Changes in sleep–wake rhythms,subjective sleep quality and pain among patients undergoing total hip arthroplasty

We evaluated nocturnal sleep–wake rhythms and subjective sleep quality on the first postoperative night compared with the preoperative night in 34 patients who had total hip arthroplasty (mean age: 61.9 years; 82.4% female) under spinal anaesthesia. We also examined secondary factors related to sleep disturbances after surgery. Patients wore an accelerometer (actigraph) during the preoperative period and the first postoperative night to track sleep–wake rhythms. Secondary end‐points were postsurgical pain and low back pain. Sleep parameters were measured objectively by actigraphy, and subjective sleep quality was measured by the Oguri–Shirakawa–Azumi Sleep Inventory, Middle‐Aged and Aged Version and found to worsen significantly after surgery. Actigram data showed a reduction in actual sleep time from 353.7 ± 121.2 min preoperatively to 263.8 ± 104.4 min postoperatively. The data indicate that normalized continuous sleep time is important for patient healing and well‐being and that postoperative sleep disturbance is related to low back pain more than to postsurgical pain.     

Improving patient quality of life with feedback to physicians about functional status

OBJECTIVE: To improve functional status among primary care patients. INTERVENTION: 1) Computer-generated feedback to physicians about the patient’s functional status, the patient’s self-reported “chief complaint,” and problem-specific resource and management suggestions; and 2) two brief interactive educational sessions for physicians. DESIGN: Randomized controlled trial. SETTING: University primary care clinic. PARTICIPANTS: All 73 internal medicine houseofficers and 557 of their new primary care patients. MEASURES: 1) Change in patient functional status from enrollment until six months later, using the Functional Status Questionnaire (FSQ); 2) management plans and additional information about functional status abstracted from the medical record; and 3) physician attitude about whether internists should address functional status problems. RESULTS: Emotional well-being scores improved significantly for the patients of the experimental group physicians compared with those of the control group physicians (p<0.03). Limitations in social activities indicated as “due to health” decreased among the elderly (>70 years of age) individuals in the experimental group compared with the control group (p<0.03). The experimental group physicians diagnosed more symptoms of stress or anxiety than did the control group physicians (p<0.001) and took more actions recommended by the feedback form (p<0.02). CONCLUSIONS: Computer-generated feedback of functional status screening results accompanied by resource and management suggestions can increase physician diagnoses of impaired emotional well-being, can influence physician management of functional status problems, and can assist physicians in improving emotional well-being and social functioning among their patients. Supported by the Robert Wood Johnson Foundation. The opinions and conclusions herein are those of the authors and do not necessarily represent the views of the Sepulveda VA, UCLA, CSUF, Rand, or the Robert Wood Johnson Foundation.     

The effects of coping style,social support,and behavioral problems on the well-being of mothers of children with Autism Spectrum Disorders in Lebanon

The present study examined the effects of coping styles, social support, and child's behavioral symptoms on the well-being of 65 mothers of children with Autism Spectrum Disorders (ASD) in Lebanon. Comparisons to the well-being of 98 mothers of typically developing children were also drawn. Regression analyses showed that disengagement and distraction coping predicted poor well-being, whereas cognitive reframing showed a correlation with better well-being levels. A significant correlation was found between child's behavioral problems and maternal well-being. T-test analyses revealed that mothers of children with ASD differed in terms of coping styles used. Additionally, mothers of children with ASD showed lower levels of perceived social support. Well-being was significantly better for mothers of typically developing children. Study limitations and implications are discussed.     

心理干预对康复期脑卒中伴焦虑抑郁障碍患者情绪及幸福感的影响

目的：探讨心理干预对康复期脑卒中伴焦虑抑郁障碍患者情绪及幸福感的影响。方法将120例康复期脑卒中伴抑郁焦虑障碍患者随机分为两组,每组60例。两组均予以神经内科常规治疗及训练,研究组联合心理干预,观察12个月。于干预前后采用焦虑自评量表、抑郁自评量表评定焦虑抑郁情绪,症状自评量表评定心理健康状况,总体幸福感指数量表评定幸福感, Barthel指数量表评定日常生活活动能力;干预12个月评估两组患者的治疗依从性。结果干预前两组各量表评分比较差异无显著性（ P＞0．05）;干预12个月两组焦虑自评量表、抑郁自评量表及症状自评量表评分较干预前显著降低（P＜0．01）,研究组显著低于对照组（P＜0．01）;干预后各时间点两组Barthel指数量表评分和研究组总体幸福感指数量表评分较干预前显著升高（P＜0．01）,研究组显著高于对照组（P＜0．01）。干预后研究组依从率为96．7％,对照组为81．7％,研究组显著高于对照组（ P＜0．01）。结论心理干预能有效缓解或消除脑卒中患者的焦虑抑郁情绪,提高其心理健康水平、总体幸福感及日常生活活动能力,有利于疾病的预后。     

大学生手机依赖与父母教养方式、主观幸福感的关系

目的:探讨大学生手机依赖与父母教养方式、主观幸福感之间的关系。方法:选取湖北省某高校大一至大三学生1477名集体施测,采用手机依赖评定量表(MPAI)测得手机依赖程度、简式父母教养方式问卷中文版(s-EMBU-c)测量被试的父母教养方式以及总体幸福感量表(GWB)测量幸福感水平。结果:大学生MPAI平均得分(36.7±11.5),女生得分高于男生[(37.8±11.2)vs.(35.8±11.6),P<0.01]。M PAI得分与父亲拒绝、父亲过度保护、母亲拒绝、母亲过度保护得分呈正相关(r=0.14~0.21,均P<0.01),与父亲温暖、母亲温暖及SWB得分呈负相关(r=-0.17、-0.16、-0.49,均P<0.01)。通径分析表明,主观幸福感在父母教养方式与手机依赖的关系中起部分中介作用,其中介效应分别占总效应的73.8%和43.5%。结论:父母教养方式、主观幸福感与手机依赖的关系密切,父母教养方式能够通过主观幸福感影响手机依赖。     

职场精神力对主观幸福感的影响:情绪劳动为中介变量

目的:从资源保存理论的视角来检验情绪劳动在职场精神力和主观幸福感之间的中介作用。方法:采用职场精神力量表、情绪劳动量表和主观幸福感量表调查了211名五星级酒店和银行的一线服务人员。结果:1职场精神力对员工的主观幸福感产生正向影响;2职场精神力对员工的深层扮演产生正向影响,对员工的表层扮演产生负向影响;3深层扮演和表层扮演分别在职场精神力和主观幸福感之间发挥中介作用。结论:职场精神力是情绪劳动的前因变量,它增加员工深层扮演的同时会降低表层扮演。职场精神力会提升员工的主观幸福感。深层扮演和表层扮演是解释职场精神力对员工主观幸福感产生影响的内在作用机制。     

Long-term subjective cognitive functioning following adjuvant systemic treatment: 7–9 years follow-up of a nationwide cohort of women treated for primary breast cancer

Background:

There is growing concern among breast cancer (BC) patients and survivors about cognitive impairment following systemic treatments. The aim of the present study was to investigate the long-term effects of standard systemic adjuvant therapies on subjective cognitive impairment (SCI) in a large nationwide cohort of BC survivors 7–9 years after primary surgery.

Methods:

Participants were recruited from the nationwide Psychosocial Factors and Breast Cancer inception cohort of Danish women treated for primary BC. SCI was assessed with the Cognitive Failures Questionnaire and women allocated to systemic treatment according to nationwide standard protocols were compared with women who had not received any systemic treatments.

Results:

A total of 1889 recurrence-free survivors were eligible for analysis. No difference in SCI was found between survivors across standardized systemic treatment protocols when analyses were stratified by menopausal status and adjusted for possible sociodemographic and treatment-related confounders. The frequency of significant SCI in a subgroup of survivors in the age range 65–74 years was ∼7%.

Conclusions:

No differences in long-term SCI at 7–9 years post surgery were found between women who had received systemic therapies and those who had not. Furthermore, the observed proportion of survivors with significant SCI was comparable to normative data. These results are important to communicate to patients, survivors, and clinicians alike, especially in the light of increasing concern about cognitive impairment following systemic therapies.     

Comparing effectiveness with efficacy: outcomes of palliative chemotherapy for non-small-cell lung cancer in routine practice

Introduction

Randomized controlled trials (rcts) are the “gold standard” for establishing treatment efficacy; however, efficacy does not automatically translate to a comparable level of effectiveness in routine practice. Our objectives were to

• □ describe outcomes of palliative platinum-doublet chemotherapy (ppdc) in non-small-cell lung cancer (nsclc) in routine practice, in terms of survival and well-being; and
• □ compare the effectiveness of ppdc in routine practice with its efficacy in rcts.

Methods

Electronic treatment records were linked to the Ontario Cancer Registry to identify patients who underwent ppdc for nsclc at Ontario’s regional cancer centres between April 2008 and December 2011. At each visit to the cancer centre, a patient’s symptoms are recorded using the Edmonton Symptom Assessment System (esas). Score on the esas “well-being” item was used here as a proxy for quality of life (qol). Survival in the cohort was compared with survival in rcts, adjusting for differences in case mix. Changes in the esas score were measured 2 months after treatment start. The proportion of patients having improved or stable well-being was compared with the proportion having improved or stable qol in relevant rcts.

Results

We identified 906 patients with pre-ppdc esas records. Median survival was 31 weeks compared with 28–48 weeks in rcts. After accounting for deaths and cases lost to follow-up, we estimated that, at 2 months, 62% of the cohort had improved or stable well-being compared with 55%–63% who had improved or stable qol in rcts.

Conclusions

The effectiveness of ppdc for nsclc in routine practice in Ontario is consistent with its efficacy in rcts, both in terms of survival and improvement in well-being.