Follow-up care of adolescent survivors of childhood cancer: The role of health beliefs

BACKGROUND Little is known about follow-up care attendance of adolescent survivors of childhood cancer, and which factors foster or hinder attendance. Attending follow-up care is especially important for adolescent survivors to allow for a successful transition into adult care. We aimed to (i) describe the proportion of adolescent survivors attending follow-up care; (ii) describe adolescents' health beliefs; and (iii) identify the association of health beliefs, demographic, and medical factors with follow-up care attendance. PROCEDURE Of 696 contacted adolescent survivors diagnosed with cancer at ≤16 years of age, ≥5 years after diagnosis, and aged 16-21 years at study, 465 (66.8%) completed the Swiss Childhood Cancer Survivor Study questionnaire. We assessed follow-up care attendance and health beliefs, and extracted demographic and medical information from the Swiss Childhood Cancer Registry. Cross-sectional data were analyzed using descriptive statistics and logistic regression models. RESULTS Overall, 56% of survivors reported attending follow-up care. Most survivors (80%) rated their susceptibility for late effects as low and believed that follow-up care may detect and prevent late effects (92%). Few (13%) believed that follow-up care is not necessary. Two health beliefs were associated with follow-up care attendance (perceived benefits: odds ratio [OR]: 1.56; 95% confidence interval [CI]: 1.07-2.27; perceived barriers: OR: 0.70; 95%CI: 0.50-1.00). CONCLUSIONS We show that health beliefs are associated with actual follow-up care attendance of adolescent survivors of childhood cancer. A successful model of health promotion in adolescent survivors should, therefore, highlight the benefits and address the barriers to keep adolescent survivors in follow-up care. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.

Irrational Beliefs and Psychological Distress: A Meta-Analysis

Background: Since the cognitive revolution of the early 1950s, cognitions have been discussed as central components in the understanding and treatment of mental illnesses. Even though there is an extensive literature on the association between therapy-related cognitions such as irrational beliefs and psychological distress over the past 60 years, there is little meta-analytical knowledge about the nature of this association. Methods: The relationship between irrational beliefs and distress was examined based on a systematic review that included 100 independent samples, gathered in 83 primary studies, using a random-effect model. The overall effects as well as potential moderators were examined: (a) distress measure, (b) irrational belief measure, (c) irrational belief type, (d) method of assessment of distress, (e) nature of irrational beliefs, (f) time lag between irrational beliefs and distress assessment, (g) nature of stressful events, (h) sample characteristics (i.e. age, gender, income, and educational, marital, occupational and clinical status), (i) developer/validator status of the author(s), and (k) publication year and country. Results: Overall, irrational beliefs were positively associated with various types of distress, such as general distress, anxiety, depression, anger, and guilt (omnibus: r = 0.38). The following variables were significant moderators of the relationship between the intensity of irrational beliefs and the level of distress: irrational belief measure and type, stressful event, age, educational and clinical status, and developer/validator status of the author. Conclusions: Irrational beliefs and distress are moderately connected to each other; this relationship remains significant even after controlling for several potential covariates.

Sleep Disturbance in the Homeless Population: The Relationship between Homelessness, Sleep and Health

Little is known about how sleep disruption impacts physical health among the homeless. The association between homelessness, quality of sleep and physical health were investigated in the current study. Convenience sampling was used to select participants from a pool of people attending the programs of Ecclesia Ministries. Interviews were conducted with 32 persons from the Boston metropolitan area, of whom 23 were currently homeless. The researcher assessed level of sleep disturbance, number of health problems and degree of homelessness using a standard demographic questionnaire, the General Health Questionnaire-12 (GHQ-12) and the Pittsburgh Sleep Quality Index (PSQI). Our results found evidence of significant sleep disturbance as well as significant mental and physical health problems in the sample. Correlational analyses provided partial support for the hypothesis that degree of homelessness impacts both sleep quality and physical health. Future work should investigate whether change in homelessness status alters sleep quality and physical health and also whether interventions may be utilized in this understudied and vulnerable population.

Physician and patient determinants of the treatment of sleep difficulties in U.S. outpatient settings

The prevalence of sleep difficulties among the patients seen in the primary care settings is about 30%. This problem increases with age and is more common among females than males. Variations are noticed in prescription choices for different patients with sleep difficulties. Many factors affect a physician's prescription decision while chosen from a wide array of available medications. Both pharmacological and behavioral therapies are available for the treatment of sleep difficulties. It is important to know the impact of use of different types of prescriptions on health outcomes related to sleep difficulties. Thus the knowledge of prescription patterns among different types of patients (e.g. age, gender, race, insurance type etc.) becomes important for determining a clinical guideline. This study is designed to assist in evidence-based policymaking on understanding the variations in physician prescriptions for sleep difficulties and reasons for such variations. ^ A modified version of the model suggested by Eisenberg was used as a theoretical framework for this study to predict the factors influencing treatment of sleep difficulties. Multivariate logistic regression methods were used to analyze the 1996–2001 National Ambulatory Medical Care Survey data. ^ This study found that increased age, female gender, white race, established patients, and mental comorbidity were associated with significantly increased likelihood for prescription of some type of therapy for sleep difficulties in US outpatient settings. Patients with private insurance were associated with lower likelihood of receipt of many therapies. Psychiatrists were more likely to prescribe some kind of treatment as well as more expensive therapies for sleep difficulty as compared to other physician specialties. HMO enrolled patient visits were more likely to be associated with receipt of behavioral therapy. This study also found that 32% of patients with sleep difficulties received no type of therapy during their visits. Only 5% of the patients received behavioral therapy only. Almost three-quarters of the patients receiving some kind of medication prescription were prescribed benzodiazepines. The study results also suggest a need for wider coverage of behavioral therapy by payers in US outpatient settings. ^

The effect of African Americans' ethnographic paradigms and cultural explanatory model of breast cancer in framing the male partner's attitudes and behaviors about the woman's breast cancer diagnosis

The disparate burden of breast cancer-related morbidity and mortality experienced by African American women compared with women of other races is a topic of intense debate in the medical and public health arenas. The anomaly is consistently attributed to the fact that at diagnosis, a large proportion of African American women have advanced-stage disease. Extensive research has documented the impacts of cultural factors and of socioeconomic factors in shaping African American women's breast-health practices; however, there is another factor of a more subtle influence that might have some role in establishing these women's vulnerability to this disease: the lack of or perceived lack of partner support. Themes expressed in the research literature reflect that many African American breast cancer patients and survivors consider their male partners as being apathetic and nonsupportive. ^ The purpose of this study was to learn how African American couples' ethnographic paradigms and cultural explanatory model of breast cancer frame the male partners' responses to the women's diagnosis and to assess his ability to cope and willingness to adapt to the subsequent challenges. The goal of the study was to determine whether these men's coping and adaptation skills positively or negatively affect the women's self-care attitudes and behaviors. ^ This study involved 4 African American couples in which the woman was a breast cancer survivor. Participants were recruited through a community-based cancer support group and a church-based cancer support group. Recruitment sessions were held at regular meetings of these organizations. Accrual took 2 months. In separate sessions, each male partner and each survivor completed a demographic survey and a questionnaire and were interviewed. Additionally, the couples were asked to participate in a communications activity (Adinkra). This activity was not done to fulfill any part of the study purpose and was not included in the data analysis; rather, it was done to assess its potential use as an intervention to promote dialogue between African American partners about the experience of breast cancer. ^ The questionnaire was analyzed on the basis of a coding schema and the interview responses were analyzed on the principles of hermeneutic phenomenology. In both cases, the instruments were used to determine whether the partner's coping skills reflected a compassionate attitude (positive response) versus an apathetic attitude (negative response) and whether his adaptation skills reflected supportive behaviors (the positive response) versus nonsupportive behaviors (the negative response). Overall, the women's responses showed that they perceived of their partners as being compassionate, yet nonsupportive, and the partner's perceived of themselves likewise. Only half of the women said that their partners' coping and adaptation abilities enabled them to relinquish traditional concepts of control and focus on their own well-being. ^ The themes that emerged indicate that African American men's attitudes and behaviors regarding his female partner's diagnosis of breast cancer and his ability to cope and willingness to adapt are influenced by their ritualistic mantras, folk beliefs, religious teachings/spiritual values, existential ideologies, socioeconomic status, and environmental factors and by their established perceptions of what causes breast cancer, what the treatments and outcomes are, and how the disease affects the entire family, particularly him. These findings imply that a culturally specific intervention might be useful in educating African American men about breast cancer and their roles in supporting their female partners, physically and psychologically, during diagnosis, treatment, and recovery. ^

A study of factors influencing high school students' attitudes and opinions about violence

Tenth grade students in a lower income neighborhood Houston school were surveyed on violence related beliefs, attitudes, and coping ability. Self-administered questionnaires were used to collect information for scale scores for statistical analysis.^ One hundred twenty six students participated of which 60% were Hispanic, 18% Black, 18% White, 2 American Indians, and 3 Asian/Pacific persons. There were 60 males, mean age 16.03, and 66 females, mean age 15.49. One-half of the sample reported repeating a grade, 53.4% of males, and 47% of females. Females' self-reported grades were slightly higher than males.^ Measures of student acceptance of violence and ability to handle conflict peacefully were studied in relation to student responses to questions about five areas: parental monitoring of the student, parent type of punishment, optimism about future prospects, frustration tolerance, and perceived peer group attitudes and practices.^ Significant gender differences included males having higher violence acceptance scores and females higher on coping with conflict peacefully. No significant race differences or gender interactions were found.^ Females' scores on future orientation were inversely related to their scores on the measure of acceptance of violence. For males, parents' punishment and perceived peer attitudes were positively related to their acceptance of violence, p $<$.0083.^ Female handling of conflict was significantly related to frustration tolerance and optimism; not significant were perceived peer attitudes, parent monitoring or punishment method. For males significantly related to handling conflict were perceived peer attitudes, parental monitoring, and severity of punishment, with the last two terms having a significant interaction effect, and inversely correlated (less monitoring, harsher punishment explained lower ability to handle conflict). ^

Introducing non-linear analysis into sustained speech characterization to improve sleep apnea detection

We present a novel approach for detecting severe obstructive sleep apnea (OSA) cases by introducing non-linear analysis into sustained speech characterization. The proposed scheme was designed for providing additional information into our baseline system, built on top of state-of-the-art cepstral domain modeling techniques, aiming to improve accuracy rates. This new information is lightly correlated with our previous MFCC modeling of sustained speech and uncorrelated with the information in our continuous speech modeling scheme. Tests have been performed to evaluate the improvement for our detection task, based on sustained speech as well as combined with a continuous speech classifier, resulting in a 10% relative reduction in classification for the first and a 33% relative reduction for the fused scheme. Results encourage us to consider the existence of non-linear effects on OSA patients' voices, and to think about tools which could be used to improve short-time analysis.

Evaluación de la contribución y el impacto de las tecnologías del habla en la detección automática del Síndrome de la Apnea Obstructiva del Sueño = Contributions and impact assessment of speech technologies on the automatic detection of severe Obstructive Sleep Apnea syndrome

La presente Tesis analiza las posibilidades que ofrecen en la actualidad las tecnologías del habla para la detección de patologías clínicas asociadas a la vía aérea superior. El estudio del habla que tradicionalmente cubre tanto la producción como el proceso de transformación del mensaje y las señales involucradas, desde el emisor hasta alcanzar al receptor, ofrece una vía de estudio alternativa para estas patologías. El hecho de que la señal emitida no solo contiene este mensaje, sino también información acerca del locutor, ha motivado el desarrollo de sistemas orientados a la identificación y verificación de la identidad de los locutores. Estos trabajos han recibido recientemente un nuevo impulso, orientándose tanto hacia la caracterización de rasgos que son comunes a varios locutores, como a las diferencias existentes entre grabaciones de un mismo locutor. Los primeros resultan especialmente relevantes para esta Tesis dado que estos rasgos podrían evidenciar la presencia de características relacionadas con una cierta condición común a varios locutores, independiente de su identidad. Tal es el caso que se enfrenta en esta Tesis, donde los rasgos identificados se relacionarían con una de la patología particular y directamente vinculada con el sistema de físico de conformación del habla. El caso del Síndrome de Apneas Hipopneas durante el Sueno (SAHS) resulta paradigmático. Se trata de una patología con una elevada prevalencia mundo, que aumenta con la edad. Los pacientes de esta patología experimentan episodios de cese involuntario de la respiración durante el sueño, que se prolongan durante varios segundos y que se reproducen a lo largo de la noche impidiendo el correcto descanso. En el caso de la apnea obstructiva, estos episodios se deben a la imposibilidad de mantener un camino abierto a través de la vía aérea, de forma que el flujo de aire se ve interrumpido. En la actualidad, el diagnostico de estos pacientes se realiza a través de un estudio polisomnográfico, que se centra en el análisis de los episodios de apnea durante el sueño, requiriendo que el paciente permanezca en el hospital durante una noche. La complejidad y el elevado coste de estos procedimientos, unidos a las crecientes listas de espera, han evidenciado la necesidad de contar con técnicas rápidas de detección, que si bien podrían no obtener tasas tan elevadas, permitirían reorganizar las listas de espera en función del grado de severidad de la patología en cada paciente. Entre otros, los sistemas de diagnostico por imagen, así como la caracterización antropométrica de los pacientes, han evidenciado la existencia de patrones anatómicos que tendrían influencia directa sobre el habla. Los trabajos dedicados al estudio del SAHS en lo relativo a como esta afecta al habla han sido escasos y algunos de ellos incluso contradictorios. Sin embargo, desde finales de la década de 1980 se conoce la existencia de patrones específicos relativos a la articulación, la fonación y la resonancia. Sin embargo, su descripción resultaba difícilmente aprovechable a través de un sistema de reconocimiento automático, pero apuntaba la existencia de un nexo entre voz y SAHS. En los últimos anos las técnicas de procesado automático han permitido el desarrollo de sistemas automáticos que ya son capaces de identificar diferencias significativas en el habla de los pacientes del SAHS, y que los distinguen de los locutores sanos. Por contra, poco se conoce acerca de la conexión entre estos nuevos resultados, los sé que habían obtenido en el pasado y la patogénesis del SAHS. Esta Tesis continua la labor desarrollada en este ámbito considerando específicamente: el estudio de la forma en que el SAHS afecta el habla de los pacientes, la mejora en las tasas de clasificación automática y la combinación de la información obtenida con los predictores utilizados por los especialistas clínicos en sus evaluaciones preliminares. Las dos primeras tareas plantean problemas simbióticos, pero diferentes. Mientras el estudio de la conexión entre el SAHS y el habla requiere de modelos acotados que puedan ser interpretados con facilidad, los sistemas de reconocimiento se sirven de un elevado número de dimensiones para la caracterización y posterior identificación de patrones. Así, la primera tarea debe permitirnos avanzar en la segunda, al igual que la incorporación de los predictores utilizados por los especialistas clínicos. La Tesis aborda el estudio tanto del habla continua como del habla sostenida, con el fin de aprovechar las sinergias y diferencias existentes entre ambas. En el análisis del habla continua se tomo como punto de partida un esquema que ya fue evaluado con anterioridad, y sobre el cual se ha tratado la evaluación y optimización de la representación del habla, así como la caracterización de los patrones específicos asociados al SAHS. Ello ha evidenciado la conexión entre el SAHS y los elementos fundamentales de la señal de voz: los formantes. Los resultados obtenidos demuestran que el éxito de estos sistemas se debe, fundamentalmente, a la capacidad de estas representaciones para describir dichas componentes, obviando las dimensiones ruidosas o con poca capacidad discriminativa. El esquema resultante ofrece una tasa de error por debajo del 18%, sirviéndose de clasificadores notablemente menos complejos que los descritos en el estado del arte y de una única grabación de voz de corta duración. En relación a la conexión entre el SAHS y los patrones observados, fue necesario considerar las diferencias inter- e intra-grupo, centrándonos en la articulación característica del locutor, sustituyendo los complejos modelos de clasificación por el estudio de los promedios espectrales. El resultado apunta con claridad hacia ciertas regiones del eje de frecuencias, sugiriendo la existencia de un estrechamiento sistemático en la sección del tracto en la región de la orofaringe, ya prevista en la patogénesis de este síndrome. En cuanto al habla sostenida, se han reproducido los estudios realizados sobre el habla continua en grabaciones de la vocal /a/ sostenida. Los resultados son cualitativamente análogos a los anteriores, si bien en este caso las tasas de clasificación resultan ser más bajas. Con el objetivo de identificar el sentido de este resultado se reprodujo el estudio de los promedios espectrales y de la variabilidad inter e intra-grupo. Ambos estudios mostraron importantes diferencias con los anteriores que podrían explicar estos resultados. Sin embargo, el habla sostenida ofrece otras oportunidades al establecer un entorno controlado para el estudio de la fonación, que también había sido identificada como una fuente de información para la detección del SAHS. De su estudio se pudo observar que, en el conjunto de datos disponibles, no existen variaciones que pudieran asociarse fácilmente con la fonación. Únicamente aquellas dimensiones que describen la distribución de energía a lo largo del eje de frecuencia evidenciaron diferencias significativas, apuntando, una vez más, en la dirección de las resonancias espectrales. Analizados los resultados anteriores, la Tesis afronta la fusión de ambas fuentes de información en un único sistema de clasificación. Con ello es posible mejorar las tasas de clasificación, bajo la hipótesis de que la información presente en el habla continua y el habla sostenida es fundamentalmente distinta. Esta tarea se realizo a través de un sencillo esquema de fusión que obtuvo un 88.6% de aciertos en clasificación (tasa de error del 11.4%), lo que representa una mejora significativa respecto al estado del arte. Finalmente, la combinación de este clasificador con los predictores utilizados por los especialistas clínicos ofreció una tasa del 91.3% (tasa de error de 8.7%), que se encuentra dentro del margen ofrecido por esquemas más costosos e intrusivos, y que a diferencia del propuesto, no pueden ser utilizados en la evaluación previa de los pacientes. Con todo, la Tesis ofrece una visión clara sobre la relación entre el SAHS y el habla, evidenciando el grado de madurez alcanzado por la tecnología del habla en la caracterización y detección del SAHS, poniendo de manifiesto que su uso para la evaluación de los pacientes ya sería posible, y dejando la puerta abierta a futuras investigaciones que continúen el trabajo aquí iniciado. ABSTRACT This Thesis explores the potential of speech technologies for the detection of clinical disorders connected to the upper airway. The study of speech traditionally covers both the production process and post processing of the signals involved, from the speaker up to the listener, offering an alternative path to study these pathologies. The fact that utterances embed not just the encoded message but also information about the speaker, has motivated the development of automatic systems oriented to the identification and verificaton the speaker’s identity. These have recently been boosted and reoriented either towards the characterization of traits that are common to several speakers, or to the differences between records of the same speaker collected under different conditions. The first are particularly relevant to this Thesis as these patterns could reveal the presence of features that are related to a common condition shared among different speakers, regardless of their identity. Such is the case faced in this Thesis, where the traits identified would relate to a particular pathology, directly connected to the speech production system. The Obstructive Sleep Apnea syndrome (OSA) is a paradigmatic case for analysis. It is a disorder with high prevalence among adults and affecting a larger number of them as they grow older. Patients suffering from this disorder experience episodes of involuntary cessation of breath during sleep that may last a few seconds and reproduce throughout the night, preventing proper rest. In the case of obstructive apnea, these episodes are related to the collapse of the pharynx, which interrupts the air flow. Currently, OSA diagnosis is done through a polysomnographic study, which focuses on the analysis of apnea episodes during sleep, requiring the patient to stay at the hospital for the whole night. The complexity and high cost of the procedures involved, combined with the waiting lists, have evidenced the need for screening techniques, which perhaps would not achieve outstanding performance rates but would allow clinicians to reorganize these lists ranking patients according to the severity of their condition. Among others, imaging diagnosis and anthropometric characterization of patients have evidenced the existence of anatomical patterns related to OSA that have direct influence on speech. Contributions devoted to the study of how this disorder affects scpeech are scarce and somehow contradictory. However, since the late 1980s the existence of specific patterns related to articulation, phonation and resonance is known. By that time these descriptions were virtually useless when coming to the development of an automatic system, but pointed out the existence of a link between speech and OSA. In recent years automatic processing techniques have evolved and are now able to identify significant differences in the speech of OSAS patients when compared to records from healthy subjects. Nevertheless, little is known about the connection between these new results with those published in the past and the pathogenesis of the OSA syndrome. This Thesis is aimed to progress beyond the previous research done in this area by addressing: the study of how OSA affects patients’ speech, the enhancement of automatic OSA classification based on speech analysis, and its integration with the information embedded in the predictors generally used by clinicians in preliminary patients’ examination. The first two tasks, though may appear symbiotic at first, are quite different. While studying the connection between speech and OSA requires simple narrow models that can be easily interpreted, classification requires larger models including a large number dimensions for the characterization and posterior identification of the observed patterns. Anyhow, it is clear that any progress made in the first task should allow us to improve our performance on the second one, and that the incorporation of the predictors used by clinicians shall contribute in this same direction. The Thesis considers both continuous and sustained speech analysis, to exploit the synergies and differences between them. On continuous speech analysis, a conventional speech processing scheme, designed and evaluated before this Thesis, was taken as a baseline. Over this initial system several alternative representations of the speech information were proposed, optimized and tested to select those more suitable for the characterization of OSA-specific patterns. Evidences were found on the existence of a connection between OSA and the fundamental constituents of the speech: the formants. Experimental results proved that the success of the proposed solution is well explained by the ability of speech representations to describe these specific OSA-related components, ignoring the noisy ones as well those presenting low discrimination capabilities. The resulting scheme obtained a 18% error rate, on a classification scheme significantly less complex than those described in the literature and operating on a single speech record. Regarding the connection between OSA and the observed patterns, it was necessary to consider inter-and intra-group differences for this analysis, and to focus on the articulation, replacing the complex classification models by the long-term average spectra. Results clearly point to certain regions on the frequency axis, suggesting the existence of a systematic narrowing in the vocal tract section at the oropharynx. This was already described in the pathogenesis of this syndrome. Regarding sustained speech, similar experiments as those conducted on continuous speech were reproduced on sustained phonations of vowel / a /. Results were qualitatively similar to the previous ones, though in this case perfomance rates were found to be noticeably lower. Trying to derive further knowledge from this result, experiments on the long-term average spectra and intraand inter-group variability ratios were also reproduced on sustained speech records. Results on both experiments showed significant differences from the previous ones obtained from continuous speech which could explain the differences observed on peformance. However, sustained speech also provided the opportunity to study phonation within the controlled framework it provides. This was also identified in the literature as a source of information for the detection of OSA. In this study it was found that, for the available dataset, no sistematic differences related to phonation could be found between the two groups of speakers. Only those dimensions which relate energy distribution along the frequency axis provided significant differences, pointing once again towards the direction of resonant components. Once classification schemes on both continuous and sustained speech were developed, the Thesis addressed their combination into a single classification system. Under the assumption that the information in continuous and sustained speech is fundamentally different, it should be possible to successfully merge the two of them. This was tested through a simple fusion scheme which obtained a 88.6% correct classification (11.4% error rate), which represents a significant improvement over the state of the art. Finally, the combination of this classifier with the variables used by clinicians obtained a 91.3% accuracy (8.7% error rate). This is within the range of alternative, but costly and intrusive schemes, which unlike the one proposed can not be used in the preliminary assessment of patients’ condition. In the end, this Thesis has shed new light on the underlying connection between OSA and speech, and evidenced the degree of maturity reached by speech technology on OSA characterization and detection, leaving the door open for future research which shall continue in the multiple directions that have been pointed out and left as future work.

What do Eurozone academics think about EMU reform? On broad support and German exceptionalism. Bruges Political Research Papers 41/2015.

This paper is an empirical contribution to the literature on the formation of policy preferences on Economic and Monetary Union (EMU) reform within its Member States. In the aftermath of the euro crisis, many proposals to ‘complete’ EMU have been tabled. However, discord among Member States has led to a piecemeal restructuring of EMU. For this paper, a survey has been conducted among euro area academic experts, gauging preferences on EMU reform. We find that general consensus masks significant discord among academics from different Member States. Our data indicates the existence of conflicting national epistemic communities, bound by shared causal beliefs on macro-economic policy. Academics within the key creditor Member State, Germany, assume an outlier position. Within the sample of German academics, economists are particularly strongly opposed to all moves in the direction of fiscal or social union. As economists are those academic experts most likely to influence the economic policy beliefs dominant among the German policy elite, these results are highly politically salient. We confront these findings with the literature on the exceptionalism of German economics. We contend that our results substantiate the claim that inadequate EMU reform and, more generally, the EU approach to the Eurozone crisis, can be partially explained by the firm grip these economic doctrines hold over the economics profession and policy-making circles in Germany.

Definition and diagnostic criteria of sleep-related hypermotor epilepsy

The syndrome known as nocturnal frontal lobe epilepsy is recognized worldwide and has been studied in a wide range of clinical and scientific settings (epilepsy, sleep medicine, neurosurgery, pediatric neurology, epidemiology, genetics). Though uncommon, it is of considerable interest to practicing neurologists because of complexity in differential diagnosis from more common, benign sleep disorders such as parasomnias, or other disorders like psychogenic nonepileptic seizures. Moreover, misdiagnosis can have substantial adverse consequences on patients' lives. At present, there is no consensus definition of this disorder and disagreement persists about its core electroclinical features and the spectrum of etiologies involved. To improve the definition of the disorder and establish diagnostic criteria with levels of certainty, a consensus conference using formal recommended methodology was held in Bologna in September 2014. It was recommended that the name be changed to sleep-related hypermotor epilepsy (SHE), reflecting evidence that the attacks are associated with sleep rather than time of day, the seizures may arise from extrafrontal sites, and the motor aspects of the seizures are characteristic. The etiology may be genetic or due to structural pathology, but in most cases remains unknown. Diagnostic criteria were developed with 3 levels of certainty: witnessed (possible) SHE, video-documented (clinical) SHE, and video-EEG-documented (confirmed) SHE. The main research gaps involve epidemiology, pathophysiology, treatment, and prognosis.

Sleep-disordered breathing among acute ischemic stroke patients in Brazil.

OBJECTIVES Sleep-disordered breathing (SDB) is very common in acute stroke patients and has been related to poor outcome. However, there is a lack of data about the association between SDB and stroke in developing countries. The study aims to characterize the frequency and severity of SDB in Brazilian patients during the acute phase of ischemic stroke; to identify clinical and laboratorial data related to SDB in those patients; and to assess the relationship between sleep apnea and functional outcome after six months of stroke. METHODS Clinical data and laboratorial tests were collected at hospital admission. The polysomnography was performed on the first night after stroke symptoms onset. Functional outcome was assessed by the modified Rankin Scale (mRS). RESULTS We prospectively evaluated 69 patients with their first-ever acute ischemic stroke. The mean apnea-hypopnea index (AHI) was 37.7 ± 30.2. Fifty-three patients (76.8%) exhibited an AHI ≥ 10 with predominantly obstructive respiratory events (90.6%), and thirty-three (47.8%) had severe sleep apnea. Age (OR: 1.09; 95% CI: 1.03-1.15; p= 0.004) and hematocrit (OR: 1.18; 95% CI: 1.03-1.34; p= 0.01) were independent predictors of sleep apnea. Age (OR: 1.13; 95% CI: 1.03-1.24; p= 0.01), body mass index (OR: 1.54; 95% CI: 1.54-2.18; p= 0.01), and hematocrit (OR: 1.19; 95% CI: 1.01-1.40; p= 0.04) were independent predictors of severe sleep apnea. The National Institutes of Health Stroke Scale (NIHSS; OR: 1.30; 95% CI: 1.1-1.5; p= 0.001) and severe sleep apnea (OR: 9.7; 95% CI: 1.3-73.8; p= 0.03) were independently associated to mRS >2 at six months, after adjusting for confounders. CONCLUSION Patients with acute ischemic stroke in Brazil have a high frequency of SDB. Severe sleep apnea is associated with a poor long-term functional outcome following stroke in that population.

BEHIND THE COMPUTER SCREEN: WHAT IRB PROFESSIONALS REALLY THINK ABOUT SOCIAL MEDIA RESEARCH

Thesis (Master's)--University of Washington, 2016-06

Sleep Patterns and Parents’ Experience in Caring for Young Children Newly Diagnosed with Juvenile Idiopathic Arthritis

Thesis (Ph.D.)--University of Washington, 2016-05

Knowledge beliefs and attitudes of squash venue operators relating to use of protective eyewear

Sports venues are in a position to potentially influence the safety practices of their patrons. This study examined the knowledge, beliefs and attitudes of venue operators that could influence the use of protective eyewear by squash players. A 50% random sample of all private and public squash venues affiliated with the Victorian Squash Federation in metropolitan Melbourne was selected. Face-to-face interviews were conducted with 15 squash venue operators during August 2001. Interviews were transcribed and content and thematic analyses were performed. The content of the interviews covered five topics: (1) overall injury risk perception, (2) eye injury occurrence, (3) knowledge, behaviors, attitudes and beliefs associated with protective eyewear, (4) compulsory protective eyewear and (5) availability of protective eyewear at venues. Venue operators were mainly concerned with the severe nature of eye injuries, rather than the relatively low incidence of these injuries. Some venue operators believed that players should wear any eyewear, rather than none at all, and believed that more players should use protective eyewear. Generally, they did not believe that players with higher levels of experience and expertise needed to wear protective eyewear when playing. Only six venues had at least one type of eyewear available for players to hire or borrow or to purchase. Operators expressed a desire to be informed about correct protective eyewear. Appropriate protective eyewear is not readily available at squash venues. Better-informed venue operators may be more likely to provide suitable protective eyewear.

Beliefs and practices of patients with advanced cancer: implications for communication

The aim of this study was to investigate the beliefs that patients with advanced cancer held about the curability of their cancer, their use of alternatives to conventional medical treatment, and their need to have control over decisions about treatment. Of 149 patients who fulfilled the criteria for participation and completed a self-administered questionnaire, 45 patients (31%) believed their cancer was incurable, 61 (42%) were uncertain and 39 (27%) believed their cancer was curable. The index of need for control over treatment decisions was low in 53 patients (35.6%) and high in only 17 patients (11.4%). Committed users of alternatives to conventional medical treatments were more likely to believe that their cancer was curable (P