Non-pharmacological solutions to sleep and circadian rhythm disruption: voiced bedside experiences of hospice and end-of-life staff caregivers

Background

Sleep disturbance is a significant issue, particularly for patients with advanced terminal illness. Currently, there are no practice-based recommended approaches for managing sleep and circadian disruptions in this population. To address this gap, a cross-sectional focus group study was performed engaging 32 staff members at four hospices/end-of-life programs in three demographically diverse counties in New York State.

Methods

Participants responded to structured open-ended questions. Responses were transcribed and subjected to qualitative content analysis. The themes and recommendations for improved practice that emerged were tabulated using Atlas TI qualitative software.

Results

This report details the experiences of hospice and end-of-life care staff in managing sleep and circadian disruptions affecting patients and analyzes their recommendations for improving care. Caregivers involved in the study described potential interventions that would improve sleep and reduce circadian disruptions. They particularly highlighted a need for improved evaluation and monitoring systems, as well as sleep education programs for both formal and informal caregivers.

Conclusions

The voiced experiences of frontline hospice and end-of-life caregivers confirmed that disruption in sleep and circadian rhythms is a common issue for their patients and is not effectively addressed in current research and practice. The caregivers’ recommendations focused on management strategies and underscored the need for well-tested interventions to promote sleep in patients receiving end-of-life care. Additional research is needed to examine the effectiveness of systematic programs that can be easily integrated into the end-of-life care process to attenuate sleep disturbances.

     

Funding illness prevention and health promotion in Australia: a way forward

Background

Unlike pharmaceuticals and private medical services there is no single source of funding for illness prevention and health promotion and no systematic process for setting priorities in public health. There is a need to improve the efficiency of access to health funding across prevention and treatment.

Discussion

We discuss a number of reforms to existing funding arrangements including the creation of a national Preventative Priorities Advisory Committee (PrePAC) to set priorities. We propose the establishment of a PrePAC to provide evidence and set priorities across health promotion and illness prevention, with a national dedicated fund for health promotion.

Conclusion

A national evidence-based funding system for illness prevention and health promotion would legitimise a substantial and sustained budget for health promotion, breaking down some of the barriers in a fragmented federal health care system.

     

Picture perfect—how seeking perfection influences sleep and romantic relationships

Background

Studies have shown that sleep quality is negatively affected by perfectionism. Moreover, partner- or relationship-oriented perfectionism negatively influences relationship quality.

Objective

This paper aims to investigate the association of general perfectionism with sleep quality and relationship quality.

Materials and methods

A study assessing perfectionism, sleep quality, and relationship quality was performed via analyzing online questionnaires completed by 489 German adults from the general population.

Results

Participants with impaired sleep showed a higher level of maladaptive perfectionism (concern over mistakes and doubts, parental expectations, and criticism) than participants with good sleep, whereby the severity of sleep problems was not determining. Relationship quality is affected by perfectionism. However, this association is mediated by sleep quality.

Conclusion

Perfectionism is associated with worse sleep quality but not with worse relationship quality when sleep quality is integrated into the model as a mediator.

     

Patterns of Primary Immunodeficiency Disorders Among a Highly Consanguineous Population: Cairo University Pediatric Hospital’s 5-Year Experience

Introduction

Primary immunodeficiency disorders (PIDs) are heterogeneous disorders that mainly present with severe, persistent, unusual, or recurrent infections in childhood. Reports from different parts of the world indicate a difference between Western and Eastern populations.

Aim

The aim of this study was to report on the different patterns of PIDs and identify subgroup characteristics in a highly consanguineous population in Egypt.

Methods

We performed a retrospective chart review for children below 18 years diagnosed with PID at Cairo University Pediatric Hospital from 2010 to 2014.

Results

Four hundred seventy-six children were diagnosed with PID disorders. Major categories included combined immunodeficiency disorders, which constituted a large proportion (30 %) of cases, along with predominantly antibody disorders (18 %) followed by syndromic combined disorders (16.8 %), phagocytic disorders (13.2 %), immune dysregulation disorders (10.5 %), and autoinflammatory disorders (9 %).

Conclusion

PIDs have different patterns within inbred populations with high consanguinity.

     

Glücklich als Paar – glücklicher Schlaf?

Background

Millions of people share a bed with their partner. Sleep und relationship could possibly influence each other.

Objectives

To identify and discuss connections between relationship and sleep quality.

Methods

Review of the literature in electronic databases.

Results

Conflict and violence in relationships lead to decreases in both partners’ sleep quality. Constructive approaches to resolving conflicts is necessary for good sleep, and vice versa. Women prefer partners with sleep-wake rhythms matching their own and report higher relationship satisfactions when the couple’s chronotypes are compatible.

Conclusions

Sleep and circadian rhythms play important roles in relationships. When treating insomnia, the relationship and the partner’s sleep should be taken into account.

     

Effects of different natural extracts in an experimental model of benign prostatic hyperplasia (BPH)

Objective and design

To characterize the impact of inflammatory process and oxidative stress in the degree of benign prostatic hyperplasia (BPH), a common condition in which chronic inflammation plays a crucial role, we investigated the effect of different plant extract preparations in an in vivo model of BPH as new therapeutic target.

Material

BPH was made in rats with daily administration of testosterone propionate (3 mg/kg) for 14 days.

Treatment

Rats were randomized into different groups to receive oral administration of plant extract preparations: Serenoa repens with selenium (SeR 28.5 mg/kg associated with Se 0.005 mg/kg), Teoside (2 mg/kg), and Puryprost (14 mg/kg containing Teoside 50% 2 mg/kg and Epilobium 12 mg/kg).

Methods

After 14 days, rats were killed and histological changes, prostate weight and apoptotic pathways were assayed.

Results

The results obtained demonstrated that the association of treatments reduced prostate weight and hyperplasia, while treatment with Puryprost demonstrated a greater trend of protection compared to the other treatments.

Conclusion

Thus, our results indicate that plant extract could be considered as new useful therapy in the treatment of BPH with particular attention on Puryprost that represents a rational approach to reduce BPH through modulation of inflammatory process and anti-oxidant process.

     

Schlafbezogene Interventionen zur Augmentation von Psychotherapie

Background

The neurobiological augmentation of psychotherapy has drawn increasing attention in research on psychotherapy over the past years. In this context, the manipulation of sleep with its beneficial effect on memory formation and underlying neuronal plasticity is of particular interest as a non-invasive intervention.

Objectives

How do sleep and its selective manipulation influence the effectiveness of psychotherapy and how can sleep be used as an intervention to augment learning processes in psychotherapy?

Materials and methods

Important studies that examine the effects of sleep on processes of memory formation and psychotherapy are presented and discussed.

Results

Sleep represents a promising approach to augment the effects of psychotherapy. Sleep patterns are relevant both before and after psychotherapy. Another possibility is the manipulation of sleep and associated neuronal processes, e.?g. by transcranial direct current stimulation (tDCS) or drugs, which might influence learning processes and neuronal plasticity in the context of psychotherapy.

Conclusion

Sleep represents a promising approach to augment psychotherapy. Future studies are needed to further unravel the underlying mechanisms and to test whether this approach can be transferred to clinical practice.

     

Ethical Assessment of Human Embryonic Stem Cell Research According to Turkish Muslim Scholars: First Critical Analysis and Some Reflections

Background

Turkey, with a Muslim population of officially over 99 %, is one of the few secular states in the Muslim world. Although state institutions are not based on Islamic juridical and ethical norms, the latter play a significant role in defining people’s attitudes towards controversial issues in the modern world, especially when backed by opinions of Muslim scholars living in Turkey. Accordingly, opinions of Muslim scholars undoubtedly have an important effect on bioethical decisions made by institutions and individuals.

Objective(s)

To explore the ethical positions of Muslim scholars living in Turkey and their arguments used in the ethical assessment of embryonic stem cell research; to discuss the biological-moral tensions arising in medical research on human embryos.

Design

Qualitative study.

Setting

Muslim scholars located in different parts of Turkey.

Methods

Qualitative method, involving the collection of opinions of various scholars, by means of 15 individual semi-structured interviews, evaluated using thematic qualitative analysis.

Results

Positions regarding embryonic stem cell research differ among Muslim scholars in Turkey. On the other hand, even where positions are similar, they are often supported by different arguments.

Conclusion

Despite the heterogeneity of the arguments presented, the dominant position considers embryonic stem cell research as morally acceptable.

     

Family members’ perceptions of end-of-life care across diverse locations of care

Background

The goal of the study was to assess perceived level of satisfaction with end-of-life care, focusing on the last 48 hours of life.

Methods

A previously validated instrument was used in a telephone survey with bereaved family members (n=90) of patients who died within an organization in British Columbia.

Results

Bereaved family members had many unmet needs for information about the patient’s changing condition, the process of dying, how symptoms would be managed and what to do at the time of death. In addition, many bereaved relatives felt that the patient or resident had an unmet need for emotional support and that their own emotional needs were not addressed adequately. The last place of care had the most significant effect on all of these variables, with acute care and residential care having the most unmet needs. Hospice had the fewest unmet needs, followed by the palliative and the intensive care units.

Conclusions

We discuss these findings in relation to overall satisfaction with care, focus on individual, ethno-cultural and diversity issues, information and decision-making, symptom management and attending to the family. We conclude by offering possible practices address the end-of-life needs of patients and family members.

     

Do stress coping strategies influence chronotype-related differences in sleep quality?

Background

Chronotype manifestation often has a broad influence on sleep quality. One possible explanation for daytime impairments in evening types is the concept of “social jetlag”. Social jetlag is caused by an incompatibility between circadian preference and the socially accepted rhythm. This can be declared as a social stressor.

Objective

The association between chronotype, stress coping, and sleep quality was assessed in a pilot study.

Materials and methods

A total of 75 female adults aged 20–41 years participated in the study and completely answered all questions. Various questionnaires including sociodemographic data, information about sleep quality (Pittsburgh Sleep Quality Index, PSQI), chronotype (morningness–eveningness questionnaire, MEQ), and stress coping (Stress Coping Style Questionnaire, SVF78) were applied.

Results

Heightened use of maladaptive coping strategies is associated with a reduction in sleep quality. Chronotypes did not differ in terms of sleep quality and the coping strategies used.

Conclusion

Maladaptive coping strategy use seems to have a negative influence on sleep quality. Preventive education in adaptive stress coping strategies and avoidance of maladaptive stress coping thus seems useful to reduce these adverse influences on sleep quality.

     

Subjektive schlafbezogene Parameter bei Patienten mit Autismus-Spektrum-Störung

Background

Sleep disorders are common in children and adolescents with autism spectrum disorder. Little is known, however, about sleep in adult patients.

Objectives

Cross-sectional analysis of subjective sleep-related parameters in patients with autism spectrum disorder and healthy control participants.

Materials and methods

Twenty-nine patients with autism spectrum disorder and 50 healthy control participants were investigated using a questionnaire battery and sleep diaries. All analyses were controlled for depression and anxiety.

Results

Patients with autism spectrum disorder had more severe insomnia symptoms, stronger dysfunctional beliefs and attitudes about sleep, an increased sleep effort, and a higher cognitive arousal compared to the control group. In addition to this, the sleep diary data showed earlier bedtimes in those with autism spectrum disorder.

Conclusions

In patients with autism spectrum disorder, sleep onset and sleep maintenance difficulties seem to be accompanied by cognitive alterations that are typically observed in insomnia patients. In light of this, it appears to be worthwhile to investigate the efficacy of cognitive behavioral treatment for insomnia in this patient group.

     

Cone beam computed tomographic evaluation of nutrient canals and foramina in the anterior region of the mandible

Purpose

To investigate the incidence and anatomical location of mandibular nutrient canals (NCs) originating from the mandibular canal using dental cone beam computed tomography (CBCT).

Methods

CBCT images from 105 patients were examined to evaluate the presence, number, diameter, and course of NCs.

Results

NCs and their foramina were bilaterally located in 17 (16.2 %) images. The mean diameters of NCs and foramina were 0.9 ± 0.4 (range, 0.2–3.2) mm and 0.9 ± 0.4 (0.2–2.1) mm, respectively. NCs coursed through the mandibular incisor region up to the lingual surface of the alveolar bone crest.

Conclusion

The present study revealed the frequency and distribution of NCs using CBCT image analysis. NCs are important because surgical injury to the neurovascular bundle within these canals can lead to excessive bleeding and postoperative paresthesia. The identification of NC on CBCT images may be useful during the harvesting of bone blocks or placement of endosseous implants in the anterior region of the mandible.

     

Preclinical evaluation of the urokinase receptor-derived peptide UPARANT as an anti-inflammatory drug

Background

Inflammation plays a key role in the pathogenesis of several chronic diseases. The urokinase plasminogen activator receptor (uPAR) exerts a plethora of functions in both physiological and pathological processes, including inflammation.

Objective and design

In this study, we evaluated the anti-inflammatory effect of a novel peptide ligand of uPAR, UPARANT, in different animal models of inflammation.

Subjects and treatment

Rats and mice were divided in different groups (n = 5) for single or repeated administration of vehicle (9% DMSO in 0.9% NaCl), UPARANT (6, 12 and 24 mg/kg) or dexamethasone (2 mg/kg). Animals were subjected to carrageenan-induced paw oedema or zymosan-induced peritonitis.

Methods

UPARANT effects were tested on: (1) the carrageenan-induced paw oedema volume, (2) the expression of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) and the nitrite/nitrate (NOx) levels in the paw exudates, (3) cells recruitment into the peritoneal cavity after zymosan injection and (4) NOx levels in the peritoneal lavage.

Results

UPARANT (12 and 24 mg/kg) reduced inflammation in both experimental paradigms. Analysis of pro-inflammatory enzymes revealed that administration of UPARANT reduced iNOS, COX2 and NO over-production.

Conclusions

Our study provides a solid evidence that UPARANT reduces the severity of inflammation in diverse animal models, thus representing a novel anti-inflammatory drug with potential advantages with respect to the typical steroidal agents.

     

Sleep problems in adolescents with Asperger syndrome or high-functioning autism

Background

Autism is a neurodevelopmental disorder defined by deficits in social interaction, communication, and restricted repetitive behavior. Research studies indicate that children with autism spectrum disorders suffer from more sleep problems than the general population.

Objective

The aim of the study was to investigate sleep problems in adolescents with Asperger syndrome (AS) or high-functioning autism (HFA) and to further examine the association between sleep problems and problem behavior as well as autism symptom severity.

Methods

In this study, 15 adolescents diagnosed with AS or HFA (aged between 10–19 years) and one parent of each answered questions about sleep and sleep disturbances.

Results

A high prevalence of sleep problems (80?%) was found. The most frequently reported sleep problems were insomnia symptoms (80?%) and parasomnias (53?%). More sleep problems were associated with decreased daytime functioning, more precisely with more externalizing problem behavior and a higher autism symptom severity.

Conclusion

The results suggest that sleep problems are common in adolescents with AS or HFA and are connected to lower daytime functioning. Therefore, in clinical practice, individuals should routinely be screened for sleeping difficulties.

     

Prevalence of persistent median artery in carpal tunnel syndrome: sonographic assessment

Purpose

This study investigated the frequency of persistent median artery (PMA) in patients with carpal tunnel syndrome (CTS) and controls.

Methods

A total of 84 CTS patient wrists, and 136 wrists of control subjects without CTS, were examined on ultrasonography (US) and color Doppler US (CDUS), and by electrophysiological evaluations. The frequency of PMA in CTS was evaluated.

Results

Of 84 CTS patient wrists, 2 (2.4 %) had a PMA (both on the right side). Of 136 control wrists, 12 (9 %) had a PMA, which was unilateral in eight (three right and five left), and bilateral in two, cases. There was no significant difference between the CTS patient and control groups with respect to the frequency of PMA (P > 0.05).

Conclusions

There was no significant difference between the CTS patient and control groups in the frequency of PMA. We suggest that an ipsilateral PMA does not increase the risk of CTS.

     

Classification of portal vein tributaries in Thai cadavers including a new type V

Purpose

To compare portal vein tributaries in Thai with Thompson classification.

Methods

In 211 Thai cadavers, abdominal regions were dissected to identify the portal veins and their tributaries. The subjects were classified into types based on modes of drainage of the left gastric and inferior mesenteric veins. Percentages of all types of venous drainage were counted.

Results

There are four types of portal tributaries as defined by Thompson, type I_47.87 %, type II_13.27 %, type III_7.58 %, and type IV_29.86 %. There were 1.42 % of whose inferior mesenteric veins entered the joining angle of the superior mesenteric and splenic veins, and were classified as type V. The left gastric vein mostly drained into the portal vein in 79.15 %, while the inferior mesenteric vein emptied into the splenic vein mainly in 55.45 %.

Conclusions

A new variance of portal tributaries in Thai cadavers is reported. The variations of portal vein formations are critical for liver surgery and interventional radiological procedures.

     

Sleep benefits emotional and neutral associative memories equally

Background

Emotions modulate memory. It has been suggested that sleep contributes to improved memory of emotional events by preferentially consolidating emotional memories, presumably because of a selective off-line reactivation of information relevant to future behavior.

Objectives

We aimed to validate sleep-dependent memory consolidation in a new associative emotional memory paradigm suitable for inducing memory reactivations during sleep. We hypothesized that sleep preferentially might benefit the consolidation of emotional associations independently of their negative vs positive emotional valence.

Methods

Seventy-two healthy young participants performed an associative emotional memory task in either the evening or the morning. During the task, they were asked to associate neutrally spoken words to neutral, negative or positive pictures. Cued recall was tested after a 12-h retention interval filled with either night-time sleep or daytime wakefulness.

Results

Generally, emotional associations were better remembered than neutral ones. However, we were not able to replicate a selective benefit of sleep on emotional memory. Sleep robustly improved the cued recall performance of all picture types compared with wakefulness, without any modulating influence of emotional arousal or valence.

Conclusions

We conclude that the consolidation of explicitly learned associations benefits from sleep, independent of emotional arousal or valence. Selective emotional memory consolidation during sleep may be restricted to non-associative item memory or incidentally learned emotional associations.

     

Hepatic mobilization of zinc after an experimental surgery,and its relationship with inflammatory cytokines release,and expression of metallothionein and Zip14 transporter

Objective

To study the relationship between the release of inflammatory cytokines and mobilization of zinc into liver, and the expression of metallothionein and Zip14 transporter after an abdominal surgery in rats.

Materials

Thirty-five male Wistar rats were subjected to experimental surgical stress, then the subgroups of five animals were killed at 3, 6, 9, 12, 16, 20 and 24 h. Matched groups without surgery were used as controls.

Methods

Zinc levels were determined by AAS, intracellular zinc by zinquin and dithizone staining. Hepatic metallothionein was assayed by a Cd-saturation method, and IL-1β, IL-6, and TNF-β by immunoassays. Zip14 expression was analyzed by real-time RT-PCR, and protein level by immunohistochemistry and Western blot.

Results

Experimental surgery produced a hypozincemia, and the increase of hepatic zinc also produced the release of IL-1β, IL-6 in serum, and the increase of hepatic MT. Histochemistry showed a decrease of free zinc at 3–6 h, but an increase at 9 h (zinquin); meanwhile, total intracellular zinc increased after 9 h (dithizone). RNAm and protein levels of Zip14 were elevated between 6 and 20 h after surgery.

Conclusion

Biochemical changes described in this work could be part of the APR, and directed to respond to the damage produced during surgical trauma.

     

Thymustumoren

Introduction

Thymic tumors including thymomas, thymic carcinomas, and thymic carcinoid tumors are rare tumors with an incidence of 0.13/100,000.

Materials and methods

A literature search was performed to identify recent findings on epidemiology, classification, and various therapeutic approaches.

Results

These tumors with a wide spectrum of histologic and biologic features may be clinically unapparent for a long time or show a very aggressive behavior with local invasion and distant metastases. Surgical resection is the mainstay in stage I and II thymomas, whereas in stage III thymomas and in thymomas with pleural dissemination surgery in context of a multimodal treatment should be discussed. Thymic tumors are chemoreactive. Targeted therapies show poor results and should only be considered in the palliative situation after failure of chemotherapy.

Conclusion

The new TNM (T: tumor, N: node, M: metastasis) classification of thymic tumors will help to identify the best treatment options.

     

The alpha-lipoic acid derivative DHLHZn: a new therapeutic agent for acute lung injury in vivo

Objective and design

An animal experiment was performed to demonstrate the anti-inflammatory effects of an alpha-lipoic acid (ALA) derivative, dihydrolipoyl histidinate zinc complex (DHLHZn) for acute lung injury (ALI) and to investigate the mechanism of action.

Material

Rats were randomly divided into three experimental groups: control group (n = 17), DHLHZn(?) group (n = 11, ALI model rats), and DHLHZn(+) group (n = 12, ALI model rats treated by DHLHZn).

Treatment

Lipopolysaccharides (LPS, 10 mg/kg) were administered intratracheally in the DHLHZn(?) group and the DHLHZn(+) group. For the DHLHZn(+) group, DHLHZn (100 mg/kg) was administered intraperitoneally 2 h prior to LPS administration.

Methods

Four hours after LPS administration, bronchoalveolar lavage fluid (BALF) and lung tissue were collected. The findings were analyzed using the Mann–Whitney U test.

Results

Total number of cells, number of neutrophils and lymphocytes, levels of various inflammatory cytokines, and NF-kB p65 concentration of BALF were significantly lower in the DHLHZn(+) group than in the DHLHZn(?) group (p < 0.05). ALI pathology scores were significantly lower in the DHLHZn(+) group than in the DHLHZn(?) group (p < 0.001).

Conclusions

Anti-inflammatory effects of DHLHZn for ALI were demonstrated by BALF and histopathological findings. The mechanism of action of DHLHZn was considered to be via inhibition of the NF-kB signaling pathway. DHLHZn is thus suggested to be a new prophylactic agent for ALI.