Med Educ. 2019 Oct 28. doi: 10.1111/medu.13998.
Perseverance, faith and stoicism: a qualitative study of medical student perspectives on managing fatigue.
Taylor TS1,2, Raynard AL2, Lingard L2.
Author information
1
Department of Obstetrics and Gynaecology, London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada.
2
Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Abstract
CONTEXT:
Fatigue risk management (FRM) strategies offer a potential solution to the widespread problem of fatigued trainees in the clinical workplace. These strategies assume a shared perception that fatigue is hazardous. Despite the growing body of evidence suggesting that fatigue leads to burnout and medical errors, previous research suggests that residents perceive fatigue as a personal, surmountable burden rather than an occupational hazard. Before we can implement FRM, we need a better understanding of when and how such problematic notions of fatigue are adopted by medical trainees. Thus, we sought to explore how third-year medical students understand and manage the workplace fatigue they experience during their first year of clinical rotations.

METHODS:
A total of 22 third-year medical students participated in semi-structured interviews exploring their perspectives of workplace fatigue. Data collection and analysis occurred iteratively in keeping with constructivist grounded theory methodology and were informed by theoretical sampling to sufficiency.

RESULTS:
Our participants described unprecedented levels of sleep deprivation combined with uncertainty and confusion that led to significant fatigue during training. Drawing on their workplace experience, trainees believed that fatigue posed three distinct threats, which evoked different coping strategies: (i) threat to personal health, managed by perseverance; (ii) threat to patients, managed by faith in the system, and (iii) threat to professional reputation, managed by stoicism.

CONCLUSIONS:
Our findings highlight how senior medical students grapple with fatigue, as they understand it, within a training context in which they are expected to deny the impact of their fatigue on patients and themselves. Despite empirical evidence to the contrary, the prevailing assumption amongst our participants is that an ability to withstand sleep deprivation without impairment will develop naturally over time. Efforts to implement FRM strategies will need to address this assumption if these strategies are to be successfully taken up and effective.

© 2019 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

PMID: 31657067 DOI: 10.1111/medu.13998
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Select item 31656631
2.
Br J Pain. 2019 Nov;13(4):244-255. doi: 10.1177/2049463718814870. Epub 2018 Nov 21.
Chronic pelvic pain in women: an embedded qualitative study to evaluate the perceived benefits of the meridian balance method electro-acupuncture treatment, health consultation and National Health Service standard care.
Chong OT1,2,3, Critchley HO1, Horne AW1, Fallon M2, Haraldsdottir E4.
Author information
1
MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK.
2
Edinburgh Cancer Research Centre (IGMM), The University of Edinburgh, Edinburgh, UK.
3
Simpson Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.
4
St Columba's Hospice/Queen Margaret University, Edinburgh, UK.
Abstract
INTRODUCTION:
Chronic pelvic pain (CPP) - defined as intermittent or constant pain in the lower abdomen or pelvis of at least 6 months' duration, not occurring exclusively with menstruation or intercourse and not associated with pregnancy - is estimated to affect 6-27% of women worldwide. In the United Kingdom, over 1 million women suffer from CPP, which has been highlighted as a key area of unmet need. Current medical treatments for CPP are often associated with unacceptable side effects. A specific style of acupuncture, the meridian balance method electro-acupuncture (BMEA) and traditional Chinese medicine health consultation (TCM HC (BMEA + TCM HC = BMEA treatment)), may be effective for CPP in women.

AIM:
Three focus group discussions and semi-structured telephone interviews were embedded in a randomised controlled feasibility trial to gain in-depth description of the perceived benefits of the participants' respective interventions.

METHODS:
Women with CPP were randomised into the BMEA treatment, TCM HC or National Health Service standard care (NHS SC). Focus group discussions were recorded, transcribed and analysed thematically. Semi-structured telephone interviews were conducted post focus group discussions.

FINDINGS:
A total of 30 women were randomised into BMEA treatment, TCM HC or NHS SC. A total of 11 participants attended the three focus group discussions. Thematic analysis of focus group discussions showed: a perceived pain reduction, enhanced sleep, energy level and sense of well-being in the BMEA treatment and TCM HC groups; a dislike for the adverse effects of medications, frustration at the lack of effective treatment, heavy reliance on medications and services that are helpful, in the NHS SC group. Semi-structured telephone interviews showed that the methodology was acceptable to the participants.

CONCLUSION:
The embedded focus group discussions captured the rich and complex narratives of the participants and provided insights into the perceived benefits of the BMEA treatment, TCM HC and NHS SC interventions.

© The British Pain Society 2018.

KEYWORDS:
Chronic pelvic pain; focus group discussions; meridian balance method acupuncture; mixed-methods study; thematic analysis; traditional Chinese medicine health consultation

PMID: 31656631 PMCID: PMC6791054 [Available on 2020-11-01] DOI: 10.1177/2049463718814870
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Select item 31656539
3.
Exp Ther Med. 2019 Nov;18(5):3905-3912. doi: 10.3892/etm.2019.8058. Epub 2019 Sep 27.
Analysis of the long-term beneficial effects of menopausal hormone therapy on sleep quality and menopausal symptoms.
Li C1, Wang L1, Sun X1, Yang X1.
Author information
1
Department of Obstetrics and Gynecology, Maternity and Child Health Care of Zaozhuang, Zaozhuang, Shandong 277100, P.R. China.
Abstract
A large number of menopausal women report sleep disturbances along with psychological, somatic and urogenital menopausal symptoms. The aim of this study was to evaluate the efficacy of menopausal hormonal therapy (MHT) in improving subjective sleep quality and the severity of menopausal symptoms. An institutional ethics committee approved this retrospective chart review of 342 women treated with MHT for menopausal symptoms. Standard 28-day MHT consisted of the oral administration of 2 mg estradiol daily for 14 days, followed by 2 mg estradiol and 10 mg dydrogesterone daily for the remaining 14 days. A subgroup of 14 participants with a family history of cancer and mammography scores of 3 and above, received only tibolone 2.5 mg daily. Perceived sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI), while the assessment of menopausal symptoms was performed using the Kupperman Menopause Index (KMI) and menopause rating scale (MRS). Of the 342 patients, 79 were followed-up for 3 years. Compared to the baseline scores, the mean decrease in PSQI scores was 1.53±0.29 points (P<0.0001) at 1 month, 2.21±0.187 points (P<0.0001) at 2 months and 2.26±0.6 points (P<0.0001) after 3 years of MHT. The KMI scores also decreased by a mean of 6.37±1.59 points (P<0.0001) at 1 month and by 8.73±1.92 points after 3 years (P<0.0001). The MRS scores decreased by a mean of 3.56±1.05 points (P<0.0001) at 1 month and by 4.28±2.01 points (P<0.0001) after 3 years, as compared to the baseline scores. Patients receiving tibolone MHT did not report any improvement in sleep quality (P=0.956). On the whole, the findings of this study indicate that conventional MHT has a rapid and prolonged beneficial effect on self-reported sleep quality and menopausal symptoms in women. However, further clinical studies are warranted to compare the effects of different MHT regimens.

Copyright: © Li et al.

KEYWORDS:
Pittsburgh Sleep Quality Index (PSQI); femoston; hormone treatment; menopausal symptoms; tibolone

PMID: 31656539 PMCID: PMC6812311 DOI: 10.3892/etm.2019.8058
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4.
J Circadian Rhythms. 2019 Oct 9;17:9. doi: 10.5334/jcr.186.
The Effect of a Common Daily Schedule on Human Circadian Rhythms During the Polar Day in Svalbard: A Field Study.
Weissová K1,2, Škrabalová J1, Skálová K1,3, Bendová Z1,3, Kopřivová J1,2.
Author information
1
National Institute of Mental Health, CZ.
2
Third Faculty of Medicine, Charles University, CZ.
3
Faculty of Science, Charles University, CZ.
Abstract
All Arctic visitors have to deal with extreme conditions, including a constant high light intensity during the summer season or constant darkness during winter. The light/dark cycle serves as the most potent synchronizing signal for the biological clock, and any Arctic visitor attending those regions during winter or summer would struggle with the absence of those entraining signals. However, the inner clock can be synchronized by other zeitgebers such as physical activity, food intake, or social interactions. Here, we investigated the effect of the polar day on the circadian clock of 10 researchers attending the polar base station in the Svalbard region during the summer season. The data collected in Svalbard was compared with data obtained just before leaving for the expedition (in the Czech Republic 49.8175°N, 15.4730°E). To determine the circadian functions, we monitored activity/rest rhythm with wrist actigraphy followed by sleep diaries, melatonin rhythm in saliva, and clock gene expression (Per1, Bmal1, and Nr1D1) in buccal mucosa samples. Our data shows that the two-week stay in Svalbard delayed melatonin onset but did not affect its rhythmic secretion, and delayed the activity/rest rhythm. Furthermore, the clock gene expression displayed a higher amplitude in Svalbard compared to the amplitude detected in the Czech Republic. We hypothesize that the common daily schedule at the Svalbard expedition strengthens circadian rhythmicity even in conditions of compromised light/dark cycles. To our knowledge, this is the first study to demonstrate peripheral clock gene expression during a polar expedition.

Copyright: © 2019 The Author(s).

KEYWORDS:
arctic; circadian system; human chronobiology; polar day; social cues

PMID: 31656532 PMCID: PMC6788356 DOI: 10.5334/jcr.186
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Select item 31656505
5.
Afr Health Sci. 2019 Jun;19(2):2198-2207. doi: 10.4314/ahs.v19i2.45.
Aerobic exercise modulates cytokine profile and sleep quality in elderly.
Abd El-Kader SM1, Al-Jiffri OH2.
Author information
1
Department of Physical Therapy, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
2
Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
Abstract
BACKGROUND:
Sleep disturbance is a major problem for older adults which can be exacerbated by increased inflammation as aging is associated with increased circulating pro-inflammatory and lower anti-inflammatory cytokines. There is a need to develop alternative medicine techniques to help improve sleep quality in the elderly.

OBJECTIVE:
To investigate the effects of aerobic exercise training on the sleep quality and inflammatory cytokines in elderly subjects.

MATERIAL AND METHODS:
Forty previously sedentary elderly subjects participated in this study, their age ranged from 61- 67 years. All subjects were randomly assigned to supervised aerobic exercise intervention group (group A, n=25) or control group (group B, n=25). Polysomnographic recordings for sleep quality assessment, interleukin- 6 (IL-6), tumor necrosis factor- alpha (TNF-α) and interleukin-10 (IL-10) were measured before and after 6 months at the end of the study.

RESULTS:
There was a significant increase in total sleep duration, sleep efficiency and sleep onset latency in group(A) after 6 months of aerobic exercise training, while, wake time after sleep onset and rapid eye movement (REM) latency significantly reduced after 6 months of aerobic training compared with values obtained prior to aerobic exercise training. Also, the mean values of TNF- α and IL-6 decreased significantly and the mean value of IL-10 significantly increased in group (A) after the aerobic exercise training, however the results of the control group were not significant. Moreover, there were significant differences between both groups at the end of the study.

CONCLUSION:
Exercise training can be considered as a non-pharmacological modality for modifying sleep quality and inflammation among elderly.

© 2019 Abd El-Kader et al.

KEYWORDS:
Sleep quality; aerobic exercise; aging; inflammatory cytokines

PMID: 31656505 PMCID: PMC6794533 DOI: 10.4314/ahs.v19i2.45
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6.
Proc (Bayl Univ Med Cent). 2019 Jul 30;32(4):481-484. doi: 10.1080/08998280.2019.1642062. eCollection 2019 Oct.
Sepsis as the primary admitting diagnosis of transferred patients who died within 48 hours of arrival at a Central Texas hospital.
Hall JA1, Khan SH1, Shaver C2, Pye K2, Salejee I1, Delmas T3, Giri B4, White HD3, Mirkes C1.
Author information
1
Department of Internal Medicine, Baylor Scott & White Medical Center and Texas A&M Health Science Center College of MedicineTempleTexas.
2
Internal Medicine, Section of Pulmonary, Critical Care, Sleep and Environmental Medicine, Baylor Scott & White Research InstituteTempleTexas.
3
Department of Pulmonology and Critical Care Medicine, Baylor Scott & White Medical Center and Texas A&M Health Science Center College of MedicineTempleTexas.
4
Virginia Tech Carilion School of Medicine, Roanoke Memorial HospitalRoanokeVirginia.
Abstract
Interhospital transfers are independently associated with inpatient mortality, and transferred patients have worse outcomes. The aim of this study was to retrospectively assess the 48-hour mortality rate in interhospital transfer cohorts of all transfers to a Central Texas teaching hospital and to identify a primary admitting diagnosis for potential intervention. A total of 15,435 patients with 19,161 transfers over the course of the study were retrospectively reviewed and placed in 18 different categories based upon the primary admitting diagnosis. There were about 5000 transfer patients yearly with ∼1.4% deaths within 48 hours of arrival. The three leading categories for transferred patients were cardiovascular, neurologic, and psychiatric. In this group, 268 of 19,161 transfers died within 48 hours of arrival. Despite being the 10th leading category for transfer, sepsis was the leading primary admitting diagnosis of patients who died within 48 hours of arrival, accounting for nearly 22% of those patients. Given the significant association found between sepsis and 48-hour mortality after transfer, we devised a novel interhospital transfer checklist based upon the Surviving Sepsis guidelines in an attempt to decrease mortality associated with these transfers.

© 2019 Baylor University Medical Center.

KEYWORDS:
Checklist; interhospital transfers; mortality; sepsis; shock

PMID: 31656401 PMCID: PMC6793986 DOI: 10.1080/08998280.2019.1642062
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Select item 31656291
7.
J Med Invest. 2019;66(3.4):289-292. doi: 10.2152/jmi.66.289.
The Effect of Laparoscopic Sleeve Gastrectomy on Obesity and Obesity-related Disease : the Results of 10 Initial Cases.
Kashihara H1, Shimada M1, Yoshikawa K1, Higashijima J1, Miyatani T1, Tokunaga T1, Nishi M1, Takasu C1, Hamada Y2.
Author information
1
Department of Surgery, Tokushima University, Tokushima, Japan.
2
Department of Therapeutic nutrition, Tokushima University, Tokushima, Japan.
Abstract
Introduction : The number of patients who undergo laparoscopic sleeve gastrectomy (LSG) has been increasing. Department of Surgery, Tokushima University performed the first LSG in 2013. The aim of this study was to report the results of the initial ten cases who underwent a LSG. Patients and methods : Ten obese patients : five males and five females ; age range from thirty-three years to fifty-six years (mean age 42.2 years) ; mean body mass index (BMI) 50.3 ; five with diabetes ; nine with hypertension (HT) ; four with hyperlipidemia (HL) ; eight with sleep apnea syndrome (SAS) who underwent LSG were enrolled in this study. The data was analyzed retrospectively and included short- and long-term outcomes. Results : There were no post-operative complications in this study. The %EWL at three and six months and one year post-operative were 44.2%, 50.2% and 48.6% respectively. In three months post-operative the non-alcoholic fatty liver (NAFLD) and non-alcoholic steatohepatitis (NASH) had improved transaminase (AST/ALT), liver to spleen ratio in plain CT value. Improvements were also evident in the obesity-related diseases : diabetes 80% (4/5) ; HT 67% (6/9) ; HL 75% (3/4) ; and SAS 88% (7/8). Conclusion : LSG is a promising option for the treatment of morbid obesity and obesity-related diseases. J. Med. Invest. 66 : 289-292, August, 2019.

KEYWORDS:
HL; HT; LSG; NASH; SAS

PMID: 31656291 DOI: 10.2152/jmi.66.289
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Select item 31656109
8.
Disabil Rehabil. 2019 Oct 26:1-11. doi: 10.1080/09638288.2019.1680748. [Epub ahead of print]
Development of a dyadic sleep intervention for Alzheimer's disease patients and their caregivers.
Song Y1,2,3, McCurry SM4, Lee D2, Josephson KR2, McGowan SK2,3, Fung CH2,3, Irwin MR5, Teng E6, Alessi CA2,3, Martin JL2,3.
Author information
1
School of Nursing, University of California, Los Angeles , Los Angeles , CA , USA.
2
Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System , North Hills , CA , USA.
3
David Geffen School of Medicine, University of California, Los Angeles , Los Angeles , CA , USA.
4
Department of Psychosocial and Community Health, School of Nursing, University of Washington , Seattle , WA , USA.
5
Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles , Los Angeles , CA , USA.
6
School of Medicine, Stanford University , Palo Alto , CA , USA.
Abstract
Purpose: This study aimed to refine a behavioral sleep intervention program targeting patients with Alzheimer's disease and their caregivers. Methods: In this case series, key components of the sleep program were built upon previous intervention studies of patients with cognitive impairment/dementia. The intervention consisted of five weekly sessions covering sleep hygiene, sleep compression, stimulus control, daily walking/light exposure, relaxation/mindfulness, and caregiver training to manage patients' behavioral problems. The materials and structure were iteratively refined based on feedback from caregivers and sleep educators. Sleep diaries were used to evaluate sleep outcomes. Results: Five out of six enrolled dyads completed the sessions. Several revisions were made during testing: the last session was changed from telephone to in-person; some components (e.g., sleep scheduling, mindfulness) were rearranged within or across sessions; sleep educator guidelines for sleep scheduling, light exposure, and walking were revised. After the fifth dyad, no additional issues were identified by the caregiver or the sleep educator. Four patients and three caregivers had improved sleep at the last session. Conclusions: The iterative refinement process was successful in finalizing the intervention program, with evidence of sleep improvements. Formal pilot testing of the program will provide further information on feasibility and effectiveness. IMPLICATIONS FOR REHABILITATION Our dyadic behavioral sleep program can be tailored to various types of sleep problems among patients with Alzheimer's disease and their family caregivers, with the goal of improving daytime function by reducing sleep disturbances at night. Caregiver training and participation of both members of the dyad in sleep management may benefit the patients' sleep and other health outcomes, reduce caregiver stress and burden, and ultimately delay or prevent institutionalization of Alzheimer's disease patients.

KEYWORDS:
Alzheimer’s disease; Behavioral sleep intervention; dyadic approach; family caregiver

PMID: 31656109 DOI: 10.1080/09638288.2019.1680748
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Select item 31656059
9.
Respirology. 2019 Oct 26. doi: 10.1111/resp.13713. [Epub ahead of print]
Biomarker-guided management reduces exacerbations in non-eosinophilic asthma in pregnancy: A secondary analysis of a randomized controlled trial.
Murphy VE1, Porsbjerg CM2, Robijn AL1, Gibson PG3,4.
Author information
1
Priority Research Centre GrowUpWell and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.
2
Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
3
Priority Research Centre for Healthy Lungs and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.
4
Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia.
Abstract
BACKGROUND AND OBJECTIVE:
The aim of this secondary analysis of a randomized controlled trial (RCT) of asthma management in pregnancy was to determine the treatment decision differences between a symptom control algorithm and a fractional exhaled nitric oxide (FENO)-guided algorithm, and whether the approach was effective in non-eosinophilic asthma (NEA).

METHODS:
In this double-blind parallel group RCT, women with asthma were randomized prior to 22 weeks gestation to treatment adjustment according to a symptom control algorithm (control group), or a FENO-guided algorithm (inhaled corticosteroid (ICS) dose adjusted according to FENO with long-acting beta-agonist (LABA) added for uncontrolled symptoms). NEA was classified as baseline blood eosinophils <0.26 × 109 /L and FENO ≤29 ppb. Exacerbations requiring medical intervention were recorded.

RESULTS:
Among 220 non-smokers (n = 109 control, n = 111 FENO), 1006 treatment decisions were made, with significant group differences after the first and second algorithm applications. 53% of women had NEA. Treatment was better targeted to phenotype in the FENO group: ICS use increased in eosinophilic asthma (EA, 48-86%), while ICS/LABA increased in NEA (11-30%). Fewer women in the FENO group had exacerbations during pregnancy in NEA only (18.9% FENO vs 44% control, P = 0.006).

CONCLUSION:
The FENO algorithm was more effective in treating NEA, resulting in reduced exacerbations, compared to a symptom control algorithm. This was not the result of ICS overtreatment, since the benefits occurred at a lower median daily ICS dose. Two applications of the FENO-guided algorithm, one month apart, were sufficient to achieve beneficial effects in terms of asthma exacerbations, among pregnant women with asthma.

© 2019 Asian Pacific Society of Respirology.

KEYWORDS:
asthma; eosinophils; nitric oxide; phenotype; pregnancy

PMID: 31656059 DOI: 10.1111/resp.13713
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Select item 31656033
10.
Swiss Med Wkly. 2019 Oct 27;149:w20140. doi: 10.4414/smw.2019.20140. eCollection 2019 Oct 21.
Interventional psychiatry in the management of behavioural and psychological symptoms of dementia: a qualitative review.
Swierkosz-Lenart K1, Mall JF1, von Gunten A1.
Author information
1
Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Abstract
INTRODUCTION:
&ldquo;Behavioural and psychological symptoms of dementia&rdquo; (BPSD) refers to a heterogeneous group of clinical manifestations related to dementia, including apathy, depression, anxiety, delusions, hallucinations, sexual or social disinhibition, sleep-wake cycle disturbances, aggression, agitation and other behaviours considered inappropriate. Because of the complexity and heterogeneity of BPSD, as well as the fragility and multimorbidity of the elderly, pharmacological treatment appears to be limited in terms of safety and efficacy, and nonpharmacological therapies are today considered the first choice. There is growing evidence that interventional approaches such as electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS) could be safe and efficient options for several psychiatric illnesses in a population presenting resistance to and/or intolerance of pharmacotherapy.

AIMS:
The aim of the present work is to provide a qualitative review of the state of the art in interventional psychiatry in the treatment of BPSD. A particular focus will be on depression and agitation, which represent major stressors on caregivers and a primary cause of institutionalisation.

CONCLUSIONS:
ECT is probably the most promising interventional procedure needing further investigation in order to obtain specific protocols and a consensus on indications. Preliminary data on rTMS, tDCS, and VNS are encouraging although randomised controlled trials to investigate and compare their efficacy in the treatment of BPSD are still lacking. Their feasibility profile could represent an important advantage over ECT. DBS could represent a very effective therapy for behavioural disorders, but knowledge of the precise neuroanatomical targets for BPSD is currently too limited to justify this invasive approach.

PMID: 31656033 DOI: 10.4414/smw.2019.20140
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Select item 31655975
11.
Qual Life Res. 2019 Oct 26. doi: 10.1007/s11136-019-02336-0. [Epub ahead of print]
Evaluation of health-related quality of life in adults with and without dyslipidaemia in rural areas of central China.
Wu H1,2,3, Li H2, Li H2, Ding Y2,3, Wang C4, Zhang G2,5, Tang N6,7, Wu W8.
Author information
1
School of Public Health, Tianjin Medical University, Tianjin, China.
2
School of Public Health, Xinxiang Medical University, Xinxiang, China.
3
Henan Province General Medical Educations and Research Center, Xinxiang, China.
4
School of Public Health, Zhengzhou University, Zhengzhou, China.
5
School of Public Health, Curtin University, Perth, Australia.
6
School of Public Health, Tianjin Medical University, Tianjin, China. tangnaijun@tmu.edu.cn.
7
Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China. tangnaijun@tmu.edu.cn.
8
Henan Province General Medical Educations and Research Center, Xinxiang, China. wdwu2013@126.com.
Abstract
PURPOSE:
Dyslipidaemia is a common chronic disease in China but is among the list of diseases treated by basic public health services. In this study, we aimed to use the European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L) and visual analogue scale (VAS) to compare differences in health-related quality of life (HRQoL) between dyslipidaemic and non-dyslipidaemic individuals in rural China and to explore possible causes for the underlying differences.

METHODS:
This study examined 10,115 participants from 22 rural communities in Xinxiang County, Henan Province, China. The study participants were interviewed between March and June 2017. Generalised linear and Tobit regression models were used to analyse factors affecting participants' HRQoL.

RESULTS:
Of 10,115 participants, 4355 had dyslipidaemia. The mean utility index was 0.953 (standard deviation = 0.119). Pain/discomfort (20.83%) and problems with mobility (15.91%) and self-care (3.75%) were frequently reported. Regression models revealed that patients with low utility index scores were older, ex-smokers, non-tea drinkers, and less active, consumed less fruit, lived in areas with a low socioeconomic status; and were less educated. Patients also had poorer sleep quality and mental health scores and suffered from chronic diseases. Cohen's D effect size for age, sleep quality, non-communicable diseases, and depression was ≥ 0.4.

CONCLUSION:
The prevalence rate of dyslipidaemia was 43.05%, and it was correlated with a lower HRQoL. Age, sleep quality, non-communicable diseases, and depression may be significant predictors of the utility index and VAS scores. Patients were unaware of the risks of dyslipidaemia caused by an unhealthy lifestyle.

KEYWORDS:
Dyslipidaemia; EQ-5D-5L; HRQoL; Rural

PMID: 31655975 DOI: 10.1007/s11136-019-02336-0
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Select item 31655923
12.
Cogn Process. 2019 Oct 26. doi: 10.1007/s10339-019-00937-8. [Epub ahead of print]
Dysfunctional sleep-related cognition and anxiety mediate the relationship between multidimensional perfectionism and insomnia symptoms.
Akram U1,2, Gardani M3, Riemann D4, Akram A5, Allen SF6, Lazuras L7, Johann AF4,8.
Author information
1
Department of Psychology, Sociology and Politics, Sheffield Hallam University, Collegiate Crescent, Sheffield, South Yorkshire, S10 2BP, UK. u.akram@shu.ac.uk.
2
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. u.akram@shu.ac.uk.
3
School of Psychology, University of Glasgow, Glasgow, UK.
4
Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.
5
Department of Psychology, The University of Sheffield, Sheffield, UK.
6
Department of Health Sciences, University of York, York, UK.
7
Department of Psychology, Sociology and Politics, Sheffield Hallam University, Collegiate Crescent, Sheffield, South Yorkshire, S10 2BP, UK.
8
Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Abstract
Perfectionism is one of several personality traits associated with insomnia. Whilst research has examined the relationships between perfectionism and insomnia, the mediating role of dysfunctional sleep-related cognition (i.e. sleep-related worry and dysfunctional beliefs about the biological attribution of and consequences of poor sleep) has yet to be examined. This study aimed to determine whether aspects of multidimensional perfectionism were related to increased reporting of insomnia symptoms. In addition, the potential mediating role of dysfunctional sleep-related cognition and anxiety symptoms was examined. Members of the general population (N = 624) completed the Dysfunctional Beliefs and Attitudes About Sleep Scale, the Insomnia Severity Index, the Hospital Anxiety and Depression Scale, and the Multidimensional Perfectionism Scale. The results showed that perfectionism dimensions, anxiety symptoms, and dysfunctional sleep-related cognition were significantly associated with insomnia symptoms. Regression-based mediation analyses further showed that both dysfunctional sleep-related cognition and anxiety significantly mediated the associations between insomnia symptoms and three perfectionism dimensions (i.e. doubts about action, parental expectations, and parental criticism). The experience of perfectionistic tendencies, anxiety, and dysfunctional sleep-related cognition may initiate behavioural strategies (e.g. daytime napping) when faced with an acute sleep problem. However, these strategies may serve to transition insomnia from an acute to a chronic condition.

KEYWORDS:
Dysfunctional cognition; Insomnia; Perfectionism; Personality; Sleep

PMID: 31655923 DOI: 10.1007/s10339-019-00937-8
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Select item 31655849
13.
Scand J Work Environ Health. 2019 Oct 27. pii: 3858. doi: 10.5271/sjweh.3858. [Epub ahead of print]
Multimorbidity is common among young workers and related to increased work absenteeism and presenteeism: results from the population-based Raine Study cohort.
Troelstra SA1, Straker L, Harris M, Brown S, van der Beek AJ, Coenen P.
Author information
1
Department of Public and Occupational Health - Amsterdam UMC, location VUmc, van der Boechorststraat 7 NL-1081 BT Amsterdam, the Netherlands. p.coenen@amsterdamumc.nl).
Abstract
Objectives This study aimed to determine the extent of both multimorbidity and work productivity loss among young adults with paid work and to analyze their association. Methods We included 604 participants from a follow-up of the Raine Study that comprised a cohort who were 22 years at the time (Gen2-22). Information on 36 health conditions, grouped into 10 condition categories, was collected through questionnaires and physical assessments (for body mass index only). Quarterly questionnaires about work productivity, including total absenteeism, sickness absenteeism, and total presenteeism, were distributed electronically over the subsequent 12 months. Descriptive statistics were used to determine the prevalence of health conditions, condition categories, multimorbidity, and work productivity. Zero-inflated negative binomial regression analyses were used to assess the association of multimorbidity with productivity loss. Results Multimorbidity prevalence was substantially higher in females (63%) compared to males (41%). Productivity loss increased as the number of condition categories increased. For example, total absenteeism was associated with an increase in the number of health condition categories in males [incidence rate ratio (IRR) 1.20, 95% confidence interval (CI) 1.05-1.36] and females (IRR 1.13, 95% CI 1.04-1.24). Similar results were found for sickness absenteeism and presenteeism. The highest burden of productivity loss was found for musculoskeletal disorders (42 444 hours/1000 workers/year), sleep problems (33 581 hours/1000 workers/year), mental and neurological conditions (15 650 hours/1000 workers/year), and 'other' medical conditions (22 519 hours/1000 workers/year). Conclusions Multimorbidity appears to be highly prevalent among young adults with paid work and is strongly related to work productivity loss. Therefore, young workers should be targeted in interventions aiming to reduce multimorbidity and its impact on work productivity.

PMID: 31655849 DOI: 10.5271/sjweh.3858
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Select item 31655840
14.
Med Oral Patol Oral Cir Bucal. 2019 Oct 27. pii: 23136. doi: 10.4317/medoral.23136. [Epub ahead of print]
Analysis of the sleep period and the amount of habitual snoring in individuals with sleep bruxism.
Palinkas M1, Marrara J, Bataglion C, Hallak J, Canto GD, Scalize PH, Regalo I, Siéssere S, Regalo S.
Author information
1
School of Dentistry of Ribeirão Preto, University of São Paulo Avenida do Café, s/n, Bairro Monte Alegre CEP 14040-904 Ribeirão Preto, SP, Brazil palinkas@usp.br.
Abstract
BACKGROUND:
The literature does not report any association between habitual snoring and sleep bruxism, but these situations can be a reason for frequent complaints of individuals, impairing the quality of life. This study was performed to investigate the sleep period and amount of habitual snoring in individuals with sleep bruxism observing expiratory, inspiratory, and mixed snoring.

MATERIAL AND METHODS:
A total of 90 individuals were screened and divided into the following groups: with sleep bruxism (n=45) and those without sleep bruxism (n=45). Single night sleep polysomnography was performed to diagnose sleep bruxism, quantify habitual snoring and sleep period. The results were tabulated and submitted to a Multivariate analysis of variance (MANOVA) to compare the means of the two independent groups, considering the affected diagnosis of sleep bruxism, snoring (independent variables) and age as covariate. For the post hoc, was used correcting for multiple comparisons (Bonferroni test, P<.05).

RESULTS:
There was statistically significant difference among the groups ( p=.001) in the sleep period, in that individuals with sleep bruxism slept for a longer duration (with sleep bruxism group: 460 minutes and without sleep bruxism group: 401 minutes). There were no statistically significant differences among the groups for the number of inspiratory, expiratory and mixed snores, but was observed greater amount of snoring in the with sleep bruxism group.

CONCLUSIONS:
The main finding of this study is that individuals with sleep bruxism slept longer than the control group. It may also be suggested that individuals with sleep bruxism tended to increase the amount of habitual snoring during sleep.

PMID: 31655840 DOI: 10.4317/medoral.23136
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Select item 31655776
15.
Endocrinol Metab Clin North Am. 2019 Dec;48(4):779-793. doi: 10.1016/j.ecl.2019.08.008. Epub 2019 Sep 17.
Hypertension and Acromegaly.
Puglisi S1, Terzolo M2.
Author information
1
Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano 10043, Italy.
2
Internal Medicine 1, Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Regione Gonzole 10, Orbassano 10043, Italy. Electronic address: terzolo@usa.net.
Abstract
Hypertension is one of the most frequent complications in acromegaly, with a median frequency of 33.6% (range, 11%-54.7%). Although the pathogenesis has not been fully elucidated, it probably results from concomitant factors leading to expansion of extracellular fluid volume, increase of peripheral vascular resistance, and development of sleep apnea syndrome. Because the effect of normalization of growth hormone and insulinlike growth factor 1 excess on blood pressure levels is unclear, an early diagnosis of hypertension and prompt antihypertensive treatment are eagerly recommended, regardless of the specific treatment of the acromegalic disease and the level of biochemical control attained.

Copyright © 2019 Elsevier Inc. All rights reserved.

KEYWORDS:
Antihypertensive treatment; Blood pressure; Cardiovascular complication; Cardiovascular risk; Mortality; Pathogenesis; Prevalence; Sleep apnea

PMID: 31655776 DOI: 10.1016/j.ecl.2019.08.008
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Select item 31655592
16.
BMC Med Educ. 2019 Oct 26;19(1):391. doi: 10.1186/s12909-019-1822-5.
A night on call or an overnight shift does not reduce residents' empathy: a randomized crossover multicenter survey.
Mizobe M1, Kataoka H2, Yamagami H3, Ito C4, Koyama Y5, Yawata E6, Shiga T7.
Author information
1
Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan.
2
Department of Primary Care and Medical Education, Okayama University Medical School, 2-5-1 Shikata, Kita, Okayama, 700-8558, Japan.
3
Department of Emergency Medicine, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
4
Department of Emergency Medicine, Asahi General Hospital, I 1326, Asahi, Chiba, 289-2511, Japan.
5
Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
6
Emergency & Critical Care, Cardiovascular, Stroke Center Niigata City General Hospital, 463-7 Shumoku, Chuo, Niigata, Niigata, 950-1197, Japan.
7
Department of Emergency Medicine, International University of Health and Welfare School of Medicine, 1-4-3 Mita, Minato, Tokyo, 108-8329, Japan. takshigaemp@gmail.com.
Abstract
BACKGROUND:
Studies have shown that sleep deprivation may reduce empathy among medical students. Yet, little is known about the empathy after a night on call or an overnight shift among resident physicians. Hence, we aimed to examine whether a night on call or an overnight shift reduces the physicians' empathy.

METHODS:
We conducted a multicenter randomized crossover survey using the Jefferson Scale of Physician Empathy (JSE). A total of 260 physicians who worked at academic hospitals and community hospitals in Japan in 2016 were recruited and randomized into two groups. Group A first completed the JSE prior to a night on call or an overnight shift; then, 8 weeks later, Group A completed the JSE after a night on call or an overnight shift. Group B first completed the JSE after a night on call or an overnight shift; then, 8 weeks later, Group B completed the JSE prior to a night on call or an overnight shift. Statistical analyses were performed to compare the JSE scores of pre- and post-night on call or overnight shifts.

RESULTS:
A total of 117 Group A physicians and 112 Group B physicians returned a completed JSE. The overall response rate was 88.08%. There was no significant difference in the JSE scores between pre- and post-night on call or overnight shift. (Group A before night vs Group B after night, p = 0.40, Group A after night vs Group B before night, p = 0.68).

CONCLUSION:
As per our results, a night on call or an overnight shift did not reduce the Japanese physicians' empathy. To the best of our knowledge, this is the first study on physicians' empathy after a night on call or an overnight shift.

KEYWORDS:
Empathy; Night call; Overnight shift; Sleep deprivation

PMID: 31655592 DOI: 10.1186/s12909-019-1822-5
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Select item 31655458
17.
Cytokine. 2019 Oct 23;126:154874. doi: 10.1016/j.cyto.2019.154874. [Epub ahead of print]
The elevated systemic cytokine levels in HIV patients are not associated with an elevated pulmonary cytokine environment.
Fernandez-Botran R1, Vega AR2, García Y2, Tirumala CC2, Srisailam P2, Raghuram A2, Peyrani P2, Furmanek S2, Tella MA2, Ritzhentaler JD3, Roman J3, Ramírez JA2.
Author information
1
Department of Pathology & Laboratory Medicine, University of Louisville Health Sciences Center, Louisville, KY 40202, United States. Electronic address: grfern01@louisville.edu.
2
Department of Medicine, Division of Infectious Diseases, University of Louisville Health Sciences Center, Louisville, KY 40202, United States.
3
Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville Health Sciences Center, Louisville, KY 40202, United States; Department of Medicine, Division of Pulmonary, Allergy, and Critical Care and the Jane & Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, United States(1).
Abstract
BACKGROUND:
HIV-positive patients on anti-retroviral therapy (ART) are at higher risk of developing many non-AIDS related chronic diseases, including chronic obstructive pulmonary disease (COPD), compared to HIV-negative individuals. While the mechanisms are not clear, a persistent pro-inflammatory state appears to be a key contributing factor. The aims of this study were to investigate whether HIV-positive patients without COPD present evidence of potentially predisposing abnormal pulmonary cytokine/chemokine environment and to explore the relationship between pulmonary and systemic cytokine levels.

METHODS:
This study included 39 HIV-seropositive and 34 HIV-seronegative subjects without COPD. All were subjected to outpatient bronchoscopy with bronchoalveolar lavage fluid (BALF) aspiration and blood sample collection. The levels of 21 cytokines and chemokines were measured in plasma and BALF using a bead-based multi-analyte assay.

RESULTS:
In plasma, HIV-infected patients showed significantly increased circulating levels of pro-inflammatory (TNFα) and Th1-associated cytokines (IL-12p70) as well as several chemokines (CXCL11 and CX3CL1). However, no statistically significant differences were found in the numbers of cells, the concentrations of protein and urea as well as cytokine levels in the BALFs of HIV-positive patients when compared to controls. Correlation analysis indicated a potential modulatory effect of the BMI in HIV-seropositive individuals.

CONCLUSIONS:
While our results are consistent with the existence of a systemic pro-inflammatory state in HIV-infected patients, they did not detect significant differences in cytokine levels and other inflammatory markers in the lungs of HIV-positive individuals when compared to HIV-negative controls.

Copyright © 2019 Elsevier Ltd. All rights reserved.

KEYWORDS:
Chemokines; Chronic lung disease (CLD); Cytokines; HIV; Inflammation

PMID: 31655458 DOI: 10.1016/j.cyto.2019.154874
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Select item 31655433
18.
Mult Scler Relat Disord. 2019 Oct 3;36:101425. doi: 10.1016/j.msard.2019.101425. [Epub ahead of print]
School performance and psychiatric morbidity 6 years after pediatric acute disseminated encephalomyelitis: A nationwide population-based cohort study.
Boesen MS1, Langkilde A2, Born AP3, Magyari M4, Blinkenberg M5, Chitnis T6, Thygesen LC7, Eriksson F8.
Author information
1
Department of Pediatrics, Rigshospitalet, University of Copenhagen, Denmark; Department of Neurology, Herlev Hospital, Denmark. Electronic address: magnus.spangsberg.boesen@regionh.dk.
2
Department of Radiology, Diagnostic Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: Annika.Langkilde@regionh.dk.
3
Department of Pediatrics, Rigshospitalet, University of Copenhagen, Denmark. Electronic address: alfred.peter.born@regionh.dk.
4
Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark; Danish Multiple Sclerosis Registry, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark. Electronic address: melinda_magyari@dadlnet.dk.
5
Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark. Electronic address: Morten.Blinkenberg@regionh.dk.
6
Partners Pediatric Multiple Sclerosis Center at the Massachusetts General Hospital for Children, Boston, MA, USA. Electronic address: tchitnis@rics.bwh.harvard.edu.
7
National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. Electronic address: lct@si-folkesundhed.dk.
8
Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark. Electronic address: eriksson@sund.ku.dk.
Abstract
BACKGROUND:
Acute disseminated encephalomyelitis (ADEM) can cause cognitive impairment in children. However, long-term consequences for school performance and psychiatric morbidity have never been characterized. Our aim was to investigate long-term school performance and psychiatric morbidity after pediatric ADEM (<18 years).

METHODS:
We identified all children with ADEM 2008-2015 in Denmark using hospital diagnostic codes for acquired demyelinating syndromes. We reviewed all medical records to validate ADEM including blinded MRI review. Reference children were the entire pediatric (<18 years) population or randomly sampled sex and age-matched reference children. Outcomes were from nationwide population-based registers on special needs assistance, grade point average, highest completed education, in-hospital psychiatric hospital diagnoses, out-of-hospital psychiatric consultations or psychopharmacological drug prescriptions.

RESULTS:
52 children had ADEM (median onset age: 5.5 years; median age at follow-up end: 13.4 years). Secondary school grade point average was similar among children with ADEM and reference children; however, children with ADEM had increased psychiatric morbidity (hazard ratio = 2.4; 95% confidence interval = 1.2-5.1; p = 0.02), primarily due to increased drug prescriptions for sleep problems and depression.

CONCLUSION:
Children with prior ADEM have increased sleep problems and possibly also depression; however, school performance is seemingly unaffected. Clinicians should consider problems with sleep and mood at follow-up.

Copyright © 2019 Elsevier B.V. All rights reserved.

KEYWORDS:
ADEM; Academic; Education; Psychiatric; School

PMID: 31655433 DOI: 10.1016/j.msard.2019.101425
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Select item 31655427
19.
Infant Behav Dev. 2019 Oct 23;57:101385. doi: 10.1016/j.infbeh.2019.101385. [Epub ahead of print]
Co-sleeping as a proximal context for infant development: The importance of physical touch.
Barry ES1.
Author information
1
Penn State Fayette, The Eberly Campus, United States; Human Development & Family Studies, The Pennsylvania State University, Fayette, The Eberly Campus, United States. Electronic address: esb12@psu.edu.
Abstract
Co-sleeping is a complex familial phenomenon that has yet to be well understood by Western scientists. This paper provides an interdisciplinary review of research from anthropology, nursing, pediatrics, sociology, social work, public health, family studies, and psychology to focus on the role of physical touch in the context of co-sleeping, and how close physical contact in this context affects infants and their caregivers. Including an anthropological, evolutionary view of co-sleeping with other perspectives highlights it as an experience-expectant proximal context for infant growth and development. From this view, the importance of physical contact and touch in the nighttime caretaking microenvironment of co-sleeping becomes a central question, rather than an artifactual byproduct of "unhealthy" sleep arrangements. Rather than trying to eliminate co-sleeping, public health messages for parents would likely benefit from a more culturally-sensitive approach that focuses on advising how to co-sleep safely for families choosing it. For families trying to retain physical closeness between parent(s) and infants in the context of modern (especially Western) infant care practices that have reduced this physical contact, co-sleeping can be an important developmental context for encouraging and engaging in sensitive and responsive caregiving and providing a context for maternal-infant physiological synchrony and regulation.

Copyright © 2019 Elsevier Inc. All rights reserved.

KEYWORDS:
Co-sleeping; Infant development; Infant sleep; Nighttime parenting; Physical touch

PMID: 31655427 DOI: 10.1016/j.infbeh.2019.101385
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Publication type
Select item 31655416
20.
J Electrocardiol. 2019 Oct 18;57:138-142. doi: 10.1016/j.jelectrocard.2019.09.019. [Epub ahead of print]
Positional sleep disordered breathing in patients with arrhythmia. Should we advise our patients to avoid supine position during sleep?
Baranowski R1, Kalin K2, Marcinkiewicz K2, Orczykowski M2, Bilińska M2, Szumowski Ł2.
Author information
1
Department of Heart Rhythm Disorders, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland. Electronic address: rb@ikard.pl.
2
Department of Heart Rhythm Disorders, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland.
Abstract
BACKGROUND:
Sleep disordered breathing [SDB] is a well-known problem in patients with cardiovascular diseases. Around 50% of pts. with SDB present positional sleep disordered breathing [PSDB].

AIMS:
The aim of this study was the investigation of the frequency of PSDB in patients with different forms of arrhythmias.

METHODS:
We analyzed the presence of SDB in 53 pts. with diagnosed atrial fibrillation (paroxysmal or persistent), 88 pts. before ablation of ventricular ectopy and 110 pts. that had Holter monitoring due to the symptoms suggesting arrhythmia.

RESULTS:
Finally, we could collect all the data in 243 pts. - 150 men 93 women. AHI < 15 was recorded in 136 (56%) pts., AHI > 15 in 107 (44%) pts. Moderate sleep disordered breathing was diagnosed in 59 (24%) pts. (AHI 15-30), severe sleep disordered breathing (AHI > 30) was recognized in 48 (20%) pts. In all of the analyzed groups, AHI in supine position was significantly higher than in nonsupine position. PSDB was recorded in 55% of pts. with AHI > 15 and in 29% of pts. (n = 14) with AHI > 30. Percentage of time in supine position was an independent factor related with the presence of at least moderate or severe sleep disordered breathing.

CONCLUSION:
1. Moderate or severe SDB is recorded in 44% of pts. with arrhythmias, almost 50% of them have positional SDB. 2. Percent of time of sleeping in supine position has an important independent impact on the presence of SDB. 3. Big studies should be conducted to verify if avoidance of sleeping in supine position may improve clinical outcome.

CONDENSED ABSTRACT:
Sleep disordered breathing SDB is a frequent problem of pts. with cardiovascular diseases. It may influence the prognosis. Moderate or severe SDB is recorded in 44% of pts. with arrhythmias, almost 50% of them have positional SDB. Percent of time of sleeping in supine position has an important independent impact on the presence of SDB. 3. Big studies should be conducted to verify if avoidance of sleeping in supine position may improve clinical outcome. What is new?

Copyright © 2018. Published by Elsevier Inc.

KEYWORDS:
Arrhythmia; Positional sleep apnea; Sleep disordered breathing

PMID: 31655416 DOI: 10.1016/j.jelectrocard.2019.09.019