Completed Diaries Research Articles

Daily diary study of adult men's and women's event-level sexual motivations and sexual behaviour.

Adult men (n=156) and women (n=192) completed thrice-daily electronic diaries assessing individual- and partner-specific attributes and non-coital or coital sexual behaviours. Sexual motivations were: interest in sex, feeling in love with partner, wanted to have sex and partner wanted to have sex. The outcome variable was: sexual behaviour type (no sex, one vaginal sex event, one vaginal sex event+any other sex types, multiple vaginal sex events, any other sex types). Mixed-effect multinomial logistic regression modelled the influence of each sexual motivation on sexual behaviour type (Stata; all p<0.05). 'No sex' was the referent in all models; all models controlled for gender. Participants contributed 14856 total partner-associated diary entries. Most (54%; women: 56.5%, men: 51.2%) were associated with no sex; when sex occurred, the most common behaviour type was one vaginal sex event (13.1%) for women and other sex types (16.4%) for men. Wanting to have sex or perceiving a partner wanted to have sex were the strongest predictors of sexual behaviour type, and were associated with a greater number of reported sexual behaviours. Event-specific sexual motivations are associated with the choice to have sex, and with variation in the chosen sexual behaviours.

Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects.

Poor sleep quality among people with chronic low back pain appears to be related to worse pain, affect, poor physical function, and pain catastrophizing. The causal direction between poor sleep and pain remains an open question, however, as does whether sleep quality exerts effects on low back pain differently across the course of the day. This daily diary study examined lagged temporal associations between prior night sleep quality and subsequent day pain, affect, physical function and pain catastrophizing, the reverse lagged temporal associations between prior day pain-related factors and subsequent night sleep quality, and whether the time of day during which an assessment was made moderated these temporal associations. Chronic low back pain patients (n=105) completed structured electronic diary assessments five times per day for 14days. Items included patient ratings of their pain, affect, physical function, and pain catastrophizing. Collapsed across all observations, poorer sleep quality was significantly related to higher pain ratings, higher negative affect, lower positive affect, poorer physical function, and higher pain catastrophizing. Lagged analyses averaged across the day revealed that poorer prior night sleep quality significantly predicted greater next day patient ratings of pain, and poorer physical function and higher pain catastrophizing. Prior poorer night sleep quality significantly predicted greater reports of pain, and poorer physical function, and higher pain catastrophizing, especially during the early part of the day. Sleep quality × time of day interactions showed that poor sleepers reported high pain, and negative mood and low function uniformly across the day, whereas good sleepers reported relatively good mornings, but showed pain, affect and function levels comparable to poor sleepers by the end of the day. Analyses of the reverse causal pathway were mostly nonsignificant. Sleep quality appears related not only to pain intensity but also to a wide range of patient mood and function factors. A good night's sleep also appears to offer only temporary respite, suggesting that comprehensive interventions for chronic low back pain not only should include attention to sleep problems but also focus on problems with pain appraisals and coping.

Social Activities Do not Distract Everyone from Work A Diary Study of Work-Related Perseverative Cognition

&lt;p&gt;Work-related perseverative cognition (WPC) involves rumination about the past and worry about the future regarding workplace issues. Such cognition impedes workers’ daily recovery and well-being as it fosters prolonged activation of psychological stressors during leisure time. Considering these detrimental effects, it is important, for both theoretical and practical considerations to highlight coping strategies that individuals can use to reduce daily WPC. Previous studies have led to contradictory results regarding the potential of social activities to decrease daily WPC. The aim of this study was to bring new insights on these results by examining how the benefits from time spent on social activities (i.e., reducing WPC) vary according to an individual’s level of neuroticism. A total of 48 daytime workers from a Canadian university completed evening diaries on 10 days during two consecutive workweeks (316 data points). Participants recorded the number of minutes spent on social activities after each workday and the extent to which a series of WPC had crossed their mind during the evening. Results from Hierarchical Linear Modeling (HLM) analyses revealed that time spent on social activities was associated to a daily decrease of WPC for workers low in neuroticism but to an increase of WPC for those high in neuroticism. This study suggests that workers high in neuroticism may be less likely to benefit from social activities. The discussion focuses on why potentially protective mechanisms associated with social activities may not be helpful to them. Practical implications based on individuals’ level of neuroticism are offered.&lt;/p&gt;

Optimising the validity and completion of adherence diaries: a multiple case study and randomised crossover trial.

BackgroundDiaries are the most commonly used adherence measurement method in home-based rehabilitation trials, yet their completion and validity varies widely between trials. We aimed to: (1) generate theory to explain this variation, (2) create an optimised diary and (3) evaluate the optimised diary’s validity.Methods Stage 1. Development: using a multiple case study approach, we collected trialist interviews (n = 7), trial publications (n = 16) and diaries (n = 7) from seven purposively sampled UK rehabilitation trials. We explored return rates, diary designs and trialists’ ideas as to what affected diary completion and validity. Using explanatory case study analysis, we developed a diary optimisation model. Stage 2. Evaluation: we compared a diary optimised according to several model components to one nonoptimised according to the same components in a randomised AB/BA crossover trial. Healthy adults aged 60+ years without mobility impairments undertook a home-based 8-week walking programme. They recorded walking duration and frequency for 4 weeks per diary. We hypothesised that the optimised diary would possess greater validity for self-reported adherence to walking duration (criterion: the Activpal accelerometer), assessed during each diary’s final week. Participants were blinded to the hypothesis. Secondary outcomes included test-retest reliability and acceptability. Ethical approval was granted from Glasgow Caledonian University.ResultsThirty-two out of 33 participants completed the study. Diaries did not significantly differ in validity, reliability or acceptability. Both diaries agreed closely with the Activpal when assessing duration adherence at a group level, however, inter and intraindividual variation in validity was high (mean difference (95 % limits of agreement (LOA): limits of agreement plot the difference between measurements collected using two different methods against their mean and thus assess the extent to which the two measures agree with each other)) optimised diary = 3.09 % (−103.3 to 109.5 %), nonoptimised diary = −0.34 % (−131.1 to 130.5 %), p = 0.732). We found similarly wide LOA for percentage of days adhered to and percentage of walks taken, whilst frequency adherence was underestimated. Participants rated both diaries as low-burden and equal numbers favoured each diary or were neutral. Preference appeared to impact minimally upon validity.ConclusionGroup-level adherence diary data are likely to be valid. However, individual diary data lack validity, which raises concerns if using this data in calculations such as predicting functional outcomes. Different diary designs are likely interchangeable, though unanticipated high variation meant that this study was underpowered.Trial registrationThe trial was not eligible for registration in a clinical trial database as diary measurement property outcomes, not clinical health outcomes of participants, were assessed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1615-7) contains supplementary material, which is available to authorized users.

Transitional Justice and Cultural Memory: The Prison Diaries of Ernest Claes and their Literary Adaptation (1944–1951)

ABSTRACTThis article considers the prison writings of the Flemish writer Ernest Claes who was imprisoned after the Second World War on suspicion of cultural collaboration with the enemy. During this period, he kept a diary that he later reworked into his book Cel 269 (1951), a literary narrative of his arrest and captivity. I will illustrate how, through his prison writings, the subject reacts to his captivity as an escape route to humanness and I will frame some aspects of these writings, such as the importance of carceral topography in the captive’s prison experience. I will also show how in Claes’ case ‘life-writing’ is to be understood as a practice in which the distinction between autobiography and fiction are deliberately blurred, with the effect of grounding the narrative in immediate testimony. Yet Claes’ complete diaries, which have since been published, reveal an alternative version of reality. As the prison diaries were only intended for him, their adaptation by the writer into a book was intended for future generations of readers. This intergenerational experience of collective memory lies at the heart of transitional justice.

Subjects with osteoarthritis can easily use a handheld touch screen electronic device to report medication use: qualitative results from a usability study.

ObjectivesElectronic data capture is increasingly used to improve collection of patient-reported outcome measures in clinical trials and care. The validation of electronic patient-reported outcome devices requires information on patient preference and ease of use. This study conducted usability testing for a General Symptom Questionnaire and Medication Module™ on a handheld device for subjects with osteoarthritis (OA) to determine whether subjects can report on their symptoms and medication use using an electronic diary.MethodsNine subjects with OA participating in a large US mode equivalency study were surveyed independently in this study. Subjects completed a General Symptom Questionnaire and Medication Module™ using the LogPad® LW handheld device. Demographic and technology use information was collected, and the subjects were queried on device usability.ResultsSubjects reported that the handheld device was easy to use and that they were able to complete a General Symptom Questionnaire and Medication Module™ with little or no assistance. They did not report any issues with the screen or size of the device. Subjects were willing to travel with the device to complete electronic diaries at home or in public. Participants indicated that they would be able to use the handheld device to answer questions during a clinical trial. Subjects with OA experienced no physical discomfort during completion of either questionnaire.ConclusionThe General Symptom Questionnaire and Medication Module™ were usable and acceptable to subjects with OA on a handheld device. This was consistent regardless of previous experience and confidence with technology, despite the potential physical restrictions for an OA cohort.

Impact of Linaclotide and Stool Form on Bowel Movement Satisfaction in Patients with Irritable Bowel Syndrome with Constipation or Chronic Idiopathic Constipation: Results from the CONTOR Study

Introduction: Our objective is toevaluate factors influencing bowel movement (BM) satisfaction in patients with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC). Methods: Fully-insured patients aged ≥18 years were identified from a large, geographically diverse, US health plan based on claims from 12/2012 to 6/2015. Criteria included: ≥1 pharmacy claim for linaclotide or lubiprostone; or ≥1 medical claim for constipation, IBS, or abdominal pain, plus a claim for a stool softener/laxative. Respondents completed a self-administered survey and 7-day daily diary of BMs at baseline. Survey measures included the Patient Assessment of Constipation Symptoms (PAC-SYM) and Quality of Life (PAC-QOL) questionnaires. Diary entries included time of each BM, treatments taken for constipation in the prior 24 hours, patients' 1-word description of each BM, and whether the BM was satisfactory. Binary variables were created for: linaclotide use in the past 24 hours, whether the 1-word BM description implied a loose or watery stool (LoWS) consistency, symptom severity and quality of life (QOL) based on median PAC-SYM and PAC-QOL scores. An interaction term between linaclotide use and LoWS was also created. Logistic regressions (with generalized estimating equations controlling for repeated measures and with and without the interaction term) analyzed the relationship between BM satisfaction and treatment, age (≥45), gender (male), race (white), PAC-SYM (≥median [i.e., greater severity]), PAC-QOL (≥median [i.e., lower quality of life]), and years with constipation symptoms (≥10). Results: Of 18,590 patients invited to participate, 2052 eligible patients completed surveys and 1747 completed BM diaries. Overall, of 15,264 BM diary entries, 7449 (49%) BMs were rated satisfactory. Patients who reported taking linaclotide in the prior 24 hours had higher odds of reporting their BMs as satisfactory (odds ratio (OR): 1.40 p < 0.001) than those who had not; the interaction term indicated that the odds were even greater among linaclotide users with LoWS (OR: 1.84 p < 0.001). Patients of white race, those with more severe symptoms, and worse QOL had lower odds of reporting their BMs as satisfactory (OR: 0.74, 0.60, and 0.69, respectively, all p≤0.001).Table 1: Model ResultsConclusion: Patients were more likely to report BMs as satisfactory when linaclotide was taken in the prior 24 hours, particularly when stool consistency was described by patients as loose and/or watery.

Treatment of insomnia reduces fatigue in chronic fatigue syndrome in those able to comply with the intervention

ABSTRACT Background: Effectiveness of cognitive behavioural therapy for insomnia (CBT-I) has not been explored in Chronic Fatigue Syndrome (CFS), a condition where disturbed sleep is a principal symptom. This study aimed to report feasibility, acceptability and initial effectiveness of CBT-I in CFS. Methods: Sixteen individuals with CFS received face-to-face CBT-I. Treatment comprised six sessions of sleep education, hygiene, restriction, stimulus control and cognitive therapy and completion of daily sleep diaries with an overarching aim to establish regularity in sleep-wake patterns. Patients completed self-report questionnaires (fatigue, pain, mood, sleep preoccupation, insomnia severity, and dysfunctional beliefs about sleep) pre- and post-treatment. Results: Of the seven who completed the intervention five improved on self-reported sleep parameters (diary measures of sleep onset latency, awakenings during the night) following treatment. However, CBT-I was not acceptable for all (56%). Total fatigue (Chalder Fatigue), dropped from mean 22 to 16. Those not able to complete the intervention had higher fatigue, pain, depression and anxiety and reported more severe insomnia at baseline compared to completers. Conclusion: CBT-I is an acceptable non-pharmacological approach with potential to treat sleep disturbances in some CFS patients. Strategies to reduce attrition and increase adherence are necessary, possibly telephone or online sessions, for this group.

Analyzing Change Processes Resulting from a Smartphone Maintenance Intervention Based on Acceptance and Commitment Therapy for Women with Chronic Widespread Pain.

This study investigated change processes resulting from a randomized controlled trial smartphone-delivered maintenance intervention with daily electronic diaries and personalized written feedback based on acceptance and commitment therapy (ACT) following a rehabilitation program for patients with chronic widespread pain. This study included 48 women who during a 5-week period completed electronic diaries three times daily, totaling 3372 entries. In response to the completed diaries, they received daily feedback from a therapist for 4weeks (excluding weekends), totaling 799 feedback messages. To analyze the change processes, we explored the associations between feedback and daily ratings of participants' physical activities, positive emotions, pain fear and avoidance, pain acceptance, and self-management. Commitment to physical activities and the participants' evaluation of feedback were also analyzed. Multilevel models were used in the statistical analyses. Participants' average pain fear and avoidance decreased over the intervention period (mean -0.019, P=0.05). Self-management, pain acceptance, and positive feelings increased (mean -0.030, P<0.01; mean -0.015, P<0.01; and mean -0.011, P=0.01, respectively). Participants' performance of physical activities decreased slightly over time, but the level of commitment was high and they evaluated the feedback as supportive for staying sufficiently active. No correlation between diary contents and feedback messages was found, even though most of the participants evaluated the feedback as supportive. No support was found for an association between diary content and feedback based on ACT. However, diary measures were consistent with the ACT model and may have influenced positively the change processes.

Food Logging and Blogging Toward Healthier Nutrition: Bringing the Curriculum Out of the Classroom and Into the 21st Century

This article focuses on the benefits of promoting lifelong, healthy eating habits within a student-centered blog. A learning community, located in an urban, northeastern section of the United States, was formed between two fifth grades from different socioeconomic backgrounds and college students enrolled in a nutrition class. Components of this unit, Food Logging and Blogging, include students’ completion and analysis of food diaries, face-to-face discussions regarding healthy eating habits, and a blog. Blogging, still a fairly new form of communication in the classroom environment, promotes engaging conversations and has increased nutrition knowledge. Advantages of blogging include authenticity with audience, transparency that gives students a platform to speak candidly, improved digital literacy savvy, and higher order thinking skills. It also offers prospective health teachers and professionals an alternative form of communication.

Optimal bladder diary duration for patients with suprapontine neurogenic lower urinary tract dysfunction.

ABSTRACTPurpose:To identify the minimum bladder diary's length required to furnish reliable documentation of LUTS in a specific cohort of patients suffering from neurogenic urinary dysfunction secondary to suprapontine pathology.Materials and Methods:From January 2008 to January 2014, patients suffering from suprapontine pathology and LUTS were requested to prospectively complete a bladder diary form for 7 consecutive days. Micturitions per day, excreta per micturition, urgency and incontinence episodes and voided volume per day were evaluated from the completed diaries.We compared the averaged records of consecutive days (2-6 days) to the total 7 days records for each patient's diary, seeking the minimum diary's length that could provide records comparable to the 7 days average, the reference point in terms of reliability.Results:From 285 subjects, 94 male and 69 female patients enrolled in the study. The records of day 1 were significantly different from the average of the 7 days records in every parameter, showing relatively small correlation and providing insufficient documentation. Correlations gradually increased along the increase in diary's duration. According to our results a 3-day duration bladder diary is efficient and can provide results comparable to a 7 day length for four of our evaluated parameters. Regarding incontinence episodes, 3 days seems inadequate to furnish comparable results, showing a borderline difference.Conclusions:A 3-day diary can be used, as its reliability is efficient regarding number of micturition per day, excreta per micturition, episodes of urgency and voided volume per day.

A comparative study of transcutaneous interferential electrical stimulation plus behavioral therapy and behavioral therapy alone on constipation in postoperative Hirschsprung disease children

PurposeWe assessed the effectiveness of transcutaneous interferential (IF) electrical stimulation on constipation in postoperative Hirschsprung's disease (HD) patients. MethodsThirty HD children (18 boys and 12 girls) with constipation who had no surgical complication were enrolled and then randomly divided into two treatment groups. The control group underwent only behavioral therapy comprising high fiber diet, hydration, toilet training and pelvic floor muscles exercises while; the IF group underwent behavioral therapy plus IF electrical stimulation. Patients underwent anorectal manometry before and 6months after the treatment. In addition, a complete bowel diary with data on the frequency of defecation per week, stool form and the number of fecal soiling episodes, a constipation score and a visual pain score were obtained from all patients before, after treatment and 6months later. ResultsConstipation symptoms were improved in 10 (66%) and 4 (26.6%) patients in IF and control groups, respectively at 6months of follow up (P<0.03). Frequency of defecation per week significantly increased after the treatment in the IF group compared with control group at the 6months of follow up (5.4±2.1 vs. 3.3±1.8 per week, respectively; P<0.009). In addition, mean pain score was significantly decreased in IF group compared with controls after treatment (P<0.05). ConclusionIF electrical stimulation is an effective adjunct to behavioral therapy to overcome symptoms of constipation in postoperative HD patients.

Delay discounting and response disinhibition moderate associations between actigraphically measured sleep parameters and body mass index.

Previous research suggests that the sleep-obesity association varies significantly across individuals. This study examined the associations between actigraphically measured sleep parameters and body mass index and hypothesized that the associations would be stronger in individuals with greater delay discounting, the devaluation of future rewards and response disinhibition and the difficulty in withholding previously rewarded responses. Seventy-eight college students carried a wrist-worn actigraph and completed diaries reporting bedtime, wake time and covariates including physical activity, alcohol and caffeine consumption, daytime nap duration and perceived stress for 7days and completed the delay discounting and go/no-go response disinhibition tasks. Their height and weight were measured. Only bedtime variability was significantly associated with body mass index in the main effect model controlling for all covariates (B=0.03, P=0.001). Delay discounting moderated associations of bedtime (B=0.03, P<0.001), sleep duration variability (B=0.05, P=0.002), bedtime variability (B=0.03, P=0.002) and wake time variability (B=0.02, P<0.001) with body mass index; these associations were significant only when the delay discounting rate was high. Response disinhibition moderated the association between bedtime variability and body mass index in a similar pattern (B=0.01, P=0.004). The findings suggest that, using actigraphy measures of sleep, circadian desynchrony rather than sleep duration is a risk factor for higher body mass index. The findings support the hypothesis that delay discounting and response disinhibition moderate the associations between sleep and body mass index. Delay discounting and response disinhibition might characterize individuals who are vulnerable to the influence of circadian desynchrony on weight.

Mixed Incontinence Masked as Stress Induced Urgency Urinary Incontinence

We sought to understand variations in the expression and temporal relation of bladder control episodes among women with mixed urinary incontinence. A random sample of women 40 years old or older with mixed urinary incontinence on GLOBE-UI (General Longitudinal Overactive Bladder Evaluation-Urinary Incontinence) was recruited in a digital daily diary study using a smartphone application. When a bladder control event occurred, women were instructed to answer episode specific questions. Episodes were defined as urgency, and urinary incontinence with and urinary incontinence without urgency. Women and episodes were compared by the type of activity preceding each episode. Urinary incontinence episodes were further defined as stress urinary incontinence, urgency urinary incontinence, stress induced urgency urinary incontinence and other. The chi-square and Wilcoxon tests were used for categorical and continuous variables, respectively. Of 40 women with a mean age of 65.5 years 35 provided complete 30-day diary data. Of the 950 bladder control episodes reported 25% were urgency only, 55% were urinary incontinence with urgency and 19% were urinary incontinence without urgency. Of the urinary incontinence episodes without urgency 82% occurred after a stress activity (eg coughing or sneezing). Notably, a stress activity also occurred just before 52.5% of the urgency urinary incontinence episodes (p <0.001). A total of 24 women (69%) reported at least 1 episode of stress induced urgency urinary incontinence, which was the most prevalent urinary incontinence subtype episode, followed by urgency urinary incontinence and stress urinary incontinence (29% vs 27% and 16%, respectively). The mean number of daily episodes was 1 or 2 across all groups. Women with mixed urinary incontinence express a heterogeneous set of bladder control episodes with stress induced urgency urinary incontinence as the dominant type.

Genetic Differential Susceptibility to Socioeconomic Status and Childhood Obesogenic Behavior: Why Targeted Prevention May Be the Best Societal Investment.

Genes may work by modulating the way individuals respond to environmental variation, and these discrete and differential genes vs environmental interactions may not be readily captured in simple association studies. To determine whether children carrying the 7-repeat allele of the DRD4 gene living under adverse economic conditions have worse-than-average fat intake compared with those living in a healthy environment. Data from an established prospective birth cohort (Maternal Adversity, Vulnerability, and Neurodevelopment) were used to study 4-year-old children from Montreal, Quebec, Canada and Hamilton, Ontario, Canada. A total of 190 children (94 girls and 96 boys) had height and weight measured and complete food diaries and were therefore eligible for the study. The study is derived from a birth cohort started in June 2003 and still ongoing. The last age of follow-up was at 6 years. Social environment was characterized based on the gross family income, and DNA was genotyped for the 7-repeat allele of the DRD4 gene. Fat intake. The 5 steps to distinguish the differential susceptibility from other types of interaction were followed, and the study confirms that differential susceptibility is a relevant model to address the association between the 7-repeat allele of DRD4 and food choices in girls. Of the 190 children, 112 did not have the DRD4 7-repeat allele and 78 did. Baseline characteristics did not differ in these 2 groups. Although not different in several confounders, such as maternal educational level, maternal smoking during gestation, birth weight, and breastfeeding duration, girls carrying the 7-repeat allele of the DRD4 gene and living in adverse socioeconomic conditions have increased fat intake compared with girls who are noncarriers (DRD4 7+ mean, 33.95% of calories derived from fat; 95% CI, 28.76%-39.13%; DRD4 7- mean, 28.76%; 95% CI, 26.77%-30.83%). However, girls carrying the 7-repeat allele of the same gene and living in better socioeconomic conditions have decreased fat intake compared with noncarriers (DRD4 7+ mean, 29.03% of calories derived from fat; 95% CI, 26.69%-31.51%; DRD4 7- mean, 31.88%; 95% CI, 30.28%-33.58%). Alleles previously considered to be obesity risk alleles might in fact function as plasticity alleles, determining openness to environmental modification and/or intervention, as seen in the girls in this study. This finding has important implications for obesity prevention and social pediatrics.

Urinary cytokines/chemokines pattern in patients with painful bone metastases undergoing external beam radiotherapy experiencing pain flare.

External beam radiotherapy (EBRT) is a mainstay for treatment of painful bone metastases. Transient worsening of pain ("pain flare") occurs in 40% of patients. We investigated the pathophysiology of pain flare through assessment of changes in urinary cytokines/chemokines in patients receiving EBRT for painful bone metastases. Urine samples were collected from patients receiving a single 8 Gy fraction for painful bone metastases preparation, day 1 or 2 and on an additional day between days 3 to 5 post radiation. Patients completed a standardized pain and analgesic use diary daily for 10 days following radiation. Patients were deemed to have pain flare if they had a two-point increase from baseline worst pain on 0-10 scale and no decrease in analgesic intake or a 25% increase in analgesic intake with no decrease in worst pain. The Millipore Milliplex 42-Plex Cyto-kine/Chemokine Kit™ was used to measure urinary levels of a panel of cytokines/chemokines. Forty-six patients consented to the study of which 28 were evaluable (complete urine and diary data), and 83/84 urine samples were available for analysis. Pain flare was experienced by 11 patients (39%). The following cytokines/chemokines were detectable in at least 50% of the patients: EGF, fractalkine, GRO, IL-4, IL-8, interferon gamma induced protein 10 (IP-10), MCP-1, macrophage derived chemokine (MDC), PDGF-AA, sIL-2Ra, TGF-Alpha, VEGF. Comparing patients with or without pain flare EGF, fractalkine, GRO, IL-8, IP-10, MCP-1, MDC, sIL-2Ra, and TGF-alpha increased following radiation in both groups. Patients with pain flare have significant lower levels on IL-8, IP-10, and MDC over time. No specific time trend was noticed. Patients who experience pain flare appear to have a different pattern in urinary cytokine/chemokine levels than patients without pain flare. A larger study is required to confirm the possible role of cytokines/chemokines in predisposition to and/or the cause of pain flare following radiation to painful bone metastases.

Subject-Controlled, On-demand, Dorsal Genital Nerve Stimulation to Treat Urgency Urinary Incontinence; a Pilot.

Objectives: To evaluate the effect of subject-controlled, on-demand, dorsal genital nerve (DGN) stimulation on non-neurogenic urgency urinary incontinence (UUI) in a domestic setting. Materials and Methods:Non-neurogenic patients >18 years with overactive bladder symptoms and UUI were included. Exclusion criteria were mainly stress urinary incontinence. Patients underwent 1 week of subject-controlled, on-demand, DGN stimulation, delivered by a percutaneously placed electrode near the DGN connected to an external stimulator (pulse-rate 20 Hz, pulse-width 300 μs). Patients activated the stimulator when feeling the urge to void and stimulated for 30 s. The amplitude was set at the highest tolerable level. A bladder diary including a severity score of the UUI episodes/void (scores: 0 = none, 1 = drops, 2 = dashes, 3 = soaks) and a padtest was kept 3 days prior to, during, and 3 days after the test period. The subjective improvement was also scored.Results: Seven patients (4 males/3 females) were enrolled, the mean age was 55 years (range 23–73). Six completed the test week. In the remaining patient the electrode migrated and was removed. 5/6 finalized the complete bladder diary, 1/6 recorded only the heavy incontinence episodes (score = 3). 4/6 completed the padtest. In all patients who finalized the bladder diary the number of UUI episodes decreased, in 3/5 with ≥60%. The heavy incontinence episodes (score = 3) were resolved in 2/6 patients, and improved ≥80% in the other 4. The severity score of the UUI episodes/void was improved with ≥ 60% in 3/5 patients. The mean subjective improvement was 73%.Conclusion: This feasibility study indicates that subject-controlled, on-demand DGN stimulation using a percutaneously placed electrode is possible over a longer time period, in a home setting, with a positive effect on non-neurogenic overactive bladder symptoms with UUI. Although the placement is an easy procedure, it is difficult to fixate the electrode to keep it in the correct position. Improvements in hardware, like a better fixated electrode and an easy to control stimulator, are necessary to make SODGNS a treatment possibility in the future.

Differences in sedentary time and physical activity among mothers and children using a movement-to-music video program in the home environment: a pilot study.

Measured objectively, less than a quarter of adults and under half of preschool children in Finland meet the physical activity recommendations. Moreover, higher sedentary time among parents (such as watching television) is associated with higher sedentary time of their children. The study introduces an intervention based on reducing sedentary behavior among mothers and their children. It utilizes a combination of music and exercise via a motivation-targeting movement-to-music video program in the home environment. Data were collected in summer 2014 from Finland’s Pirkanmaa region. Each mother–child pair (n = 24, child age: 4–7 years) was assigned to the intervention and control group. Both groups used an accelerometer and completed physical activity diaries for two consecutive weeks (14 days) during waking hours. In addition, the intervention group was instructed to use the movement-to-music video program during the second week. Differences between groups were expected in analysis of sedentary time and physical activity between weeks 1 and 2. The parameters assessed were sedentary time (i.e., lying down or sitting), standing still, and time spent in physical activity. Less sedentary time was revealed in week 2 than in week 1 among both intervention group mothers (56.6 vs. 53.3 %) and for intervention group children (49.5 vs. 46.0 %). The opposite was true of control group mothers (52.1 vs. 52.4 %) and children (46.7 vs. 49.8 %). Within-group differences in mothers’ sedentary time correlated moderately with the children’s sedentary time (Spearman’s r = 0.56). All groups exhibited slightly more standing in the second week than in week 1. Both sets of intervention participants also engaged in more light physical activity in week 2, with the opposite evident for the two control sets. In all groups, except the control children, the proportion of moderate to vigorous physical activity was higher in the second week than the first. The use of music and video content together may yield added benefits in efforts to reduce sedentary behavior and increase physical activity among mothers and their children in the home environment.

Help-seeking and antibiotic prescribing for acute cough in a Chinese primary care population: a prospective multicentre observational study.

Acute cough is a common reason to prescribe antibiotics in primary care. This study aimed to explore help-seeking and antibiotic prescribing for acute cough in Chinese primary care population. This is a prospective multicentre observational study that included adults presenting with acute cough. Clinicians recorded patients’ presenting symptoms, examination findings and medication prescription. Patients completed symptom diaries for up to 28 days by charting their symptom severity and recovery. Adjusted binary logistic regression models identified factors independently associated with antibiotic prescription. Primary care clinicians (n=19) recruited 455 patients. A total of 321 patients (70.5%) returned their completed symptom diaries. Concern about illness severity (41.6%) and obtaining a prescription for symptomatic medications (45.9%), rather than obtaining a prescription for antibiotics, were the main reasons for consulting. Antibiotics were prescribed for 6.8% (n=31) of patients, of which amoxicillin was the most common antimicrobial prescribed (61.3%), as it was associated with clinicians’ perception of benefit from antibiotic treatment (odds ratio (OR): 25.9, 95% confidence interval (CI): 6.7–101.1), patients’ expectation for antibiotics (OR: 5.1, 95% CI: 1.7–11.6), anticipation (OR: 5.1, 95% CI: 1.6–15.0) and request for antibiotics (OR 15.7, 95% CI: 5.0–49.4), as well as the severity of respiratory symptoms (cough, sputum, short of breath and wheeze OR: 2.7–3.7, all P<0.05). There was a significant difference in antibiotic prescription rates between private primary care clinicians and public primary care clinicians (17.4 vs 1.6%, P=0.00). Symptomatic medication was prescribed in 98.0% of patients. Mean recovery was 9 days for cough and 10 days for all symptoms, which was not significantly associated with antibiotic treatment. Although overall antibiotic-prescribing rates were low, there was a higher rate of antibiotic prescribing among private primary care clinicians, which warrants further exploration and scope for education and intervention.

The Culture of Nurses in a Critical Care Unit

Critical care nurses have to adapt to a fast-paced and stressful environment by functioning within their own culture. The objective of this study was to explore and describe the culture of critical care nurses with the purpose of facilitating recognition of wholeness in critical care nurses. The study had a qualitative, exploratory, descriptive, and contextual design. The ethnographic study included data triangulation of field notes written during 12 months of ethnographic observations, 13 interviews from registered nurses, and three completed diaries. Coding and analysis of data revealed patterns of behavior and interaction. The culture of critical care nurses was identified through patterns of patient adoption, armor display, despondency because of the demands to adjust, sibling-like teamwork, and non-support from management and medical doctors. An understanding of the complexity of these patterns of behavior and interaction within the critical care nursing culture is essential for transformation in the practice of critical care nursing.