The prevalence and severity of insomnia in university students and their associations with migraine,tension-type headache,anxiety and depression disorders: a cross-sectional study

BackgroundThere is possibly an association between migraine, tension-type headache, anxiety, depression and insomnia. These conditions are prevalent among university students. Our primary objective was to verify whether students with primary headaches (migraine and tension-type headache) have a higher prevalence of insomnia. Our secondary objective was to assess whether the impact of headaches was associated with greater severity of insomnia.MethodsCross-sectional study. 440 students out of 3030 were randomly selected. A semi-structured questionnaire containing information about the characteristics of the headaches, including their frequencies in the last 3 months; the Headache Impact Test (HIT-6); the Hospital Anxiety Depression Scale; and the Insomnia Severity Index were used.Results420 students (95.5%) agreed to participate; 51.4% men; median age of 21 (19, 23); 95 (22.6%) had insomnia; 265 (63.1%), migraine; 152 (36.2%), tension-type headache; 201 (47.9%) suffered from anxiety and 108 (25.7%), from depression. The severe impact of headache (HIT-6>55 points; OR = 3.9; p = 0.003) and anxiety (OR = 3.6; p = 0.003) were associated with insomnia (logistic regression). The severity of insomnia was positively and significantly correlated with the impact (HIT-6 score), with frequency of headache, and with having anxiety (multiple linear regression).ConclusionsThe diagnoses of migraine and tension-type headache are not associated with the presence of insomnia. The severity of insomnia is associated with the impact and the frequency of the headaches.     

Do different types of stress differentially alter behavioural and neurobiological outcomes associated with depression in rodent models? A systematic review

Cataloguing the effects of different types of stress on behaviour and physiology in rodent models has not been comprehensively attempted. Here, we systematically review whether chronic exposure to physical stress, psychosocial stress, or both types of stress can induce different behavioural and neurobiological outcomes in male and female rodents. We found that physical stress consistently increased depressive-like behaviour, impaired social interaction and decreased body weight, while psychosocial stress consistently increased both anxiety- and depressive-like behaviour, impaired social interaction and learning and memory, increased HPA axis activity, peripheral inflammation and microglial activation, and decreased hippocampal neurogenesis in male rodents. Moreover, we found that the combined effect of both stress types resulted in a more severe pathological state defined by increased anxiety- and depressive-like behaviour, impaired social interaction and learning and memory, increased HPA axis activity and central inflammation, and reduced hippocampal neurogenesis and neural plasticity in male rodents. Phenotypes for females were less consistent, irrespective of the type of stress exposure, on account of the limited number of studies using females. This review highlights that the type of stress may indeed matter and will help animal researchers to more appropriately choose a stress/depression model that fits their research purposes.     

The Effect of Lavender Aroma on Anxiety of Patients Having Bone Marrow Biopsy

Introduction: Bone marrow biopsy is a common procedure for the diagnosis and treatment of hematologic diseases and tumors, which are associated with anxiety. The purpose of this study was to examine the effect of lavender aroma on anxiety of patients having bone marrow biopsy. Materials and Methods: This study was performed on 80 patients referred to Vali-e-Asr Hospital for bone marrow biopsy. Samples were selected by convenience method and were assigned into intervention and control groups using randomized blocks of 4. Random sequence was generated by RAS software. Several drops of distilled water on a cotton ball was used in the control group and same amount of lavender essential oil on a cotton ball was used in the intervention group. Then, participants in both groups were asked to smell the cotton ball for 15 minutes and then, their anxiety level was measured immediately. The results were analyzed by SPSS software version 25 using covariance analysis and rank regression. Results: The results showed that, the mean scores of anxiety in the control and intervention groups were 6.3 ± 1.92 and 3.75 ± 1.05, respectively. There was a significant difference (p <0.05) between the two groups in terms of anxiety score.The results showed that there was a significant difference in anxiety score between two groups in terms of variables such as age, gender, physician experience, biopsy history and biopsy site (P <0.05). The results also showed no significant difference between the (p >0.05). Conclusion: The results of this study showed that bone marrow biopsy is associated with anxiety, and smelling of lavender aroma is effective in reducing anxiety in patients undergoing this procedure. This fragrance can be used by treatment team in hematology and oncology clinics to reduce anxiety caused by bone marrow biopsy.     

Comprendre les troubles du sommeil de patients adultes atteints d’une maladie de Crohn pris en charge en ambulatoire

ObjectivesResearch has shown that sleep disturbances can negatively influence the progression of chronic inflammatory diseases, including chronic inflammatory bowel disease (IBD). More specifically, poor sleep quality is strongly related to the clinical activity of the disease. Nevertheless, some patients suffer from sleep disorders even when the disease is clinically inactive. Psychological factors, such as depression and anxiety, are also known to contribute to poor sleep quality. Depression and anxiety are common in chronic diseases. In addition, while the link between depression or anxiety and sleep disorders is well-known, the link between sleep disorders and inflammation has only been studied recently. Sleep studies in IBD patients have generally excluded patients with clinically diagnosed depression or anxiety in order to neutralize their effects on the relationship between inflammation and sleep disorders. Nevertheless, there is no consensus on the relationship between depression and anxiety and the clinical activity of the disease. When a patient with chronic inflammatory bowel disease (Crohn's disease here) complains of fatigue or poor sleep, the subjective aspects of these complaints therefore lead the clinician to consider them simply as: a characteristic of IBD, exhaustion related to the chronicity of the disease, unsatisfactory sleep quality, a manifestation of a depressive mood, or a consequence of an anxious state. When a patient reports a subjective complaint of poor sleep or fatigue in a complex, multi-determined clinical situation, it can thus be difficult to identify its most likely cause and to establish the best possible therapeutic intervention.Patients, materials and methodsThe aim of this work was to determine which element (disease activity, inflammation, depression, anxiety) is most closely related to sleep disorders in patients with Crohn's disease (CD) referred for outpatient psychological assessment. Ninety-seven patients with CD participated in this study. Their mean age was 34.70 (± 10.85) years. They were asked about their sleep (IQSP, ISI, ESD) and mood (HADS). They also provided details of clinical disease activity (Harvey–Bradshaw Index) and inflammation (CRP). In order to determine the nature and extent of the relationship between the variables, Spearman correlation coefficients were calculated, supplemented by multiple regression analyses to determine the variables that could explain the sleep disorders.ResultsThe results show that sleep quality (IQSP) was significantly predicted by the Harvey–Bradshaw score (β = 0.21; β standardized = 0.24; t = 2.6; P = 0.01) and depression (β = 0.45; β standardized = 0.41; t = 4.55; P < 0.001). The Harvey–Bradshaw score (β = 26; β standardized = 2; t = 2.27; P = 0.026) and depression score (β = 75; β standardized = 47; t = 5.34; P < 0.001) were related to the insomnia score (ISI). Finally, daytime sleepiness (DSA) was predicted by the depression score (β = 42; β standardized = 432; t = 3.17; P = 0.002) and by the CRP (β = − 0.05; β standardized = − 0.21; t = − 2.13; P = 0.036). The results show that the severity of clinical activity of the disease was associated with poor sleep quality and insomnia. However, there was a stronger association between the intensity of depression and sleep disturbances than between these variables and clinical disease activity. It therefore seems important that sleep disorders and their management should be considered first from the perspective of depression. However, it is important that CD is not assumed to be the sole cause of depression: other factors (dispositional or situational) should also be taken into consideration. Nevertheless, while our results show a weaker link between inflammation and sleep disorders than other studies, they confirm the link between sleep disorders and disease activity.ConclusionsIn order to predict the likelihood and nature of relapses, it seems important that future research should take into account not only disease activity and inflammation, but also disorders of arousal and nocturnal awakenings experienced by the patient.     

2014—2019年四川省通江县居民主要慢性病死亡及早死概率分析

摘 要 目的 分析2014—2019年四川省通江县死因监测数据，了解居民主要慢性病死亡及早死概率等数据，为地区卫生健康工作提供依据。方法 利用2014—2019年通江县死因监测数据，按照国际疾病分类标准(ICD-10)对数据进行分类，采用死亡率、早死概率等指标进行分析。结果 2014—2019年通江县居民慢性病死亡占总死亡的比例为89.99%，其中30~69岁死亡的占慢性病死亡总数的32.69%，总人群、男性和女性慢性病粗死亡率呈上升趋势，年度变化百分比分别为5.04%、4.98%和5.12%，男性慢性病粗死亡率高于女性(x2=123.02，P＜0.01)；主要慢性病死亡占总死亡的82.86%，其中恶性肿瘤粗死亡率呈下降趋势(APC=-3.65%，P＜0.05)，心脑血管疾病、慢性呼吸系统疾病和糖尿病的粗死亡率呈上升趋势(APC=6.39%、9.90%和33.73%，P＜0.05)；主要慢性病早死概率在13.32%~20.51%之间波动，心脑血管疾病、恶性肿瘤、慢性呼吸系统疾病和糖尿病的早死概率分别为7.69%、5.71%、2.28%和0.33%，随着时间变化趋势差异无统计学意义(P＞0.05)。结论 主要慢性病已成为通江县居民慢性病死亡的主要原因，应采取健全慢性病防控体系、加强慢性病筛查与早诊早治及践行健康生活方式等综合干预措施，降低主要慢性病的影响。     

La thérapie par exposition en réalité virtuelle pour les états de stress post-traumatiques,les troubles obsessionnels compulsifs et les troubles anxieux : indications,plus-value et limites

The exposure in cognitive behavioral therapy (CBT) is a well-known intervention, widely investigated in scientific research. Several studies have shown the benefits of this intervention in the treatment of anxiety disorders, obsessive-compulsive disorders (OCD) and post-traumatic stress disorders (PTSD). The different exposure techniques are mainly based on the emotional processing of fear theory and use an emotional stimulation of fear, following by its habituation. However, new approaches have emerged and are based on the inhibitory learning theory. The virtual reality technology allows emotional involvement from patients and represents a complementary approach to the classical modalities of exposure therapy (e.g., mental or in vivo expositions). This modern approach presents specific features that need to be taken into account by the therapist. Firstly, the presence feeling, which is defined as the “be there” feeling. This feeling is dependent on immersive technical features and personality factors. Secondly, virtual reality sickness, similar to motion sickness, represents a limitation that might prejudice a virtual therapy. The main scientific investigations of Virtual Reality Exposure Therapy (VRET) for treating social phobia, specific phobia, PTSD, and panic disorders are encouraging and demonstrate a similar effectiveness between both in vivo and in virtuo exposures. The scarce investigations on generalized anxiety disorders and OCD also suggeste a similar effectiveness between these exposures. However, further scientific investigations are needed to support these preliminary findings. The attrition rates and deteriorating states are similar to classical CBT approaches. Nevertheless, scientific literature presents several limits: 1) much of the research on this topic has interest conflicts (e.g., developers are also authors of a large number of studies); 2) there is a high heterogeneity of materials and virtual environments used; 3) important measures are not always taken into account in scientific research (e.g., the presence feeling); and 4) a massive use of waiting lists as a control measure. Despite these limitations, the VRET have strong silver linings: 1) the easy access to exposure (less limited than standard exposure techniques) and a cost reduction; 2) highly guaranteed security; 3) the anonymization of exposures (i.e., the patients do not risk meeting someone they know during the exposure therapy); 4) the therapist has a greater control of exposures; 5) a standardization of the exposures; 6) a greater involvement in therapy for technophile patients. Virtual exposure also seems to be generally more accepted by patients.     

基于EHR对骨质疏松分级诊疗管理模式的探索与实践

目的探讨EHR对骨质疏松分级诊疗管理模式的临床效果。方法以上海市某社区慢性病管理团队为例,依托瑞金-卢湾医联体"全-专门诊"进行分级诊疗,介绍该区域医联体内专科与全科医生团队如何开展区域医联体特色的家庭医生"1+1+1"签约服务,建立个人EHR,通过调阅区、市两级EHR查阅患者区域内就诊信息,对签约骨质疏松患者进行管理,分析管理效果。结果研究对象疼痛症状、身体机能、社会适应能力和精神心理功能较一年前得分均有下降(P0.05);骨代谢指标β-CTX、PICP、PTH和BGP明显下降(P0.05),维生素D升高(P0.001);L1～3、股骨颈、wards三角、大粗隆和total髋的骨密度有提高(P0.05)。结论 EHR对骨质疏松分级诊疗、实施区域医联体特色的签约服务和建立个人EHR等方案可改善骨质疏松患者生活质量,值得推广。     

早期症状改善预测焦虑患者rTMS治疗的疗效

目的 探讨重复经颅磁刺激(Repetitive transcranial magnetic stimulation,rTMS)治疗焦虑障碍患者早期症状的改善能否预测最终的临床疗效。方法 选择40例2017年7月-2019年11月本院焦虑障碍患者进行rTMS治疗,早期症状改善的界限值定义为治疗1或2周后汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)减分率15%～40%,分别计算其预测治疗4周后最终临床疗效的灵敏度、特异度、阳性预报值、阴性预报值,并通过受试者工作特征曲线(Receiver operating characteristic curve,ROC曲线)评估其预测效应。结果 治疗总有效率为62.5%; 以rTMS治疗1周后HAMA减分率15%及20%或治疗2周后HAMA减分率15%、20%、25%、30%及35%为界限值预测临床疗效有相对较高的灵敏度和阴性预报值; 以rTMS治疗1周后HAMA减分率30%、35%及40%或治疗2周后HAMA减分率35%及40%为界限值预测临床疗效有相对较高的特异度和阳性预报值; 以治疗1和2周后HAMA减分率预测治疗4周后临床疗效的ROC曲线下面积分别为0.712(P<0.05)和0.856(P<0.01)。结论 rTMS治疗焦虑障碍早期症状改善可有效预测最终临床疗效。     

Cyclooxygenase-2 inhibition prevents stress induced amygdala activation and anxiety-like behavior

Stress is a major risk factor for the development and exacerbation of mood and anxiety disorders, and recent studies have suggested inflammatory contributions to the pathogenesis of depression. Interestingly, pharmacological inhibition of cyclooxygenase-2 (COX-2) has shown promise in the treatment of affective disorders in small scale clinical studies; however, the mechanisms by which COX-2 inhibition affects behavioral domains relevant to affective disorders are not well understood. Here, we examined the effects of pharmacological inhibition of COX-2 with the highly selective inhibitor Lumiracoxib (LMX) on anxiety-like behavior and in vivo basolateral amygdala (BLA) neural activity in response to acute restraint stress exposure. In male mice, pretreatment with LMX prevented the increase in BLA calcium transients induced by restraint stress and prevented anxiogenic behavior seen after restraint stress exposure. Specifically, acute injection of LMX 5 mg kg⁻¹ reduced anxiety-like behavior in the light–dark box (LD) and elevated-zero maze (EZM). In addition, in vivo fiber photometry studies showed that acute stress increased calcium transients and the predicted action potential frequency of BLA neurons, which was also normalized by acute LMX pretreatment. These findings indicate pharmacological inhibition of COX-2 can prevent acute stress-induced increase in BLA cellular activity and anxiety-like behavior and provides insights into the neural mechanisms by which COX-2 inhibition could affect anxiety domain symptoms in patients with affective disorders.