions.

A self-regulation lifestyle program for post-cardiac rehabilitation patients has long-term effects on exercise adherence.

As maintenance of lifestyle change and risk factor modification following completion of cardiac rehabilitation has been shown to be notoriously difficult, we developed a brief self-regulation lifestyle program for post-cardiac rehabilitation patients. Randomized-controlled trial. Following completion of cardiac rehabilitation 210 patients were randomized to receive either a lifestyle maintenance program (n = 112) or standard care (n = 98). The program was based on self-regulation principles and consisted of a motivational interview, 7 group sessions and home assignments. Risk factors and health behaviors were assessed at baseline (end of cardiac rehabilitation), and 6 and 15 months thereafter. ANCOVAs showed a significant effect of the lifestyle program on exercise behavior at 15-month follow-up. Mediation analysis demonstrated that the treatment effect on exercise behavior could be explained by self-regulation skills. Chi squared tests showed that patients in the intervention group had significantly fewer uncontrolled risk factors as compared to the control group. Finally, the lifestyle intervention program was associated with a 12 % reduction in self-reported cardiac hospital admission rates. This trial indicates that a relatively brief, theory-based lifestyle program is capable of inciting and maintaining improvements in exercise adherence. It is suggested that patients may need ongoing attention and guidance, for example in the form of (internet-based) booster sessions, as long-term consolidation of changes is arduous.

Changes in illness perceptions and quality of life during participation in cardiac rehabilitation.

BACKGROUND: The beliefs patients hold about their disease and corresponding treatment have been shown to predict recovery in cardiac patients. PURPOSE: However, it is not known to what extent these beliefs change during participation in cardiac rehabilitation and whether this is related to psychological indicators of outcome. METHOD: Illness perceptions and health-related quality of life (HRQOL) were measured upon entry to (T0) and completion of (T1) a 3-month outpatient cardiac rehabilitation program in 158 cardiac patients. RESULTS: Repeated-measures ANOVA revealed that all illness perceptions other than timeline and personal control changed significantly over the course of cardiac rehabilitation. Overall, cardiac rehabilitation patients came to view their illness as more benign. Further analysis revealed that perceiving fewer emotional consequences of the illness, gaining a better understanding, and attributing fewer symptoms to the illness at the end of cardiac rehabilitation, was related to better HRQOL. CONCLUSION: Illness perceptions change during cardiac rehabilitation and these changes are associated with enhanced quality of life. Clinical trials have shown illness beliefs in cardiac patients to be modifiable during hospital admission; our results suggest that cardiac rehabilitation may provide a second window of opportunity during which illness perceptions can be actively monitored and modified if maladaptive.

Protocol for the "four steps to control your fatigue (4-STEPS)" randomised controlled trial: a self-regulation based physical activity intervention for patients with unexplained chronic fatigue.

BACKGROUND: Unexplained Chronic Fatigue is a medical condition characterized by the presence of persistent, severe and debilitating medically unexplained fatigue, leading to impaired functioning and lower quality of life. Research suggests that physical activity can contribute to the reduction of fatigue and other somatic symptoms and can thus significantly improve physical functioning and quality of life in these patients. Based on the self-regulation (SR) theory of behaviour change, we developed a brief physical activity program for patients suffering from unexplained chronic fatigue which focuses on the training of self-regulation skills, the "4-STEPS to control your fatigue" program. METHODS/DESIGN: This is a multi-centre, randomised controlled trial (RCT) that will be carried out in local primary care centres and at the Portuguese Fibromyalgia and Chronic Fatigue Syndrome Patients Association. Patients aged between 18 and 65 and fulfilling operationalized criteria for Idiopathic Chronic Fatigue (ICF) and Chronic Fatigue Syndrome (CFS) will be recruited and randomly allocated to standard care (SC) or standard care plus a self-regulation based physical activity program (4-STEPS). Patients will be assessed at baseline, after the intervention (3 months) and at 12 months follow-up. The primary outcome is fatigue severity. DISCUSSION: The results of the RCT will provide information about the effectiveness of a brief self-regulation intervention for promoting physical activity in patients with unexplained chronic fatigue. If the program proves to be effective, it may be considered as an adjunctive treatment for these patients. TRIAL REGISTRATION: ISRCTN: ISRCTN70763996.

Exploring the burden of emergency care: predictors of stress-health outcomes in emergency nurses.

AIMS: This paper is a report of a study that examines (1) whether emergency nurses differ from a general hospital nursing comparison group in terms of job and organizational characteristics and (2) to what extent these characteristics predict job satisfaction, turnover intention, work engagement, fatigue and psychosomatic distress in emergency nurses. BACKGROUND: The work environment and job characteristics of nurses are important predictors of stress-health outcomes. Emergency nurses are particularly exposed to stressful events and unpredictable work conditions. METHODS: This cross-sectional study (N = 254) was carried out in 15 emergency departments of Belgian general hospitals in 2007-2008 by means of the Leiden Quality of Work Questionnaire for Nurses, the Checklist Individual Strength, the Utrecht Work Engagement Scale and the Brief Symptom Inventory. RESULTS: Emergency nurses report more time pressure and physical demands, lower decision authority, less adequate work procedures and less reward than a general hospital nursing population. They report, however, more opportunity for skill discretion and better social support by colleagues. Work-time demands appear to be important determinants of psychosomatic complaints and fatigue in emergency nurses. Apart from personal characteristics, decision authority, skill discretion, adequate work procedures, perceived reward and social support by supervisors prove to be strong determinants of job satisfaction, work engagement and lower turnover intention in emergency nurses. CONCLUSION: Emergency departments should be screened regularly on job and organizational characteristics to identify determinants of stress-health outcomes that can be the target of preventive interventions.

Low goal ownership predicts drop-out from a weight intervention study in overweight patients with type 2 diabetes.

BACKGROUND: Drop-out is a major problem in weight loss studies. Although previous attrition research has examined some predictors of drop-out, theoretically grounded research on psychological predictors of drop-out from weight interventions has been lacking. PURPOSE: To examine psychological predictors of drop-out from a weight reduction study in diabetes type 2 patients. METHOD: A clinical trial was conducted with 101 overweight/obese (body mass index >27) diabetes type 2 patients. Patients were randomly assigned to a self-regulation intervention, an active control group, and a passive control group. Psychological, somatic, socio-demographic, and lifestyle variables were examined as predictors of drop-out from baseline to 6 months follow-up. RESULTS: Multiple logistic regression analysis indicated that low autonomous regulation or low 'goal ownership' was the best predictor of drop-out. CONCLUSION: It is suggested that the assessment of 'goal ownership' prior to a weight reduction intervention could identify patients who are sufficiently motivated to participate. Patients who score low on 'goal ownership' may be offered pretreatment interventions to increase their motivation.

Self-regulation and weight reduction in patients with type 2 diabetes: a pilot intervention study.

OBJECTIVE: To evaluate the efficacy of a self-regulation (SR) weight reduction intervention on weight, body mass index (BMI), glycosylated hemoglobin (HbA1c) (primary outcomes), exercise, nutrition and quality of life (secondary outcomes). METHODS: A pilot intervention (n=53) based on SR-principles consisted of a motivational interview, group sessions and a workbook and was evaluated against standard care with (n=38) and without a self-help manual (n=38). Subjects were overweight (BMI>27) patients with type 2 diabetes (52% female) from a Dutch hospital (mean age 58.14, S.D.=8.86). RESULTS: No differences in the outcomes were found between the intervention and control groups at 3 (T2) or 6 (T3) months. However, results at T2 and T3 revealed that patients with higher SR-skills scores had lower HbA1c levels than patients with lower scores. CONCLUSION: The SR-intervention did not significantly influence the outcomes. This apparent lack of effect might, however, partly be due to high attrition rates in all treatment groups. SR-skills were positively related to changes in HbA1c-levels. PRACTICE IMPLICATIONS: Improving SR-skills of overweight diabetes type 2 patients may improve their glycemic control. Patients who are 'external regulators' may however profit more from directive than from SR-interventions.

Linking goal progress to subjective well-being at work: the moderating role of goal-related self-efficacy and attainability.

Although goal progress is often hypothesized to be positively linked to well-being, existing research points to an inconsistent relationship and suggests that potential moderators need to be examined. This longitudinal study investigated whether 2 aspects of goal cognition-goal attainability and self-efficacy-influence the relationship between goal progress and well-being (viz., job satisfaction and emotional exhaustion) in a sample of 172 nurses. Work goal progress was not directly associated with well-being. Rather, the link between goal progress and well-being was moderated by goal cognition. Individuals who started off with unfavorable goal cognitions but who managed to achieve goal progress reported an increase in well-being, compared with those who had favorable goal cognitions and similar rates of progress. Progress appears to have compensated for low initial goal cognition in the prediction of well-being, and high initial goal cognition appears to have undermined this predictive relationship. Also, goal progress was associated with an increase in self-efficacy and goal attainability from Time 1 to Time 2. Results are discussed in relation to goal theories and the concept of self-correcting goal cycles.

Cognitive coping, goal self-efficacy and personal growth in HIV-infected men who have sex with men.

OBJECTIVE: The relationships between cognitive coping strategies, goal self-efficacy and personal growth were studied in HIV-positive men who have sex with men. METHODS: All members of a national organization for people living with HIV received a call for participation. The Cognitive Emotion Regulation Questionnaire, the Goal Obstruction Questionnaire and the Personal Growth Scale were filled out at home by 104 HIV-infected men. RESULTS: Thinking about joyful and pleasant issues instead of thinking about being HIV-positive, thinking about what steps to take and how to handle being HIV-positive, thoughts of attaching a positive meaning to being HIV-positive, thoughts of playing down the seriousness of being HIV-positive or emphasizing its relativity when compared to other events, thoughts of putting the blame of being HIV-positive on others (inversely) and the extent to which one considers oneself able to reengage in alternative meaningful goals were related to personal growth. CONCLUSION: The study showed that both cognitive coping strategies and goal self-efficacy were related to personal growth. The findings suggest that mainly positive ways to handle being HIV-infected are related to personal growth. PRACTICE IMPLICATIONS: These findings suggested that intervention programs for people with HIV should pay attention to cognitive coping strategies and goal self-efficacy.

Symptoms of traumatic stress after coronary artery bypass grafting.

BACKGROUND: Traumatic stress symptoms have only recently been studied in association with medical treatment procedures. PURPOSE: The study examined associations of physical and psychological functioning during hospitalization to symptoms of traumatic stress after cardiac surgery. METHODS: One hundred thirteen patients admitted for coronary artery bypass grafting participated in the study. Symptoms of traumatic stress were assessed one and six months after surgery, with the Impact of Event Scale. Preoperative stress and ruminative thinking, length of preoperative waiting, duration of surgery, and postoperative recovery indices (length of stay in the intensive care unit, cognitive functioning during intensive care, length of stay in the hospital) were examined. RESULTS: Ten percent of the patients reported severe (> 19) symptoms of avoidance, and five percent reported severe symptoms of intrusion in both follow-ups. Hierarchical regression analyses showed that preoperative stress was positively associated to avoidance symptoms in both follow-ups (p < .01). Preoperative stress and ruminative thinking was positively associated to intrusion symptoms one month after surgery (p < .01). Disease related factors were not related to symptoms of traumatic stress during the postoperative period. CONCLUSION: This study highlights the role of preoperative surgery-related stress as a risk factor for traumatic stress in the postoperative period.

Predicting quality of life and self-management from dyadic support and overprotection after myocardial infarction.

OBJECTIVES: Using a self-regulatory framework, this study aims to identify how couples perceive a partner's support style after myocardial infarction (MI), and whether this predicts the patient's health-related quality of life (HR-QoL) and self-management (S-M) 9 months later. METHOD: This longitudinal dyadic study includes 73 couples (86% of patients were men), recruited from two cardiac rehabilitation programmes in the Netherlands. Mean age of patients was 54.8 (SD=9.6) and of partners 52.5 (SD=9.8). Participants were interviewed and completed questionnaires at baseline (T1). Repeat questionnaires were returned by 69 and 67 couples after 3 (T2) and 9 months (T3), respectively. RESULTS: Support by partners is conceptualized in this study as 'active engagement' (AE), which involves the extent to which a partner engages the patient in conversations which focus on emotional support and problem solving. Levels of AE do not change over time, nor do they differ between members of the dyad. Levels of overprotection (OP) diminish with time, whilst patients consistently perceive more OP than partners report providing. Patients' experience of goal hindrance (at T3) due to the MI is associated with a decreased HR-QoL at T3 (controlling for baseline measures). The perception of having a supportive (AE) partner at T1 contributes to enhanced patient HR-QoL at each subsequent time point, although not to physical functioning. Perceiving a partner as overprotective (at T1) predicts worsened physical functioning in patients (at T3). Improvements in S-M at T3 (controlling for baseline measures) are reported by patients whose partner displays active engagement at T1. CONCLUSIONS: Cardiac rehabilitation should aim to redress the experience of goal disturbance and advise partners on how to provide support.

The facilitation of important personal goals through exercise.

In a sample of 1287 adolescents, it appeared that weekly exercise facilitates a variety of goals; particularly those related to being or remaining healthy, feeling relaxed, not being bored, feeling physically good, not being stressed, and attaining high achievements were endorsed. Sedentary and active adolescents reported a similar order of 10 specific goals with respect to the likelihood of being positively influenced by exercise. The frequency of reported facilitation for each of the goals, however, was higher among the active adolescernts. This suggests that the more exercise is incorporated in daily life, the more it can be regarded as an integral part of the personal goal structure.

Evaluation of a self-regulation based psycho-educational pilot intervention targeting children and adolescents with epilepsy in Greece.

PURPOSE: The purpose of this study is to describe the development and initial evaluation of a minimal structured psycho-educational intervention for children and adolescents with epilepsy. The intervention aimed at increasing the understanding and personal control (self-management) of epilepsy, and at reducing psychological distress, sleep problems and somatic complaints. METHOD: Twelve patients participated in our intervention and another 12, matched on age and gender, served as the control group. Data were obtained at baseline (prior to the intervention) and 3 months later in the context of an interview based on several validated questionnaires. The intervention was limited to one 4-h session using Cognitive Behavioural Therapy techniques, relaxation techniques, video and storytelling. Effects of the intervention on primary and secondary outcomes were examined using 2 (baseline, T1 vs. post-treatment, T2)×2 (intervention vs. control) mixed model repeated measures analysis of covariance (ANCOVA), controlling for epilepsy severity. RESULTS: The analysis revealed that over the three months of the study, significant main effects (group x time) were observed on coherence (F(1,21)=6.12; p=0.02) with important changes in favour of the intervention group. Significant main effects were also observed on psychological distress levels (F(1,21)=10.08; p=0.005) and sleep problems (F(1,21)=11.40; p=0.003). CONCLUSION: The results of this study show that a brief self-regulation-based intervention may have beneficial effects for children and adolescents suffering from epilepsy by inciting improvements in coherence, psychological distress and sleep problems.

Explaining medically unexplained symptoms: toward a multidimensional, theory-based approach to somatization.

In spite of the apparent clinical importance of somatization, the concept does not have a single meaning. The focus of the present article is therefore not on scrutinizing existing diagnostic categories but rather on the different dimensions that relate to somatization and on the relevance of psychological models such as social learning theory, stress coping, illness cognition, and self-regulation models for explaining more carefully the predisposing, precipitating, and perpetuating factors of (different types of) somatization. This combined approach could lead to the definition of more homogeneous and, therefore, clinically more meaningful subgroups of somatization.

Social sharing of emotion in anticipation of cardiac surgery: effects on preoperative distress.

This study examined associations between social sharing of emotions, social support and preoperative psychological distress. Social sharing was operationalized in terms of quantity and quality. Quantity of social sharing was measured daily using a diary method. Quality of social sharing was measured with the Quality of Sharing Inventory. Participants were 157 hospitalized Greek patients. Hierarchical regression analysis showed that controlling for distress on admission, quality of social sharing was negatively related to distress one day before surgery (p < .01). No effects were found for quantity of social sharing. Results emphasize the importance of studying qualitative aspects of emotional disclosure.

Goal processes in relation to goal attainment: predicting health-related quality of life in myocardial infarction patients.

Goal theory suggests that both goal attainment and psychological processes concerning goal pursuit can influence a patient's (health-related) quality of life (HRQL) (e.g. Carver & Scheier, 1999). In the present longitudinal study, 46 MI patients completed questionnaires shortly after hospitalization and four months later, assessing a health, social and individual goal for the coming year, goal conflict, goal self-efficacy, goal attainment and HRQL. The results of a multiple regression analysis suggest that both goal conflict and goal self-efficacy predict goal attainment. Furthermore, goal self-efficacy appeared to be an independent predictor of physical and social HRQL. Goal attainment had a medium effect on social HRQL, but its effect was mediated by goal conflict and goal self-efficacy. A goal theory perspective seems to offer additional insights into HRQL after an MI.

The impact of occupational hazards and traumatic events among Belgian emergency physicians.

BACKGROUND: Emergency Physicians (EPs) are regularly confronted with work related traumatic events and hectic work conditions. Several studies mention a high incidence of post-traumatic stress disorder (PTSD) and psychosomatic complaints in EP. The main objective of this study is to examine the contribution of demographics, traumatic events, life events, the occurrence of occupational hazards and social support to post-traumatic stress symptoms (PTSS), psychological distress, fatigue, somatic complaints and job satisfaction in Emergency Physicians. METHODS: For this study questionnaires were distributed to Belgian Emergency Physicians, These include, as determinants socio-demographic characteristics, traumatic events, life events, the occurrence of physical hazards, occurrences of violence, occurrence of situations that increase the risk of burnout and social support by supervisors and colleagues (LQWQ-Med), and as outcomes PTSS (IES), psychological distress (BSI), somatic complaints (PHQ 15), perceived fatigue (CIS20 R) and job satisfaction (LQWQ-MD). The response rate was 52.3 %. Hierarchical multiple regression analysis was performed to examine the association between the determinants and each of the outcomes. RESULTS: Emergency Physicians are particularly vulnerable to post-traumatic and chronic stress consequences due to repetitive exposure to work related traumatic incidents such as serious injuries or death of a child/adolescent. One out of three Emergency Physicians met sub-clinical levels of anxiety and 14.5 % met a clinical level of PTSD, short for Post-Traumatic Stress Disorder. Levels of fatigue were high but not directly related to traumatic events and occupational hazards. Social support from colleagues was found to have a beneficial effect on these complaints. Job satisfaction seems to have a protective factor. All of these not only affect the Emergency Physicians themselves, but can also have an adverse impact on patient care. DISCUSSION: EPs are, according to our and other studies, confronted on a regular basis with significant, potentially traumatizing work related events. There is a higher perception of traumatic events in older Eps. We find out that 36 % of the EPs find dealing with sudden death of a young person and traumatic accident/disease involving a young person the most traumatic experience during their work activity. Three quarter of these EPs have children of their own. The results of the study show that frequency of exposure to traumatic (work) events contributes next to occurrence of situations that increase the risk of burnout to the explanation of variance in posttraumatic stress and psychological distress. The novelty of this study is that it explores the effect of specific determinants of PTSS, psychological distress, fatigue, somatic complaints and job satisfaction in Emergency Physicians. Especially occurrence of situations that increase the risk of burnout seems to have a major impact on all outcomes including job satisfaction, while occurrence of violence contributes especially to psychological distress and perceived fatigue. Lack of social support is a well-known predictor of occupational stress in emergency care workers. In contrast however, good social support of colleagues at work, as we found in our study, can facilitate the recovery process after confrontation with traumatic events and occupational hazards. CONCLUSION: Emergency Physicians are particularly vulnerable to post-traumatic stress and chronic stress consequences due to repetitive exposure to work related traumatic events. Training in dealing with violence and situations that can increase the risk of burnout can reduce detrimental consequences in emergency physicians. In addition, it is suggested that emergency units are screened systematically on determinants of burnout, in view of interventions. Finally, creating a supportive work environment and training the medical staff in supportive skills with backup by experts may also reduce adverse consequences of confrontation with traumatic work events.

The contribution of illness perceptions to fatigue and sleep problems in youngsters with epilepsy.

PURPOSE: The present study aims to explore the extent to which gender, epilepsy severity and illness perceptions predict fatigue and sleep problems in youngsters with epilepsy. METHOD: Structured interviews were conducted in 100 young patients (Mage = 13,9, SD = 2.21; 41% girls) and data were analyzed by means of multiple hierarchical regression analyses. RESULTS: Most patients (91%) were well controlled by anti-epileptics; 3% had infrequent seizures and 6% were pharmacoresistant. At a multivariate level it appeared that youngsters with epilepsy who believe that they have less personal control over their illness and who feel that the illness has a high emotional impact on their lives reported higher levels of fatigue. In addition, more sleep problems were reported by youngsters who think they have less personal control over the disease, who believe that treatment controls epilepsy and report that the disease has a high emotional impact on their lives. CONCLUSION: Given the importance of illness perceptions, it is suggested that they are targets for future interventions that aim to reduce fatigue and sleep problems in youngsters with epilepsy.