How clerks understand the requests of people living with aphasia in service encounters

ABSTRACT

Aphasia often restricts participation. People living with aphasia (PLWA) engage in fewer activities, which leads to fewer interactions than before aphasia. Analyses of interactions with non-familiar people in activities of daily life could provide knowledge about how to integrate these situations in rehabilitation and facilitate ongoing PLWA participation post-rehabilitation. This qualitative study is the first to examine how PLWA make their requests understood in service encounters despite aphasia. Six people living with moderate or severe aphasia were video-recorded in situations of service encounters, e.g., pharmacies, specialised shops, restaurants, and others. We identified fifty-nine occurrences with one or several difficulties in the formulation of the request. They were examined, including the clerks’ responses and ensuing interaction using multimodal conversation analysis. Results showed that PLWA used nonverbal communication within the physical environment and the context of the interaction to support verbal production. In the majority of situations, the clerks understood the request promptly. In other situations, they both collaborated to achieve a clear understanding of the request. Moreover, the findings attest to the competence of people living with moderate or severe aphasia in engaging in service encounters and add to the knowledge base about interaction and social participation in aphasia.     

柴胡桂枝干姜汤治疗失眠的功效网络研究

目的运用网络药理学分析方法,明确柴胡桂枝干姜汤治疗失眠的作用机制。方法运用TCMSP、TCMID数据库锁定柴胡桂枝干姜汤7味药的药物靶标,TTD、DrugBank、PubMed数据库查找失眠的疾病靶点,构建"疾病-方剂-靶点"网络,用STRING和Cytoscape分析软件对其关键靶点进行富集分析,明确作用机制。结果柴胡桂枝干姜汤蛋白质-蛋白质相互作用(PPI)网络包含靶标640个,失眠的PPI网络包括靶标175个,富集分析得29个关键靶标和其间80条互作关系;GO富集分析及KEGG途径分析结果显示柴胡桂枝干姜汤中柴胡皂苷a、柴胡皂苷d、槲皮素、碳酸钙、6-姜辣醇、山柰酚、汉黄芩素等171个活性成分主要通过CACNA1C、GABRA1、GABRA2、GABRB3、GABRA3等29个关键靶标及突触信号传导、膜电位的调节、G蛋白偶联受体信号通路等生物过程,神经递质受体活性、离子门控通道活动、GABA-A受体活性等分子功能,质膜、突触等细胞组成作用于神经活性配体-受体相互作用、逆行内源性大麻素信号传导、5-羟色胺能突触等多条作用通路发挥治疗失眠作用。结论柴胡皂苷a、柴胡皂苷d等171个活性成分是柴胡桂枝干姜汤治疗失眠的药效物质基础,神经活性配体-受体相互作用等通路和CACNA1C等29个靶标构成了其发挥"疏肝健脾、调和阴阳"的功效作用网络,为临床合理运用柴胡桂枝干姜汤治疗失眠提供了网络药理学证据。     

Associations between objective afternoon and evening physical activity and objective sleep in patients with fibromyalgia and insomnia

Patients with fibromyalgia (FM) suffer from chronic pain, which limits physical activity and is associated with disturbed sleep. However, the relationship between physical activity, pain and sleep is unclear in these patients. This study examined whether actigraphic (Actiwatch‐2, Philips Respironics) afternoon and evening activity and pain are associated with actigraphic sleep. Adults with FM and insomnia complaints (n = 160, mean age [M_age] = 52, SD = 12, 94% female) completed 14 days of actigraphy. Activity levels (i.e., activity counts per minute) were recorded, and average afternoon/evening activity for intervals 12:00–3:00 PM, 3:00–6:00 PM and 6:00–9:00 PM was computed. Multiple linear regressions examined whether afternoon/evening activity, pain (daily evening diaries from 0 [no pain sensation] to 100 [most intense pain imaginable]), or their interaction, predicted sleep onset latency (SOL), wake time after sleep onset (WASO), total sleep time (TST) and sleep efficiency (SE). Greater afternoon activity was independently associated with lower SE (B = ?0.08, p < .001), lower TST (β = ?0.36, standard error [SE] = 0.06, p < .001) and longer WASO (B = 0.34, p < .001). Greater early evening activity was independently associated with lower SE (B = ?0.06, p < .001), lower TST (β = ?0.26, SE = 0.06, p < .001) and longer WASO (B = 0.23, p < .001). Self‐reported pain intensity interacted with afternoon and early evening physical activity, such that associations between higher activity and lower SE were stronger for individuals reporting higher pain. Late evening activity was not associated with sleep outcomes. Results suggest that in FM, increased afternoon and early evening physical activity is associated with sleep disturbance, and this relationship is stronger in individuals with higher pain.     

Dynamic features of placebo effects addressing persistent insomnia disorder: A meta‐analysis of placebo‐controlled randomized clinical trials

It has been accepted knowledge that placebo effects have been significant in insomnia clinical trials. However, the dynamic features of placebo effects have not been clarified. Our aim was therefore to conduct a meta‐analysis of placebo‐controlled randomized clinical trials to characterize the dynamic features of placebo effects addressing persistent insomnia disorder. We performed a comprehensive literature search for randomized, placebo‐controlled, double‐blind clinical trials evaluating the efficacy of therapeutic regimens addressing persistent insomnia disorder. We pooled separate effect size estimates (Hedge's g) of placebo and regimen conditions across trials for outcome measures, and multilevel mixed‐effects models were used to explore potential sources of heterogeneity. The placebo effects were significant and robust to improve the symptoms of insomnia, and subjective measures were significantly smaller than objective measures (p < .001), but placebo response rates were nearly identical between subjective and objective measures. The overall placebo effects were influenced by publication year (p = .015), treatment duration (p = .010), sample size (p < .001) and therapeutic regimen (p < .001). Placebo effects showed a diphasic feature within treatment duration: initially a decrease and subsequently being stable; a sustained decline trend after withdrawals; and a steady‐to‐upward trend for a mixed therapeutic regimens in a large‐scale period over decades. The dynamic features of placebo effects addressing persistent insomnia disorder may lead to the development and validation of dosing strategies that require less medication exposure to maintain clinical effects.     

Prevalence of shift work disorder among hospital personnel: A cross‐sectional study using objective working hour data

The prevalence of shift work disorder (SWD) has been studied using self‐reported data and the International Classification of Sleep Disorders, Second Edition (ICSD‐2) criteria. We examined the prevalence in relation to ICSD‐2 and ICSD‐3 criteria, work schedules and the number of non‐day shifts (work outside 06:00–18:00 hours) using objective working‐hours data. Secondly, we explored a minimum cut‐off for the occurrence of SWD symptoms. Hospital shift workers without (n = 1,813) and with night shifts (n = 2,917) and permanent night workers (n = 84) answered a survey (response rate 69%) on SWD and fatigue on days off. The prevalence of SWD was calculated for groups with ≥1, ≥3, ≥5 and ≥7 monthly non‐day shifts utilizing the working hours registry. ICSD‐3‐based SWD prevalence was 2.5%–3.7% (shift workers without nights), 2.6%–9.5% (shift workers with nights) and 6.0% (permanent night workers), depending on the cut‐off of non‐day shifts (≥7–1/month, respectively). The ICSD‐2‐based prevalence was higher: 7.1%–9.2%, 5.6%–33.5% and 16.7%, respectively. The prevalence was significantly higher among shift workers with than those without nights (p‐values <.001) when using the cut‐offs of ≥1–3 non‐day shifts. Shift workers with nights who had ≥3 days with ICSD‐3‐based SWD symptoms/month more commonly had fatigue on days off (49.3%) than those below the cut‐off (35.8%, p < .05). The ICSD‐3 criteria provided lower estimates for SWD prevalence than ISCD‐2 criteria, similarly to exclusion of employees with the fewest non‐day shifts. The results suggest that a plausible cut‐off for days with ICSD‐3‐based SWD symptoms is ≥3/month, resulting in 3%–6% prevalence of SWD.     

百乐眠胶囊联合艾司唑仑治疗失眠症的疗效观察

目的探讨百乐眠胶囊联合艾司唑仑治疗失眠症的临床疗效。方法选取2016-2018年到云浮市人民医院接受治疗的210例失眠症患者,根据给药不同将所有患者分为3组,每组患者70例。百乐眠组口服百乐眠胶囊,4粒/次,2次/d;艾司唑仑组晚上入睡前30 min口服艾司唑仑片,1片/次,1次/d;联合组口服百乐眠胶囊联合艾司唑仑片,相关药物服用方法同以上两组。三组患者均连续治疗2周。观察三组的临床疗效,比较三组患者匹兹堡睡眠质量指数(PSQI)和不良反应发生情况。结果治疗后,百乐眠组、艾司唑仑组、联合组总有效率分别是74.28%、82.86%、97.14%,联合组总有效率显著高于百乐眠组、艾司唑仑组,差异有统计学意义(P<0.05)。治疗后,3组患者PSQI评分均有所降低(P<0.05);但治疗后,联合组患者PSQI各评分均显著低于百乐眠组、艾司唑仑组(P<0.05)。百乐眠组、艾司唑仑组、联合组不良反应发生率分别是8.57%、22.86%、10.00%,艾司唑仑组失眠症患者不良反应发生率明显高于百乐眠组、联合组(P<0.05)。结论百乐眠胶囊联合艾司唑仑治疗失眠症具有较好的临床疗效,可显著降低PSQI评分,改善患者睡眠质量,具有一定的临床推广应用价值。     

Racial Differences in the Associations of Posttraumatic Stress and Insomnia With Body Mass Index Among Trauma-Exposed Veterans

Posttraumatic stress is associated with increased body mass index (BMI) and rates of obesity. Black adults are at greater risk for obesity, trauma exposure, development of posttraumatic stress disorder, and comorbid sleep problems compared to White adults. Accordingly, Black adults with a history of trauma exposure may be at greater risk for elevated BMI associated with posttraumatic stress and insomnia. Multiple linear regression was used to examine race as a moderator of the relationship between posttraumatic symptoms and insomnia with BMI in a sample of Black and White trauma-exposed Veterans (N = 171), controlling for age and sex. There was a significant interaction of race with PTSD (p = 0.042) and insomnia symptoms (p = 0.045) on BMI. Simple slopes showed a significant positive association of posttraumatic stress and BMI among Black (p = 0.003), but not White Veterans (p = 0.590). Similarly, insomnia was significantly associated with greater BMI for Black (p = 0.023), but not White Veterans (p = 0.496). Posttraumatic stress and insomnia may play a particularly important role in the development of weight related health problems among Black Veterans. Early identification and treatment of these symptoms may reduce the risk of obesity among this vulnerable population.