Quality of life of adolescents with type 1 diabetes

INTRODUCTION:

Diabetes mellitus is a highly prevalent chronic disease. Type 1 diabetes mellitus usually develops during infancy and adolescence and may affect the quality of life of adolescents.

OBJECTIVE:

To evaluate the quality of life of adolescents with type 1 diabetes mellitus in a metropolitan region of western central Brazil.

METHODS:

Adolescents aged 10–19 years who had been diagnosed with type 1 diabetes mellitus at least 1 year previously were included. Patients with verbal communication difficulties, severe disease, and symptomatic hypo- or hyperglycemic crisis as well as those without an adult companion and who were <18 years of age were excluded. The self-administered Diabetes Quality of Life for Youths instrument was applied.

RESULTS:

Among 96 adolescents (57% females; 47% white, and 53% nonwhite), 81% had an HbA1c level of >7%. In general, the adolescents consistently reported having a good quality of life. The median scores for the domains of the instrument were as follows: “satisfaction”: 35; “impact”: 51; and “worries“: 26. The total score for all domains was 112. Bivariate analysis showed significant associations among a lower family income, public health assistance, and insulin type in the “satisfaction” domain; and a lower family income, public health assistance, public school attendance, and a low parental education level in the “worries“ domain and for the total score. A longer time since diagnosis was associated with a lower total score. Multivariable analysis confirmed the association of a worse quality of life with public health assistance, time since diagnosis, and sedentary lifestyle in the “satisfaction” domain; female gender in the “worries” domain; and public health assistance for the total score.

CONCLUSIONS:

Overall, the adolescents evaluated in this study viewed their quality of life as good. Specific factors that led to the deterioration of quality of life, including public assistance, time since diagnosis, sedentary lifestyle, and female gender, were identified.     

How could depression guidelines be made more relevant and applicable to primary care?: A quantitative and qualitative review of national guidelines

Background

Many guidelines have been developed in the area of depression but there has been no systematic assessment of their relevance to general practice.

Aim

To assess national guidelines on general practice management of depression using two complementary approaches to identify specific ways in which guidance could be made more relevant and applicable to the nature of general practice and the patients who seek help in this context.

Design of study

Review of national guidelines.

Setting

Seven English speaking countries: UK, US, Australia, New Zealand, Ireland, Canada, and Singapore.

Method

Seven guidelines were independently reviewed quantitatively using the Appraisal of Guidelines for Research and Evaluation (AGREE) scores and qualitatively using thematic coding.

Results

The quantitative assessment highlights that most of the guidelines fail to meet the criteria on rigour of development, applicability, and editorial independence. The qualitative assessment shows that the majority of guidelines do not address associated risk factors sufficiently and the dilemma of diagnostic uncertainty flows over into management recommendations. Management strategies for depression (antidepressants and psychological strategies) are supported by all of the guidelines, with several listing drugs before psychological therapies; there is limited attention paid to the different types of psychological therapies. Moreover, the guidelines in the main fail to acknowledge individual patient circumstances, in particular the influence on response to treatment of social issues such as adverse life events or social support.

Conclusion

Assessments of current national guidelines on depression management in general practice suggest significant limitations in their relevance to general practice.     

Social Support Patterns of Collegiate Athletes Before and After Injury

Context:

Social support has been identified as an important factor in facilitating recovery from injury. However, no previous authors have prospectively assessed the change in social support patterns before and after injury.

Objective:

To examine the preinjury and postinjury social support patterns among male and female collegiate athletes.

Design:

Prospective observational study.

Setting:

A Big Ten Conference university.

Patients or Other Participants:

A total of 256 National Collegiate Athletic Association Division I male and female collegiate athletes aged 18 or older from 13 sports teams.

Main Outcome Measure(s):

Injury incidence was identified using the Sports Injury Monitoring System. Social support was measured using the 6-item Social Support Questionnaire. Data on preinjury and postinjury social support patterns were compared.

Results:

Male athletes reported more sources of social support than female athletes, whereas female athletes had greater satisfaction with the support they received. Athletes'' social support patterns changed after they became injured. Injured athletes reported relying more on coaches (P  =  .003), athletic trainers (P < .0001), and physicians (P  =  .003) for social support after they became injured. Athletes also reported greater postinjury satisfaction with social support received from friends (P  =  .019), coaches (P  =  .001), athletic trainers (P < .0001), and physicians (P  =  .003).

Conclusions:

Our findings identify an urgent need to better define the psychosocial needs of injured athletes and also strongly suggest that athletic trainers have a critical role in meeting these needs.     

The Ume? University Database of Facial Expressions: A Validation Study

Background

A set of face stimuli, called the Umeå University Database of Facial Expressions, is described. The set consists of 30 female and 30 male models aged 17–67 years (M = 30.19, SD = 10.66). Each model shows seven different facial expressions (angry, surprised, happy, sad, neutral, afraid, and disgusted). Most models are ethnic Swedes but models of Central European, Arabic, and Asian origin are also included.

Objective

Creating and validating a new database of facial expressions that can be used for scientific experiments.

Methods

The images, presented in random order one at a time, were validated by 526 volunteers rating on average 125 images on seven 10-point Likert-type scales ranging from “completely disagree” to “completely agree” for each emotion.

Results

The proportion of the aggregated results that were correctly classified was considered to be high (M = 88%).

Conclusions

The results lend empirical support for the validity of this set of facial expressions. The set can be used freely by the scientific community.     

Self-reported differences in empowerment between lurkers and posters in online patient support groups

Background

Patients who visit online support groups benefit in various ways. Results of our earlier study indicated that participation in online support groups had a profound effect on the participants’ feelings of “being empowered.” However, most studies of online patient support groups have focused on the members of these groups who actively contribute by sending postings (posters). Thus far, little is known about the impact for “lurkers” (ie, those who do not actively participate by sending postings).

Objective

In the present study, we explored if lurkers in online patient support groups profit to the same extent as posters do.

Methods

We searched the Internet with the search engine Google to identify all Dutch online support groups for patients with breast cancer, fibromyalgia, and arthritis. Invitations to complete an online survey were sent out by the owners of 19 groups. In the online questionnaire, we asked questions about demographic and health characteristics, use of and satisfaction with the online support group, empowering processes, and empowering outcomes. The online questionnaire was completed by 528 individuals, of which 109 (21%) identified themselves as lurkers.

Results

Lurkers (mean age 47 years) were slightly older than active participants (mean age 43 years, P = .002), had a shorter disease history (time since diagnosis 3.7 years vs 5.4 years, P = .001), and reported lower mental well-being (SF 12 subscore 37.7 vs 40.5, P = .004). No significant differences were found in other demographic variables. Posters indicated visiting the online support groups significantly more often for social reasons, such as curiosity about how other members were doing, to enjoy themselves, as a part of their daily routine (all P < .001), and because other members expected them to be there (P = .003). Lurkers and posters did not differ in their information-related reasons for visiting the online support group. Lurkers were significantly less satisfied with the online support group compared to posters (P < .001). With regard to empowering processes such as “exchanging information” and “finding recognition,” lurkers scored significantly lower than posters. However, lurkers did not differ significantly from posters with regard to most empowering outcomes, such as “being better informed,” “feeling more confident in the relationship with their physician,” “improved acceptance of the disease,” “feeling more confident about the treatment,” “enhanced self-esteem,” and “increased optimism and control.” The exception was “enhanced social well-being,” which scored significantly lower for lurkers compared to posters (P < .001).

Conclusion

Our study revealed that participation in an online support group had the same profound effect on lurkers’ self-reported feelings of being empowered in several areas as it had on posters. Apparently, reading in itself is sufficient to profit from participation in an online patient support group.     

Effects of the economic crisis and social support on health-related quality of life: first wave of a longitudinal study in Spain

Background

Economic recession affects quality of life by increasing rates of mental disorders in particular. Social support can be an important protective factor.

Aim

To estimate the impact of being personally affected by an economic crisis on health-related quality of life (HRQoL), taking into account the possible buffering effect of perceived social support.

Design and setting

Data from the first wave (March 2012 to November 2012) of the ‘Social Support and Quality of Life Study’, a longitudinal study carried out in a primary health care centre in a deprived neighbourhood of Barcelona, Spain.

Method

A total of 143 participants were assessed using the 12-item Short-Form Health Survey, the List of Threatening Experiences and the Duke Social Support scales. The effect of economic crisis on mental and physical HRQoL was assessed using ordinary least squares regression models to test the interaction between social support and having experienced an economic crisis.

Results

There was no statistical association between having suffered an economic crisis and physical HRQoL. The interaction between social support and economic crisis was also tested without finding any statistical association. An interaction was detected between social support and economic crisis in relation to mental HRQoL; those who had low levels of social support and had also experienced an economic crisis had the lowest levels of mental HRQoL.

Conclusion

Social support constitutes a safety net that offers protection against the adverse effect of economic recessions on mental health. Primary care professionals are in a key position to promote social activities and to strengthen social networks in the community.     

Insomnia,Depression, and Physical Disorders in Late Life: A 2-year Longitudinal Community Study in Koreans

Study Objectives:

To investigate prevalence, incidence, and persistence of insomnia, and their bidirectional longitudinal associations with depression and physical disorders.

Design:

A community based longitudinal study.

Setting:

Elders living in private households in South Korea.

Participants:

1204 people ≥ 65 years of age were evaluated at baseline; 909 of them (75%) were re-interviewed after 2 years.

Measurements and Results:

Insomnia was defined as difficulty in initiation or maintenance of sleep ≥ 3 nights per week over the last month. Diagnosis of depression (Geriatric Mental State) and number of physical disorders were ascertained. Sociodemographic and clinical covariates included age, gender, education, housing, past occupation, current employment, living area, life events, social deficit, physical activity, cognitive impairment, anxiety, and daily drinking. Of those (27%) with insomnia at baseline, 40% had insomnia at follow-up. Of those without insomnia at baseline, 23% had insomnia at follow-up. Baseline depression was significantly associated with prevalence and incidence of insomnia. Baseline number of physical disorders was significantly associated with prevalence, incidence, and persistence of insomnia. Baseline insomnia was independently associated with incident depression and an increase in reported physical disorders.

Conclusions:

Insomnia was common and often persistent in this population. Insomnia was closely and reciprocally related to depression and physical disorders.

Citation:

Kim JM; Stewart R; Kim SW; Yang SJ; Shin IS; Yoon JS. Insomnia, depression, and physical disorders in late life: a 2-year longitudinal community study in Koreans. SLEEP 2009;32(9):1221-1228.     

A real-life study of the effectiveness of different pharmacological approaches to the treatment of smoking cessation: re-discussing the predictors of success

OBJECTIVE:

To evaluate the effectiveness of nicotine replacement therapy (NRT), bupropion, nortriptyline and combination therapy and describe factors associated with treatment success.

INTRODUCTION:

Clinical trials clearly demonstrate the efficacy of pharmacotherapy in smoking cessation. However, it is only after its use in real‐life settings that clinical effectiveness and limitations of a treatment are fully known.

METHODS:

Patients attended a four‐session cognitive‐behavioral program and received medicines free of charge. Abstinence from smoking was assessed at each visit.

RESULTS:

A total of 868 smokers (68.8% women) were included. Their mean age was 49.6 years; the amount smoked was 25 cigarettes/day and the Fagerström Score was 6.6. Abstinence rates after 6 months and 1 year were 36.5% and 33.6%. In univariate analysis, male gender, age (>50), higher number of cigarettes smoked, cardiovascular comorbidities, longer interval from the last cigarette and combined treatment of nortriptyline plus NRT were predictive of abstinence, while neuropsychiatric comorbidities and the answer “yes” to the question “Do you smoke more often during the first hours after waking” were correlated with failure. In a multivariate model, predictors of abstinence were neuropsychiatric comorbidities, the answer “yes” to the question “Do you smoke more often during the first hours after waking” and combined treatment of nortriptyline plus NRT. Male gender and a longer period from the last cigarette were correlated with lower abstinence rate.

CONCLUSION:

Satisfactory success rates were obtained in a teaching hospital. Factors such as age, daily cigarette consumption, number of pack‐years and dependency score were not reliable markers of abstinence. The combination nortriptyline+NRT was independently associated with higher abstinence rates.     

Anxiety and depression among North Korean young defectors in South Korea and their association with health-related quality of life

Purpose

This study examined anxiety and depression among 108 North Korean adolescent and young adult (age, 12-29 years) defectors who settled in South Korea, and evaluated the relationship between their mental health and health-related quality of life (HRQoL).

Materials and Methods

Subjects completed a questionnaire that included the Hospital Anxiety and Depression Scale (HADS), the Short Form with 36 questions (SF-36; consists of mental and physical health components) for measuring HRQoL, and items related to the period of time since defection and settlement and socio-demographic variables.

Results

Among the participants, 53.7% scored≥8 on the anxiety measure questionnaire, and 22.2% scored≥11; 36.1% of the participants scored≥8 on the depression measure questionnaire and 14.8% scored≥11. Both anxiety and depression subscales were associated with lower scores of total SF-36, physical component and mental component score. Depressive symptom appeared more frequently among the subjects who had lived in South Korea for <1 year than among the subjects who had lived in South Korea for 2 year or longer (odds ratio=3.77, 95% confidence intervals=1.12 to 12.70).

Conclusion

Among North Korean adolescent and young adult defectors, anxiety and depression were associated with lower HRQoL. Therefore, it is needed to develop strategies to screen for mental health and intervene to reduce anxiety and depression during their early resettlement stage.     

Quality of life in rectal cancer patients with permanent colostomy in Xi'an

Objectives

To observe the quality of life (QOL) in rectal cancer patients with permanent colostomy in different periods after operation.

Methods

A 1-,3-,6-month prospective study of QOL in 51 rectal cancer patients with permanent colostomy and 50 without permanent colostomy was assessed using European Organization for Research and Treatment of Cancer (EORTC) QOL-30 and CR38 questionnaires.

Results

The variation of QOL in different periods was “v” type. In the 1st postoperative month, these patients had the lowest quality of life scores, accompanied significantly varied functions and severe symptoms. Almost of all indexes of these patients had improved consistently in the postoperative period. The scores of global QOL even better than pre-operative level at 6th months post-operation, but the social function, body image, chemotherapy side effects and financial difficulties had not restored to the baseline level. Patients without permanent colostomy had a better score in most of categories of QOL-30 and CR38.

Conclusions

The 1st postoperative month was crucial for patients'' recovery, in which we should pay great attention to these problems which relate to the recovery of rectal cancer patients with permanent colostomy.     

Mental health and health-related quality of life in Croatian island population

Aim

To explore differences in self-perceived health as an indicator of health status and mortality, in six isolated populations from Croatian islands and to compare the results with control from general Croatian population obtained through the National Health Survey.

Method

Health-related quality of life was measured using the Short Form Health Status Questionnaire (SF-36). The questionnaire was administered to 600 participants, inhabitants of 6 villages: Rab, Barbat, Lopar, and Supetarska Draga on island Rab, and Komiža and Vis, on island Vis, and to control group of 600 participants from the general Croatian population matched by age and gender to islanders.

Results

The islanders scored higher than controls on 3 out of 8 health dimensions, physical functioning (80.1 ± 22.4 vs 73.2 ± 24.8, P<0.001), vitality (61.0±20.3 vs 55.7 ± 19.9, P<0.001), and pain (70.1 ± 28.0 vs 65.9 ± 26.5, P = 0.008). Social functioning of islanders was significantly lower than in control group (73.4 ± 18.6 vs 77.6 ± 23.4, P = 0.001). There was also a significant variation in health status among the islanders according to the isolation level, with the largest differences in general health perception and mental health. High isolation group reported the lowest score of all groups on mental health (P = 0.018), physical functioning (P = 0.045), general health (P = 0.001), and vitality dimension (P = 0.027).

Conclusion

Inhabitants of Croatian islands in general showed better health-related functioning on the most of the health dimensions than general population. Islanders scored lower than controls only on social functioning which can be explained by their geographical isolation and small population. Low mental health score of islanders in the high isolation group should be taken in account in planning health services for islands.Research dealing with environmental and cultural issues has mainly been focused on urban life. Little attention has so far been paid to the quality of life parameters on remote or geographically isolated areas such as islands, where lifestyle is affected mostly by geographical conditions.There are two important characteristics of the lifestyle in remote islands or geographically isolated communities: a) medical health care is usually insufficient and b) there are few opportunities for personal growth of inhabitants due to limited interaction with new stimuli (1). Geographical environment and social and health needs of the island population require a specific type of health care, the implementation of which demands investment of considerably larger financial resources. On the other hand, islands and isolated areas are places with many positive lifestyle aspects, such as clean and healthy environment (no smoke or noise, proximity to the sea or the mountains), and less hassle and stress in life (easier transportation, more free time, less competition, well known social environment). The inhabitants of Dalmatian islands represent an exceptional example of rare, genetically isolated groups residing in the contemporary Europe (2). The geographical specificity induced development of a number of isolated groups, each exhibiting specific social and health-related phenomenon. As a direct result of isolation, several genetic disorders have emerged (3-7). Isolate island populations provide a valuable resource for health research. They not only allow investigations that improve our understanding of unique and rare genetic disorders, but can also contribute to a better understanding of common diseases that are important contributors to the burden of disease globally. An example is the research in the population of Sardinia, which showed that 12% of the inhabitants carry beta thalassemia-predisposing mutations in the beta globin gene; it was subsequently shown that beta thalassemia carriers have 25% lower plasma low density lipoprotein (LDL) than the non-carriers (8). In contrast to various anthropological and genetic analyses, there have been little or no investigations of the health-related quality of life in such populations (9).Health-related quality of life refers to the personal sense of physical and mental health and the ability to react to factors in the physical and social environments. It is more subjective than life expectancy and therefore is more difficult to measure. A self-administered health status questionnaire gives us subjective assessments of health for both individual persons and entire communities. These measures capture individuals’ subjective assessment of their health through examining various health domains, such as physical, psychological and role function. In both clinical and public health settings, subjective perceptions of health have often greater saliency for functioning and survival than do physiologic and clinical assessments. Global assessments, in which a person rates his or her health as “poor,” “fair,” “good,” “very good,” or “excellent,” can serve as reliable indicators of one’s perceived health (10). Subjective measures of health status have been advocated as a useful proxy for objective measures. In some studies the question about global self rated health has been found to be a powerful predictor of the mortality within a targeted population group (11). Since self-perceived health represents an important indicator of health status and morbidity, the aim of this study was to explore differences in self-perceived health in 6 isolated communities on Croatian islands. The results were compared with Croatian data from National Health Survey 2003 (12). According to the characteristics of Croatian island population, it is to be expected that the specificity of isolated populations will be reflected in the self-perceived physical and mental health as well in the indicators of social functioning of individuals.     

Pediatric HIV/AIDS in sub-Saharan Africa: emerging issues and way forward

Background

Sub-Saharan Africa has the largest burden of pediatric HIV in the world. Global target has been set for eradication of pediatric HIV by 2015 but there are still so many complex issues facing HIV infected and affected children in the sub-continent.

Objective

To review the current and emerging challenges facing pediatric HIV care in sub-Saharan Africa; and proffer solutions that could help in tackling these challenges.

Method

A Medline literature search of recent publications was performed to identify articles on “pediatric HIV”, “HIV and children”, “HIV and infants”, “HIV and adolescents” in sub-Saharan Africa.

Result

There are a number of challenges and emerging complex issues facing children infected and affected by HIV in sub-Saharan Africa. These include late presentation, limited access to pediatric HIV services, delayed diagnosis, infant feeding choices, malnutrition, limited and complex drug regimen, disclosure, treatment failure and reproductive health concerns. A holistic cost effective preventive, diagnostic and treatment strategies are required in order to eliminate pediatric HIV in SSA.

Conclusion

HIV infected children and their families in sub-Saharan Africa face myriad of complex medical and psychosocial issues. A holistic health promotional approach is being advocated as the required step for eradication of pediatric HIV in Africa.     

Suicide in urban Kampala, Uganda: a preliminary exploration

Background

Suicide was investigated in the urban setting of Kampala, Uganda.

Objectives

Firstly, to explore the use of two research methodologies, a retrospective review of patient records and the psychological autopsy methodology in suicide research in Uganda. Secondly to investigate the characteristics and correlates of urban suicide in Uganda.

Results

A male to female ratio of suicide of 3.4:1 and a peak age of suicide in the 20–39 years age group were found. The main methods of suicide were hanging and ingestion of poison (organophosphates). Problems with social networks, negative life events, higher psychological distress and lower quality of life were associated with suicide at univariate analysis. It was only psychological distress that retained significance at multivariate analysis.

Conclusion

The retrospective review of records at Mulago hospital was beset by incomplete records whereas a pilot psychological autopsy study was well accepted and might contribute valuable data in African settings.     

Depression and conservative surgery for breast cancer

BACKGROUND:

Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer.

OBJECTIVE:

To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction.

METHODS:

Seventy‐five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25) or without breast reconstruction (n = 25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the χ² test.

RESULTS:

There were no significant differences between groups in age (p = 0.72) or educational level (p = 0.20). A smaller number of patients had undergone the menopause (p = 0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (χ² = 9.97; p = 0.126).

CONCLUSION:

Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed.     

Polysomnographic Values In Children Undergoing Puberty: Pediatric Vs. Adult Respiratory Rules in Adolescents

Study Objectives:

Polysomnographic respiratory events in children should be scored using pediatric respiratory rules. However, due to a lack of data on adolescents, recently revised rules allow children aged 13–18 years to be scored by adult or pediatric criteria. To clarify which criteria to use, we describe the evolution of respiratory events with Tanner stage, and we compare events in children aged 13–18 years with the new American Academy of Sleep Medicine adult and pediatric respiratory rules.

Design:

Cross-sectional

Setting:

Academic hospital

Participants:

Healthy subjects aged 8–18 years recruited for research purposes

Interventions:

Physical examination to determine Tanner stage, overnight polysomnogram, and determination of sex hormones.

Results:

Sixty-eight subjects (Tanner 1–5) were studied, mean age [SD] = 13 ± 3 years, median apnea hypopnea index (AHI) = 0.1 (range: 0–1.2)/h. The median percentages of total sleep time (TST) with SpO₂ < 92% were 0.1 (0–4.2)%, and with end-tidal CO₂ > 50 torr was 0.1 (0–88.6)%. Thirty-two subjects were aged 13–18 years, (Tanner 3–5). The difference between AHI scored by pediatric (median = 0 [0–0.9]/h) and adult (median = 0 [0 – 0.5]/h) criteria was statistically significant (P = 0.043), but not clinically relevant.

Conclusions:

Respiratory events in normal children aged 8–18 years are rare and unrelated to Tanner stage. Adult or pediatric respiratory rules can be used for scoring polysomnograms in asymptomatic subjects approaching adulthood. Further studies are needed in symptomatic children within this age group.

Citation:

Tapia IE; Karamessinis L; Bandla P; Huang J; Kelly A; Pepe M; Schultz B; Gallagher P; Brooks LJ; Marcus CL. Polysomnographic values in children undergoing puberty: pediatric vs. adult respiratory rules in adolescents. SLEEP 2008;31(12):1737–1744.     

A comparison of insomnia and depression as predictors of disability pension: the HUNT Study

Study Objectives:

Depression and insomnia are common and frequently comorbid. Unlike the priority now accorded to depression, insomnia is comparatively ignored as a reason for impaired occupational functioning. The objective of this study was to compare their relative impact upon medically certified disability pension award.

Design:

Historical cohort study

Setting:

Data from a population-based health survey in Nord-Trøndelag County in Norway (HUNT-2) was linked with a comprehensive national social security database.

Participants:

Participants within working age (20-66 years of age) not claiming disability pension (N = 37,302).

Interventions:

N/A

Measurements and Results:

We compared complaints of insomnia and depression as predictors of disability pension award 18–48 months after a health survey. Insomnia complaints and depression each were similarly associated with disability pension award after adjustment for multiple health and sociodemographic factors, with similar odds ratios (1.66 [1.37–2.01] and 1.56 [1.24–1.96] respectively). Comorbidity did not contribute to disability beyond that expected from each condition. Taking the higher prevalence of insomnia complaints into account, insomnia complaints contributed as much or even more than depression to work-related disability.

Conclusions:

Depression is regarded as a major contributor to work disability and is increasingly the primary diagnosis in disability pension award. Our results suggest that although rarely reported in official registries of disability pension causes, insomnia has an equally important and independent role, particularly among the younger group. This suggests that this potentially treatable factor has considerable economic impact and should receive more attention in clinical and public health management.

Citation:

Overland S; Glozier N; Sivertsen B; Stewart R; Neckelmann D; Krokstad S; Mykletun A. A Comparison of Insomnia and Depression as Predictors of Disability Pension: The HUNT Study. SLEEP 2008;31(6):875-880.     

Using metrics to describe the participative stances of members within discussion forums

Background

Researchers using forums and online focus groups need to ensure they are safe and need tools to make best use of the data. We explored the use of metrics that would allow better forum management and more effective analysis of participant contributions.

Objective

To report retrospectively calculated metrics from self-harm discussion forums and to assess whether metrics add to other methods such as discourse analysis. We asked (1) which metrics are most useful to compare and manage forums, and (2) how metrics can be used to identify the participative stances of members to help manage discussion forums.

Methods

We studied the use of metrics in discussion forums on self-harm. SharpTalk comprised five discussion forums, all using the same software but with different forum compositions. SharpTalk forums were similar to most moderated forums but combined support and general social chat with online focus groups discussing issues on self-harm. Routinely recorded time-stamp data were used to derive metrics of episodes, time online, pages read, and postings. We compared metrics from the forums with views from discussion threads and from moderators. We identified patterns of participants’ online behavior by plotting scattergrams and identifying outliers and clusters within different metrics.

Results

In comparing forums, important metrics seem to be number of participants, number of active participants, total time of all participants logged on in each 24 hours, and total number of postings by all participants in 24 hours. In examining participative stances, the important metrics were individuals’ time logged per 24 hours, number of episodes, mean length of episodes, number of postings per 24 hours, and location within the forum of those postings. Metric scattergrams identified several participative stances: (1) the “caretaker,” who was “always around,” logged on for a much greater time than most other participants, posting but mainly in response to others and rarely initiating threads, (2) the “butterfly,” who “flitted in and out,” had a large number of short episodes, (3) two “discussants,” who initiated many more discussion threads than anybody else and posted proportionately less in the support room, (4) “here for you,” who posted frequently in the support room in response to other participants’ threads, and (5) seven “people in distress,” who posted many comments in the support room in comparison with their total postings and tended to post on their own threads.

Conclusions

Real-time metrics may be useful: (1) by offering additional ways of comparing different discussion forums helping with their management, and (2) by identifying participative stances of individuals so allowing better moderation and support of forums, and more effective use of the data collected. For this to happen, researchers need to publish metrics for their discussion forums and software developers need to offer more real-time metrics facilities.     

Clinical “case series”: a concept analysis

Objectives

To analyze the concept of “case series” in the medical literature compared with case reports.

Methods

A PubMed search for articles published during 2009 which had “case series” in their title was performed. A total number of 621 articles were retrieved. 586 papers were included in the analysis and 35 were excluded (18 were commentary letters, 5 were not in English, and twelve could not be retrieved by our Library). The number of patients and category of these articles were analyzed.

Results

The median (range) of the number of cases of articles having “case series” in their title was 7 (1–6432) cases. 186/ 586 articles had less than 5 cases (31.7%, 95% CI (28.3–35.1%)). The median (range) of the number of cases of articles having “case report” as their publication type was 4 (1–178) cases. Out of the 219 articles categorized as case reports 114 (52.1%, 95% CI (45.6–58.6%)) had less than five cases.

Conclusions

The concept of “case series” is not well defined in the literature and does not reflect a specific research design. We suggest that a case series should have more than four patients while four paitents or less should be reported individually as case reports.