Symptoms Of Problems Research Articles

P0269SYMPTOM-BURDEN IN PEOPLE LIVING WITH FRAILTY AND CHRONIC KIDNEY DISEASE

Abstract Background and Aims Patients with chronic kidney disease (CKD) report high symptom-burden that adversely affects health-related quality of life (HRQOL). Frailty is an independent predictor of poor HRQOL in those with CKD. Although there is a clear relationship between frailty and HRQOL in patients with CKD, the associated relationship with symptom experience is not well understood. Understanding how living with both frailty and CKD influences symptom-burden could inform management strategies that improve HRQOL of this vulnerable patient group. This study’s aim was to evaluate the symptom experience of patients living with frailty and CKD. Methods A total of 353 participants were recruited between February 2018 and October 2018 to this cross-sectional observational study. Participants completed physical activity (GP Physical Activity Questionnaire [GPPAQ]), cardiopulmonary fitness (Duke Activity Status Index, providing estimated VO2 peak), symptom-burden (Kidney Symptom Questionnaire [KSQ]) and HRQOL (Short Form 12 [SF-12]) questionnaires. Frailty was assessed using a modified Frailty Phenotype comprising 3 self-report components: 1) weakness/slowness defined as a SF-12 Physical Functioning score <75; 2) low physical activity defined as ‘inactive’ by the GPPAQ; and 3) exhaustion defined as a SF-12 Vitality score <55. Participants were categorised as frail if ≥2 components were present. Multiple imputation was performed for data considered to be either missing completely at random or missing at random. Regression analyses were used to assess the association between frailty, symptom-burden and HRQOL. Principal Component Analysis (PCA) was performed to explore symptom clusters experienced by non-frail and frail participants. Results Two hundred and twenty-five (64%) participants were categorised as frail. Frail participants were significantly older (77.7 vs. 71.5 years, p<0.001) and had a significantly lower eGFR (45.8 vs. 50.9 mL/min/1.73m2, p<0.001), albumin concentration (39.2 vs. 41.4 g/L, p<0.001) and estimated VO2 peak (21.7 vs. 33.9 mL/kg/min, p<0.001) than non-frail participants. Frailty, when adjusted for age, sex, eGFR and haemoglobin, was independently associated with higher KSQ total symptom score (p<0.001) and lower SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores (p<0.001 and p=0.001, respectively). Lower eGFR was associated with higher KSQ total symptom score (p=0.004) and lower SF-12 PCS score (p=0.01). Frailty, when adjusted for age, sex, eGFR and haemoglobin, was independently associated with a two- to over five-fold increase in odds of experiencing all reported symptoms frequently, except loss of appetite and urinary frequency. Lower eGFR was only associated with increased odds of reporting frequent loss of muscle strength (p=0.04). PCA revealed two symptom clusters for non-frail participants and three symptom clusters for frail participants. Both non-frail and frail participants had symptom clusters associated with sleep disturbance and musculoskeletal symptoms. There was an additional unique symptom cluster (comprising loss of appetite, tiredness, feeling cold and poor concentration) experienced by frail participants. Conclusion Frailty is an independent predictor of high symptom-burden and poor HRQOL. Furthermore, symptom experience for people living with frailty and CKD is distinct from non-frail individuals, reporting a unique symptom cluster that may be a consequence of the frailty syndrome itself. This group of patients should be offered a holistic assessment so that problematic symptoms can be identified and addressed early before they impact more significantly on HRQOL. Future efforts should be focused on evaluating holistic models of care, such as the comprehensive geriatric assessment, for patients living with frailty and CKD.

T210. REVIEW OF USE OF ADJUNCTIVE PSYCHOSTIMULANTS IN PATIENTS WITH SCHIZOPHRENIA: A RETROSPECTIVE STUDY

BackgroundAugmentation with psychostimulants has been postulated as one of the potential treatment options for negative and/or cognitive symptoms of schizophrenia. However, the major drawback for use of these agents is a potential risk of relapse or worsening of psychosis through direct or indirect dopamine agonism activity. Therefore a great deal of caution is required when using stimulants in individuals with psychosis. The present study aims to review the rate of adjunct psychostimulant prescription, and their efficacy and safety in a real life setting. Furthermore, we intend to compare the efficacy of psychostimulants when added to clozapine compared to other antipsychotics. Data was obtained from a schizophrenia outpatient clinic, in a tertiary care centre in Canada.MethodsA chart review was conducted on outpatients enrolled in the schizophrenia program at the Royal Ottawa Mental Health Centre, between 31/5/2014 - 1/6/2019. For patients who were prescribed any psychostimulants at any time point up to 3-months prior to the study end date, clinical information related to efficacy and tolerability of stimulants, psychotic symptoms and concomitant antipsychotic treatment was collected.ResultsA total number of 1300 patients were included in the chart review study. Of those, 80 patients (6.15%) were prescribed stimulants during the study period. Of the participants who prescribed stimulants, 70% were male, 17.5% had a diagnosis of ADHD, and 38.75% were on clozapine. 21.25% had more than one trial of stimulant medications. Over half of participants continued on stimulants during the study period, with an overall good response in 36.25%, and minimal or equivocal response in 20% of participants on stimulants. Stimulants were discontinued in 13.75% of patients due to lack of efficacy, and 30% due to problematic symptoms.The data is currently being analysed; Comprehensive results to follow.DiscussionThe preliminary results indicate that the use of stimulants was associated with improvement in cognitive and/or negative symptoms in a subset of patients and resulted in worsening of psychosis in some patients. The authors will discuss the efficacy and tolerability of use of adjunctive stimulants in outpatients with schizophrenia. Potential factors associated with the observed response and side effects will be discussed further.

A Preliminary Analysis of a Multidisciplinary Fibroid Clinic Patient Satisfaction and Demographics [10F

INTRODUCTION: Fibroids are benign growths of the uterine muscle that can cause a variety of symptoms including abnormal uterine bleeding, pelvic pain, and bulk symptoms. Our institution created a dedicated multidisciplinary Fibroid Program to address the needs of patients with symptomatic fibroids. Cases were reviewed with gynecologists, diagnostic radiologists, and interventional radiologists to provide tailored treatment plans and counseling for patients. METHODS: Patients seen between 1/2014 and 8/2018 (n=312) completed intake surveys detailing demographic background, prior treatments, most problematic symptoms, and a validated quality of life (UFS-QOL) survey. One-year follow up surveys about treatments, Likert scale rated satisfaction, and updated UFS-QOL were sent out to all patients and responses (n=111) were analyzed. Chart review clarifying fibroid size and locations was also performed. RESULTS: The average age of patients was 43.6 ± 0.4 years old. Upon initial presentation, 70.1% reported abnormal bleeding, 80.6% had pain, 44.3% had urinary symptoms, 77.4% had abdominal fullness, and 32.5% had bowel complaints. The average UFS-QOL score prior to treatment was 53.0 (out of 100). After treatment the average UFS-QOL score was 78.3, a difference of 25.3 points after being seen in the Fibroid Program. Patient reported satisfaction was excellent, with 79.2% of patients rating their satisfaction at 5 out of 5. CONCLUSION: Patients had a high rate of satisfaction after participation in our multidisciplinary Fibroid Program and UFS-QOL scores improved. We hope that this model can continue to be used to improve the life of patients by demonstrating the success of multidisciplinary informed counseling, tailored treatment, and shared-decision making.

Microbiota munch on medications, causing big effects on drug activity

Millions of patients with Parkinson’s disease rely on the drug Levodopa for relief from tremors, slowed movement, and other motor symptoms. But many patients experience side effects such as cardiac arrhythmias, nausea, and gastrointestinal problems. Levodopa’s side effects and benefits vary widely among patients. Those puzzling disparities, it turns out, have a lot to do with the microbes in their guts. Researchers have found that many side effects of the Parkinson’s drug Levodopa were the result of a bacterial decarboxylase enzyme, produced by the commensal gut microbe E. faecalis (pictured in colored-scanning electron micrograph). Image credit: ScienceSource/Dennis Kunkel Microscopy. Earlier this year, chemist Emily Balskus and her colleagues at Harvard University in Cambridge, MA, found that many side effects were the result of a bacterial decarboxylase enzyme, produced by the gut microbe Enterococcus faecalis . Levodopa is an inactive form of the neurotransmitter dopamine and must be activated by a human decarboxylase enzyme to work. Activate the medicine too soon—before it crosses the blood–brain barrier—and side effects will occur. To block this premature activation, drug makers have long added an enzyme inhibitor known as carbodopa to Levodopa. But Balskus and her colleagues found that although carbodopa works on human enzymes, it does not inhibit bacterial decarboxylase. In fact, the bacterial enzyme acts on the drug in the intestines before it crosses the blood–brain barrier, triggering problematic symptoms (1). Balskus and others are learning that the interactions among our microbes and medications are far more complex than previously assumed, potentially causing toxic side effects or altering drugs’ activity. Medications left unabsorbed in the body are usually marked for removal in the liver and then transported to the gut. Although human cells no longer recognize these excretory products, intestinal bacteria can act on inactivated drug molecules. This stage could be labeled …

The relationship between problem gambling, excessive gaming, psychological distress and spending on loot boxes in Aotearoa New Zealand, Australia, and the United States-A cross-national survey.

Loot boxes are digital containers of randomised rewards available in many video games. Due to similarities between some loot boxes and traditional forms of gambling, concerns regarding the relationship between spending on loot boxes in video games and symptoms of problematic gambling have been expressed by policy makers and the general public. We present the first investigation of these concerns in large cross-sectional cross-national samples from three countries (Aotearoa New Zealand, Australia, and the United States). A sample of 1,049 participants were recruited through Qualtrics’ Survey Targeting service from a broad cross-section of the population in Australia (n = 339), Aotearoa New Zealand (n = 323), and the United States (n = 387). Participants answered a survey assessing problem gambling, problem gaming symptomology, and how much they spent on loot boxes per month. On average, individuals with problem gambling issues spent approximately $13 USD per month more on loot boxes than those with no such symptoms. Loot box spending was also associated with both positive and negative moods, albeit with small effect sizes. Analyses showed both interactions and correlations between problematic gambling and problematic gaming symptoms, indicating both some commonality in the mechanisms underlying, and independent contributions made by, these proposed diagnostic criteria. These results provide context for dialogues regarding how best to reduce the impacts of loot box spending among those with problematic gambling symptoms.

Emotional Overinvolvement with Adolescents: a Problematic Construct?

The purpose of the current study was to examine emotional overinvolvement (EOI) among caregivers of adolescents with a range of physical and psychiatric disorders to determine whether it is a problematic construct. Expressed emotion is a robust predictor of treatment dropout, outcome, and relapse across a range of physical and psychiatric disorders. The two components of expressed emotion that have received the most research attention are criticism and EOI. Although criticism plays a significant role in treatment outcome, evidence is mixed for EOI, particularly in children and adolescent populations. Forty-seven articles published between 2000 and 2018 were included in the current review, covering eating disorders, depression and bipolar disorder, ADHD, internalizing/externalizing behaviors, nonsuicidal self-injury/parasuicide, schizophrenia/psychosis, autism, posttraumatic stress, tic disorders, general psychopathology, and a number of medical illnesses. The majority of studies did not find a relationship between EOI and problematic symptoms or behaviors, and several found that EOI was associated with improved outcome. It is possible that EOI may be appropriate for caregivers of adolescents with a physical or psychiatric illness, or that a number of disparate constructs are being assessed by current measures of EOI. Avenues for future research are discussed.

Benzodiazepine Prescribing in People with Chronic Obstructive Pulmonary Disease: Clinical Considerations

Benzodiazepines, available clinically for almost six decades, are still one of the most widely prescribed classes of medication. The proportion of the population prescribed benzodiazepines increases with age, and harms also increase with age. The prevalence of prescribing in people > 85years of age is as high as one in three, including in people with chronic obstructive pulmonary disease (COPD). The prevalence of COPD also increases with age. In COPD, indications cited for prescribing a benzodiazepine include anxiety, sleep disorders, or chronic breathlessness. Each of these symptoms is prevalent in the population with COPD, especially later in the course of the illness. For anxiety and insomnia, there is evidence to support short-term use, with little robust evidence to support prescribing for the symptomatic reduction of chronic breathlessness. People prescribed benzodiazepines are more likely to experience drowsiness or somnolence, exacerbations of their COPD, and respiratory tract infections. Furthermore, the longer people take benzodiazepines, the more likely they will become dependent on them. Prescribing patterns vary internationally but prescriptions of longer-acting benzodiazepines are declining in favour of shorter-acting compounds. Other evidence-based therapies that can more safely treat these problematic symptoms are available. For people already taking benzodiazepines, there are a number of interventions that have been shown to reduce the rate of prescribing. For people with COPD and not taking a benzodiazepine, but with symptoms where there is evidence of benefit, clinicians should weigh carefully the potential net benefit and prescribe at the lowest dose for the briefest time possible.

Stimulation of the tibial nerve: a protocol for a multicentred randomised controlled trial for urinary problems associated with Parkinson’s disease—STARTUP

IntroductionParkinson’s disease is the second most common chronic neurodegenerative condition with bladder dysfunction affecting up to 71%. Symptoms affect quality of life and include urgency, frequency, hesitancy, nocturia and incontinence....

Manualized cognitive behavioral group therapy to treat vasomotor symptoms for women diagnosed with mood disorders

ObjectiveThis 6-week, prospective, single-arm study examined the feasibility, acceptability, and preliminary efficacy of cognitive behavioral group therapy in peri- and postmenopausal women with mood disorders (major depression or bipolar) and problematic vasomotor menopausal symptoms. Methods59 participants from an outpatient clinic with mood disorders and problematic vasomotor symptoms were enrolled. The primary outcomes were change from baseline to 6 weeks in Hot Flush Night Sweat Problem Rating, Hot Flash Related Daily Interference, and Quality of Life. Secondary outcomes were change in Hot Flush Frequency, depression, anxiety, perceived stress, anhedonia, beliefs and cognitive appraisals of menopause. ClinicalTrials.gov [identifier: NCT02860910]. ResultsOn the Hot Flush Night Sweat Problem Rating, 39.3% improved 2 or more points, which was clinically relevant. Changes in Quality of Life (p = .001) and the Hot Flash Related Daily Interference Scale were also significant (p < .001). Significant results were found on most secondary outcomes (hot flush frequency on the Hot Flush Daily Diary, depression, anxiety, perceived stress (p < .001) and anhedonia (p = .001). One of six subscales (control subscale) on the cognitive appraisal of menopause significantly improved (p < .001). Three subscales on the beliefs measure did not change significantly (p = .05, p = .91, and p = .14). Six-week study retention was robust (N = 55, 93%) and 94.2% of individuals reported that cognitive behavioral group therapy sessions were useful. ConclusionThis exploratory study suggests that CBGT is acceptable, feasible, and efficacious in women with mood disorders and problematic menopause vasomotor symptoms. Further studies are needed using more rigorous and controlled methods.

Implementation and effectiveness of non-specialist mediated interventions for children with Autism Spectrum Disorder: A systematic review and meta-analysis.

In recent years, several non-specialist mediated interventions have been developed and tested to address problematic symptoms associated with autism. These can be implemented with a fraction of cost required for specialist delivered interventions. This review represents a robust evidence of clinical effectiveness of these interventions in improving the social, motor and communication deficits among children with autism. An electronic search was conducted in eight academic databases from their inception to 31st December 2018. A total of 31 randomized controlled trials were published post-2010 while only 2 were published prior to it. Outcomes pertaining to communication, social skills and caregiver-child relationship were meta-analyzed when reported in > 2 studies. A significant improvement was noted in child distress (SMD = 0.55), communication (SMD = 0.23), expressive language (SMD = 0.47), joint engagement (SMD = 0.63), motor skills (SMD = 0.25), parental distress (SMD = 0.33) parental self-efficacy (SMD = 0.42) parent-child relationship (SMD = 0.67) repetitive behaviors (SMD = 0.33), self-regulation (SMD = 0.54), social skills (SMD = 0.53) symptom severity (SMD = 0.44) and visual reception (SMD = 0.29). Non-specialist mediated interventions for autism spectrum disorder demonstrate effectiveness across a range of outcomes for children with autism and their caregivers.

Two cases that show the effects of bevacizumab on the recurrence of cervical cancer with pleural effusion

Abstract Introduction Bevacizumab has been applied clinically to advanced and recurrent cervical cancer, after showing improved overall survival in the GOG 240 trial. We report two cases of patients with recurrent cervical cancer who showed remarkable decrease in pleural effusion by chemotherapy combined with bevacizumab. Case 1 A 41-year-old patient with stage IIB cervical adenocarcinoma who presented with cervical carcinoma recurrence in the lung and paraaortic/ supraclavicular lymph nodes after primary treatments with concurrent chemoradiotherapy (CCRT), total hysterectomy, and paclitaxel-carboplatin (TC) therapy. As symptomatic pleural effusion emerged after irinotecan-cisplatin therapy and radiotherapy, paclitaxel-cisplatin-bevacizumab (Pac-Cis-Bev) was administered and relieved the pleural effusion promptly and the respiratory distress and back pain symptoms over 13 months. Case 2 The second case involved a 53-year-old patient with stage IIIB cervical squamous cell carcinoma who had a pulmonary recurrence following treatment with CCRT. As pleural effusion emerged at the end of the six-month drug holiday, after a total of 21 cycles of TC or Pac-Cis-Bev therapy to treat the recurrence, topotecan-paclitaxel-bevacizumab (Topo-Pac-Bev) was administered. Respiratory distress was relieved in two weeks, and the pleural effusion disappeared almost completely after two months. The patient received 12 cycles of Topo-Pac-Bev, in total. Conclusion The present two patients have survived over three years, without problematic symptoms, after pulmonary recurrences with pleural effusion, despite that the three-year survival rate for recurrent/metastatic cervical cancer has been reported to be less than 5% without bevacizumab therapy. Chemotherapies that contain bevacizumab present promising regimens for recurrent cases with pleural effusion, despite the uncommon risks of bladder-vaginal or recto-vaginal fistulas.

POSITIVE PSYCHIATRY AND POSITIVE PSYCHOLOGY: TRANSLATION TO CLINICAL PRACTICE

Child and adolescent mental health clinicians generally practice in a framework that emphasizes identification and treatment of mental illness toward a goal of symptom reduction. However, this method of treatment neglects the substantial and growing literature that demonstrates the benefits of positive psychosocial factors not only in alleviating suffering but also in building resilience and beyond, cultivating flourishing. Additionally, engagement in mental health care often is hampered by stigma associated with diagnoses; this stigma may be reduced through focusing on building character strengths and seeking to thrive rather than simply ameliorating problematic symptoms.

Social Drinking Contexts and Their Influence on Problematic Drinking at Age 30

Aims: Understanding the social contexts in which problematic drinking occurs can inform prevention strategies. In this article, we investigate gender-specific social contexts associated with problematic drinking and depression among adults aged 30 years. Because depression has been consistently linked with harmful alcohol consumption, we will also examine its association with drinking contexts. Methods: We used data from 2490 young adults who completed the 30-year follow-up phase of the Mater-University of Queensland Study of Pregnancy and its Outcomes, a prospective study commenced in 1981. Exploratory and confirmatory factor analyses were used to identify latent constructs of drinking contexts stratified by gender, with subsequent regression analysis to assess the role of these contexts in problematic drinking (measured using the Alcohol Use Disorders Identification Test). Results: Six distinct drinking contexts were identified, which differed by gender, three for men and three for women. For both men and women, “social drinking”, was associated with problematic drinking. “Home drinking” was also common to men and women but associations with problematic drinking differed, being risky only among men. “Daytime drinking” (women) was associated with risk but “work-related drinking” (men) was not. Both “home drinking” (men) and “daytime drinking” (women) were linked to depression symptoms. Conclusion: Specific contexts appeared to be associated with problematic drinking for both sexes. Among both men and women, “social drinking” was associated with problematic drinking. Both “home drinking” (men) and “daytime drinking” (women) contexts, were associated with problematic drinking and depressive symptoms. Targeted alcohol-focused interventions need to address co-occurring mental health issues.

Neonatal Eating Assessment Tool-Breastfeeding: Reference Values for Infants Less Than 7 Months old.

The Neonatal Eating Assessment Tool-Breastfeeding is a valid and reliable 62-item parent-report assessment of symptoms of problematic breastfeeding behavior intended for infants less than 7 months old. The aim of this study was to describe the Neonatal Eating Assessment Tool-Breastfeeding total score and subscale scores within a sample of full-term, healthy, typically-developing infants under 7 months old. Parents of healthy, full-term breastfeeding infants (N = 475) less than 7 months old completed the Neonatal Eating Assessment Tool - Breastfeeding through an online survey. Descriptive statistics were calculated for the total score and seven subscale scores within each age group: 0-2, 2-4, 4-6, and 6-7 months. Neonatal Eating Assessment Tool-Breastfeeding total scores were highest (i.e., more problematic symptoms) at 0-2 months and decreased in older infant age groups. All subscale scores also had a downward trajectory in symptoms of problematic breastfeeding except the subscale Compelling Symptoms of Problematic Feeding, which was very low across age groups. Scores on the Infant Regulation subscale remained elevated for the first 6 months of life, then declined markedly in the 6-7 month age group. The Neonatal Eating Assessment Tool-Breastfeeding now has reference values to facilitate interpretation of scores and guide decision-making, personalization of interventions, and assessment of response to interventions. For research, the Neonatal Eating Assessment Tool-Breastfeeding can be used to follow longitudinal development of breastfeeding as well as to test efficacy of breastfeeding interventions.

Neonatal Eating Assessment Tool - Mixed Breastfeeding and Bottle-Feeding (NeoEAT - Mixed Feeding): factor analysis and psychometric properties

BackgroundEarly identification of feeding difficulty in infancy is critical to supporting breastfeeding and ensuring optimal nutrition for brain development. The Neonatal Eating Assessment Tool (NeoEAT) is a parent-report assessment that currently has two versions: NeoEAT – Breastfeeding and NeoEAT – Bottle-feeding for use in breast and bottle-fed infants, respectively. There are currently no valid and reliable parent-report measures to assess feeding through a combination of both breast and bottle delivery. The purpose of this study was to conduct a factor analysis and test the psychometric properties of a new measure, the NeoEAT – Mixed Breastfeeding and Bottle-Feeding (NeoEAT – Mixed Feeding), including internal consistency reliability, test-retest reliability, construct validity and known-groups validity.MethodsParents of infants younger than 7 months who had fed by both bottle and breast in the previous 7 days were invited to participate. Internal consistency reliability was tested using Cronbach’s α. Test-retest reliability was tested between scores on the NeoEAT – Mixed Feeding completed 2 weeks apart. Construct validity was tested using correlations between the NeoEAT – Mixed-Feeding, the Infant Gastroesophageal Reflux Questionnaire - Revised (I-GERQ-R), and the Infant Gastrointestinal Symptoms Questionnaire (IGSQ). Known-groups validation was tested between healthy infants and infants with feeding problems.ResultsA total of 608 parents participated. Exploratory factor analysis revealed a 68-item scale with 5 sub-scales. Internal consistency reliability (Cronbach’s α = .88) and test-retest reliability (r = 0.91; p < .001) were both acceptable. Construct validity was demonstrated through correlations with the I-GERQ-R (r = 0.57; p < .001) and IGSQ (r = 0.5; p < .001). Infants with feeding problems scored significantly higher on the NeoEAT – Mixed Feeding, indicating more problematic feeding symptoms, than infants without feeding problems (p < .001), supporting known-groups validity.ConclusionsThe NeoEAT – Mixed Feeding is a 68-item parent-reported measure of breast- and bottle-feeding behavior for infants less than 7 months old that now has evidence of validity and reliability for use in clinical practice and research. The NeoEAT – Mixed Feeding can be used to identify infants with problematic feeding, guide referral decisions, and evaluate response to interventions.

Preschool children's eating and sleeping habits: late rising and brunch on weekends is related to several physical and mental symptoms

ObjectiveAs the relationships of sleep-wake schedule and mealtime with children's behaviors have not often been studied together, we investigated the relationships of these lifestyles variables with preschool children's well-being. MethodsUsing a network survey, we investigated several lifestyle variables of 1000 families with preschool children. ResultsOur previous articles reported that preschool children's bedtime was delayed by the compulsory nap routine in Japanese nursery schools. The present study revealed similar results. We conducted a cluster analysis with children's meal and sleep time data, which yielded five different lifestyle groups. Cluster 1 was characterized by “extremely late and irregular” meal and sleep times; similar to Cluster 1, Cluster 2 was a “late and irregular” lifestyle group. Cluster 3 was a “mildly late” lifestyle group. Cluster 4 was an “early bird and regular lifestyle” group, and Cluster 5 resembled the “early bird and regular lifestyle” group on weekdays, but was “late and irregular on weekends.” It was found that the later and more irregular the children's meal and sleep times, the worse their physical and mental condition. Even for Cluster 5, the children who had early and regular meal and sleep times on weekdays, getting up and having breakfast late and irregularly on weekends showed worse physical and mental conditions. These problematic symptoms observed in children with late meal and sleep times on weekends might be partly associated with the irregularity of their habits and partly associated with delayed mealtime, especially for breakfast (brunch). ConclusionA stable lifestyle, including a regular sleep and wake schedule and mealtime, is important for preschool children's mental and physical health.

Emotion-Focused Therapy: A Transdiagnostic Formulation

Recent years have seen the emergence of transdiagnostic psychotherapeutic treatments, typically targeting depression, anxiety and related disorders. The rationale for developing transdiagnostic protocols is based on a number of factors; shared etiology and maintenance mechanisms, high co-morbidity, hypothesising that discrete disorders may be underpinned by common psychological vulnerabilities, and the burden currently placed on clinicians to master multiple disorder-specific interventions. This paper describes a transdiagnostic model of emotion-focused therapy (EFT-T), which combines modular (targeting specific clusters of symptoms) and shared mechanisms (targeting underlying vulnerability) approaches to the treatment of depression, anxiety and related disorders such as obsessive–compulsive and trauma/stressor related disorders. The model proposes that clients’ core vulnerabilities are linked to specific chronic painful feelings, and that these chronic feelings are constellations of sadness/loneliness, shame, and fear-based emotions, idiosyncratically shaped by personal history. The paper describes how EFT-T addresses problematic symptoms but primarily focuses on transforming emotion vulnerability, or Core Pain, by activating adaptive emotional responses, such as compassion and protective anger, to embedded unmet needs. As all hitherto presented transdiagnostic protocols have emanated from within the cognitive behavioural paradigm, the aim of the described model is to increase the choice of evidence-based transdiagnostic interventions available to clinicians and clients.

Effectiveness of Group Play Therapy on Problematic Behaviors and Symptoms of Anxiety of Preschool Children

ABSTRACTThe current study explored the effects of child-centered group play therapy (CCGPT) on anxiety symptoms and problematic classroom behaviors of preschool children. Using a single case design, 4 preschool children with clinical levels of anxiety problems as rated by parents or teachers on the Child Behavior Checklist/Caregiver-Teacher Report Form, participated in 10 sessions of CCGPT. Participants’ problematic classroom behaviors were examined prior to and during participation in CCGPT. After participation in group play therapy, all 4 children exhibited decreased anxiety symptoms and fewer problematic classroom behaviors. A discussion of limitations and implications for future research are discussed.

Walking the thin white line – managing voice in the older adult

ABSTRACTPurpose of reviewThis article reviews our understanding and the evolution of management of age-related vocal changes and phonatory complaints in the older adult, from the otolaryngologist and speech-language therapists’ perspective.Recent findingsVocal change may occur with ageing but may not produce problematic symptoms or dysfunction. A perceptually ‘older voice’ is often characterized by breathiness, reduced projection and increase vocal fatigue. Physical changes observed include vocal fold atrophy with incomplete glottal contact whilst histologically there is a reduction in muscle fibre diameter, variation to the composition of the superficial lamina propria and alteration in viscoelasticity. When coupled with additional changes in the respiratory system such as a decline in breath support, reduced lubrication and global sarcopenia, glottal function may decline and audible or perceptual disturbances become apparent. In individuals who are bothered by phonatory decline, speech therapy and selected surgical interventions have demonstrated favourable responses and patient satisfaction. Growth factor and molecular therapies hold promise in the future.SummaryAs people today continue to work and contribute to Society well into their ninth decade, functional voice holds greater importance. Understanding of occurrence of pathology as well as ageing effects is needed to ensure early appropriate assessment and provide a treatment where needed, thereby limiting the occupational impact and social isolation.

Complementary and Alternative Medicine for Menopause.

Menopause is associated with problematic symptoms, including hot flashes, sleep problems, mood disorders, sexual dysfunction, weight gain, and declines in cognitive functioning. Many women seek complementary and alternative medicine (CAM) for symptom management. This article critically reviews the existing literature on CAM treatments most commonly used for menopausal symptoms. Electronic searches were conducted to identify relevant, English-language literature published through March 2017. Results indicate that mind and body practices may be of benefit in reducing stress and bothersomeness of some menopausal symptoms. In particular, hypnosis is a mind-body intervention that has consistently shown to have a clinically significant effect on reducing hot flashes. Evidence is mixed in regard to the efficacy of natural products and there are some safety concerns. Health care providers should consider the evidence on CAM in providing an integrative health approach to menopausal symptom management.