Physical Activity Protects Against the Risk of Erosive Esophagitis on the Basis of Body Mass Index.

GOAL: To determine whether physical activity lowers the risk for erosive esophagitis on the basis of body mass index (BMI). BACKGROUND: Although previous studies have shown that physical activity is closely associated with erosive esophagitis, these data may be confounded by obesity. STUDY: In this retrospective study, we included 182,409 patients who underwent an upper endoscopy and were diagnosed with erosive esophagitis. The impact of the amount and intensity of physical activity on the risk for erosive esophagitis was analyzed based on BMI groups. Subjects were classified into three BMI groups with equal numbers in each group. RESULTS: Overall, 10.3% (n=18,859) of patients were diagnosed with erosive esophagitis. After adjusting for confounding factors, a greater amount of exercise [lower tertile: odd ratio (OR), 0.86; 95% confidence interval (CI), 0.77-0.96; middle tertile: OR, 0.91; 95%, CI 0.84-1.00; upper tertile: OR, 0.79; 95% CI, 0.73-0.85) and increased exercise intensity (lower tertile, moderate: OR, 0.61; 95% CI, 0.52-0.71; vigorous: OR, 0.51; 95% CI, 0.44-0.58; middle tertile, moderate: OR, 0.62; 95% CI, 0.55-0.70; vigorous: OR, 0.58; 95% CI, 0.51-0.65; upper tertile, moderate: OR, 0.58; 95% CI, 0.53-0.65; vigorous: OR, 0.58; 95% CI, 0.53-0.64) was associated with a decreased risk for erosive esophagitis in all 3 BMI groups. In addition, we observed that increased physical activity intensity notably decreased the risk for erosive esophagitis in subjects performing lesser physical activity, but slightly decreased the risk for erosive esophagitis in subjects performing more physical activity. CONCLUSION: Physical activity is inversely associated with erosive esophagitis.

Mediating effect of interpersonal coping on meaning in spirituality and quality of life and the influences of depression and anxiety thereon in cancer patients.

OBJECTIVE: This study aimed to investigate associations among spirituality, coping strategies, quality of life (QOL), and the effects of depression and anxiety thereon in cancer patients. METHOD: In total, 237 cancer patients referred to a psycho-oncology clinic at a university hospital in Korea were enrolled. After identifying predictors of patient QOL in a stepwise regression model, we developed a hypothetical path model wherein interpersonal coping was considered as a mediating variable between spirituality (meaning/peace) and QOL and wherein depression and anxiety affected each of these three variables. RESULT: The direct effect of spirituality (meaning/peace) on QOL was 36.7%. In an indirect model, interpersonal coping significantly mediated the relationship between spirituality (meaning/peace) and QOL. Depression exerted the largest negative effect on spirituality (meaning/peace), interpersonal coping, and QOL. Anxiety had negative effects on spirituality (meaning/peace) and QOL, but a positive effect on interpersonal coping. SIGNIFICANCE OF RESULTS: Interpersonal coping strategies work as a partial mediator of the relationship between meaning/peace subscales of spirituality and QOL. Effective management of depression may help in achieving better outcomes associated therewith. Greater attention and efforts to improve social connectedness and meaning of life in spiritual well-being may improve the QOL of cancer patients.

Depression and insomnia as mediators of the relationship between distress and quality of life in cancer patients.

BACKGROUND: Distress in cancer patients leads to poorer quality of life (QOL) and negatively impacts survival. For efficient management of a patient's disease course, the interrelationships among distress, depression, insomnia, and QOL must be understood. This study aimed to investigate whether depression and insomnia mediate the relationship between distress and QOL in cancer patients. METHODS: Cancer patients referred to a specialized psycho-oncology clinic (n=208) participated in this study. Distress, depression, insomnia, and QOL were measured with the following questionnaires: Distress Thermometer, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and Functional Assessment of Cancer Therapy-General. Structural equation modeling and path analysis were performed to analyze the mediating effects of depression and insomnia on the relationship between distress and QOL. RESULTS: Distress exerted nearly equal direct (ß=-0.291, p=0.002) and indirect (mediated by depression and insomnia) (ß=-0.299, p=0.003) negative effects on QOL. Depression exhibited the largest direct negative effect on QOL. The indirect effects of distress on QOL through depression alone, through insomnia alone, and through an insomnia to depression pathway were all significant (ß=-0.122, p=0.011; ß=-0.102, p=0.002; and ß=-0.075, p<0.001, respectively). LIMITATIONS: The cross-sectional analyses limit the measurement of causal relationships between each variable. CONCLUSIONS: Depression and insomnia, both individually and as part of an interrelated pathway, partially mediate the relationship between distress and QOL. Appropriate interventions to alleviate insomnia and depression may mitigate the negative impacts of distress on QOL in cancer patients.