Self-administered Rating Scale Research Articles

Diagnosis and Treatment of Generalized Anxiety Disorder in Japan: Psychiatric Specialist Survey.

Generalized anxiety disorder (GAD) is a suboptimally managed chronic recurring psychiatric condition with a lifetime prevalence of 2.6% in Japan. We assessed the current status of GAD management in Japan. This was an observational, cross-sectional study conducted through an anonymous web-based survey in Japan from December 12-16, 2022. Psychiatrists and psychosomatic medicine physicians who agreed to participate and saw ≥10 outpatients in the previous month were eligible. Survey questionnaire comprised 37 single/multiple choice, numerical entry, or open-ended questions in Japanese. Among 509 participants (493 psychiatrists and 16 psychosomatic medicine physicians), 96.9% were aware of GAD. On average, 12.4 outpatients and 1.0 inpatient were diagnosed with GAD per physician per month. Of 433 physicians having patients diagnosed with GAD, 46.9% used operational diagnostic tools; among these, DSM-5 diagnostic criteria were used by 81.5% physicians. The majority (54.7%) of participants did not use a self-administered rating scale; depression scales were used more than anxiety scales. Among these 433 physicians, 96.8% used selective serotonin reuptake inhibitors for GAD management, and 79.2% used it as the first choice; of 431 physicians who prescribed drug therapy, 54.3% gave antidepressant monotherapy as first choice. The most frequent symptom in patients diagnosed with GAD was excessive anxiety/worry (96.5%); depression was the most commonly reported comorbidity (84.3%) as per physicians aware of GAD (N=508). This study illustrates that although GAD awareness is high among Japanese psychiatric specialists, GAD is not frequently diagnosed using operational diagnostic approaches. Due to a lack of Japanese guidelines for GAD diagnosis and treatment, diverse international guidelines are followed, with similar treatment paradigms as that of depression. This may not be an optimal approach given cultural/geographical differences. These findings highlight the need for uniform diagnosis and treatment recommendations for GAD management in Japan. UMIN-CTR: UMIN000049572.

P1184 Two simple tools for assessing depression and anxiety in patients with Inflammatory Bowel Diseases

Abstract Background Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), can trigger the onset of depressive and anxiety symptoms. The evaluation of mental well-being in patients with a chronic medical condition is considered a good clinical practice and it is strongly recommended by the World Health Organization. Nevertheless, mental health is not routinely investigated in this context for several reasons, including lack of training by healthcare professionals, stigma associated to mental health and gender-relatedstereotypes. The objectives of our study were to assess the presence of depressive and anxiety symptoms inpatients affected by IBD using two simple validated questionnaires and to identify potential related factors, particularly gender differences. Methods We conducted a single center observational study evaluating anxiety and depressive symptoms in patients with IBD treated with biological therapy at the IBD Unit of Ospedale Policlinico of Milan during October 2022. We assessed depressive and anxiety symptoms using respectively the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) that are easy self-administered rating scales. Univariate analyses and regression models were applied for the purpose of the study. Results Among a total of 174 consecutive patients, 158 completed the questionnaires. The prevalence of moderate tosevere depression (PHQ-9 score > 9) in the total sample was 18.4%, and it was higher in CD than in UC (21% vs 9.7%). The prevalence of clinically significant anxiety symptoms (GAD-7 score > 9) was 24% (25.7% in CD and 19.3% in UC). Focusing on gender differences, similar prevalence of significant anxiety anddepression was observed between males (M) and females (F); respectively 18.6% M vs 17.6% F for depression (PHQ-9 > 9) and 22.2% M vs 25.4% F for anxiety (GAD-7 > 9). Of note, a relevant association was observed between younger age and higher GAD-7 (β =-0.639; p=0.021) and PHQ-9 (β =-0.604, p=0.055) scores. Conclusion Both males and females (especially younger) IBD patients in biological therapy are largely affected bysignificant depressive and anxiety symptoms. The administration of simple questionnaires like PHQ-9 andGAD-7 in routine clinical practice can facilitate early identification of patients requiring mental health support, this is crucial as psychiatric conditions can complicate the course of the disease and adherence to treatments.

Assessment of Attitudes, Ethics and Communication Skills in a Competency-Based Undergraduate Medical Curriculum

Affective learning outcomes are difficult to objectively analyse and assess as they refer to feelings and internal processes of the mind and heart. These cannot be quantified by traditional testing methods. The available methods rely on qualitative self-reflection and the observation of simple to complex internally consistent qualities of character. Just as in the other domains of learning, the validity and reliability of these assessments need to be ensured. The assessment of the affective domain requires careful observation of specified behaviours by multiple observers. Miller’s pyramid, Krathwohl’s levels and Epstein’s conceptual frameworks can be used to devise suitable assessment plans for the complex and varied competencies in this domain. Many techniques including paper-based tests, self-administered rating scale, faculty and peer assessment, simulations, reflections, portfolios, observed clinical encounters, collated views of co-workers, record of incidents of unprofessionalism, critical incident reports, patient surveys and global view of supervisor have been used for assessment of affective domain. The effective utilization of these assessment tools needs to factor in the ground realities that exist in different medical colleges. The acceptability and feasibility of using resource intensive assessment methods needs to be carefully balanced against their contributions towards increasing validity and reliability

Assessment of Depression in Adults and Youth.

This article selectively reviews the key issues and measures for the assessment of depressive disorders and symptoms in youth and adults. The first portion of the article addresses the nature and conceptualization of depression and some key issues that must be considered in its assessment. Next, the diagnostic interview and clinician- and self-administered rating scales that are most widely used to diagnose, screen for, and assess the severity of depression in adults and youth are selectively reviewed. In addition, the assessment of three transdiagnostic clinical features (anhedonia, irritability, and suicidality) that are frequently associated with both depression and other forms of psychopathology is discussed. The article concludes with some broad recommendations for assessing depression in research and clinical practice and suggestions for future research.

Fatigue in patients with cancer receiving outpatient chemotherapy: a prospective two-center study

BackgroundCancer-related fatigue (CRF) is one of the most common symptoms in patients with cancer. However, CRF has not been sufficiently evaluated as it involves various factors. In this study, we evaluated fatigue in patients with cancer receiving chemotherapy in an outpatient setting.MethodsPatients with cancer receiving chemotherapy at the outpatient treatment center of Fukui University Hospital and Saitama Medical University Medical Center Outpatient Chemotherapy Center were included. The survey period was from March 2020 to June 2020. The frequency of occurrence, time, degree, and related factors were examined. All patients were asked to fill out the Edmonton Symptom Assessment System Revised Japanese version (ESAS-r-J) questionnaire, which is a self-administered rating scale, and patients with ESAS-r-J “Tiredness” scores of ≥ 3 were evaluated for factors related to tiredness, such as age, sex, weight, and laboratory parameters.ResultsA total of 608 patients were enrolled in this study. Fatigue after chemotherapy occurred in 71.0% of patients. ESAS-r-J “Tiredness” scores of ≥ 3 were observed in 20.4% of patients. The factors related to CRF were low hemoglobin level and high C-reactive protein level.ConclusionsTwenty percent of patients receiving cancer chemotherapy on an outpatient basis had moderate or severe CRF. Patients with anemia and inflammation are at increased risk of developing fatigue after cancer chemotherapy.

Psychiatric Symptoms in Parkinson's Disease Patients before and One Year after Subthalamic Nucleus Deep Brain Stimulation Therapy: Role of Lead Positioning and Not of Total Electrical Energy Delivered.

Parkinson’s disease (PD) patients may experience neuropsychiatric symptoms, including depression, anxiety, sleep disturbances, psychosis, as well as behavioral and cognitive symptoms during all the different stages of the illness. Deep Brain Stimulation (DBS) therapy has proven to be successful in controlling the motor symptoms of PD and its possible correlation with the occurrence or worsening of neuropsychiatric symptoms has been reported. We aimed to assess the neuropsychiatric symptoms of 14 PD patients before and after one year of Subthalamic Nucleus (STN)-DBS and to correlate the possible changes to the lead placement and to the total electrical energy delivered. We assessed PD motor symptoms, depression, anxiety, apathy, impulsivity, and suicidality using clinician- and/or self-administered rating scales and correlated the results to the lead position using the Medtronic SuretuneTM software and to the total electrical energy delivered (TEED). At the 12-month follow-up, the patients showed a significant improvement in PD symptoms on the UPDRS (Unified Parkinson’s disease Rating Scale) (−38.5%; p < 0.001) and in anxiety on the Hamilton Anxiety Rating Scale (HAM-A) (−29%; p = 0.041), with the most significant reduction in the physiological anxiety subscore (−36.26%; p < 0.001). A mild worsening of impulsivity was detected on the Barratt Impulsiveness Scale (BIS-11) (+9%; p = 0.048), with the greatest increase in the attentional impulsiveness subscore (+13.60%; p = 0.050). No statistically significant differences were found for the other scales. No correlation was found between TEED and scales’ scores, while the positioning of the stimulating electrodes in the different portions of the STN was shown to considerably influence the outcome, with more anterior and/or medial lead position negatively influencing psychiatric symptoms.

Free Papers Compiled

Background:Excessive daytime sleepiness (EDS) and poor sleep quality have shown to be associated with myriad of physical and psychological problems. Increasingly, excessive use of smartphones and Internet, leading to EDS and poor sleep quality, especially among students has become an area of concern. This study was undertaken to check for EDS and sleep quality in the medical undergraduates and its association with smartphone and Internet addiction, psychological distress, depression, and anxiety.Materials and Methods:This is a cross-sectional, observational, and descriptive study done on MBBS students and interns. Semi-structured pro forma was used to collect sociodemographic data and students were asked to complete self-administered rating scales, namely, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Kessler Psychological Distress Scale (K10), Smartphone Addiction Scale-short version (SAS-SV), and Young’s Internet Addiction Test (IAT).Results:About 27.4% of students reported EDS and 44.4% fulfilled the criteria of poor sleeper on PSQI. About 56.5% of students reported psychological distress on K10. Almost half (45.3%) of the students reported addictive behavior toward their smartphones and one out of four students at risk of becoming Internet addicted. EDS was significantly (P < 0.05) correlated with PSQI, especially subjective sleep quality and daytime dysfunction component. EDS was also significantly associated (P < 0.05) with psychological distress. EDS was also significantly (P < 0.05) associated with SAS-SV and Young’s IAT scores. Poor sleep quality was also significantly (P < 0.05) associated with psychological distress, anxiety, and depression.Conclusion:The impact of smartphone and Internet overuse on sleep quality as well as their association with EDS is significant. We need to be aware of these factors in order to improve the sleep quality of our students.

The effect of exposure to long working hours on depression: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury

BackgroundThe World Health Organization (WHO) and the International Labour Organization (ILO) are developing the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates), supported by a large number of individual experts. Evidence from previous reviews suggests that exposure to long working hours may cause depression. In this article, we present a systematic review and meta-analysis of parameters for estimating (if feasible) the number of deaths and disability-adjusted life years from depression that are attributable to exposure to long working hours, for the development of the WHO/ILO Joint Estimates. ObjectivesWe aimed to systematically review and meta-analyse estimates of the effect of exposure to long working hours (three categories: 41–48, 49–54 and ≥55 h/week), compared with exposure to standard working hours (35–40 h/week), on depression (three outcomes: prevalence, incidence and mortality). Data sourcesWe developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies, including the WHO International Clinical Trial Registers Platform, Medline, PubMed, EMBASE, Web of Science, CISDOC and PsycInfo. We also searched grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts. Study eligibility and criteriaWe included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (aged <15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of exposure to long working hours (41–48, 49–54 and ≥55 h/week), compared with exposure to standard working hours (35–40 h/week), on depression (prevalence, incidence and/or mortality). Study appraisal and synthesis methodsAt least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined odds ratios using random-effects meta-analysis. Two or more review authors assessed the risk of bias, quality of evidence and strength of evidence, using Navigation Guide and GRADE tools and approaches adapted to this project. ResultsTwenty-two studies (all cohort studies) met the inclusion criteria, comprising a total of 109,906 participants (51,324 females) in 32 countries (as one study included multiple countries) in three WHO regions (Americas, Europe and Western Pacific). The exposure was measured using self-reports in all studies, and the outcome was assessed with a clinical diagnostic interview (four studies), interview questions about diagnosis and treatment of depression (three studies) or a validated self-administered rating scale (15 studies). The outcome was defined as incident depression in all 22 studies, with first time incident depression in 21 studies and recurrence of depression in one study. We did not identify any study on prevalence of depression or on mortality from depression. For the body of evidence for the outcome incident depression, we had serious concerns for risk of bias due to selection because of incomplete outcome data (most studies assessed depression only twice, at baseline and at a later follow-up measurement, and likely have missed cases of depression that occurred after baseline but were in remission at the time of the follow-up measurement) and due to missing information on life-time prevalence of depression before baseline measurement.Compared with working 35–40 h/week, we are uncertain about the effect on acquiring (or incidence of) depression of working 41–48 h/week (pooled odds ratio (OR) 1.05, 95% confidence interval (CI) 0.86 to 1.29, 8 studies, 49,392 participants, I2 46%, low quality of evidence); 49–54 h/week (OR 1.06, 95% CI 0.93 to 1.21, 8 studies, 49,392 participants, I2 40%, low quality of evidence); and ≥ 55 h/week (OR 1.08, 95% CI 0.94 to 1.24, 17 studies, 91,142 participants, I2 46%, low quality of evidence).Subgroup analyses found no evidence for statistically significant (P < 0.05) differences by WHO region, sex, age group and socioeconomic status. Sensitivity analyses found no statistically significant differences by outcome measurement (clinical diagnostic interview [gold standard] versus other measures) and risk of bias (“high”/“probably high” ratings in any domain versus “low”/“probably low” in all domains). ConclusionsWe judged the existing bodies of evidence from human data as “inadequate evidence for harmfulness” for all three exposure categories, 41–48, 48–54 and ≥55 h/week, for depression prevalence, incidence and mortality; the available evidence is insufficient to assess effects of the exposure. Producing estimates of the burden of depression attributable to exposure to long working appears not evidence-based at this point. Instead, studies examining the association between long working hours and risk of depression are needed that address the limitations of the current evidence.

Excessive Daytime sleepiness and sleep quality in medical students and their association with smartphone and internet addiction: A cross-sectional study

Background: Excessive daytime sleepiness (EDS) and poor sleep quality have shown to be associated with myriad of physical and psychological problems. Increasingly, excessive use of smartphones and Internet, leading to EDS and poor sleep quality, especially among students has become an area of concern. This study was undertaken to check for EDS and sleep quality in the medical undergraduates and its association with smartphone and Internet addiction, psychological distress, depression, and anxiety. Materials and Methods: This is a cross-sectional, observational, and descriptive study done on MBBS students and interns. Semi-structured pro forma was used to collect sociodemographic data and students were asked to complete self-administered rating scales, namely, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Kessler Psychological Distress Scale (K10), Smartphone Addiction Scale-short version (SAS-SV), and Young's Internet Addiction Test (IAT). Results: About 27.4% of students reported EDS and 44.4% fulfilled the criteria of poor sleeper on PSQI. About 56.5% of students reported psychological distress on K10. Almost half (45.3%) of the students reported addictive behavior toward their smartphones and one out of four students at risk of becoming Internet addicted. EDS was significantly (P < 0.05) correlated with PSQI, especially subjective sleep quality and daytime dysfunction component. EDS was also significantly associated (P < 0.05) with psychological distress. EDS was also significantly (P < 0.05) associated with SAS-SV and Young's IAT scores. Poor sleep quality was also significantly (P < 0.05) associated with psychological distress, anxiety, and depression. Conclusion: The impact of smartphone and Internet overuse on sleep quality as well as their association with EDS is significant. We need to be aware of these factors in order to improve the sleep quality of our students.

A New Rating Scale for the Rapid Evaluation of High-Level Sports Ability.

Background:Nearly half of patients with an anterior cruciate ligament (ACL) injury who have returned to sport after ACL reconstruction can return to sports activity at a competitive level, so emphasis should be focused not only on the timing of return to the sport but also on measuring the ability to participate in high-level sports activity.Purpose:To develop and evaluate a new, self-administered rating scale for rapid evaluation of high-level sports ability among community-level athletes who return to sports after ACL reconstruction surgery.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:We developed the new rating scale—the Knee Stability in Sports/Cutting-Pivoting Ability (KSS/CPA) scale—in 2 stages. Initially, we used a survey and roundtable discussion to achieve an expert consensus for the KSS/CPA scale from a group of independent orthopaedic experts. Next, 77 amateur athletes who underwent ACL reconstruction by a single surgeon were recruited for a background analysis of data to compare the new scale with results from the Marx activity rating scale, Tegner activity scale, International Knee Documentation Committee Subjective Knee Form, and self-assessment of overall knee function.Results:The KSS/CPA scale was applicable and effective for evaluating the high-level sports ability of community-level athletes who had returned to their sport after ACL reconstruction. Statistical analysis confirmed the test-retest reliability of the new rating scale (intraclass correlation coefficient, 0.85/0.84 postoperatively) as well as its internal consistency (Cronbach alpha coefficient, 0.73 preoperatively and 0.89 postoperatively), construct validity (Spearman correlation coefficient, >0.35 postoperatively), excellent discriminant validity, acceptable responsiveness, and reasonable minimal detectable change (<25).Conclusion:The KSS/CPA scale can act as a supplement to other clinical outcome measures for a more comprehensive evaluation of community-level athletes’ cutting-pivoting ability and knee stability.

Onset of workplace sexual harassment and subsequent depressive symptoms and incident depressive disorder in the Danish workforce

BackgroundWe studied onset of workplace sexual harassment and subsequent risk of depressive symptoms and depressive disorder. MethodsWe examined 9,981 individuals who participated in the Work Environment and Health in Denmark survey in 2012 and 2014 and 6,647 individuals who also participated in 2016, all unexposed to sexual harassment in 2012. Depressive symptoms and disorder were assessed with the Major Depression Inventory. Using linear regression, we estimated the associations between onset of sexual harassment in the 12 months preceding the 2014 survey and depressive symptoms in 2014 and 2016, respectively. Using logistic regression, we estimated risk of incident depressive disorder in 2014. ResultsOnset of sexual harassment was associated with elevated depressive symptoms in 2014, both for harassment by non-workplace personnel (e.g., patients, estimate (B): 1.61, 95% CI: 0.51–2.72, p = 0.004) and workplace personnel (e.g., supervisors, B: 3.85, 95% CI: 2.51–5.20, p < 0.001), after adjustment for depressive symptoms in 2012. Harassment by workplace personnel was further associated with elevated depressive symptoms in 2016 after adjustment for symptoms in 2012, but not after adjustment for symptoms in 2014. Harassment by workplace personnel was associated with incident depressive disorder in 2014 (odds ratio: 5.26, 95% CI: 2.68–10.31, p < 0.001). LimitationsDepressive symptoms and disorder were assessed with a validated self-administered rating scale but not a clinical diagnostic interview. Participants reporting harassment in 2014 had elevated depressive symptoms already in 2012 requiring future investigation. ConclusionsExposure to sexual harassments at the workplace may be a contributing factor in the aetiology of depressive symptoms and disorder.

A Multi-Method Assessment in Adolescent and Adult Females with Giant Congenital Melanocytic Naevus and their Families: Body Image and Psychological Adjustment

Background: Giant Congenital Melanocytic Naevus (GCMN) is a morphological skin alteration present from birth, involving up to 80% of the body surface. GCMN could have a detrimental effect on body perception due to several factors including its aspect, extension and the potential exposure to significant number of surgical interventions. Objective: This pilot study assessed quality of Body Image (BI) and psychological adjustment in subjects with GCMN and their parents. Methods: Subjects and parents underwent a multi-method assessment including a semi-structured interview, a self-administered rating scale to assess BI (Body Uneasiness Test, BUT) and two personality tests: A self-report (MMPI-2RF/A) and a performance test (Rorschach, R-PAS method). Results: Ten families were enrolled in the study. GCMN subjects were all females with high average surgical interventions (median=13). In GCMNs a substantial impairment of BI was detected by the BUT (global severity index=2.34 ± 0.81; Body Image Concern=3.25 ± 0.95), MMPI-2RF/A presented normal ranges and R-PAS showed elevations for the quality of human representations (PHR/GPHR: 119.1 ± 8.1). Mothers showed a trend for health concerns at MMPI-2RF (Malaise: 64.2 ± 9.5), fathers showed under-reporting in almost all tests. Conclusion: This set of GCMN females with relevant surgical history shows significant BI impairment with several aspects of non-integrated body identity at unconscious level, that may result in inability to envision the self and relations with others in adaptive way. Parents show different profiles, including conscious health concerns in mothers and denial in fathers. Families with a GCMN subject could benefit from integrated approaches including medical advice, psychological support and social integration projects.

Relationship Among Repeated Sprint Ability, Chronological Age, and Puberty in Young Soccer Players.

Perroni, F, Pintus, A, Frandino, M, Guidetti, L, and Baldari, C. Relationship among repeated sprint ability, chronological age, and puberty in young soccer players. J Strength Cond Res 32(2): 364-371, 2018-The aim of this study was to analyzed the relationship of repeated sprint ability (RSA) with chronological age and puberty in 100 young soccer players (age: 13 ± 3 years-160 ± 33 months-; height: 159 ± 16 cm, mass: 49.7 ± 14.1 kg; body mass index [BMI] 19.2 ± 2.5 kg/m) grouped on "Pulcini" (9-10 years), "Esordienti" (11-12 years), "Giovanissimi" (13-14 years), "Allievi" (15-16 years), and "Juniores" (>17 years) categories. Anthropometric (weight, height, BMI), RSA (7 × 30 m sprint with 25 seconds active rest: total time-TT, the lowest sprinting time, and the fatigue index percentage-%IF), and development (self-administered rating scale for pubertal development PDS; puberty) parameters were measured. ANOVA among categories was applied to asses differences (p ≤ 0.05) in TT and %IF. When a significant effect was found, Bonferroni's post hoc analysis was used. Pearson correlation among all variables was calculated considering all subjects and also within categories. Among categories, statistical analysis showed significant differences (p < 0.001) in TT and a considerable trend toward significance (p = 0.06) in %IF. Significant correlations among variables were found in all subjects and within categories. In particular, TT showed large significant correlation with PDS (r = -0.66) and puberty (r = -0.67) only in "Esordienti." This study provides useful information for the coach to propose an appropriate training and to obtain the optimal training effect and to minimize the risk of injury and overtraining during the different phases of growth and maturation.

Treatment of sleep disturbances in trauma-affected refugees: Study protocol for a randomised controlled trial

BackgroundSleep disturbances are often referred to as a hallmark and as core symptoms of post-traumatic stress disorder (PTSD). Untreated sleep disturbances can contribute to the maintenance and exacerbation of PTSD symptoms, which may diminish treatment response and constitute a risk factor for poor treatment outcome. Controlled trials on treatment of sleep disturbances in refugees suffering from PTSD are scarce. The present study aims to examine sleep-enhancing treatment in refugees with PTSD. We aim to assess if add-on treatment with mianserin and/or Imagery Rehearsal Therapy (IRT) to treatment as usual (TAU) for PTSD improves sleep disturbances. We will study the relation between sleep disturbances, PTSD symptoms, psychosocial functioning and quality of life.MethodsThe study is a randomised controlled superiority trial with a 2 × 2 factorial design. The study will include 230 trauma-affected refugees.The patients are randomised into four groups. All four groups receive TAU – an interdisciplinary treatment approach covering a period of 6–8 months with pharmacological treatment, physiotherapy, psychoeducation and manual-based cognitive behavioural therapy within a framework of weekly sessions with a physician, physiotherapist or psychologist. One group receives solely TAU, serving as a control group, while the three remaining groups are active-treatment groups receiving add-on treatment with either mianserin, IRT or a combination of both.Treatment outcome is evaluated using self-administered rating scales, observer ratings and actigraph measurements at baseline, during treatment and post treatment. The primary outcome is subjective sleep quality using the Pittsburgh Sleep Quality Index. Secondary outcome measures are objective sleep length, nightmares, PTSD severity, symptoms of depression and anxiety, pain, quality of life and psychosocial functioning.DiscussionThis trial will be the first randomised controlled trial to examine sleep-enhancing treatment in trauma-affected refugees, as well as the first trial to investigate the effect of IRT and mianserin in this population. Therefore, this trial may optimise treatment recommendations for sleep disturbances in trauma-affected refugees. Based on our findings, we expect to discuss the effect of treatment, focussing on sleep disturbances. Furthermore, the results will provide new information regarding the association between sleep disturbances, PTSD symptoms, psychosocial functioning and quality of life in trauma-affected refugees.Trial registrationEudraCT registration under the name ‘Treatment of sleep disturbances in trauma-affected refugees – a randomised controlled trial’, registration number: 2015-004153-40, registered on 13 November 2015.ClinicalTrials.gov, ID: NCT02761161. Registered on 27 April 2016.

Is Self-Administered Rating Scale for Pubertal Development a Predictor of Countermovement Jump in Young Soccer Players?

Objective:Considering that in Young sport competitions children are divided according to their chronological age, the aim of this study was to examine the correlation among chronological age and Self-Administered Rating Scale for Pubertal Development (PDS), anthropometry (Body Mass Index -BMI-, percent body fat -%BF-, fat free mass -FFM-), and Countermovement jump (CMJ) measures.Methods:112 young soccer players (age: 14±2 yrs; height: 1.68±0.11 m; weight: 60.3±11.6 kg; BMI: 21.3±2.5 kg.m-2) grouped in “Giovanissimi” (12-14 yrs), “Allievi” (15-16 yrs), and “Juniores” (&gt;17 yrs), categories were evaluated. Pearson correlations and stepwise multiple regression analysis among variables were calculated considering all subjects and within categories. The internal consistency of PDS was determined by Cronbach’s α coefficient (Cα). Considering all subjects, PDS showed an excellent Cα (0.89) and significant correlations with sub-category (r=0.66), age (r=0.67), %BF (r=-0.31), FFM (r=0.71), and CMJ (r=0.55). Within “Giovanissimi” category, significant correlations were found between PDS and age (r=0.56), CMJ (r=0.33), FFM (r=0.63), and sub-category (r=0.55). In “Allievi”, PDS showed correlations with CMJ (r=0.46), FFM (r=0.42), and %BF (r=-0.45). In “Juniores” no significant correlations between PDS and other variables were present. The regression model with sub-category, PDS, and %BF as predictors explained 41% of the variance of CMJ in all subjects. In the “Allievi” category the PSD was the only predictor explaining the 18% of the CMJ performance variance.Results:PDS can provide useful information for the coach to create individual conditioning programs taking into account the growth problems of young soccer players and to minimize the risk of an excessive workload.

Influence de la maturation pubertaire et de l’estime de soi corporelle sur la sexualité à l’adolescence

AimThe aim of this study was to explore the links between pubertal maturation, physical self-esteem and sexuality in adolescence, differentiating between boys and girls. MethodThe sample was comprised of 312 French secondary school children (seventh and ninth grades); 52.6 % (n=164) of whom were girls. Participants answered three self-evaluation questionnaires: the scale of sexuality (interests, emotions, relationships: IERS) in prime adolescence (12 to 15 years); (b) the self-administered rating scale for pubertal development and (c) the Physical Self-Description Questionnaire (PSDQ). ResultsPubertal maturation was associated with higher scores on “Flirting with the aim of having sexual relations” and “Going out with someone”, and a drop in overall and physical self-esteem, mainly in socially valued domains, namely “Body fat” for girls, and “Strength” and “Health” for boys. Overall physical self-esteem was associated with “Going out with someone” and “Flirting with the aim of having sexual relations” in boys. DiscussionPhysical changes at puberty induce two distinct trends in adolescents: sexual exploration and discovery (genitalized body), and self-depreciation (social body).

Effectiveness of Benson's relaxation therapy on reduction of stress among primigravid mothers

Objectives: The study attempt to assess the effectiveness of Benson's relaxation therapy on reduction of stress among primigravid mothers attending the outpatient department in a selected hospital at Kannur, with the objectives of evaluating the stress among the primigravid mothers before and after the Benson's relaxation therapy and to associate the level of stress with selected demographic variables. Methods: A total of 30 primigravid mothers after third month of gestation were selected for the study. The information regarding background data were collected from the primigravid mothers by self-administered rating scale and the level of hemoglobin status was noted from the health records. Selected primigravid mothers were given pretest questionnaire and Benson's relaxation therapy was administered to all group members for 20 minutes and instructed to continue this for a period of 15 days. Post-test using rating scale was conducted 15 days after the administration of Benson's relaxation therapy. Result: The result of the study shows that the post-test mean stress score was less than the pre-test mean stress score. The obtained mean difference between the pre-test and post-test regarding stress score was statistically significant. Hence research hypothesis “there will be a significant difference in the stress scores before and after Benson's relaxation therapy among the primigravid mothers” has been retained. Conclusions: It was inferred that primigravid mothers who practiced Benson's relaxation therapy had significant decrease in post-test stress score. Also there was significant association with the level of stress and some demographic variables.

Relationship among explosive power, body fat, fat free mass and pubertal development in youth soccer players: a preliminary study

Purpose Changes in body size and functional capacities are highly individual during puberty, and the performance of a soccer player is often closely related to their maturity status. The aim of the study was to evaluate the relationships among explosive power, body fat, fat free mass and pubertal development in young soccer players. Methods Explosive power (countermovement jump— CMJ), body mass index (BMI), percentage of body fat (%BF), fat free mass (FFM) and a Self-Administered Rating Scale for pubertal development (PDS) values of 11 ‘‘Giovanissimi’’ (age 13 year), 13 ‘‘Allievi’’ (age 15 year) and 10 ‘‘Juniores’’ (age [17 year) male soccer players were compared. The statistical analysis was performed using an analysis of variance among categories with Fisher’s post hoc as appropriate. Furthermore, Pearson correlations among variables were calculated considering all subjects and also within categories. Results Statistical differences emerged among categories in CMJ (F(2,30) = 28.3, p 0.01), body fat weight (F(2,31) = 29.2, p 0.01) and PDS (F(2,29) = 18.5, p 0.01), while %BF values showed statistical differences only for ‘‘Giovanissimi’’ and ‘‘Juniores’’ (F(2,31) = 3.4, p = 0.01). CMJ showed significant correlations with FFM (r = 0.68) and PDS (r = 0.63), PDS with FFM (r = 0.66) and BMI with %BF (r = 0.71) and FFM (r = 0.71). A high correlation was found within categories. Conclusion Since we found differences between categories and no correlation between chronological age and pubertal status, this study highlights the importance of assessing of puberty in youth soccer team.

Light therapy as a treatment for sexual dysfunctions. Beyond a pilot study.

Seasonal trends were demonstrated in reproduction and sexual activity. Through the secretion ofmelatonin the pineal gland plays an important role in the neuroendocrine control of sexual function and reproductive physiology. We hypothesized that inhibition of the pineal gland activity through a light treatment may favorably affect sexual function. We recruited 24 subjects with a diagnosis of hypoactive sexual desire disorder and/or primary sexual arousal disorder. The subjects were randomly assigned to either active light treatment (ALT) or placebo light treatment (L-PBO). Participants were assessed during the first evaluation and after 2 weeks of treatment, using the Structured Clinical Interview for Sexual Disorders DSM-IV (SCID-S) and a self-administered rating scale of the level of sexual satisfaction (1 to 10). Repeated ANOVA measures were performed to compare the two groups of patients. Post-hoc analysis was performed by Holm-Sidak test for repeated comparisons. Results. At baseline the two groups were comparable. After 2 weeks the group treated with Light Therapy showed a significant improvement in sexual satisfaction, about 3 times higher than the group that received placebo, while no significant improvement was observed in the group L-PBO. Conclusions. Our results confirm a potentially beneficial effect of Light Therapy on primary sexual dysfunction. In the future, we propose to correlate clinical findings with testosterone levels pre/post treatment.

Which Drug For Which Patient? Is There a Fluoxetine Responding Versus a Bupropion Responding Personality Profile?

This paper proposes that a certain premorbid personality type – that of hard driving, achievement-oriented, often exercise-oriented individuals – correlates with bupropion response; conversely, patients without these premorbid traits and whose depression is marked by mood swings, irritability and rumination are likely fluoxetine responders. The authors developed the Fluoxetine Bupropion Assessment Scale (FBAS), a 10-question, self-administered rating scale, to assess these traits and hypothesized that its use would improve outcomes. A Marriage and Family Therapist (MFT) and a Registered Nurse/Nurse Practitioner (RN/NP) retrospectively reviewed 72 charts from one psychiatrist’s office for two time periods: before and after the psychiatrist utilized the questionnaire to guide antidepressant selection (33 charts before and 39 charts after). Raters were blinded to the theory and to the treatment time period. On the basis of clinical information in the charts, they formulated Clinical Global Impression assessments of treatment response in patients with Beck Depression Inventory scores ≥17 who were not on either drug at the time of intake, and who were prescribed either fluoxetine or bupropion.The data were in the direction of better results in the FBAS-guided group, particularly after adjusting for age, gender and marital status (efficacy p = 0.087). When global improvement data were combined into three groups describing treatment response (improved, minimal to no improvement, and worse) there were statistically significant better results (p = 0.047) in the FBAS-guided treatment group. Revision and validation of the questionnaire and a larger, randomized study seem indicated.