***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : We explored the factors that predicted psychological distress in the first six months post stroke in a sample including people with aphasia . Design : Prospect i ve longitudinal observational study . Setting and subjects : Participants with a first stroke from two acute stroke units were assessed while still in hospital ( baseline ) and at three and six months post stroke . Main measures : Distress was assessed with the  General Health Question naire-12 .  Other measures included : NIH Stroke Scale , Barthel Index , Frenchay Aphasia Screening Test , Frenchay Activities Index , MOS Social Support Scale and social network indicators .  Logistic regression was used to identify predictors of distress at each stage post stroke ; and to determine what baseline factors predicted distress at six months . Results : Eighty-seven participants were able to self-report on measures used , of whom 32 ( 37 % ) had aphasia . 71 ( 82 % ) were seen at six months , including 11 ( 16 % ) with aphasia . Predictors of distress were : stroke severity at baseline ; low social support at three months ; and loneliness and low satisfaction with social network at six months . The baseline factors that predicted distress at six months were psychological distress , loneliness and low satisfaction with social network ( Nagelkerke R2 = 0.49 ) . Aphasia was not a predictor of distress at any time point . Yet , at three months post stroke 93 % of those with aphasia experienced high distress , as opposed to 50 % of those without aphasia ( χ2 ( 1 ) = 8.61 , P<0.01 ) . Conclusions : Factors contributing to distress after stroke vary across time . Loneliness and low satisfaction with one ’s social network are particularly important and contribute to long-term psychological distress We investigated the prospect i ve impact of self-reported loneliness on all-cause mortality , mortality from ischemic disease and mortality from other cardiovascular diseases .  We tested these effects through GEE binomial regression models applied to longitudinal data from the Alameda County Study of persons aged 21 and over arranged into person-years . Controlling for age and gender , the chances of all-cause mortality were significantly higher among respondents reporting that they often feel lonely compared to those who report that they never feel lonely . Frequent loneliness was not significantly associated with mortality from ischemic heart disease but more than doubled the odds of mortality from other ailments of the circulatory system in models controlling for age and gender . Subsequent models showed that physical activity and depression may be important mediators of loneliness-mortality associations . Finally , we find support for the contention that chronic loneliness significantly increases risk of mortality but also find reason to believe that relatively recent changes in feelings of loneliness increase risk of mortality as well PURPOSE The purpose of this paper is to present the development of LISTEN ( Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes ) , a new intervention for loneliness . METHODS LISTEN was developed using the Medical Research Council ( MRC ) framework for intervention development . Extensive literature review revealed that belonging , relating , placing in community , challenges , and meanings of coping were concepts significant to loneliness . Past interventions were limited but it was determined from a recent meta- analysis that enhanced effectiveness might result from interventions that targeted the poorly adapted cognitive processes of loneliness . These processes include social undesirability , stigma , and negative thoughts about self in relation to others . LISTEN is design ed to be delivered in a determined logical sequence of 5 sessions , each focusing on the concepts relevant to loneliness as derived from the literature . For each session , intervention delivery is guided by the concepts from story theory ( including intentional dialogue , nurse as listener , examination of self in relation to others and community , synthesizing concerns and patterns , and identifying messages ) and the principles of cognitive restructuring ( self- assessment of maladaptive cognitions , emotions , and behaviors , identifying challenges of changing , reconceptualization of self , new skill acquisition through group interaction , and identifying patterns of meaning in loneliness ) . RESULTS LISTEN is developed and the first r and omized trial is complete with a sample of 27 lonely , chronically ill , community dwelling , and older adults .  LISTEN was evaluated as feasible to deliver by the study team and acceptable for significantly diminishing loneliness by participants of the LISTEN groups who were compared to attention control groups ( p < 0.5 ) . CONCLUSIONS LISTEN has the potential to enhance health by diminishing loneliness which could result in improving the long-term negative known sequelae of loneliness . Future longitudinal r and omized trials are needed in varied population s to assess long term health and healthcare system benefit of using LISTEN to treat loneliness Self-reported conditions have become increasingly important in patient care , and perceived loneliness and social relationships in patients with chronic heart failure ( CHF ) are not sufficiently investigated . Aim : The aim was to investigate perceived loneliness and social support in patients with CHF . Further , to investigate whether loneliness and social support might be associated with gender , age , healthcare utilization and mortality . Methods : One hundred and forty nine patients with CHF , hospitalised at least once during a 4-month period in 2006 , completed a self-reported question naire including measurements about  loneliness and social support . Healthcare utilization was assessed prospect ively by frequency of readmissions and number of days hospitalised during 1 year . Results : Loneliness was reported by 29 ( 20 % ) participants . They were more often women ( p < 0.001 ) and younger ( p = 0.024 ) . Patients who perceived loneliness had fewer social contacts ( p = 0.033 ) , reported lower occurrence of emotional contacts ( p = 0.004 ) , were less satisfied with social contacts and close relationships ( p < 0.001 ) . Those reporting loneliness had more days hospitalised ( p = 0.044 ) , and more readmissions to hospital ( p = 0.027 ) , despite not having more severe CHF . Conclusion : Loneliness is a health-related risk indicator in that patients with CHF who perceived loneliness have more healthcare utilization than those who do not report loneliness despite not having more severe CHF We present evidence from a 5-year longitudinal study for the prospect i ve associations between loneliness and depressive symptoms in a population -based , ethnically diverse sample of 229 men and women who were 50 - 68 years old at study onset .  Cross-lagged panel models were used in which the criterion variables were loneliness and depressive symptoms , considered simultaneously . We used variations on this model to evaluate the possible effects of gender , ethnicity , education , physical functioning , medications , social network size , neuroticism , stressful life events , perceived stress , and social support on the observed associations between loneliness and depressive symptoms . Cross-lagged analyses indicated that loneliness predicted subsequent changes in depressive symptomatology , but not vice versa , and that this temporal association was not attributable to demographic variables , objective social isolation , dispositional negativity , stress , or social support . The importance of distinguishing between loneliness and depressive symptoms and the implication s for loneliness and depressive symptomatology in older adults are discussed Objective : To investigate the association of serum levels of proangiogenic cytokines with different indices of social support and loneliness by measuring the levels of expression of two important proangiogenic cytokines , vascular endothelial growth factor ( VEGF ) , and interleukin-6 in tumors of colon and rectum . Lack of social support has been prospect ively associated with cancer progression . Methods : Fifty-one newly diagnosed patients with colorectal tumors ( mean age , 68.3 years ) completed two measures of loneliness 1 to 2 days before their surgical treatment . The first was an explicit self-report question naire , which tapped into negative feelings as a result of low social support . The second was a st and ardized computer-based task , which measured loneliness implicitly . Immunohistochemical analyses were performed on tumor tissues post surgery to determine the expression of cytokines . Results : Logistic regression showed that higher levels of implicit loneliness independently predicted stronger expression of VEGF , controlling for Dukes stage and explicit loneliness , both of which were nonsignificant predictors . No significant relationships were found between the loneliness measures and interleukin-6 . Conclusions : The results of this study suggest VEGF to be an angiogenic mechanism through which loneliness may lead to worse cancer-related outcomes . Implication s are discussed in terms of devising targeted psychosocial and immunotherapeutic interventions for cancer patients with low social support . ACTH = adrenocorticotropin hormone ; CRF = corticotrophin releasing factor ; DAB = diaminobenzidine ; IL = interleukin ; SNS = sympathetic nervous system ; VEGF = vascular endothelial growth factor Background . The harmful associates of suffering from loneliness are still in dispute . Objective . To examine the association of feelings of loneliness with all-cause mortality in a general aged population . Methods . A postal question naire was sent to r and omly selected community-dwelling of elderly people ( > 74 years ) from the Finnish National Population Register . The question naire included demographic characteristics , living conditions , functioning , health , and need for help . Suffering from loneliness was assessed with one question and participants were categorized as lonely or not lonely . Total mortality was retrieved from the National Population Information System . Results . Of 3687 respondents , 39 % suffered from loneliness . Lonely people were more likely to be deceased during the 57-month follow-up ( 31 % ) than subjects not feeling lonely ( 23 % , P < .001 ) . Excess mortality ( HR = 1.38 , 95 % CI = 1.21–1.57 ) of lonely people increased over time . After controlling for age and gender , the mortality risk of the lonely individuals was 1.33 ( 95 % CI = 1.17–1.51 ) and after further controlling for subjective health 1.17 ( CI = 1.02–1.33 ) . The excess mortality was consistent in all major subgroups . Conclusion . Suffering from loneliness is common and indicates significant mortality risk in old age BACKGROUND AND PURPOSE Data on survival and functioning after stroke needs to be supplemented by measures emphasizing the patients ' subjective perception . We studied ( 1 ) subjective well-being ( SWB ) as a latent variable in a common-factor model with four items , ( 2 ) the reliability of these four items , and ( 3 ) variables related to SWB in stroke patients . METHODS Data on all stroke patients ( n=1417 ) and a r and om sub sample of stroke-free individuals of similar age ( n=1439 ) were collected from the Nord-Trøndelag Health Survey , a cross-sectional study of 74977 persons . Based on a two- sample factor analysis model , scores of SWB were calculated , and variables explaining SWB were studied in a regression model . RESULTS Four items were a priori believed to measure SWB as a latent variable ( " satisfaction , " " strength , " " calmness , " and " cheerfulness " ) . This was confirmed by factor analysis . The reliability of these items ( the proportion of the variance of the items that can be explained by the common factor ) was between .42 and .53 . Regression analyses showed a significant effect of having had a stroke , gender ( lower SWB in men ) , age ( increasing SWB with increasing age ) , perceived general health , nervousness , loneliness , sleep problems , social support , and use of analgesics . There was no statistical interaction between these variables and having had a stroke . CONCLUSIONS Higher SWB after stroke relates to female gender , older age , good general and mental health , and a firm social network Objectives : This study examined relations between social isolation , loneliness , and social support to health outcomes in a sample of New Mexico seniors . Method : We used r and om-digit dialing to obtain a r and om sample of 755 southern New Mexico seniors . Participants answered questions pertaining to demographics , social isolation and loneliness , social support , and disease diagnosis including diabetes , hypertension , heart disease , liver disease , arthritis , emphysema , tuberculosis , kidney disease , cancer , asthma , and stroke . The sample allowed for comparison of Caucasian and Hispanic participants . Results : Correlational and logistic analyses indicated that belongingness support related most consistently to health outcomes . Ethnic subgroup analysis revealed similarities and differences in the pattern of associations among the predictor and outcome variables . Discussion : The results demonstrate the importance of social variables for predicting disease outcomes in the elderly and across ethnic groups Objective : To assess the relationship between social isolation and stroke outcomes in a multiethnic cohort . Methods : As part of the Northern Manhattan Stroke Study , the authors prospect ively followed a cohort of patients with stroke for 5 years .  Baseline data including social isolation  were collected . At follow-up , the authors documented outcome events as defined by the first occurrence of myocardial infa rct ion ( MI ) , stroke recurrence , or death . Cox hazard models were used to calculate the hazard ratio ( HR , 95 % CI ) for prestroke predictors of post stroke outcomes . Results : The authors followed 655 ischemic stroke cases for a mean of 5 years . The cohort was 55 % women ; 17 % white , 27 % African American , 54 % Hispanic ; mean age 69 ± 12 years . There were 265 first outcome events . In univariate analysis , coronary artery disease ( OR 1.3 , 1.0 to 1.7 ) , age > 70 years ( OR 1.9 , 1.5 to 2.5 ) , atrial fibrillation ( AF ) ( OR 1.8 , 1.3 to 2.5 ) , race-ethnicity ( white vs Hispanic ) ( OR 1.7 , 1.1 to 2.9 ) , physical inactivity 
    Output:
    
A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness population s.  Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease , hypertension , stroke , and lung disease .
The relationships among loneliness , obesity , and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons .
Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions .