Impairment In Daily Functioning Research Articles

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Maladaptive Daydreaming Scale (BMDS-16)

Introduction and objective: Daydreaming is a common mental experience in which one gets immersed in stories, narratives, images, and fantasies, imagining them as they were real, although knowing they are unreal. Maladaptive daydreaming is characterised by an excessive and compulsive involvement on fantasy which in severe cases replaces human interaction and impairs academic, interpersonal, or vocational functioning. It can be measured using the 16-item Maladaptive Daydreaming Scale (MDS-16) which has been translated into 39 languages but validated only in eight. This study investigates the psychometric properties of the Brazilian version of this instrument (BMDS-16). Materials and methods: A total of 2,682 Brazilian adults (78% women; Mage = 26.6 years, standard deviation, SD = 7.0) participated in the study. Exploratory and confirmatory factor analyses provided support for a three-factor structure of BMDS-16 with satisfactory reliability indices. Results: Maladaptive daydreaming had positive but weak correlations with attention deficit hyperactivity disorder symptoms and dissociative experiences. As a result of the latent profile analysis, a cut-off score of 63 for maladaptive daydreaming was suggested. Based on this cut-off score, 18.6% of our sample could be considered maladaptive daydreamers. The general reliability of the scale was good (McDonald’s ω = 0.93; Cronbach’s α = 0.90). Conclusions: Overall, BMDS-16 demonstrated sound psychometric properties and applicability for general use to assess maladaptive daydreaming. The daydreaming tendency should be carefully examined in people with scores above 63, who may use fantasy in a maladaptive way, causing impairment in daily functioning and potentially conflicting with treatment.

Change on the Repeatable Battery for the Assessment of Neuropsychological Status and its relationship to brain amyloid

AbstractBackgroundThe Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been associated with commonly used biomarkers of Alzheimer’s disease (AD), including brain amyloid plaque density. However, less is known about if changes in the RBANS across time are also related to brain amyloid deposition. The current study sought to expand on prior work by examining the relationship between changes over time on the RBANS and amyloid deposition via positron emission tomography (PET).MethodOne‐hundred twenty‐six older adults with intact or impaired cognition and daily functioning underwent repeat assessment with the RBANS across nearly 16 months, as well as had a baseline amyloid PET scan.ResultIn the entire sample, amyloid deposition was significantly related to change on all five Indexes and the Total Scale score of the RBANS (rs = ‐0.28 – ‐0.61), with greater amyloid deposition being associated with worsening cognition. This pattern was also observed in 11 of 12 subtests. In the intact individuals, this pattern was only observed on change in the Immediate Memory Index (r = ‐0.32). In the subjects with MCI, this pattern was only observed on change in the Delayed Memory Index (r = ‐0.35). There was no association between change on the RBANS and brain amyloid deposition in those with AD.ConclusionWhereas prior studies have identified a relationship between baseline RBANS and amyloid status, the current findings support that changes in the RBANS are also indicative of AD brain pathology. Although replication in a more diverse sample is needed, these results continue to support the use of the RBANS in AD clinical trials.

Proton Pump Inhibitors and Cognitive Health: Review on Unraveling the Dementia Connection and Co-morbid Risks.

Dementia, an international health issue distinguished by the impairment of daily functioning due to cognitive decline, currently affects more than 55 million people worldwide, with the majority residing in low-income and middle-income countries. Globally, dementia entails significant economic burdens in 2019, amounting to a cost of 1.3 trillion US dollars. Informal caregivers devote considerable hours to providing care for those affected. Dementia imposes a greater caregiving and disability-adjusted life-year burden on women. A recent study has established a correlation between prolonged Proton Pump Inhibitor (PPI) usage and dementia, in addition to other neurodegenerative conditions. PPIs are frequently prescribed to treat peptic ulcers and GERD (gastroesophageal reflux disease) by decreasing stomach acid secretion. They alleviate acid-related symptoms through the inhibition of acid-secreting H+-K+ ATPase. In a number of observational studies, cognitive decline and dementia in the elderly have been linked to the use of PPIs. The precise mechanism underlying this relationship is unknown. These drugs might also alter the pH of brain cells, resulting in the accumulation of amyloid-beta (Aβ) peptides and the development of Alzheimer's disease (AD). Despite the compelling evidence supporting the association of PPIs with dementia, the results of studies remain inconsistent. The absence of a correlation between PPI use and cognitive decline in some studies emphasizes the need for additional research. Chronic PPI use can conceal underlying conditions, including cancer, celiac disease, vitamin B12 deficiency, and renal injury, highlighting dementia risk and the need for further investigations on cognitive health.

Connections between family violence and violence in the public sphere in Afghanistan

Afghanistan has endured over four decades of violence in the public sphere, such as war and suicide attacks. To effectively provide psychosocial counseling using a psychodynamic approach in Afghanistan, it is crucial to recognize the potential connection between ongoing public violence and high rates of family violence. In 2019, we conducted a study to explore the relationship between public violence and family violence among Kabul residents, including those seeking counseling and those who were not. Our cross-sectional mixed methods survey recruited 299 participants from a psychosocial counseling service as well as community members who were not receiving the service. The findings revealed a significant positive correlation between experiences of public violence and family violence. Both clients and non-clients reported experiencing high levels of violence, which led to impairments in daily functioning and increased suicidality. Additionally, a thematic analysis of open-ended questions indicated changes in attitudes resulting from exposure to violence, including feelings of helplessness and hopelessness both in and out of the home. We conclude that applying a psychodynamic approach to psychosocial counseling in Afghanistan requires awareness of the positive correlation between public violence and family violence in a society that has been exposed to violence in the public sphere for over forty years. Mental health care needs to contribute towards breaking cycles of violence by empowering clients to take control of their lives and become agents of change within their families and communities.

Potential strategies to optimize the efficacy of antidepressants: Beyond the monoamine theory

Depression is characterized by a feeling of sadness and a lack of pleasure, with impaired daily functioning and poor quality of life. The neurobiology and the pathogenesis of depression are not fully understood yet. Several hypotheses have been discussed including, monoamine theory, neurotransmission, oxidation, inflammation, glutamatergic transmission, neurotrophic factors, and others. Reviewing three decades of randomized controlled trials of antidepressants revealed that the antidepressants response rate is about 54% compared to a placebo response rate of 37%. Treatment-resistant depression (TRD) could be defined as an inadequate response to two different of antidepressants. In TRD, a combination strategy of using two FDA-approved antidepressants is used, which may predispose patients to adverse effects. Therefore, there is a compelling need to explore the potential “out of the box” adjuvants to antidepressants to provide higher and consistent response rates with high tolerability. These adjuvants could be medications available for other indications, food supplements, or even experimental drugs. This review will highlight potentially beneficial adjuvants to antidepressants such as nitric oxide modulators, NMDA antagonists, anti-inflammatory, antioxidants, mitochondrial modulators, insulin sensitizers, opioids, probiotics, and GABA agonists.

Posttraumatic stress disorder in a war-affected area of Northeast Ethiopia: a cross-sectional study

BackgroundPost-Traumatic Stress Disorder (PTSD) is a chronic condition that affects a significant proportion of war survivors following war and conflict. If PTSD is not managed, it can lead to decreased quality of life and impairments in daily functioning and lead to death. This study aimed to assess the prevalence of post-traumatic stress disorder and its associated factors among residents in a war-affected area, Dessie Town, Northeast Ethiopia.MethodsA community-based cross-sectional study was conducted among adult residents in the war-affected area, Dessie Town. A total of 615 individuals were selected by a systematic random sampling method. PTSD was assessed using the Post-Traumatic Stress Disorder Checklist, Civilian Version. Multivariable logistic regressions were used to measure the associated factors. Associations between variables were described using odds ratios, 95% confidence intervals, and a p-value less than 0.05.ResultsThe prevalence of PTSD was 34.5% (95% CI: 31–38). Female sex (AOR: 1.82; CI: 1.18–2.82), divorced or widowed (AOR: 2.12, CI: 1.23–3.66), having only primary schooling (AOR: 2.17; CI: 1.25–3.78), depression (AOR: 2.03; CI: 1.34–3.08), experienced ill health without medical care during the wartime (AOR: 2.97; CI: 1.43–6.16), forced separation from family (AOR: 1.90; CI: 1.16–3.12), and experienced stressful life events (AOR: 1.60; CI: 1.06–2.42) were significantly associated with PTSD.ConclusionA significant rate of PTSD was found among residents of the war-affected area, Dessie Town. One in three people was experiencing PTSD. As a result, post-war mental health early screening and intervention is a priority, particularly for females, those who are separated or divorced, and those who have experienced stressful life events due to the war.

Impairment in Functioning and Quality of Life in Patients with Idiopathic Hypersomnia: The Real World Idiopathic Hypersomnia Outcomes Study (ARISE).

Idiopathic hypersomnia is a debilitating neurologic sleep disorder characterized by excessive daytime sleepiness, sleep inertia, and prolonged sleep. Its impact on patients' quality of life and daily functioning has not been fully elucidated. The Real World Idiopathic Hypersomnia Outcomes Study (ARISE) evaluated the daily functioning, relationships, cognition, emotional well-being, and productivity/employment of participants with idiopathic hypersomnia. ARISE was a US-based virtual cross-sectional survey comprising multiple patient-reported outcome measures (Functional Outcomes of Sleep Questionnaire, short version [FOSQ-10], Quality of Life in Neurological Disorders [Neuro-QoL] Social Roles and Stigma domains, British Columbia Cognitive Complaints Inventory [BC-CCI], Patient Health Questionnaire [PHQ-9], and the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem [WPAI:SHP]). Participants were adults 21-65 years of age with idiopathic hypersomnia. Data were analyzed for all participants and for subgroups with/without long sleep time (LST; self-reported sleep ≥11 hours in 24 hours). Of 75 participants enrolled, most were female (81.3%) and the mean (SD) age was 34.1 (10.7) years. Participants' scores on the FOSQ-10 (mean [SD] score: 10.7 [2.8]) and the Neuro-QoL Social Roles (43.4 [4.2]) and Stigma (57.3 [5.9]) domains reflected impairments in daily functioning and quality of life. More than half of participants reported moderate to severe cognitive complaints (BC-CCI; 62.7%) and moderate to severe depressive symptoms (PHQ-9; 66.7%). Scores on the WPAI:SHP showed substantial impairments in absenteeism, presenteeism, overall work productivity, and overall regular daily activity (mean percent [SD]: 12.3 [23.6], 47.6 [22.7], 51.4 [24.7], and 64.0 [21.9], respectively). These considerable impairments were found in participants with and without LST. ARISE participants with idiopathic hypersomnia demonstrated poor quality of life and impaired functioning across multiple symptom domains.

Delayed Surgical Treatment in Patients with Chronic Carpal Tunnel Syndrome Is Still Effective in the Improvement of Hand Function.

Background and Objectives: Severe carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper extremities treated conservatively; later, when advanced, CTS is treated mostly surgically. The most prevalent symptoms comprise numbness, as well as sensation loss in the thumb, index, and middle finger, and thenar muscle strength loss, resulting in impaired daily functioning for patients. Data on the results of CTS treatment in patients with delayed surgical intervention are scarce. The aim of this study was to determine the postoperative results of chronic carpal tunnel syndrome treatment in patients with symptoms lasting for at least 5 years. Materials and Methods: A total of 86 patients (69 females, 17 males) with a mean age of 58 years reporting symptoms of CTS for at least 5 years (mean: 8.5 years) were prospectively studied. The average follow-up time was 33 months. All patients underwent the surgical open decompression of the median nerve at the wrist. A preoperative observation was composed of an interview and a clinical examination. The subjects completed the DASH (the Disabilities of the Arm, Shoulder, and Hand), PRWE (Patient-Rated Wrist Evaluation), and self-report questionnaires. Global grip strength, sensory discrimination, characteristic symptoms of CTS, and thenar muscle atrophy were examined. Postoperatively, clinical and functional examinations were repeated, and patients expressed their opinions by completing a BCTQ (Boston Carpal Tunnel Syndrome Questionnaire). Results: We found improvements in daily activities and hand function postoperatively. Overall, 88% of patients were satisfied with the outcome of surgery. DASH scores decreased after surgery from 44.82 to 14.12 at p < 0.001. PRWE questionnaire scores decreased from 53.34 to 15.19 at p < 0.001. The mean score of the BCTQ on the scale regarding the severity of symptoms was 1.48 and 1.62 on the scale regarding function after surgery. No significant differences were found in the scores between the male and female groups or between age groups (p > 0.05). A significant increase in global grip strength from 16.61 kg to 21.91 kg was observed postoperatively at p < 0.001. No significant difference was detected in the measurement of sensory discrimination (6.02 vs. 5.44). In most of the examined patients, night numbness and wrist pain subsided after surgery at p < 0.001. Thenar muscle atrophy diminished after surgery at p < 0.001. Conclusions: Most patients were satisfied with the results of CTS surgery regarding the open decompression of the median nerve even after 5 years of ineffective conservative treatment. Significant improvement of the hand function was confirmed in the functional studies.

Efficacy of Comedy on Health-Related Quality of Life and Oxidative Stress in Cancer Survivors.

Cancer survivors have reduced health-related quality of life (HRQOL) due to impaired daily functioning. In addition, daily stress leads to worsening oxidative stress. The purpose of this study is to investigate the efficacy of laughter therapy on HRQOL and oxidative stress in cancer survivors. This before-and-after study asked cancer survivors to watch a 15-minute or longer comedy video over a four-week period to assess the Functional Assessment of Cancer Therapy-General (FACT-G), EuroQOL 5 dimension 3-level (EQ-5D-3L), Hospital Anxiety and Depression Scale (HADS), biological Antioxidant Potential (BAP), Reactive Oxygen Metabolites-derived compounds (d-ROMs), Oxidative Stress Index (OSI), and the antioxidant/oxidative stress ratio. The nonparametric Friedman test showed significant increases from baseline in FACT-G and EQ-VAS scores and significant decreases in HADS-Anxiety and HADS-Depression scores. Post hoc analyses showed that these items commonly differed significantly at baseline versus three and four weeks after Bonferroni correction. T-test results in the biological analysis revealed small and moderate effects with significant differences in BAP (p < 0.01, d = 0.49), OSI (p = 0.03, d = 0.33), and BAP/d-ROMs (p < 0.01, d = 0.51). These results suggest that daily comedy viewing may be an effective intervention to improve quality of life and antioxidant capacity in cancer survivors. Considering its safety, convenience, and low cost, it should be considered a high-value intervention for cancer survivors.

Cholesterol Paradox in Older People with Type 2 Diabetes Mellitus Regardless of Lipid-Lowering Drug Use: A Cross-Sectional Cohort Study.

Lipid-lowering drugs (LLDs) have protective effects against coronary artery disease (CAD) and cerebrovascular disease (CVD); however, a paradoxical association with cholesterol has been identified in several diseases, such as diabetes, dementia, and atrial fibrillation. We aimed to analyze the association between LLDs and cholesterol levels in older adults with type 2 diabetes mellitus (T2DM). This cross-sectional study enrolled consecutive patients aged ≥50 years from three centers in Taiwan. A multiple logistic regression model was used, and odds ratios (ORs) for different levels of total cholesterol (TC) or low-density-lipoprotein cholesterol (LDL-C) compared with the highest level were adjusted for age, triglyceride level, sex, comorbidities, and medications. Among the 3688 participants, 572 with and 676 without T2DM used LLDs. After adjusting for age and sex, the non-T2DM group demonstrated better medical conditions, cognition, and daily function than the T2DM group, regardless of LLD use. Compared to the highest TC level (≥240 mg/dL), ORs were significantly increased as TC levels decreased. A similar pattern of T2DM prevalence was observed in LDL-C levels. Older people with T2DM demonstrated low cognitive and daily functions. Significantly reduced TC and LDL levels were associated with a higher T2DM prevalence in older adults regardless of LLD use. T2DM was associated with impaired cognitive and daily functioning. A higher prevalence of T2DM in older people with low cholesterol levels raises doubt surrounding cognition and daily function being jeopardized when the "lower is better" strategy is applied for the secondary prevention of CAD or CVD.

The prevalence of undiagnosed anxiety: A national survey

Generalized anxiety disorder (GAD) is a chronic condition characterized by excessive, unrealistic worry and anxiety about multiple events or activities and leads to significant impairment in daily functioning and quality of life. Effective treatments for GAD exist, but the first step is identification of the disorder. The current study aims to document the frequency of GAD symptoms amongst the general US population. A web-based survey was conducted to assess the frequency of daily anxiety symptoms amongst adults residing in the United States. Questions from the GAD-7 were used to be able to quantify the burden of diagnosed and undiagnosed generalized anxiety disorder. JMP 16.0 for Mac OS was used to perform statistical analyses. Institutional Board Review gave the study an exempt determination (#2022–569). The median GAD-7 score was 16 (IQR 12–19) with a range from to 7 to 28. GAD-7 scores stratified by diagnosed (median=14) vs. undiagnosed (median =18) demonstrated a significant difference (P<0.0001) with a robust goodness-of-fit coefficient (R2= 14.3%).Persons who were retired (p = 0.0262) or older (p = 0.0356) were significantly less likely to experience GAD symptoms. Conversely, sex, age, income and the use of depressants, stimulants or benzodiazepines were not significantly correlated with a GAD score of ≥15. The present findings are based on cross-sectional survey data. This study suggests that more than 50% experience symptoms concerning for GAD, without a formal diagnosis. The relevance of this research is it underscores the importance of mental health outreach, and removal of stigma surrounding mental health.

GERD - still current problem of society, diagnosis, practical methods of management and treatment

Introduction and purpose: Gastroesophageal reflux disease (GERD) is a very common digestive disease worldwide. About half of all adults will report symptoms of reflux at some point in their lives. The symptoms of the disease are non-specific, which is why doctors of many specializations face the problem both in doctor's offices and hospital rooms. GERD is a disorder with troublesome symptoms and complications resulting from the regurgitation of gastric contents into the esophagus, causing subjective symptoms and related complications, negatively affecting the quality of life. Symptoms negatively affect the quality of life of patients, lowering well-being, physical activity, and social functioning. Diagnosis is based in most cases on the observation of symptoms, which is why this paper presents the symptoms that should be taken into account when diagnosing patients. Therapeutic procedures, selection of the appropriate form of treatment: conservative, pharmacological and surgical, were discussed.Materials and methods: The review was based on the analysis of materials collected in the "Pubmed" database, books and other scientific articles.Summary: Gastroesophageal reflux disease is an important health problem because it is associated with impaired daily functioning and morbidity. Proper management of GERD symptoms can result in significant improvements in patients' well-being, including reduction in physical pain, increase in vitality, physical and social functioning, and improvement in emotional well-being. In some patients, only lifestyle modification and a change in habits are enough to reduce the occurrence of symptoms. First-line drugs are proton pump inhibitors. Endoscopic examination should be performed when pharmacological therapy is ineffective or in the event of alarm symptoms, i.e. dysphagia, weight loss, anemia, bleeding and recurrent vomiting. Surgical treatment is used as a last resort when pharmacological treatment fails.

Painful Diabetic Peripheral Neuropathy: Practical Guidance and Challenges for Clinical Management.

Painful diabetic peripheral neuropathy (PDPN) is present in nearly a quarter of people with diabetes. It is estimated to affect over 100 million people worldwide. PDPN is associated with impaired daily functioning, depression, sleep disturbance, financial instability, and a decreased quality of life. Despite its high prevalence and significant health burden, it remains an underdiagnosed and undertreated condition. PDPN is a complex pain phenomenon with the experience of pain associated with and exacerbated by poor sleep and low mood. A holistic approach to patient-centred care alongside the pharmacological therapy is required to maximise benefit. A key treatment challenge is managing patient expectation, as a good outcome from treatment is defined as a reduction in pain of 30-50%, with a complete pain-free outcome being rare. The future for the treatment of PDPN holds promise, despite a 20-year void in the licensing of new analgesic agents for neuropathic pain. There are over 50 new molecular entities reaching clinical development and several demonstrating benefit in early-stage clinical trials. We review the current approaches to its diagnosis, the tools, and questionnaires available to clinicians, international guidance on PDPN management, and existing pharmacological and non-pharmacological treatment options. We synthesise evidence and the guidance from the American Association of Clinical Endocrinology, American Academy of Neurology, American Diabetes Association, Diabetes Canada, German Diabetes Association, and the International Diabetes Federation into a practical guide to the treatment of PDPN and highlight the need for future research into mechanistic-based treatments in order to prioritise the development of personalised medicine.

Feasibility of using wearable technology to monitor agitation and sleep in patients with Alzheimer’s dementia: Lessons learned

AbstractBackgroundIndividuals with Alzheimer’s dementia (AD) often go through a period of significant behavioral and psychological symptoms including agitation. This can lead to impaired daily functioning, prolongation of hospitalization, early institutionalization, and higher mortality. The integration of biomedical data acquisition systems and information technology enables continuous real‐time monitoring of physiological data in daily life.MethodThis feasibility study is part of a clinical trial that examines the effects of THC‐free CBD oil on agitation in patients with AD (NCT04436081), involves caregiver/care‐recipient dyads and the use of technology to capture agitation during a 14‐week period. Participants are given 2 Fitbit versa 2 (each includes a 3‐axis accelerometer and an optical heart rate monitor), a smartphone, a tablet, and a digital timer. Participants’ Fitbit are paired with their smartphone, while the caregivers’ FitBit is paired with their tablet. Participants include males/females over 50 years old, with the diagnosis of AD, a MMSE score ≤28 &amp; ≥4, and agitation measured with an NPI agitation/aggression subscore &gt;3. Each dyad completes 24 forms/questionnaires throughout the study electronically via provided apps. Caregivers are instructed to send a real time electronic alert when agitation episodes happen.ResultSo far, we have enrolled 26 dyads. For this report we have collected data on 22 participants with 140 million data points for limb movement and heart rate, and 969 nights of sleep data records. Overall compliance with wearable use was 77% of the time, with 82% in 11 participants, 65% in 8 participants and 32% in 3 participants. Compliance with electronic form/questionnaire completion was 87%. Electronic alert for agitation episodes were recorded by the caregivers only 50% of time.ConclusionThis study explores the feasibility and acceptability of using technology (wearables, electronic form data completion and submission, sleep, and real time agitation episode collection) for a 16‐week period in AD patients with agitation and their caregivers. We found high acceptability of wearing the Fitbit by AD patients with agitation. The primary issues interfering with data collection and device compliance were device battery life and memory, remembering to wear the device after charging, and technical fault in capturing the data.

Impaired Awareness in People with Severe Alcohol-Related Cognitive Deficits Including Korskoff's Syndrome: A Network Analysis.

Impaired awareness of one's own functioning is highly common in people with Korsakoff's syndrome (KS). However, it is currently unclear how awareness relates to impairments in daily functioning and quality of life (QoL). We assessed how impaired awareness relates to cognitive, behavioral, physical, and social functioning and QoL by applying a network analysis. We used cross-sectional data from 215 patients with KS or other severe alcohol-related cognitive deficits living in Dutch long-term care facilities (LTCFs). Apathy has the most central position in the network. Higher apathy scores relate positively to reduced cognition and to a greater decline in activities of daily living and negatively to social participation and the use of antipsychotic drugs. Impaired awareness is also a central node. It is positively related to a higher perceived QoL, reduced cognition and apathy, and negatively to social participation and length of stay in the LTCF. Mediated through apathy and social participation, impaired awareness is indirectly related to other neuropsychiatric symptoms. Impaired awareness is closely related to other domains of daily functioning and QoL of people with KS or other severe alcohol-related cognitive deficits living in LTCFs. Apathy plays a central role. Network analysis offers interesting insights to evaluate the interconnection of different symptoms and impairments in brain disorders such as KS.

The Mental Health State of Canadian Ophthalmologists during the COVID-19 Pandemic: A Survey-Based Study and Review.

The coronavirus disease 2019 (COVID-19) pandemic disrupted the practice of medicine, causing stress and uncertainty among ophthalmologists. This cross-sectional, survey-based study of Canadian Ophthalmological Society members (n = 1152) aims to report on Canadian ophthalmologists' mental health during the COVID-19 pandemic. Four questionnaires were administered between December 2020 and May 2021: the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), the 7-item Insomnia Severity Index (ISI), and the Impact of Event Scale-Revised (IES-R). From all of the responses, 60/85 answers were deemed complete and were included. The median age was 50-59 years and 53% were women. On PHQ-9, most respondents had no or minimal depressive symptoms (n = 38, 63%), while 12% (n = 7) had moderately severe depressive symptoms and 12% (n = 7) reported impaired daily functioning and/or thoughts of suicide or self-harm. On the GAD-7 scale, 65% (n = 39) had no significant anxiety, while 13% (n = 8) had moderate to severe anxiety. Most respondents did not have clinically significant insomnia (n = 41, 68%). Finally, 16 respondents (27%) had an IES-R score ≥24 suggesting possible post-traumatic stress disorder. No significant differences were found based on demographics. During the COVID-19 pandemic, up to 40% of respondents experienced varying degrees of depression, anxiety, insomnia, and distress from the event. In 12%, there were concerns for impaired daily functioning and/or suicidal thoughts.

Sleep and Military Leaders: Examining the Values, Beliefs, and Quality of Sleep and the Impact on Occupational Performance.

Sleep deprivation is rampant within the military population, and insufficient sleep can lead to physical and mental health problems impacting soldier's readiness and deployability. Past research has shown the importance of leadership's role in subordinates' sleep health. Understanding the values, beliefs, and quality of military leader sleep is essential to the development of effective interventions to optimize occupational performance and overall sleep health. Therefore, the purpose of this study was to examine the military leaders' values, beliefs, and sleep quality and the impact on occupational performance. The authors aimed to (1) identify military leaders' sleep quality and beliefs; (2) explore the relationship between military leaders' sleep quality, beliefs and attitudes about sleep, and impact on occupational performance; and (3) examine the value leaders place on sleep for themselves and subordinates in relation to occupational performance. This observational, mixed-methods study design recruited a convenience sample of 109 Army active duty medical service members currently serving in a leadership role. Participants completed an electronic survey to include general demographic information and three self-report measures: the Pittsburgh Quality of Sleep Index, the Dysfunctional Beliefs about Sleep, and the Functional Outcomes of Sleep Questionnaire. Eleven participants completed the semi-structured qualitative interview focusing on sleep values and the impacts on performance. Univariate and multivariate regressions were performed for statistical analysis of the quantitative survey data, whereas thematic analysis was used to analyze the qualitative interview data. This study was approved by the U.S. Army Medical Center of Excellence Institutional Review Board. Multivariate regression analysis demonstrated small-to-medium effect sizes (R2 = 0.355-0.559) for relationships between sleep quality, sleep beliefs, functional performance, and demographic variables. More specifically, military grade, position, use of alcohol, time in service, and gender were all found to contribute significantly to scores on the Pittsburgh Sleep Quality Index, the Dysfunctional Beliefs About Sleep Scale-16, and the Functional Outcomes of Sleep Questionnaire-10 (P < .05). Qualitative data resulted in three primary themes: (1) Poor sleep degrades performance, (2) sleep is a top priority, and (3) leaders have a responsibility for subordinates' sleep health. This sample of military leaders was found to perceive themselves as poor-quality sleepers despite demonstrating more functional attitudes and beliefs about sleep and reporting normal-to-mild impairments in daily functioning as a result of daytime sleepiness. Furthermore, findings suggest that leaders' sleep quality and beliefs stand to be further improved, whereas their sleep values need to be consistently demonstrated to subordinates. With a clearer understanding of military leaders' values, beliefs, and sleep quality, future research could focus on implementing and developing holistically based and individualized sleep interventions intended to optimize performance and sleep health.

Assessing the relationship of psychological health with addiction to food.

Background: Food addiction is a behavioral addiction toward foods with high fat and sugar content that leads to overeating. In clinical practice, there is no diagnosis of addiction because diagnostic criteria focus on symptoms, distress, and impairment in daily functioning. Thus, this study aimed to assess the relationship of psychological health with addiction to food.&#x0D; Methodology: A self-administered questionnaire-based cross-sectional study was conducted on a total of 1200 participants aged between 15 and 60. The relationship between food addiction towards emotional and physical health was assessed using Yale Food Addiction Scale; items were rated and scored using a) a five-point Likert scale for assessing food addiction and b) a two-point scale used for assessing psychological health.&#x0D; Results: It was found that most of the participants had mild food addiction (66.5%). It was found that 65.5% of participants had mild psychological problems. When the food addiction was assessed in association with the demographic variable, a significant association was found for gender (P-value=0.009), BMI (P-value=0.024), lifestyle activity (P-value= 0.038), and family history (P-value=0.000).&#x0D; Conclusion: It was found that increased food addiction might lead to increased psychological problems.

Adapting CBT for youth anxiety: Flexibility, within fidelity, in different settings.

Anxiety disorders are common in youth, associated with impairments in daily functioning, and often persist into adulthood when untreated. Cognitive behavioral therapy (CBT) for youth anxiety is a well-established intervention and has been modified to fit several treatment settings. Despite decades of results supporting the efficacy of CBT, there is a large gap in access to this treatment and a need to consider how it can best be administered flexibly to increase uptake and personalization. We first discuss the core components of treatment for CBT through the lens of the Coping Cat treatment. Next, we review the empirical findings regarding adjustments made for CBT for youth anxiety delivered (a) in schools, (b) in community settings, (c) through telehealth, (d) through online computer programs, and (e) by caregivers at home. In each setting, we provide specific suggestions for how to implement CBT with flexibility while maintaining fidelity.

Outcomes after cardiac rehabilitation in patients following repair of thoracic aortic aneurysm or dissection: a protocol for a systematic review and meta-analysis

BackgroundPatients receiving thoracic aortic repair suffer from long-term impairment in daily functioning and quality of life following intervention due to a combination of their life-threatening condition (i.e. aortic aneurysm or dissection), undergoing major surgery, as well as long-term exercise restrictions thereafter. Despite the known risks of exercise, it is vital that patients regain physical activity in order to recover their daily functioning and quality of life. Cardiac rehabilitation could be a safe and effective treatment to support patients to become physically active by providing exercise training, comprehensive rehabilitation services, and safety recommendations. Despite new insights in recent literature and clinical practice, international guidelines do not recommend cardiac rehabilitation due to limited evidence. We aim to fill this knowledge gap by performing a systematic review and meta-analysis on the effectiveness of cardiac rehabilitation in patients following thoracic aortic repair.MethodsThis protocol has been developed following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). MEDLINE, Embase, and CINAHL will be searched for eligible observational and interventional studies from inception up to April 2022. Screening (title/abstract and full text), data extraction, risk of bias assessment, and therapeutic validity rating will be conducted by two independent reviewers. A random-effects model will be used to meta-analyse performance-based outcomes, patient-reported outcomes, clinician-reported outcomes, and researcher-reported outcomes. Subsequently, meta-bias and confidence in evidence will be analysed by two independent reviewers.DiscussionTo exercise or not to exercise in patients following thoracic aortic repair has been a topic of discussion for years. The intended systematic review and meta-analysis will provide comprehensive evidence on the effectiveness of phase III outpatient exercise-based cardiac rehabilitation in patients following thoracic aortic repair. Findings from this review may inform future guidelines for the management of patients with thoracic aortic disease.Systematic review registrationPROSPERO CRD42022301204.