Background:
Sleep disturbances, including insomnia and sleep-disordered breathing, are a common complaint in people with heart failure and impair well-being. Exercise training (ET) improves quality ...of life in stable heart failure patients. ET also improves sleep quality in healthy older patients, but there are no previous intervention studies in heart failure patients.
Aim:
The aim of this study was to examine the impact of ET on sleep quality in patients recently discharged from hospital with heart failure.
Methods:
This was a sub-study of a multisite randomised controlled trial. Participants with a heart failure hospitalisation were randomised within six weeks of discharge to a 12-week disease management programme including exercise advice (n=52) or to the same programme with twice weekly structured ET (n=54). ET consisted of two one-hour supervised aerobic and resistance training sessions, prescribed and advanced by an exercise specialist. The primary outcome was change in Pittsburgh Sleep Quality Index (PSQI) between randomisation and week 12.
Results:
At randomisation, 45% of participants reported poor sleep (PSQI≥5). PSQI global score improved significantly more in the ET group than the control group (–1.5±3.7 vs 0.4±3.8, p=0.03). Improved sleep quality correlated with improved exercise capacity and reduced depressive symptoms, but not with changes in body mass index or resting heart rate.
Conclusion:
Twelve weeks of twice-weekly supervised ET improved sleep quality in patients recently discharged from hospital with heart failure.
Abstract Information about serostability of cutaneous HPV types over time is very limited. We investigated seroprevalence and serostability of 37 different HPV types over 4½ years in an Australian ...population-based study. Sera and data were analyzed for 390 people who had never been diagnosed with SCC and had blood collected in 1992, 1993 and 1996. Eighty-six percent of participants were seropositive to at least one of the 37 HPV types at baseline. HPV-4 was the type with the highest seroprevalence (41%), followed by HPV-38 and HPV-8 (both 33%). Over 90% of people retained their baseline serostatus during the 4½ year follow-up. Highest serostability was observed for HPV-88 (99.7% stayed seropositive or seronegative), while HPV-65 was least stable with 17% altering their serostatus during follow-up. Seroprevalence to cutaneous HPV types are relatively stable over time, and a single measure can be used as a reasonable marker of long-term antibody status.
Objectives. To explore in a cohort of Queensland (Qld) GPs' their attitudes to; knowledge about; and practice behaviour regarding complementary medicines (CMs), and to identify their perceptions of ...need for information resources on CMs. Design. A faxed self-administered survey to a random sample of 800 GPs in Qld. Participants. 463 completed surveys were returned, representing a 58% response rate. Results. The majority of GPs had a positive attitude about incorporating CMs in their clinical practice; however, only 12% perceived they had adequate knowledge to be able to advise patients about CMs. GPs most preferred evidence-based resources for receiving information on CMs (fact sheets, booklets, and journals) that contain clinical, pharmacological, and toxicological information. Most GPs perceived a need for an information resource on herbal medicines, vitamins, minerals, and trace elements, and nutritional supplements. Conclusion. GPs are open to integrating CMs into their clinical practice. They identify a current lack of knowledge coupled with a substantive level of interest to learn more. GPs perceive a high level of need for information resources on CMs. These resources should be developed and readily available to GPs to increase their knowledge about CMs and better equip them in communicating with patients about CMs use.
Objective: To determine item, subscale and total score agreement on the Frenchay Activities Index (FAI) between stroke patients and proxies six months after discharge from rehabilitation.
Design: ...Prospective study design.
Setting/subjects: Fifty patient–proxy pairs, interviewed separately, in the patient's residence.
Main outcome measures: Modified FAI using 13 items. Individual FAI items, subscales and total score agreement as measured by weighted kappa and intraclass correlation coefficients (ICC).
Results: Excellent agreement was found for the total FAI (ICC 0.87, 95% confidence interval (CI) 0.78–0.93), and domestic (ICC 0.85, 95% CI 0.73–0.91) and outdoor (ICC 0.87, 95% CI 0.78–0.95) subscales, with moderate agreement found for the work/leisure subscale (ICC 0.63, 95% CI 0.34–0.78). For the individual FAI items, good, moderate, fair and poor agreement was found for five, three, four and one item, respectively. The best agreement was for objective items of preparing meals, washing-up, washing clothes, shopping and driving. The poorest agreement was for participation in hobbies, social outings and heavy housework. Scoring biases associated with patient or proxy demographic characteristics were found. Female proxies, and those who were spouses, scored patients lower on domestic activities; male patients, and those who were younger, scored themselves higher on outdoor activities and higher patient FIM scores were positively correlated with higher FAI scores.
Conclusions: While total and subscale agreement on the FAI was high, individual item agreement varied. Proxy scores should be used with caution due to bias.
High levels of depression and anxiety are experienced alongside Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). Psychological causal and maintenance factors are not well-understood. ...Perfectionism is a multifactorial, transdiagnostic risk factor for various physical and mental health conditions. This systematic review assesses the association between perfectionism and depression and/or anxiety in people with CFS/ME.
Systematic literature searches used a combination of terms for ‘perfectionism’, ‘depression’, ‘anxiety’ and ‘CFS/ME’. Peer-reviewed English-language papers reporting quantitative data regarding the relationship between perfectionism and depression and/or anxiety in adults (aged 18–65 years) with a clinical diagnosis of CFS/ME were included. Screening, selection and assessment of risk of bias was completed independently by two authors. Bivariate and multivariate associations between perfectionism and anxiety and depression were extracted. Data were synthesised narratively.
Seven studies, reported in eight papers, were included. Seven examined the relationship between perfectionism and depression. Moderate-strong significant positive associations were found between depression and maladaptive perfectionism (r = 0.42 to .48, p < .01), and its component factors of concern over mistakes (r = 0.40 to .60, p < .01) and doubts about actions (r = 0.51 to .60, p < .01). Methodological limitations included sample size justification and selection, psychometric measures, and control of potential confounders.
Maladaptive perfectionism is consistently associated with depression in patients with CFS/ME. The relationship between perfectionism and anxiety is under-researched. Corroboration is required from longitudinal, cross-cultural studies. Clinical understanding may be increased through examining the interplay between maladaptive perfectionism, depression and anxiety and the physical and cognitive symptoms of CFS/ME.
•Adults with chronic fatigue syndrome (CFS) often experience depression and anxiety.•Maladaptive perfectionism is associated with greater depression in CFS.•The relationship between anxiety and perfectionism is under-researched in CFS.•Longitudinal, cross-cultural studies could help to determine causal mechanisms.
Background and purpose
The prevalence of chronic kidney disease (estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m2 for ≥3 months, chronic kidney disease (CKD)) in ischemic stroke and ...transient ischemic attack (TIA) is unknown, as estimates have been based on single-point estimates of renal function. Studies investigating the effect of renal dysfunction (eGFR < 60 mL/min per 1.73 m2, renal dysfunction) on post-stroke outcomes are limited to hospitalized cohorts and have provided conflicting results.
Methods
We investigated rates, determinants and outcomes of renal dysfunction in ischemic stroke and TIA in the North Dublin Population Stroke Study. We also investigate the persistence of renal dysfunction in 90-day survivors to determine the prevalence of CKD. Ascertainment included hot and cold pursuit using multiple overlapping sources. Survival analysis was performed using Kaplan–Meier survival curves and Cox proportional hazards modeling.
Results
In 547 patients (ischemic stroke in 76.4%, TIA in 23.6%), the mean eGFR at presentation was 63.7 mL/min/1.73 m2 (SD 22.1). Renal dysfunction was observed in 44.6% (244/547). Among 90-day survivors, 31.2% (139/446) met criteria for CKD. After adjusting for age and stroke severity, eGFR < 45 mL/min/1.73 m2 (hazard ratio 2.53, p = 0.01) independently predicted 28-day fatality but not at two years. Poor post-stroke functional outcome (Modified Rankin Scale 3–5) at two years was more common in those with renal dysfunction (52.5% vs. 20.6%, p < 0.001). After adjusting for age, stroke severity and pre-stroke disability, renal dysfunction (OR 2.17, p = 0.04) predicted poor functional outcome.
Conclusion
Renal dysfunction and CKD are common in ischemic stroke and TIA. Renal dysfunction is associated with considerable post-stroke morbidity and mortality. Further studies are needed to investigate if modifiable mechanisms underlie these associations.
The purpose of this study is to determine the relationship between the psychosocial work environment and labor market experiences (including unemployment) on mental health among adults living with ...HIV. We used data provided by 538 participants at clinical and community sites across Ontario, Canada. Generalized estimating equation models showed that employment was associated with lower depressive symptoms. For employed participants, adverse psychosocial work conditions, specifically job insecurity, psychological demands, and decision authority were associated with depressive symptoms. For the entire sample, the number of adverse psychosocial work conditions was associated with higher depressive symptoms while participants working in poor quality jobs reported similar levels of depressive symptoms than those who were unemployed or not in the labor force. This study showed that poor quality employment (as assessed by having a high number of adverse psychosocial work exposures) was associated with a similar level of depressive symptoms as unemployment, suggesting that "bad jobs" may not offer the same mental health benefits as "good jobs." Policies to improve employment outcomes should take the quality of employment into account to maximize mental health benefits as better employment may lead to better mental health.
PDF
