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Purpose Irritable bowel syndrome (IBS) is a functional bowel disorder with a large negative impact on HRQOL. The present study examines whether severity of bowel symptoms is directly related to HRQOL, and/or indirectly, mediated by the patients' illness perceptions. Methods Patients were recruited from an IBS support group (N = 123), and data were collected online. HRQOL was measured with the Quality of Life Measure for Persons with IBS and illness perceptions with the brief Illness Perception Questionnaire. Mediation models were tested using the bootstrapping procedure developed by Hayes. Results Irritable bowel syndrome symptom severity is directly related to total HRQOL and its subscales; after entering the mediator variables (i.e. the patients' illness perceptions) into the model, this direct association remained only significant for total HRQOL. The relationship between bowel symptom severity and total HRQOL was partially mediated by illness perceptions, and its relationship with each of the HRQOL subscales was fully mediated by the patients' illness perceptions. Perceived consequences were a mediator of the relationship between bowel symptom severity, total HRQOL as well as its subscales, with the exception of Sexuality. Conclusions Bowel symptom severity not only has a direct relationship with HRQOL, but also an indirect relationship via the patients' cognitive and emotional representations of their illness. In order to better understand this relationship, future research should not only include illness perceptions but also assess cognitive and behavioural coping responses. Clinicians wanting to improve patients' HRQOL should not only focus on the patients' symptoms, but also on their illness beliefs and coping responses.

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.

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

The outcome measures most frequently used in studies on the effectiveness of migraine treatment are whether the patient is free of pain, nausea, and free of photophobia/phonophobia within two hours. However, no patient-centred outcome measures are available. Therefore, we performed an online Delphi procedure to compile a list of outcome measures deemed most important to migraine patients. From a large database of migraine patients, we randomly selected 150 males and 150 females patients. We asked the open-ended question: 'If a new medicine was developed for migraine attacks, what would you wish the effect of this medication to be?' In the second and third rounds, we presented the answers of the first round and asked the patients to rate the importance of each item. The initial response rate was 56% (n = 169). In the subsequent rounds the response rates were 90% (n = 152), and 97% (n = 147), respectively. Patients wanted their attack medication to treat the headache within 30 min, to prevent the attack from getting worse, to ensure they could function properly within 1 h, and prevent the recurrence of symptoms during the same day. The currently used outcome measures in migraine research do not sufficiently reflect the wishes of patients. Patients want the medication to work faster, to take away pain at an earlier stage, to make them able to function properly quickly, and to prevent recurrence. These aspects should be considered in future evaluation of new attack medication for migraine.

A wide range of instruments have been used in health-related quality of life (HRQL) assessment of patients with coronary artery disease. The MacNew heart disease health-related quality of life questionnaire (MacNew) is a disease-specific measure of HRQL, that has been found to have both good discriminative and evaluative properties. The objective of the present study was to translate the MacNew for a Dutch population, and assess its reliability and validity. Three hundred and thirty-nine cardiac patients, admitted to the hospital after a cardiac event, participated in the study. Questionnaires were filled out at baseline, at 3 months, and at 12 months. A clinically relevant three-factor solution, reflecting an emotional, physical, and social domain of HRQL, allowed us to explain 55% of variance. Angina pectoris was consistently found to be significantly associated with worse HRQL. The pattern of correlations between the subscales of the MacNew on the one hand, and between the subscales of the MacNew and two other, related questionnaires on the other hand, indicated only modest convergent and discriminant validity. The internal consistency was found to be fair to (very) good (ranging between 0.78 and 0.95). Finally, the Dutch MacNew was demonstrated to be substantially more responsive than two other instruments measuring physical and psychological well-being.

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.

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.

The purpose of this prospective study was to examine (a) whether Sensory Processing Sensitivity (SPS) measured at baseline (T0) predicts distress at one year follow-up (T1), and (b) whether and in what way resilience mediates the effect of SPS on distress. The study sample consisted of gifted adults. A total of 738 respondents participated in the study at T0 and T1 (mean age of 44.86; 63.4% female). Structural Equation Modeling and logistic regression analysis were conducted. A high level of SPS at T0 predicted psychological (anxiety and depression) and somatic (physical symptoms and fatigue) distress at T1. As far as indirect effects are concerned, results depended upon whether we looked at the negative or positive higher-order dimension of SPS. A higher score on negative SPS was associated with lower resilience which in turn led to more distress, indicating that low resilience increased the negative impact of negative SPS on distress. In contrast, a higher score on positive SPS was related to more resilience, resulting in less distress, suggesting that in this case resilience had a buffering effect. As resilience is a buffer between SPS and distress, follow-up research could focus on psychological interventions aimed at increasing resilience.

The personality traits neuroticism and alexithymia have been hypothesized as predisposing factors for somatization. Stability over time is a basic assumption underlying any trait construct. Although there are considerable (and sometimes conflicting) data relevant to this issue, the stability of neuroticism and alexithymia has not been assessed in somatization. The main purpose of this study was to examine the temporal stability of neuroticism and alexithymia in patients presenting to their primary care physician with medically unexplained symptoms, and compare this to the stability of negative and positive affect, anxiety, and depression. A total number of 318 patients were assessed at baseline and at 6-months follow-up. Whereas the affective state dimensions changed significantly over the follow-up period, neuroticism and alexithymia were substantially stable.

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