Global Index Scores Research Articles

Acupuncture for Treatment of Persistent Disturbed Sleep

To evaluate real, as compared with sham, acupuncture in improving persistent sleep disturbance in veterans with mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD). This sham-controlled randomized clinical trial at a US Department of Veterans Affairs Medical Center (2010-2015) included 60 veterans aged 24-55 years (mean of 40 years) with history of mTBI of at least 3 months and refractory sleep disturbance. Most of these participants (66.7%) carried a concurrent DSM-IV clinical diagnosis of PTSD. For the present study, they were randomized into 2 groups and stratified by PTSD status using the PTSD Checklist-Military Version. Each participant received up to 10 treatment sessions. The primary outcome measure was change in baseline-adjusted global Pittsburgh Sleep Quality Index (PSQI) score following intervention. Secondary outcomes were wrist-actigraphy-assessed objective sleep measurements. Comorbid PTSD was analyzed as a covariate. Mean (SD) preintervention global PSQI score was 14.3 (3.2). Those receiving real acupuncture had a global PSQI score improvement of 4.4 points (relative to 2.4 points in sham, P = .04) and actigraphically measured sleep efficiency (absolute) improvement of 2.7% (relative to a decrement of 5.3% in sham, P = .0016). Effective blinding for active treatment was maintained in the study. PTSD participants presented with more clinically significant sleep difficulties at baseline; acupuncture was effective for both those with and without PTSD. Real acupuncture, compared with a sham needling procedure, resulted in a significant improvement in sleep measures for veterans with mTBI and disturbed sleep, even in the presence of PTSD. These results indicate that an alternative-medicine treatment modality like acupuncture can provide clinically significant relief for a particularly recalcitrant problem affecting large segments of the veteran population. ClinicalTrials.gov identifier: NCT01162317.

Effect of self-care interventions on sleep quality in post-coronary artery bypass grafting patients: A single-center, randomized-controlled study.

This study aims to evaluate the effect of self-care interventions based on sleep hygiene practices, nutrition, and physical activity on sleep quality in post-coronary artery bypass grafting patients. This randomized-controlled study included a total of 146 patients (109 males, 37 females; mean age 55.31 years; range, 41 to 65 years) who underwent isolated coronary artery bypass grafting at Seyyed Al- Shohada Hospital of Urmia Medical Sciences University, between September 2017 and May 2018. The patients were divided into two groups as the self-care intervention group (n=73) and as the control group (n=73). The self-care intervention group received six educational courses on sleep hygiene, nutrition, and physical activity. Then they received individualized consulting weekly for three months. The control group was instructed to continue their normal life and routine care and received no education. The Demographic Information Form and the Pittsburgh Sleep Quality Index were used for data collection. The mean Pittsburgh Sleep Quality Index scores in the self-care intervention group decreased to 7.1±2.3 after the intervention, while it increased to 9.5±2.1 in the control group. There was no significant difference between the two groups in terms of the mean global Pittsburgh Sleep Quality Index scores before the study (p=0.91); however, the scores were statistically significantly higher after the self-care intervention (p=0.001). Patients undergoing coronary artery bypass grafting may benefit from self-care interventions based on sleep hygiene, nutrition, and physical activity to improve the quality of sleep.

Rapid screening for cognitive deficits in attention deficit and hyperactivity disorders with the screen for cognitive impairment in psychiatry.

Cognitive impairments constitute a core feature of attention deficit and hyperactivity disorders (ADHD), but are infrequently assessed in the clinical setting. We have previously demonstrated the ability of an objective cognitive battery, the Screen for Cognitive Impairment in Psychiatry (SCIP), to differentiate adult ADHD patients from healthy controls in five cognitive domains. Here, we further characterize these subtle cognitive deficits by conducting additional univariate analyses on our ADHD dataset to assess the contributions of various demographic characteristics on SCIP performance and to determine correlations between SCIP scores and scores on other measures evaluating illness severity, perceived cognitive deficits, and overall functioning. Age and years of education were moderately associated with performance on the SCIP and/or its subscales in our ADHD cohort. The SCIP global index score was moderately correlated with clinician-rated measures of illness severity and weakly associated with clinician-rated overall functional status. Intriguingly, overall SCIP performance was only weakly associated with patient self-reported measures of cognitive functioning. Of practical importance, small-to-moderate associations were consistently observed between performances on two subscales of the SCIP and the other measures evaluating illness severity, overall functioning, and patient self-reported cognitive functioning (the working memory and visuomotor tracking subscales). Thus, these data demonstrate that the SCIP, particularly the working memory and visuomotor tracking subscales, is sensitive enough to detect cognitive deficits in adult patients with ADHD, and that these deficits are correlated with functional impairments. Furthermore, these data highlight the importance of integrating both objective and subjective evaluations of cognition in adult ADHD.

Human T-Lymphotropic Virus-1-Associated Myelopathy/Tropical Spastic Paraparesis Is Associated With Sexual Dysfunction in Infected Women of Reproductive Age.

IntroductionHuman T-lymphotropic virus (HTLV)-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a neurological disorder that mostly affects women. This disease is characterized by a progressive loss of motor function and disruptions in sensory function in the lower limbs. HTLV-1 is also associated with isolated neurologic dysfunctions, overactive bladder, and erectile dysfunction. The occurrence of sexual dysfunction in HTLV-1–infected women remain unclear.AimTo investigate associations between HTLV-1 infection and sexual dysfunction in both asymptomatic infected women and those diagnosed with HAM/TSP compared with uninfected women.MethodsHTLV-1–infected and uninfected women were assessed for sexual dysfunction using the Female Sexual Function Index instrument. Sexual dysfunction was considered if global Female Sexual Function Index scores were <26.5. Crude and adjusted prevalence ratios (PR) with 95% CI were calculated to identify associations between sexual dysfunction (outcome) and HTLV infection status–asymptomatic or HAM/TSP (main exposure), compared with uninfected women, and adjusted by sociodemographic and/or clinical characteristics (covariables).ResultsHTLV-1–infected women (n = 72; 57 asymptomatic; 15 HAM/TSP) and HTLV-1 uninfected women (n = 49) were evaluated. The overall sexual dysfunction prevalence was 53.7% (65/121), which was higher in the HAM/TSP group (80.0%; adjusted PR 1.89; 95% CI 1.23–2.90) when compared with non-infected individuals (44.9%). Sexual dysfunction was found in 54.4% of the HTLV-1–infected asymptomatic women (PR 1.21; 95% CI 0.82–1.79). Sexual dysfunction was associated with income lower than 1 minimal wage (∼US $300, October 2017) and number of previous birthday.ConclusionThe obtained results indicate that sexual dysfunction is associated with HAM/TSP in women infected with HTLV-1 of reproductive age.Lima Lopes Martins A, Rios Grassi MF, de Aquino Firmino A, et al. Human T-Lymphotropic Virus-1–Associated Myelopathy/Tropical Spastic Paraparesis Is Associated With Sexual Dysfunction in Infected Women of Reproductive Age. Sex Med 2018;6:324–331.

Surgery is not superior to dilation for the management of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome: a multicenter comparative observational study in 131 patients

Vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome can be managed either by various surgeries or dilation. The choice still depends on surgeon's preferences rather than on quality comparative studies and validated protocols. We sought to compare dilation and surgical management of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome, in terms of quality of life, anatomical results, and complications in a large multicenter population. Our multicenter study included 131 patients >18 years, at least 1 year after completing vaginal agenesis management. All had an independent gynecological evaluation including a standardized pelvic exam, and completed the World Health Organization Quality of Life instrument (general quality of life) as well as the Female Sexual Function Index and Female Sexual Distress Scale-Revised (sexual quality of life) scales. Groups were: surgery (N= 84), dilation therapy (N= 26), and intercourse (N= 20). One patient was secondarily excluded because of incomplete surgical data. For statistics, data were compared using analysis of variance, Student, Kruskal-Wallis, Wilcoxon, and Student exact test. Mean age was 26.5 ± 5.5 years at inclusion. In all groups, World Health Organization Quality of Life scores were not different between patients and the general population except for lower psychosocial health and social relationship scores (which were not different between groups). Global Female Sexual Function Index scores were significantly lower in the surgery and dilation therapy groups (median 26 range [2.8-34.8] and 24.7 [2.6-34.4], respectively) than the intercourse group (30.2 [7.8-34.8], P= .044), which had a higher score only in the satisfaction dimension (P= .004). However, the scores in the other dimensions of Female Sexual Function Index were not different between groups. The Female Sexual Distress Scale-Revised median scores were, respectively, 17 [0-52], 20 [0-47], and 10 [10-40] in the surgery, dilation therapy, and intercourse groups (P= .38), with sexual distress in 71% of patients. Median vaginal depth was shorter in dilatation therapy group (9.6 cm [5.5-12]) compared to surgery group (11 cm [6-15]) and intercourse group (11 cm [6-12.5]) (P= .039), but remained within normal ranges. One bias in the surgery group was the high number of sigmoid vaginoplasties (57/84, 68%), but no differences were observed between surgeries. Only 4 patients achieved vaginas <6.5 cm. Delay between management and first intercourse was 6 months (not significant). Seventy patients (53%) had dyspareunia (not significant), and 17 patients all from the surgery group had an abnormal pelvic exam. In the surgery group, 34 patients (40.5%) had complications, requiring 20 secondary surgeries in 17 patients, and 35 (42%) needed postoperative dilation. In the dilation therapy group, 13 (50%) needed maintenance dilation. Surgery is not superior to therapeutic or intercourse dilation, bears complications, and should therefore be only a second-line treatment. Psychological counseling is mandatory at diagnosis and during therapeutic management.

Acupuncture for treatment of persistent disturbed sleep: A randomized clinical trial in veterans with mild traumatic brain injury and post-traumatic stress disorder

Persistent sleep disturbance is one of the most highly prevalent symptoms after mild traumatic brain injury (mTBI) and is often refractory to conventional therapies. In the presence of co-existing post-traumatic stress disorder (PTSD), it is especially hard to treat. This randomized clinical trial (RCT) is to evaluate real acupuncture, as compared to sham, in improving persistent sleep disturbance in veterans with mTBI and PTSD. This RCT was conducted at a US Department of Veterans Affairs Medical Center and included sixty veterans aged 24–55 (mean 40) with history of mTBI of at least 3-months and refractory sleep disturbance. They were randomized into 2 groups and stratified by PTSD status. Each received up to 10 treatment sessions. The primary outcome measure was change in baseline-adjusted global Pittsburgh Sleep Quality Index (PSQI) score following intervention. Secondary outcomes were wrist-actigraphy assessed objective sleep measurements. Comorbid PTSD was analyzed as a covariate. Mean [SD] pre-intervention global PSQI score was 14.3 [3.2]. Those receiving real acupuncture had a global PSQI score improvement of 4.4 points (relative to 2.4 points in sham, P = 0.04), and actigraphically measured sleep efficiency (absolute) improvement of 2.7% (relative to a decrement of 5.3% in sham, P = 0.0016). Effective blinding for active treatment was maintained throughout the study. PTSD participants presented with more significant sleep difficulties at baseline; acupuncture was effective for those both with and without PTSD. Real acupuncture, compared to a sham needling procedure, resulted in a significant improvement in subjective and objective sleep measures for veterans with mTBI and disturbed sleep, even in the presence of PTSD. These results indicate that an alternative medicine treatment modality like acupuncture provides meaningful relief for a particularly recalcitrant problem affecting large segments of the veteran population.

Sleep quality and psychosocial characteristics of patients with painful post-traumatic trigeminal neuropathies

The aim of this study was to explore how pain and psychological distress influence the sleep quality of patients with painful post-traumatic trigeminal neuropathy (PPTN). Thirty-two patients with a diagnosis of PPTN according to the International Classification for Headache Disorders of the International Headache Society were enrolled. All patients completed a number of questionnaires that examined sleep quality, psychological distress, and quality of life. The global Pittsburg Sleep Quality Index (PSQI) score was "5" or greater in 75% of the patients. Additionally, the Symptom Check List-90-Revised (SCL-90-R) global severity index (GSI) revealed that 71.9% of the study sample reported values of psychological distress over the level of clinical significance. Sleep quality was analyzed through a linear regression model of global PSQI (dependent variable) that included gender, age, pain intensity, and pain duration (independent variables). This model revealed a significant positive association between the PSQI global score and the SCL-90-R GSI that was independent of age, gender, pain intensity, and duration. Patients with PPTN present higher levels of sleep disturbance and psychological distress compared with the general population. Sleep quality disturbances and levels of psychological distress are strongly associated and seem to be independent of age, gender, medication use, pain intensity and duration.

Health-related quality of life in multiple sclerosis: temperament outweighs EDSS

BackgroundThe influence of personality on health-related quality of life in patients with multiple sclerosis has been the focus of previous studies showing that introversion and neuroticism were related with reduced health related quality of life. However, no data exist on the impact of temperament on quality of life in this patient group.MethodsBetween April 2014 and March 2016 139 multiple sclerosis patients were recruited from a specialized outpatient clinic of the general hospital of Vienna. Health-related quality of life was measured by “The Multiple Sclerosis International Quality of Life Questionnaire (MusiQol)”, temperament by “Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Questionnaire – Münster version” (briefTEMPS-M), and disability by the “Expanded disability status scale”. All patients underwent a diagnostic psychiatric semi-structured interview (MINI).ResultsKnown predictors (like disease duration, EDSS, psychiatric co-morbidities, immunomodulatory treatments) explain the proportion of variation in the outcome of MusiQol global index score in 30.9% in multi-variable linear regression analysis. It increased respectively to 40.3, 42.5, and 45.8% if adding the depressive, cyclothymic, or hyperthymic temperament to the list of variables. An increase of depressive and cyclothymic temperament scores significantly reduced global index score of MusiQol (p = 0.005, p = 0.002, respectively), while the hyperthymic temperament significantly raised it (p < 0.001).ConclusionIn MS patients, the depressive and cyclothymic temperament predict a lower and hyperthymic temperament an increased health-related quality of life, independent of current disability status, immunomodulatory treatments, and affective co-morbidities.

Measuring health related quality of life (HRQoL) in community and facility-based care settings with the interRAI assessment instruments: development of a crosswalk to HUI3

BackgroundHealth-related quality of life (HRQoL) measures are of interest because they can be used to describe health of populations and represent a broader health outcome for population health analyses than mortality rates or life expectancy. The most widely used measure of HRQoL for deriving estimates of health-adjusted life expectancy is the Health Utilities Index Mark 3 (HUI3). The HUI3 is available in most national surveys administered by Statistics Canada, and has been used as part of a microsimulation model to examine the impact of neurological conditions over the life course. Persons receiving home care and nursing home services are often not well-represented in these surveys; however, interRAI assessment instruments are now used as part of normal clinical practice in these settings for nine Canadian provinces/territories. Building on previous research that developed a HUI2 crosswalk for the interRAI assessments, the present study examined a new interRAI HRQoL index crosswalked to the HUI3.MethodsinterRAI and survey data were used to examine the distributional properties of global and domain-specific interRAI HRQoL and HUI3 index scores, respectively. Three populations were considered: well-elderly persons not receiving home care, home care clients and nursing home residents.ResultsThe mean HUI3 and interRAI HRQoL index global scores declined from independent healthy older persons to home care clients, followed by nursing home residents. For the home care and nursing home populations, the interRAI HRQoL global estimates tended to be lower than HUI3 global scores obtained from survey respondents. While there were some statistically significant age, sex and diagnostic group differences in global scores and within attributes, the most notable differences were between populations from different care settings.DiscussionThe present study provides strong evidence for the validity of the interRAI HRQoL based on comparisons of distributional properties with those obtained with survey data based on the HUI3. The results demonstrate the importance of admission criteria for home care and nursing home settings, where function plays a more important role than demographic or diagnostic criteria. The interRAI HRQoL has a distinct advantage because it is gathered as part of normal clinical practice in care settings where interRAI instruments are mandatory and are used to assess all eligible persons in those sectors. In particular, those with severe cognitive and functional impairments (who tend to be under-represented in survey data) will be evaluated using the interRAI tools. Future research should build on this work by providing direct, person-level comparisons of interRAI HRQoL index and HUI3 scores, as well as longitudinal analyses to examine responsiveness to change.

Efficacy of melatonin for sleep disturbance following traumatic brain injury: a randomised controlled trial

BackgroundThe study aimed to determine the efficacy of melatonin supplementation for sleep disturbances in patients with traumatic brain injury (TBI).MethodsThis is a randomised double-blind placebo-controlled two-period two-treatment (melatonin and placebo) crossover study. Outpatients were recruited from Epworth and Austin Hospitals Melbourne, Australia. They had mild to severe TBI (n = 33) reporting sleep disturbances post-injury (mean age 37 years, standard deviation 11 years; 67% men). They were given prolonged-release melatonin formulation (2 mg; Circadin®) and placebo capsules for 4 weeks each in a counterbalanced fashion separated by a 48-hour washout period. Treatment was taken nightly 2 hours before bedtime. Serious adverse events and side-effects were monitored.ResultsMelatonin supplementation significantly reduced global Pittsburgh Sleep Quality Index scores relative to placebo, indicating improved sleep quality [melatonin 7.68 vs. placebo 9.47, original score units; difference -1.79; 95% confidence interval (CI), -2.70 to -0.88; p ≤ 0.0001]. Melatonin had no effect on sleep onset latency (melatonin 1.37 vs. placebo 1.42, log units; difference -0.05; 95% CI, -0.14 to 0.03; p = 0.23). With respect to the secondary outcomes, melatonin supplementation increased sleep efficiency on actigraphy, and vitality and mental health on the SF-36 v1 questionnaire (p ≤ 0.05 for each). Melatonin decreased anxiety on the Hospital Anxiety Depression Scale and fatigue on the Fatigue Severity Scale (p ≤ 0.05 for both), but had no significant effect on daytime sleepiness on the Epworth Sleepiness Scale (p = 0.15). No serious adverse events were reported.ConclusionsMelatonin supplementation over a 4-week period is effective and safe in improving subjective sleep quality as well as some aspects of objective sleep quality in patients with TBI.Trial registrationIdentifier: 12611000734965; Prospectively registered on 13 July 2011.

Efficacy of intensive multidisciplinary rehabilitation in Parkinson’s disease: a randomised controlled study

ObjectiveTo evaluate whether a 4-week multidisciplinary, aerobic, motor-cognitive and intensive rehabilitation treatment (MIRT) improves the quality of life (QoL) of patients with Parkinson’s disease (PD), in the short-term and long-term...

Perceived Self-Control is Related to Mental Distress in Patients Entering Substance Use Disorder Treatment

ABSTRACTBackground: Levels of mental distress are high in patients with substance use disorders (SUD) and investigation of correlates may broaden our understanding of this comorbidity. Objectives: We investigated self-reported symptoms of mental distress among individuals entering either outpatient opioid maintenance treatment (OMT) or other inpatient SUD treatment and related factors, with a particular focus on perceived self-control. Methods: A cross-sectional study including substance users (n = 548; mean age 34 years; 27% women) entering treatment at 21 different treatment-centers across Norway, interviewed between December 2012 and April 2015. Symptoms of mental distress were assessed with Global Symptom Index (GSI) score. Adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) were estimated through multinomial logistic regression. Results: More than half of the participants in both treatment groups reported mental distress (GSI) above clinical cut-off. The use of alcohol and exposure to violence were associated with increased likelihood of high GSI for both patient groups. Also, lower perceived self-control was related to high GSI in both treatment groups. Conclusion: Symptoms of mental distress were equally common among patients entering OMT and those entering other inpatient SUD treatment, even if the patients differed on a number of clinical characteristics. Use of alcohol and exposure to violence were associated with more mental distress in both groups. Perceived self-control also appeared to be important when explaining symptoms of mental distress among these SUD patients.

Effects of Amitriptyline and Escitalopram on Sleep and Mood in Patients With Functional Dyspepsia

Tricyclic antidepressants are effective in reducing symptoms of functional dyspepsia (FD). We performed a post hoc analysis of data from a previous randomized clinical trial to determine whether the benefits of an antidepressant on gastrointestinal symptoms in patients with FD were mediated by improving sleep or reducing anxiety. We explored the relationships between psychological measures, quality of sleep, and relief of symptoms. We analyzed data from a multicenter, double-blind trial that evaluated the efficacy of antidepressants on symptoms of FD, from October 2006 through October 2012. Patients (n= 292) were randomly assigned to groups given 50 mg amitriptyline, 10 mg escitalopram, or placebo for 12 weeks. During the study, participants completed the following validated psychological questionnaires: Symptom Check List 90, Symptom Somatic Checklist, Hospital Anxiety Depression Scale, Profile of Mood States, State Trait Anxiety Inventory, and Pittsburgh Sleep Quality Index at baseline and 12 weeks following treatment. Baseline scores for the psychological and sleep measures were similar among groups; after 12 weeks there were no significant differences in scores among groups. Baseline mean global Pittsburgh Sleep Quality Index scores indicated poor sleep quality in all groups at baseline and after 12 weeks. Overall, antidepressants affected sleep duration scores: patients given amitriptyline had lower (better) scores than patients given placebo or escitalopram (P= .019). In all groups, responders had decreased anxiety and improvements in some sleep components. In a post hoc analysis of data from a clinical trial that evaluated the effects of antidepressants in patients with FD, amitriptyline was found to reduce symptoms of FD, but its mechanism is unlikely to involve reductions in psychological distress. The drug may modestly improve sleep. Clinicaltrials.gov no: NCT00248651.

Reliability and Validity of the Korean Memorial Symptom Assessment Scale—Short Form in Gynecological Cancer Patients

ContextSymptoms of patients with cancer need to be evaluated with a standard instrument. The Memorial Symptom Assessment Scale-Short Form (MSAS-SF) is a symptom assessment tool that has been validated in many languages. ObjectivesThe aim of the present study was to validate the Korean-version Memorial Symptom Assessment Scale—Short Form (MSAS-SF) in patients with gynecologic cancer. MethodsWe translated the MSAS-SF into Korean, and 175 gynecologic cancer inpatients completed the MSAS-SF, Functional Assessment Cancer Therapy—General (FACT-G), and gathered demographic and clinical data and Karnofsky Performance Status (KPS). Reliability was assessed for internal consistency with Cronbach's alpha coefficient. Pearson's correlation coefficient was calculated between the MSAS-SF and FACT-G subscales for convergent validity. T-test analysis was used to compare differences in MSAS-SF subscales by cancer stage and KPS for discriminant validity. ResultsThe Cronbach's alpha coefficients for the MSAS-SF subscales ranged from 0.80 to 0.91. The Korean-version MSAS-SF subscales showed convergent validity with FACT-G subscales. The correlation coefficients were −0.640 (P < 0.001) and −0.628 (P < 0.001) for global distress index and total MSAS score with FACT-G total score. The scores of MSAS-SF subscales showed appropriate differences by cancer stage and KPS. ConclusionThe Korean-version MSAS-SF is a valid tool for the reliable assessment of patients with gynecologic cancer in Korea.

Sleep quality in long-term survivors of head and neck cancer: preliminary findings.

This preliminary study evaluated sleep quality in long-term head and neck cancer survivors, using demographic data and clinical features of the cancers as assessment criteria. In addition, a possible correlation was examined between scores on self-rated questionnaires of sleep quality and assessments of quality of life and oral health status. Subjects were 77 head and neck cancer survivors. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Oral and general health status was assessed using The Oral Health Impact Profile (OHIP-14) and the Short-Form Health Survey (SF-36), respectively, and correlated with clinical parameters. Spearman's correlation coefficients were calculated to examine relationships between variables. Logistic regression analysis was performed to identify independent variables associated with poor sleep quality. Eighty-three percent of patients had poor sleep quality (global scores ≥5) and 40% had a global Pittsburgh Sleep Quality Index score ≥8, indicating significantly poor sleep quality. Nocturnal enuresis, daytime sleepiness, and early morning awakening were the most common complaints. Extensive neck dissection, a lower SF-36 mental component score, and a higher OHIP-14 psychological disability score were independently associated with poor sleep quality. OHIP-14 global score was linked independently with daytime sleepiness. This is the first study to demonstrate a high prevalence of poor sleep quality in long-term head and neck cancer survivors. Extensive neck dissection, poor mental health, and psychological disability may contribute to poor sleep quality. Maintaining good oral health-related quality of life could promote better sleep in these patients.

The effect of psychological state and social support on nail-biting in adolescents: An exploratory study

Nail-biting is one of the most common behavioral problems in children. This study aimed to examine factors affecting nail-biting among adolescents and the effects of psychological state and social support on nail-biting. This cross-sectional study was conducted between January and May of 2014 in seven schools in Istanbul ( N = 724). Data were collected using the Personal Information Form, Brief Symptom Inventory, and Child and Adolescent Social Support Scale. This study found that 48.2% of adolescents in the 11- to 17-years-old age group had a habit of nail-biting. Anxiety, depression, negative self image, somatization, hostility, and three global index scores of adolescents who bit their nails were significantly higher than in those who did not. Social support scores of those who bit their nails were significantly lower than in those who did not in the ‘mother’ and ‘classmates’ subscales and total scores. Psychological state and social support were factors affecting nail-biting among adolescents.

Hiperemezis gravidarumu olan gebelerde ruhsal belirtiler, stresle başa çıkma tarzları, algılanan sosyal destek ve çift uyumu

Objective: Hyperemesis gravidarum (HG) is a condition with severe nausea and vomiting, which is seen in 0.3-2% of pregnancies. In addition to biological factors, psychosocial factors were also reported to play a role in the development of HG. However, the impact of psychosocial factors in HG has not been elucidated yet. In this research, we aimed to investigate psychiatric symptoms in patients with HG and their relationships with perceived social support, coping styles, and dyadic adjustment. Method: Forty-eight women with HG hospitalized in the Obstetrics and Gynecology Inpatient Unit and 48 healthy pregnant women consulted to the Obstetric Outpatient Unit for their routine obstetric control were recruited for the study. The subjects were evaluated with sociodemographic form, Symptom Check List (SCL-90-R), Multidimensional Scale of Perceived Social Support (MSPSS), Ways of Coping Scale (WCS), and Dyadic Adjustment Scale (DAS). Results: All sociodemographic variables except nausea and vomiting history in previous pregnancies were similar in both groups. All subscales and global symptom index scores of SCL-90-R were higher; optimistic and submissive subscale scores of WCS were lower, satisfaction, consensus and total scores of DAS were higher in HG group (p

Social support, social strain, sleep quality, and actigraphic sleep characteristics: evidence from a national survey of US adults

ObjectiveTo determine the associations between average family and friend social support and strain over 10 years and sleep quality, sleep efficiency, total sleep time, and night-to-night total sleep time variability. ParticipantsNon-institutionalized English-speaking US adults aged 34–81 who participated in the MacArthur Study on Aging: Midlife in the United States. MeasurementsSleep quality was assessed by the Pittsburgh Sleep Quality Index and by a 7-day daily diary. Sleep efficiency, total sleep time, and night-to-night total sleep time variability were assessed by actigraphy (MiniMitter 64). ResultsSocial support, but not social strain, was significantly associated with both self-reported measures of quality (social support β=−1.239, P=.019 for global Pittsburgh Sleep Quality Index scores; social support β=−0.248, P=.016 for diary assessed quality). Lower scores on both quality measures indicate better sleep. In contrast, social strain, but not social support, was significantly associated with sleep efficiency (social strain β=−3.780, P=.007). Social strain, but not social support, was significantly associated with night-to-night sleep variability (social strain β=0.421, P=.034); however, the overall model was not significant. Neither social support nor social strain was significantly associated with total sleep time. ConclusionSocial support was significant for self-reported sleep, whereas only social strain was significantly associated with objective sleep parameters. Future research on social relationships and sleep should analyze both positive and negative aspects of relationships in tandem because effects appear to differ based on outcome.

Prevalence of Suicidal Ideation, Depression, and Anxiety in Chronic Temporomandibular Disorder Patients.

To investigate the prevalence of suicidal ideation (SI), depression, and anxiety in patients with a chronic temporomandibular disorder (TMD). The sample consisted of 1,241 consecutive patients diagnosed with muscle or joint pain, consistent with the Research Diagnostic Criteria for TMD (RDC/TMD), and assigned to one of three groups: Muscle pain (MM) group, joint pain (TMJ) group, and Mixed group. Variables of interest were specific demographics and psychometrics derived from the Symptom Checklist 90-Revised (SCL-90-R): three SI-related items, depression, anxiety, and Global Symptom Index score. Group comparisons were performed with χ² tests and t tests; the level of significance was set at α = .05. The mean (± standard deviation) age for the whole sample was 35.76 ± 12.6 years; 88.3% were women. The overall prevalence of SI items from the SCL-90-R was 8.4% for "thoughts of ending your life," 28.5% for "feeling hopeless about the future," and 20.5% for "having thoughts of death and dying." The overall prevalence of depression was 30.4% and overall prevalence of anxiety was 28.9%. Patients in the MM group reported the highest prevalence of SI. Patients in the MM group were significantly more likely to be depressed and anxious compared to patients in the TMJ (P < .0001) and Mixed groups (P < .0001). Elevated levels of SI, depression, and anxiety were reported in a chronic TMD population, especially in those with chronic muscle pain, compared to the general population. These findings emphasize the need for screening for suicidality and other comorbidities in TMD patients suffering from chronic pain.

Mapping Uncertainty Due to Missing Data in the Global Ocean Health Index.

Indicators are increasingly used to measure environmental systems; however, they are often criticized for failing to measure and describe uncertainty. Uncertainty is particularly difficult to evaluate and communicate in the case of composite indicators which aggregate many indicators of ecosystem condition. One of the ongoing goals of the Ocean Health Index (OHI) has been to improve our approach to dealing with missing data, which is a major source of uncertainty. Here we: (1) quantify the potential influence of gapfilled data on index scores from the 2015 global OHI assessment; (2) develop effective methods of tracking, quantifying, and communicating this information; and (3) provide general guidance for implementing gapfilling procedures for existing and emerging indicators, including regional OHI assessments. For the overall OHI global index score, the percent contribution of gapfilled data was relatively small (18.5%); however, it varied substantially among regions and goals. In general, smaller territorial jurisdictions and the food provision and tourism and recreation goals required the most gapfilling. We found the best approach for managing gapfilled data was to mirror the general framework used to organize, calculate, and communicate the Index data and scores. Quantifying gapfilling provides a measure of the reliability of the scores for different regions and components of an indicator. Importantly, this information highlights the importance of the underlying datasets used to calculate composite indicators and can inform and incentivize future data collection.