Choice and the Placebo Effect: A Meta-analysis

Background Choice has been proposed as a method of enhancing placebo effects. However, there have been no attempts to systematically evaluate the magnitude, reliability, and moderators of the influence of choice on the placebo effect. Purpose To estimate the effect size of choice on the placebo effect and identify any moderators of this effect. Methods Web of Science, PsycINFO, EMBASE, and PubMed were systematically searched from inception to May 2021 for studies comparing placebo treatment with any form of choice over its administration (e.g., type, timing) to placebo treatment without choice, on any health-related outcome. Random-effects meta-analysis was then used to estimate the effect size associated with the influence of choice on the placebo effect. Meta-regression was subsequently employed to determine the moderating effect of factors such as type of choice, frequency of choice, and size of the placebo effect without choice. Results Fifteen independent studies (N = 1,506) assessing a range of conditions, including pain, discomfort, sleep difficulty, and anxiety, met inclusion criteria. Meta-analysis revealed that choice did significantly enhance the placebo effect (Hedges’ g = 0.298). Size of the placebo effect without choice was the only reliable moderator of this effect, whereby a greater effect of choice was associated with smaller placebo effects without choice. Conclusions Treatment choice can effectively facilitate the placebo effect, but this effect appears more pronounced in contexts where the placebo effect without choice is weaker. Because most evidence to date is experimental, translational studies are needed to test whether providing choice in clinical scenarios where placebo effects are weaker may help boost the placebo effect and thereby improve patient outcomes.

Post-traumatic Stress Disorder Symptoms and Quality of Life of COVID-19 Survivors at 6-Month Follow-Up: A Cross-Sectional Observational Study

Background: Post-traumatic stress disorder (PTSD) is the most common psychiatric sequelae among novel coronavirus disease (COVID-19) patients. The aim of this study was to determine the prevalence of PTSD symptoms, PTSD-related factors, and its relationship with quality of life at long-term follow-up in hospitalized COVID-19 survivors.Methods: A cross-sectional study was undertaken to evaluate the health consequences of hospitalized COVID-19 survivors. All participants were interviewed face-to-face through a series of questionnaires: a researcher-developed symptom questionnaire, the Post-traumatic Stress Disorder Checklist–Civilian Version, the Generalized Anxiety Disorder 7-item, and the 36-item Short Form.Results: A total of 574 participants were enrolled with an average age of 57 years. The median follow-up time post-discharge was 193.9 days (SD = 15.32). Among the participants, 77.9% of survivors presented with at least one symptom, where fatigue or muscle weakness (47.9%) was reported the most frequently, followed by chest distress (29.4%) and sleep difficulty (29.4%). The prevalence of PTSD was 11.15% [95% confidence interval (CI): 8.56, 13.73] with a cut-off score of 44. Factors such as respiratory symptoms [odds ratio (OR): 3.53; 95% CI: 1.68–7.42], anxiety (OR: 14.64; 95% CI: 7.09–30.21), and sleep difficulty (OR: 2.17; 95% CI: 1.14–4.16) were positively related to PTSD. Those COVID-19 survivors with potential PTSD had significantly lower quality of life than those without (P < 0.05).Conclusion: Our study illustrated that a significant number of COVID-19 survivors were suffering from physical or mental distress to varying degrees at 6 months post-discharge. People with PTSD were more likely to experience persistent respiratory symptoms and sleep difficulty, as well as anxiety and a decreased quality of life. Such survivors require greater attention to their mental health, particularly the PTSD symptoms at the early phase, which may play an important role in the recovery of both the physical and psychological health of COVID-19 survivors.

What Could Interfere with a Good Night’s Sleep? The Risks of Social Isolation, Poor Physical and Psychological Health among Older Adults in China

This study provides one of the first population-based investigations of the longitudinal association between social isolation and sleep difficulty among older adults in China. We analyzed three waves of longitudinal data from the China Longitudinal Aging Social Survey (2014–2018), in which 8456 respondents contributed 16,156 person-year observations. Results from multilevel logistic regression models showed that social isolation was related to a higher risk of sleep difficulty. We also found that socially isolated older adults were more likely to report higher levels of depressive symptoms, a greater prevalence of loneliness and pain, and more chronic diseases compared to their socially integrated counterparts, which in turn increased their risks of sleep difficulty. Moreover, socially isolated older adults with chronic diseases were particularly vulnerable to the risk of sleep difficulty. These findings provide helpful guidance for policymakers and practitioners to design effective intervention strategies to help older adults with sleep problems.

What are People That Seek Care for Rotator Cuff Tendinopathy Experiencing in Their Daily Life?

This qualitative study sought to answer three questions: What is it like to live with rotator cuff tendinopathy? What are the barriers and facilitators of a healthy lifestyle with an aging shoulder? And, what are the outcomes that matter most to people seeking care for rotator cuff tendinopathy? Patients diagnosed with rotator cuff tendinopathy participated in group discussions using semi-structured guides that focus on diagnosis, daily experiences living with rotator cuff tendinopathy, goals, concerns, and clinical care experiences. A hybrid of initial inductive coding of themes and subsequent deductive consideration of these themes within the capability, comfort, and calm framework was utilized. Themes associated with rotator cuff tendinopathy were less restful sleep, difficulty with work and life transitions, loss of baseline abilities, and limitation in social roles in the capability realm; physical pain, despair, and loneliness in the comfort realm; and lack of direction or progress and feeling uncared for in the calm realm. Barriers identified included: the sense that rotator cuff tendinopathy is something correctable rather than age-associated and the sense that painful activities will make the tendinopathy worse (common misconceptions); tenuous relationships and limited trust with clinicians; loss of hope; and a sense that care is directionless. What matters most to a person seeking specialty care for shoulder pain are feeling that they are getting effective care and not being dismissed; maintaining meaningful activity and life roles; and replacing despair and frustration with hope and progress. Anticipating these needs may facilitate the design of more effective care models. Level of Evidence: N/A.

The “Sleep Well, Lincolnshire” Project: Evaluation of an Online Sleep Practitioner Clinic

Objectives: Poor sleep is associated with adverse outcomes during childhood. Behavioral insomnia is the most common sleep difficulty experienced by children. The coronavirus disease 2019 (COVID-19) global pandemic in 2020 has profoundly affected children’s sleep patterns. This project aimed to evaluate a one-toone sleep service delivered via online clinics by community sleep practitioners in the UK.Methods: This was an observational pre- and post-evaluation study over a 12-month period. The intervention derived from aspects of cognitive-behavioral therapy for insomnia. The evaluation was questionnaire-based and assessed sleep parameters and well-being.Results: 104 parents returned completed questionnaires. The average time of sleep onset was 1 hour and 39 minutes pre-intervention and 20 minutes post-intervention. The average number of nights per week that children woke up was 3.9 pre-intervention and 0.9 post-intervention; the number of night awakenings fell from 1.9 to 0.5 and the time that children were awake after sleep onset fell from 66.8 minutes to 5.8 minutes. The average time that children were asleep was 8.0 hours per night pre-intervention and 10.2 hours post-intervention. The improvement in all sleep parameters was statistically significant (p<0.05). All parameters of parental and children’s well-being improved significantly (p<0.05), except for perceived ability to drive (p=0.07). All parents stated that they would recommend sleep support and 20% already had done so.Conclusions: The COVID-19 pandemic has accelerated the development of remote health care solutions, and in the case of children’s sleep clinics, the online mode of intervention delivery that is as effective, acceptable, and accessible as face-to-face delivery.

Exploring the clinical usefulness of an electronic diary in fibromyalgia patients: A pilot study

This study examines the usefulness of an electronic diary (ED) in the monitoring of clinical manifestations of fibromyalgia (FM), compared to traditional pencil-and-paper self-reports. Fourteen women with FM completed an interview, several questionnaires, and an ED for a week (several times a day) recording pain, fatigue, sleep, difficulty in thinking, emotional distress, difficulty in daily functioning, and coping with the disease, and stress. There were no differences in the symptoms throughout the moments of the day, observing a sleep latency of 45.36 minutes and sleep duration of 6.25 hours. Significant correlations were found between ED measures depending on the time of day, and between ED measures and questionnaires. The ED showed to be useful for the evaluation of FM symptomatology, and can be a key component in psychological intervention programs.

Social Isolation and Sleep Quality of Older Adults in China: Do Family and Friendship Isolation Differ?

This study provides one of the first population-based studies investigating associations between social isolation, especially its two sub-dimensions (family isolation and friendship isolation), and sleep quality among older adults in China. We address three major research questions: 1) Does the risk of poor sleep quality vary by social isolation status? 2) Are the associations between social isolation and sleep quality mediated by mental disorders (depressive symptoms and loneliness) and physical impairments (pain and comorbidity)? and 3) Does the isolation from family members and friends differ in explaining sleep quality? We analyzed data from the 2014 wave of the China Longitudinal Aging Social Survey (CLASS), in which 7,597 respondents (aged 60-98) had complete information on measures of sleep quality (self-rated sleep difficulty), social isolation (using the Lubben Social Network Scale), and other analytical variables. Logistic regression models were estimated to predict the risk of sleep difficulty and Karlson-Holm-Breen (KHB) decomposition method was employed to test potential mediating effects. Results showed that social isolation, both family and friendship isolation, was significantly associated with higher risks of having sleep difficulty. The adverse effect of family isolation was found to be stronger than that of friendship isolation. Although both mental disorders and physical impairments mediated significant shares of associations between social isolation and sleep quality, physical impairments explained a lesser extent of them than mental disorders. These findings will be helpful for health policymakers and practitioners to design effective intervention strategies to help older adults with sleep problems.

Rural/Urban Differences in Sleep Disorders Among Older Adults in Ghana

Sleep plays a significant role in the maintenance of the body, and experiences of sleep disorders may have adverse health outcomes on older adults. While a substantial number of studies have documented rural and urban differences in sleep quality and duration, none has examined rural/urban differences in sleep disorders among older adults in Ghana. The analytical sample included 2,142 older adults (65 years and above) who are part of the cross-national study of the Research on Early Life and Aging Trends and Effects (RELATE) conducted in Ghana in 2007 (µage = 74, female 54%). The analysis was based on multivariate logistic regression in predicting the odds of experiencing sleep difficulty among older adults and how this may differ based on rural/urban residence. Results reveal that net of other factors, older adults in rural Ghana are more likely to experience sleep disorders than their urban counterparts (OR=1.29, P&lt;.05). Possession of Jewelry in Africa is a symbol of higher social status, the result shows that net of other factors, those who own jewelry are more likely to experience sleep disorder than those who do not possess jewelry (OR=1.69, P&lt;.001), those who are obese show greater odds of sleep disorder than those with normal weight (OR=1.59, P&lt;.01). Other significant differences were education, self-rated health, and feeling of happiness. These findings show that causal factors of sleep disorder among older adults are multifactorial and their underlying mechanisms may vary by geography(rural/urban)