Outcomes of Thai patients with acute ischemic stroke after intravenous thrombolysis

The purpose of this study was to assess outcomes in Thai patients after treatment with intravenous recombinant tissue plasminogen activator (rtPA) and to determine the factors associated with good outcome and death.MethodsPatients with acute ischemic stroke who were treated with intravenous rtPA at Thammasat University Hospital between June 2007 and April 2010 were included. The measured outcome variables were good outcome (mRS 0,1) and death at 3 months. Stepwise multivariable analyses were performed by including the prespecified factors that were associated with the measured outcome variables in the univariate analysis.ResultsThe sample size was 197 patients. At 3 months, 93 patients (47%) had good outcomes while 23 patients (12%) died within the same period. Severe stroke (OR 0.19, 95% CI 0.08–0.44, p-value < 0.0001) and history of hypertension (OR 0.39, 95% CI 0.16–0.93, p-value = 0.033) were independently related to bad outcome at 3 months, while receiving intravenous nicardipine (OR 2.76, 95% CI 1.09–6.94, p-value = 0.032) was associated with good outcome. Severe stroke (OR 5.89, 95% CI 1.29–26.85, p-value = 0.022) and pretreatment high blood glucose levels (OR 8.06, 95% CI 1.21–53.62, p-value = 0.031) each were independently associated with patient death.ConclusionsStandard-dose intravenous rtPA in a cohort of Thai patients led to better clinical outcomes and comparable death rates when compared to other Asian cohorts receiving intravenous rtPA. Several factors were independently associated with patient outcomes at 3 months.     

Frequency and natural history of fatigue after stroke: a systematic review of longitudinal studies

BackgroundFatigue is a common and distressing symptom after stroke. Stroke survivors and health professionals need to know whether fatigue is likely to improve, or get worse over time; and whether there is a temporal association with depression or anxiety, which might provide a target for treatment,Aims and objectivesTo systematically review all longitudinal observational studies which have assessed fatigue on at least two separate time points after stroke onset to determine its frequency, natural history and temporal relationship with anxiety and/or depression.MethodWe systematically searched MEDLINE, EMBASE, CINAHL and PsychInfo using the keywords “fatigue” and “stroke” and their associated terms or synonyms. Data were extracted regarding time points after stroke where fatigue was assessed, frequency of fatigue at each time point and any reported associations with anxiety and/or depression.Results101 full texts were retrieved after scrutinising the titles and abstracts. Nine fulfilled our inclusion criteria. Fatigue was assessed at a variety of time points after stroke (from admission—to 36 months). The frequency of fatigue ranged from 35%–92% at the first time point. Frequency of fatigue declined across time points in seven of the studies (n = 764) and increased in two studies (n = 195). Three papers found significant associations between fatigue and mood at the same time point. The single study investigating temporal associations between fatigue and mood disorders reported that depression predicted subsequent fatigue.ConclusionsFatigue is present soon after stroke onset and remains common in the longer term. There is little evidence regarding the temporal relationship between fatigue and mood: this is an area where further research is needed.     

Fatigue among stroke patients on long-term follow-up. The Bergen Stroke Study

BackgroundTo evaluate characteristics and mortality related to post-stroke fatigue (PSF).MethodsAll surviving stroke patients admitted to the Stroke Unit, Haukeland University Hospital, between February 2006 and November 2008 were sent a postal questionnaire including the Fatigue Severity Scale (FSS), the hospital anxiety and depression scale (HADSD), and the Barthel Index (BI) at least 6 months after stroke onset. Survival among patients returning the questionnaire was determined by November 2009. PSF was defined as FSS score ≥ 5.ResultsAmong 377 patients returning the questionnaire, 42.3% had PSF. Logistic regression showed that PSF was independently associated with pre-stroke depression, leucoaraiosis, myocardial infarction, diabetes mellitus, pain, and sleeping disturbances. Mean FSS score was lower among TIA patients than among patients with minor cerebral infarction (patients with BI = 100) (P = .002). Cox regression analysis showed mortality to be associated with PSF.ConclusionThere is a multifactorial basis for PSF suggesting different therapy options. Cerebral lesions may cause PSF in some patients. Post-stroke fatigue is associated with higher mortality.     

Behavioral and characterological self-blame in chronic obstructive pulmonary disease

ObjectiveTo assess behavioral and characterological self-blame, identify demographic and relational correlates of self-blame, and determine the association of self-blame with psychological and clinical outcomes of chronic obstructive pulmonary disease (COPD).MethodsData were collected via self-report questionnaires completed by 398 individuals with COPD who had at least a 10 pack-year history of smoking. Behavioral and characterological self-blame were measured, and multiple regression was used to identify correlates of both types of self-blame. Multiple regression was also used to determine the association of self-blame with outcomes of COPD.ResultsMore than one-third of participants endorsed the maximum possible score on the measure of behavioral self-blame. The perception that family members blamed the individual for having COPD (p = .001), tobacco exposure (p = .005), and general family functioning (p = .002) were associated with behavioral self-blame. Current smoking status (p = .001) and perception of blame from family (p < .001) were associated with characterological self-blame. While behavioral self-blame was associated with fewer symptoms of depression (p = .02), characterological self-blame was associated with more symptoms of depression (p = .02).ConclusionsIndividuals with COPD tend to blame themselves for smoking and other behaviors that may have led to their COPD. Smoking-related variables and the perception that family members blamed the individual for having COPD were associated with self-blame. Findings support the importance of distinguishing between behavioral and characterological self-blame in COPD, as behavioral self-blame had a negative association with depression and characterological self-blame had a positive association with depression.     

Stroke symptoms impact on mental and physical health: A Lebanese population based study

Background/ObjectiveStroke symptoms in the absence of diagnosed stroke are common worldwide and associated with stroke risk factors and great impact on the physical and mental health functioning. The aim of this study was to assess, at the national level, the association of stroke symptoms with mental and physical health.MethodsQuality of life was assessed using physical and mental component summary scores (PCS and MCS) of the Short Form 12v2 Health Survey in the Lebanese population. We assessed the differences in the mean PCS and MCS scores among asymptomatic individuals with no stroke/transient ischemic attack (TIA) history (n = 1167), symptomatic individuals with no stroke/TIA history (n = 125) and those with stroke/TIA history (n = 46). Psychometric properties of the Lebanese version of the SF- 12v2 were evaluated using principal component analysis.ResultsSymptomatic individuals had an average PCS scores of 2.31 (95%CI: 0.75–3.88) points lower and those with stroke/TIA history had 3.26 (95%CI: 1.01–5.51) points lower when compared with asymptomatic individuals with no stroke/TIA history. Similarly, MCS scores for symptomatic individuals were 2.58 (95%CI: 1.02–4.13) points lower and those with stroke/TIA history had 3.28 (95%CI: 1.06–5.50) points lower than asymptomatic individuals.ConclusionPhysical and mental health functioning declined among symptomatic individuals and those with stroke/TIA history. Thus, frequent monitoring for the early detection of stroke symptoms may be recommended.     

Evaluation of telephone assessment in stroke and TIA recurrence

IntroductionStroke recurrence is an important issue in stroke registries, but direct patient contact months after stroke is not always feasible. Telephone assessment is often used to evaluate long term stroke outcome, treatments and recurrences. Our aim is to evaluate telephone interview in a stroke registry.Material and methodsThree hundred and eighty patients with a stroke or TIA were prospectively registered, evaluating baseline characteristics and type of event. At 6 months, 248 patients were reviewed by structured telephone interview and 132 were reviewed by direct contact. We analysed stroke outcome and disability, treatments and stroke or TIA recurrences.ResultsThere were no differences in baseline characteristics and type or severity of the index event. At 6 months, treatments were similar between both groups and 10.5% (40 patients) had a recurrent event. There were no differences in recurrent ischaemic strokes (6.1% in direct contact vs 4.4% telephone, P = .49), but we detected a higher number of TIA in direct examination compared to phone interview (9.1% vs 4.0%, P = .04).ConclusionsTelephone assessment of stroke patients is reliable and facilitates stroke registries in detecting long-term treatments and stroke recurrences. However, it is probable that new transient events or TIA are under-estimated.     

Cigarette smoking and mood disorders in U.S. adolescents: sex-specific associations with symptoms, diagnoses, impairment and health services use

ObjectiveTo report sex-specific associations between cigarette smoking and DSM-IV disorders, symptoms, and mental health services use related to depression and anxiety in a nationally representative sample of U.S. adolescents.MethodsData on two samples were drawn from the 1999–2004 National Health and Nutrition Examination Surveys to examine the association of ever smoking (versus never smoking) with depression (n = 1884 12–15 year-olds) and anxiety (n = 6336 12–19 year-olds). Sex-specific associations between smoking and DSM-IV diagnoses, subthreshold and severe disorder, symptoms, impairment and mental health services use were assessed using logistic regression modeling.ResultsRates of DSM-IV depression and anxiety were increased in adolescent female ever smokers as compared to never smokers (OR = 3.9, 95% CI: 1.3–11.3 and OR = 10.6, 95% CI: 3.1–37.0, respectively). Females also showed statistically significant increases in severe disorder, subthreshold disorder, all symptoms of major depressive disorder, most symptoms of panic disorder, and increases in severe impairment, especially those related to schoolwork and teachers. Male adolescents showed smaller variations in depression and anxiety by smoking status, but were more likely to seek mental health services.ConclusionsSmoking prevention efforts may benefit from specifically targeting female youth who show signs of depression or anxiety diagnoses through a school-based program, while greater benefits with males may be evident through programs integrated into mental health services.     

Depressive symptoms in HIV-infected patients treated with highly active antiretroviral therapy

IntroductionThe prevalence of depressive disorders in HIV-infected patients ranges from 12% to 66% and is undiagnosed in 50% to 60% of these patients. Depression in HIV-infected individuals may be associated with poor antiretroviral treatment (ART) outcomes, since it may direct influence compliance.ObjectiveTo assess the presence of symptoms and risk factors for depression in patients on ART.MethodsCross-sectional study. Certified interviewers administered questionnaires and the Beck Depression Inventory (BDI), and participants' self-reported compliance to ART. Clinical and laboratory variables were obtained from clinical records. Patients with BDI ≥ 12 were defined as depressed.ResultsOut of the 250 patients invited to participate, 246 (98%) consented. Mean age was 41 ± 9.9 years; most were male (63%). Income ranged from 0–14 Brazilian minimum wages. AIDS (CDC stage C) had been diagnosed in 97%, and 81% were in stable immune status. One hundred ninety-one (78%) reported compliance, and 161 (68%) had undetectable viral loads. The prevalence of depressive symptoms was 32% (95% CI 26–40). In multivariate analysis, depressive symptoms were significantly associated with income (prevalence ratio [PR] = 0.85; 95% CI 0.74–0.97; p = 0.02).ConclusionsDepressive symptoms are frequent in patients on ART, and are associated with low income.     

Anxiety and depression in incident stroke survivors and their carers in rural Tanzania: A case-control follow-up study over five years

AimsTo quantify the extent and nature of anxiety and depression in a representative cohort of stroke survivors and their carers in rural Tanzania.DesignA cross-sectional design was used and stroke cases were followed up at 6–60 months post-stroke. Levels of anxiety and depression in stroke survivors, their carers (for physically dependent stroke survivors) and age- and sex-matched controls were assessed using the hospital anxiety and depression (HAD) scale. Other data collected included age, sex, time elapsed since stroke, quality of life, cognitive function, level of disability and socioeconomic status.ResultsLevels of depression seen in our cohort of stroke survivors (53.0%) are high compared to data from the developed and developing world. Anxiety levels (21.6%) are similar to published data. Stroke survivors (n = 58, full data set n = 51) and carers (n = 27) were significantly more anxious than controls (n = 58), whereas levels of depression were similar across all three groups. High stroke survivor HAD scores correlated with lower scores in physical health, psychological health and environment sections of the WHOQOL-Bref. Increased carer anxiety and depression were associated with reduced informant-reported levels of cognitive function in stroke survivors.ConclusionsTo our knowledge this is the first long term study of incident stroke cases in sub-Saharan Africa which has investigated the psychological health of stroke survivors and their carers. Our study highlights the growing need to develop community rehabilitation services in the developing world, which address both physical and psychological morbidity.     

Posttraumatic stress disorder and hypertension in Australian veterans of the 1991 Gulf War

ObjectiveMilitary veterans experience a high prevalence of psychopathologies such as posttraumatic stress disorder (PTSD). Relationships between physical and psychological health are increasingly recognised. This study investigated associations between PTSD and hypertension in male Australian Gulf War veterans.MethodsIn 2000–02, 1456 veterans underwent medical and psychological assessments. Medical practitioners rated self-reported medical conditions as probable diagnoses, possible, unlikely or non-medical. The Composite International Diagnostic Interview (CIDI) assessed psychological symptomatology present in the 12 months preceding evaluation, and lifetime prevalence. Odds of hypertension among those with and without PTSD were calculated for each timeframe using logistic regression.ResultsAnalysis was restricted to the 1381 veterans for whom CIDI and medical data were available. Hypertension was considered probable in 100 subjects (7.2%). Adjusted odds ratios of hypertension were 2.90 (95% CI 1.19–7.09) amongst veterans with PTSD in the past 12 months and 2.27 (95% CI 1.01–5.10) for lifetime prevalence, compared with those without PTSD. Hypertension was over seven times more likely amongst veterans with PTSD alone than those with no mental illness in the past 12 months.ConclusionsVeterans with a history of PTSD had increased odds of having hypertension. Given the array of disabling psychosocial associations of PTSD, and the numerous potential clinical sequelae of hypertension, co-existence of these conditions may have implications for prevention and management at the individual, clinical, and public health policy and practice level. Early identification of PTSD in military samples may help to ameliorate longer-term adverse physical health outcomes.     

PTSD and depression as predictors of physical health-related quality of life in tobacco-dependent veterans

ObjectiveSmoking, depression and PTSD are related to poor physical health outcomes and health-related quality of life (HRQoL). Previous studies examining the effects of quitting smoking on HRQoL have been mixed. This study aimed to examine the effects of PTSD, depressive symptoms and smoking cessation on HRQoL in a sample receiving treatment for PTSD.MethodThis study utilized archival interview and self-report data from a clinical trial (VA Cooperative Study 519) that recruited tobacco dependent veterans with chronic PTSD (N = 943).ResultsAnalyses were conducted using hierarchical linear modeling and indicated that PTSD and depressive symptoms differentially affected the various physical health status domains. Additionally, quitting smoking was associated with better self-perceived health status and social functioning.ConclusionOur findings further explain the interrelationships of PTSD, depression, and smoking in the prediction of physical HRQoL and advocate the importance of integrated care.     

Who is at risk for having persistent insomnia symptoms? A longitudinal study in the general population in Korea

ObjectivesOur study had three goals: (1) to investigate the longitudinal course of insomnia symptoms over 4 years (3 time points) by analyzing the trajectory of insomnia symptoms for all participants, (2) to compare persistent insomnia symptom to nonpersistent insomnia symptom groups on mental health and quality of life (QoL), and (3) to conduct exploratory analyses on the relative contribution of multiple factors to persistence of insomnia symptoms.MethodsOur population-based longitudinal study utilized a community-based sample from the Korean Genome and Epidemiology study (KoGES). Participants were 1247 individuals (40.1% men; mean age, 54.3 ± 7.1 years). Insomnia, QoL (measured by 12-item Short-Form health survey [SF-12]), sleep-interfering behaviors, and depression (measured by the Beck Depression Inventory [BDI]) were followed with biennial examinations at 3 data points spaced 2 years apart (baseline, time 1, and time 2).ResultsAmong individuals experiencing insomnia symptoms at baseline, the most common trajectory was to experience persistent nocturnal insomnia symptoms across all 3 time points. Those with persistent insomnia symptoms had significantly lower physical and mental QoL (measured by SF-12) and higher depression (measured by BDI) at time points compared to those without persistent nocturnal insomnia symptoms. A follow-up exploratory receiver operating characteristic curve (ROC) analysis identified poor sleep quality, frequent sleep-interfering behaviors, and low mental health QoL as the strongest predictors of persistent insomnia symptoms above other well-known risk factors.ConclusionsIn particular, an interaction between poor sleep quality, sleep-interfering behaviors, and mental health QoL appeared to be the strongest risk factor for persistent insomnia symptoms.     

Associations of nonrestorative sleep with insomnia, depression, and daytime function

Study objectivesNonrestorative sleep (NRS) complaints are common but associations with insomnia, daytime function or depressive symptoms are not well-established. This study aims to (1) describe insomnia related symptoms and sleep quality in those with NRS compared to those with no NRS; (2) identify the independent associations between NRS, insomnia severity, and depression; and (3) identify the association between NRS and daytime function independent of insomnia severity and depression.DesignCross sectional survey of enrollees at a health plan in the Midwestern United States.MeasurementRespondents were surveyed about the presence and frequency of NRS complaints, depression, insomnia severity and related symptoms. Multivariate regression was used to examine the study’s three research aims.ParticipantsStudy sample consisted of 541 subjects with NRS and 717 who reported never experiencing any NRS symptoms.ResultsWe found a statistically significant interaction between NRS and total sleep duration such that the association between sleep duration and sleep quality was attenuated in those with NRS compared to those without NRS (b = ?0.26, SE = 0.07, p < 0.0001). In multivariate analysis, subthreshold, moderate and severe insomnia were associated with NRS (OR [95%CI] = 5.93 [4.24–8.31], 9.22 [6.15–13.83] and 6.10 [3.34–11.14], respectively). NRS was independently associated with daytime physical function, cognitive function and emotional function OR [95%CI] = 2.21 [1.59–3.08], 1.90 [1.37–2.64] and 1.71 [1.23–2.36], respectively.ConclusionNRS is a complex concept that should be further defined and studied in the larger context of sleep quality, other insomnia related symptoms, daytime function and depression.     

Evaluation of oral iron treatment in pediatric restless legs syndrome (RLS)

ObjectiveWe conducted a retrospective chart review of children with restless legs syndrome (RLS) to evaluate the efficacy of oral iron treatment, which was administered open-label during the course of clinical care. In addition, we provided detailed clinical information about RLS in this pediatric cohort.Patients and methodsThe study included 30 consecutive Japanese children with RLS who visited the Pediatric Sleep Clinic at Osaka University Hospital, and consisted of 17 boys and 13 girls, aged 2–14 years (mean ± SD, 6.5 ± 2.8). All-night polysomnography was performed in 18 patients and serum ferritin levels were measured in all the patients. After the diagnosis of RLS, iron was administered at doses between 1.6 and 7.8 mg/kg/day (3.2 ± 1.3). Serum ferritin was re-evaluated 3–6 months after iron treatment, or when RLS symptoms had disappeared.ResultsThe patient age at onset of RLS symptoms ranged from six months to 13 years (4.3 ± 3.6). A positive family history was recognized in 19 children (63.3%). Serum ferritin levels before therapy were 9–62 ng/ml (26.6 ± 12.8) and oral iron supplementation was reported to be highly effective in 17 children, effective in 10, and ineffective in three. The serum ferritin level at follow-up was 23–182 ng/ml (83.5 ± 49.8). The onset of treatment effect was within approximately three months.ConclusionsIron treatment could be effective in Japanese pediatric RLS.     

Multiple sclerosis relapses and depression

ObjectiveThe expression of clinically significant depression symptoms during and post multiple sclerosis (MS) relapse was investigated. The point prevalence of possible depression during a confirmed MS relapse and at 2 and 6 months post-relapse was examined and the influence of disability on the time course of depression symptoms post-relapse determined.Methods132 sequential patients were recruited from an open access relapse clinic. Clinical data including disability (Expanded Disability Status Scale: EDSS) and depression symptoms (Hospital Anxiety and Depression Scale depression subscale: HADS-D) were recorded at 0, 2 and 6 months post-relapse.ResultsPrevalence of possible depression (HADS-D score of ≥ 8) was 44.5% during relapse, reducing to 29.2% at 2 months and 34.4% at 6 months post-relapse. HADS-D scores were significantly lower at follow-up than during relapse. Possible depression at relapse was significantly related to a higher likelihood of possible depression at 2 month follow-up (OR 12.12) and improvement in EDSS was related to a lower likelihood (OR 0.51). EDSS at relapse (OR 1.47) and possible depression at relapse (OR 11.87) were significantly associated with possible depression 6 months post-relapse.ConclusionsHigh rates of possible depression were observed during relapse. Although depression scores reduced significantly post-relapse, rates of possible depression at follow-ups remained high. The results suggest that although improvements in disability may influence depression symptoms over the short-term, once depression symptoms are elevated at relapse then depression symptoms become persistent. Further studies are required on the relationship between relapses and depression and whether targeted psychological interventions are beneficial.     

Characteristics of myasthenia gravis according to onset-age: Japanese nationwide survey

Background and purposePredicting stroke using biomarkers would enable clinicians to help prevent stroke or mitigate damage. Several stroke biomarkers have been investigated but none has shown near term predictive value.MethodsWe studied patients presenting with a history of stroke or transient ischemic attack (TIA) to determine whether serum levels of autoantibodies to the NMDA receptor NR2 peptide (NR2Ab) reflected the presence of recent stroke compared with controls. Antibody levels were also correlated with clinical risk factors for stroke, including diabetes, hypertension, hyperlipidemia, and history of recent TIA or stroke.ResultsOf the 245 patients that presented with acute stroke or TIA, 130 consented to participate and results are available for the 120. Volunteers from the community were recruited as controls. Males and females with multiple recent strokes and females with acute strokes had elevated NR2Ab levels compared to non-stroke patients or controls. Using a multiple regression model, the predictive value for NR2Ab was compared to clinical risk factors. In men, the presence of stroke correlated with hypertension (p < 0.001) and NR2Ab levels (p < 0.01) and in women the presence of stroke correlated with hypertension (p < 0.001), diabetes (p < 0.05), atrial fibrillation (p < 0.05) and NR2Ab (p < 0.01).ConclusionThese results suggest that NR2Ab levels reflect a history of multiple strokes and may serve as a predictive factor for stroke.     

Post-discharge insomnia symptoms are associated with quality of life impairment among survivors of acute lung injury

IntroductionSleep disturbance is common during critical illness, yet little is known about its prevalence or role in post-discharge quality of life among high-risk acute lung injury (ALI) patients.MethodsIn a prospective cohort of 61 mechanically ventilated ALI patients, we examined the association between insomnia symptoms and quality of life six months after discharge. Subjects completed surveys rating quality of life (MOS SF-36), post-traumatic stress disorder (PCL), and depression (PHQ-9). Using an individual item from the PCL, we defined insomnia symptoms as moderate or greater trouble falling or staying asleep in the past month. We performed multivariable linear regression to examine the association between insomnia symptoms and SF-36 physical and mental component summary scores, adjusting for PTSD and depression.ResultsForty subjects (85% of eligible) completed six-month questionnaires; 20 (50%) met criteria for insomnia symptoms. After adjustment for PTSD and depression, insomnia symptoms remained significantly associated with worse physical component summary scores (adjusted mean difference = ?8.8; 95% CI: ?15.0, ?2.5; P < 0.01).ConclusionsPost-discharge insomnia symptoms were common and significantly associated with physical quality of life impairment among six-month ALI survivors, even after adjustment for PTSD and depression symptoms. Further studies are needed to validate these results and to characterize sleep disturbance after ALI using sleep-specific metrics.     

Self-referral to group cognitive behavioural therapy: Is it effective for treating chronic insomnia?

ObjectivesTo evaluate the effectiveness of a short (3 session) programme of group cognitive behavioural therapy (CBT) on insomnia, sleepiness and symptoms of anxiety and depression.MethodsProspective observational study of group CBT with follow-up at 3 months. Participants were self-referred patients with chronic insomnia. Outcome measures were the insomnia severity scale (ISI), the Epworth sleepiness scale (ESS), depression (Pichot scale), and the number of anxiety symptoms.ResultsParticipation in CBT was offered to 489 patients of whom 474 completed the programme and 154 were followed up at 3 months. Significant improvements in insomnia were seen: ISI score (17.74–14.27, P < 0.0001) after CBT and at follow-up (13.78, P < 0.0001). At the end of CBT, 76% (59/78) with initial severe insomnia and 52% (132/255) with moderate insomnia were improved, maintained at 3 months in 71% (15/21) with severe insomnia and 56% (50/90) with moderate insomnia. Depression and anxiety symptoms were significantly improved: mean depression symptoms (4.15–3.35, P < 0.0001) and anxiety symptoms (4.52–3.95, P < 0.0001), maintained at 3 months with mean depression symptoms (3.17, P < 0.0001) and mean anxiety symptoms (3.62, P < 0.0001). Sleepiness increased between baseline and the end of the group (6.67–7.24, P = 0.015) followed by a reduction at 3 months (7.19–6.34 at 3 months, P = 0.001). Initial ISI score but neither sex nor age were predictive of outcome.ConclusionsA short programme of CBT can improve sleep, depression and anxiety symptoms in self-referred patients suffering from chronic insomnia with good adherence and maximum benefit in patients with severe insomnia.     

Serum GFAP levels in optic neuropathies

ObjectiveExperimental studies have indicated that adipocytokines are associated with vascular diseases with regard to the pathology of atherosclerotic plaque. We hypothesized that the strength of the associations between adipocytokines and stroke would differ between ischemic stroke subtypes.MethodsA total of 96 acute ischemic stroke patients (within 5 days from onset) and 48 non-stroke subjects were analyzed in this study. Stroke patients were comprised of 26 strokes due to large artery atherosclerosis (LAA) and 72 non-LAA strokes. Venous blood from all participants was drawn after an overnight fast, and serum levels of leptin, adiponectin and resistin were measured by multiple sandwich immunoassay techniques.ResultsCompared with non-LAA strokes, patients with LAA strokes had lower levels of serum adiponectin (6.4 ± 3.1 vs. 8.5 ± 3.9 μg/mL; P = 0.04), and a higher level of leptin-to-adiponectin ratio (L:A ratio; 1.6 ± 1.4 vs. 0.9 ± 0.9; P < 0.01). Multinomial logistic regression analyses showed that, although none of the adipocytokines was associated with non-LAA strokes, lower adiponectin (adjusted OR, 0.79 per 1-μg/mL increase; 95% CI, 0.64–0.98), higher leptin (aOR, 1.12 per 1-ng/mL increase; 95% CI, 1.004–1.25) and higher L:A ratio (aOR, 2.93 per 1-quartile increase; 95% CI, 1.39–6.15) showed significant associations with increased odds of having LAA stroke, compared to non-stroke subjects.ConclusionFrom our study, we documented that leptin and adiponectin had differential association patterns with ischemic stroke according to the stroke subtype. Careful consideration of the heterogeneity of stroke subtypes would be warranted in studying the utility of biomarkers including adipocytokines.     

Psychometric properties of the Pre-Sleep Arousal Scale in a large community sample

ObjectiveThe purpose was to examine the psychometric properties of the Pre-Sleep Arousal Scale.MethodsFrom a randomly selected sample of the general population (N = 5000), 2327 participants completed a survey on nighttime symptoms, daytime symptoms, health outcomes, and psychological processes. The study sample consisted of 1890 participants who did not fulfill criteria for a sleep disorder other than insomnia.ResultsFindings indicated that the PSAS did not produce an adequate factorial solution. When three problematic items were removed, the solution, accounting for 48.5% of the variance, improved (PSAS-13). One subscale, cognitive arousal (α = .88), consisted of five items (37.1%), and one subscale, somatic arousal (α = .72), of eight items (11.4%). The two factors were significantly inter-correlated (ρ = .51) and associated with the PSAS-13 (ρ = .91, ρ = .80). Among those with insomnia, a shortened PSAS (PSAS-14) was established, which consisted of a cognitive and a somatic subscale (48.6% of the variance). The PSAS-13 and the two subscales showed discriminant validity between three sleep groups (normal sleep, poor sleep, and insomnia disorder) (R² = .24–.34). The PSAS-13 and the subscales demonstrated convergent validity with measures on sleep-related worry, sleep-related beliefs, anxiety, and depression. The PSAS-13 and the two subscales were significantly correlated with sleep parameters and daytime impairment.ConclusionThough acceptable psychometric properties were established for the PSAS, the cognitive subscale's focus upon general pre-sleep arousal and the relatively low variance accounted for calls for further work on and a possible re-conceptualization of the PSAS.