Pilot Study of Mindfulness Training on the Self-Awareness of Motor Symptoms in Parkinson’s Disease – A Randomized Controlled Trial

Objective: This study aims to evaluate feasibility and effects of a newly developed mindfulness intervention tailored to specific needs of patients with Parkinson’s disease (PD).Background: The phenomenon of impaired self-awareness of motor symptoms (ISAm) in PD might be reduced by increasing patients’ mindfulness. A PD-specific mindfulness intervention has been developed and evaluated as a potential treatment option: IPSUM (“Insight into Parkinson’s Disease Symptoms by using Mindfulness”).Methods: IPSUM’s effectiveness is evaluated by comparing an intervention with a waitlist-control group. Applying a pre-post design, patients were assessed before, directly after and 8weeks after treatment. The primary outcome was the change in a quantitative ISAm score from baseline to post-assessment. Secondary outcome measures were PD-related affective changes and neuropsychological test performance. Feasibility was evaluated via feedback forms.Results: In total, 30 non-depressed and non-demented PD patients were included (intervention: n=14, waitlist-control: n=16). ISAm score did not change significantly, but the training group showed greater performance in sustained attention and language tasks over time. Additional changes included greater mindfulness as well as less sleeping problems and anxiety. Cognitive disturbances, apathy, and sleeping problems worsened only in the waitlist-control group. Patients’ feedback regarding the training concept and material was excellent.Conclusion: Insight into Parkinson’s Disease Symptoms by using Mindfulness has not been capable of reducing ISAm in PD patients but appears to be a feasible and effective concept to, among others, support mental health in the mid-term. It has to be noted though that the study was stopped beforehand because of the SARS CoV-2 pandemic. The lack of findings might therefore be caused by a lack of statistical power. The need for further research to better understand the mechanisms of ISAm and its connection to mindfulness in PD is highlighted.

Prevalence of Sleep Disorders among general population of Karachi and its associated co-morbidities

Background: Sleep disorders are being more prevalent among general population. Its poor sleep quality causes depression, accidents, mortality, and morbidity among general population. Aim: To know the prevalence of sleep disorder among general population. Methods: Data was collected from general population of Karachi in 6 days. Questionnaire for Sleep-Quality Developed by Colin Espie, Professor of Sleep Medicine, University of Oxford was used to assess the sleep problems and sleep quality of respondents. Results: Moreover, 6.2% reported had severe sleeping problems and need clinical attention. 5.9% had some sleeping problems. 38.2% of respondents have good sleep while 49.75 had great sleep quality. Majority of respondents belong to age 20 to 30 age groups, students, undergraduate, female, exercised once in a week and were vegetarian. Age 20 to 30 age groups, students, undergraduate, female, exercised once in a week and being vegetarian was associated with sleep problem (P<0.05). 20 to 30 age group, Health sector and inter education level, diabetes, obesity, difficult breathing, snoring while sleeping and smoking was associated with sleep problems(P<0.05). Wherever, >30 age group, undergraduate education level, students, exercising once in a week and eating vegetarian food were associated with good sleep quality(P<0.05). Poor sleep quality causes depression, accidents, mortality, and morbidity among general population. Conclusion: This study will provide the important information to the higher authorities related to the most vulnerable groups related to sleep problems and factors associated with good sleep quality. Keywords: Sleep disorders, sleep quality, vulnerable groups, comorbidities

And they slept happily ever after: Online interpretive repertoires on the use of benzodiazepines and z-drugs

Drawing on a critical social-psychological framework for discourse analysis, data from a popular forum for people over 50 were analysed to study how the habitual use of benzodiazepines and Z-drugs (BZD/Z) is discursively negotiated by Flemish older adults. We present five different repertoires (risk and addiction; alternative pathways; suffering; rationalisation; cessation) that illustrate how a pharmaceutical imaginary of these medications is constructed online and how posters act as reflexive users taking on a health role. Most repertoires emerge from a tacit norm on the undesirability of medication use for sleeping problems. In the alternative pathways and cessation repertoires this norm is implicitly accepted by focussing on how to either prevent or overcome chronic use with various alternative solutions or through tapering off, while the risk and addiction repertoire is used to more openly defend and discursively magnify the idea that medication has to be avoided at all cost. We discuss how this reflects a prevailing imperative of health and ethos of healthicisation of sleep. The rationalisation and suffering repertoires on the other hand challenge this norm by defending medication use. We further explore how these repertoires are used to self-position as either ‘noble non-user’, ‘deserving and/or compliant patient’ or ‘rational user’, reflecting previously found moral positions in offline settings. Our data add another position that has thus far not been discussed extensively with regard to prescription medication use, namely that of a ‘recovered user’. As such, this study shows how this particular online community is a site for contestation of health promotion and medical/pharmaceuticalised discourses on sleep by users and non-users alike and offers a unique insight into how people in the age group that is known to use most BZD/Z discursively negotiate the use of these medications in pseudonymised online interactions.

How Did the COVID-19 Lockdown Affect Children and Adolescent's Well-Being: Spanish Parents, Children, and Adolescents Respond

Background: During the COVID-19 pandemic, lockdown strategies have been widely used to contain SARS-CoV-2 virus spread. Children and adolescents are especially vulnerable to suffering psychological effects as result of such measures. In Spain, children were enforced to a strict home lockdown for 42 days during the first wave. Here, we studied the effects of lockdown in children and adolescents through an online questionnaire.Methods: A cross-sectional study was conducted in Spain using an open online survey from July (after the lockdown resulting from the first pandemic wave) to November 2020 (second wave). We included families with children under 16 years-old living in Spain. Parents answered a survey regarding the lockdown effects on their children and were instructed to invite their children from 7 to 16 years-old (mandatory scholar age in Spain) to respond a specific set of questions. Answers were collected through an application programming interface system, and data analysis was performed using R.Results: We included 1,957 families who completed the questionnaires, covering a total of 3,347 children. The specific children's questionnaire was completed by 167 kids (7–11 years-old), and 100 adolescents (12–16 years-old). Children, in general, showed high resilience and capability to adapt to new situations. Sleeping problems were reported in more than half of the children (54%) and adolescents (59%), and these were strongly associated with less time doing sports and spending more than 5 h per day using electronic devices. Parents perceived their children to gain weight (41%), be more irritable and anxious (63%) and sadder (46%). Parents and children differed significantly when evaluating children's sleeping disturbances.Conclusions: Enforced lockdown measures and isolation can have a negative impact on children and adolescent's mental health and well-being. In future waves of the current pandemic, or in the light of potential epidemics of new emerging infections, lockdown measures targeting children, and adolescents should be reconsidered taking into account their infectiousness potential and their age-specific needs, especially to facilitate physical activity and to limit time spent on electronic devices.

Online Consultations Between General Practitioners and Psychiatrists in the Netherlands: A Qualitative Study

Objective: To examine the nature and scope of questions about psychiatric patient cases submitted by general practitioners (GPs) to an established online consultation platform and to determine if they could have been answered by consulting existing clinical guidelines.Methods: All anonymized psychiatric cases submitted by GPs to the online electronic Prisma platform between September 2018 and November 2019 were examined in a mixed-methods study. Descriptive statistics and qualitative thematic analysis were used, followed by axial coding to arrive at overarching themes to characterize cases.Results: Of the 136 included cases, 44.1% concerned female patients and about half concerned patients aged 31–60 years. Common psychiatric disorders were depression, attention deficit hyperactivity disorder, sleeping problems, sexual disorders, and eating disorders. The first response was usually given within 2 h (interquartile range, 0–14.3 h), with 86% answered within 24 h and 95% within 48 h. Qualitative analysis revealed four themes, namely “type of question,” “cases in relation to current clinical guidelines,” “case complexity” and “the doctor being pressured.” Type of question comprised diagnostic, therapeutic, and referral questions. Notably, for 44.1% of questions no current clinical guidelines was present and 46.3% of cases were deemed complex in nature. GPs were willing to share their experiences of coping with being pressured by patients.Conclusion: The findings of this study support the potential for an online electronic consultation platform to facilitate feasible and useful interprofessional consultation between GPs and psychiatrists for a broad range mental illnesses and questions of varying complexity.

Health-Promoting Factors Among Students in Higher Education within Health Care and Social Work: A Cross-Sectional Analysis of Baseline Data in a Multicentre Longitudinal Study

Background: Educational environments are considered important for strengthening students’ health status and knowledge, which is associated with good educational outcomes. It has been suggested to establish healthy universities based on a salutogenic approach—namely, health promotion. The aim of this study was to describe health-promoting resources and factors among first-semester students in higher education in healthcare and social work.Methods: This cross-sectional study is based on a survey provided to all students in seven healthcare and social work programmes from six universities in southern Sweden. The survey was performed in 2018 using a self-reported, web-based questionnaire focussing on general health and well-being, lifestyle factors and three validated instruments measuring health-promoting factors and processes—the Sense of Coherence (SOC) scale, Salutogenic Health Indicator Scale (SHIS) and Occupational Balance Questionnaire (OBQ).Results: Of 2283 students, 851 completed the survey, where 742 (87.1%) were women; 722 students participated in healthcare programmes, and 129 students participated in social work programmes. Most reported good general health and well-being (88.1% and 83.7%, respectively). The total mean scores for the SOC scale, SHIS and OBQ were 59.09 (SD = 11.78), 44.04 (SD = 9.38) and 26.40 (SD = 7.07), respectively. Well-being and several health-promoting lifestyle factors were related to better general health and higher SOC, SHIS and OBQ scores. Multiple linear and logistic regressions showed that perceived well-being and no sleeping problems significantly predicted higher general health and higher SOC, SHIS and OBQ scores. Being less sedentary and non-smoking habits were significant predictors of higher SOC.Conclusions: Swedish students in higher education within the healthcare and social work sector report good general health and well-being in the first semester, as well as health-promoting resources (i.e. SOC, SHIS and OBQ), and in some aspects, a healthy lifestyle. High-intensity exercise, no sleeping problems and non-smoking seem to be of importance to both general health and health-promotive resources. This study contributes to the health promotive characteristics of students in the healthcare and social work sectors, which is of importance for planning universities with a salutogenic approach.

Reducing the use of sleep-inducing drugs during hospitalization by a multi-faceted intervention - a pilot study

Objectives. Many patients receive benzodiazepines or Z-drugs during hospitalization due to sleeping problems. In a pilot study, we aimed to find out whether, and to what degree, a multi-faceted intervention can reduce the use of these drugs, especially in older patients and those without a psychiatric or neurological disorder. The results of this pilot study should inform the design of a randomised controlled trial (RCT). Methods. In a quasi-experimental design, we implemented the intervention in a German hospital with the support of the hospital director, medical and nursing staff and employee representatives. We compared prescription data for sleep-inducing drugs before and after the intervention by Fisher's exact test and used Odds-Ratios (ORs) with their 95 % confidence intervals (CI) as measure of effect size. Results. The data from 960 patients aged 65 and older before intervention and 1049 patients after in-tervention were analysed. Before intervention, 483 (50.3%) of the patients received sleep-inducing drugs at some time during their hospital stay. After the intervention, 381 (36.3%) patients received a sleep-inducing drug, resulting in an OR of 0.56 (95% CI: 0.47 to 0.68; p <0.001). The reduction was particularly pronounced in patients without a psychiatric or neurological disorder (from 45.0% to 28.8%). Especially benzodiazepines were significantly reduced (from 24.3% to 8.5%; OR: 0.31 (0.23-0.4); <0.001). Conclusions. A multi-faceted intervention to change the practice of the use of sleep-inducing drugs in one hospital was successful in terms of drug reduction, particularly for benzodiazepines. The interven-tion was effective especially for target persons, i.e. those without a psychiatric or neurological disease. Being aware of the magnitude of the change and the role of important stakeholders could help researchers, hospital physicians and hospital pharmacists to design a large RCT, including control hospitals, to evaluate the success of a multi-faceted intervention on a scientifically sound basis.

Meaning Making for Psychological Adjustment and Quality of Life in Older Long-Term Breast Cancer Survivors

Objectives: This study aims to explore in depth the meaning and meaning discrepancies among older Norwegian breast cancer survivors in light of the meaning making model by Park (2013).Design: We utilized a qualitative design collecting data using semi-structured interviews of 23 elderly breast cancer survivors 7–8 years after treatment. The interviews followed an interview guide structured along three main themes: “everyday life activities,” “follow-up-care experiences” and “health status and QoL.”Results: Several health problems were reported by the women in the aftermaths of the disease, such as sleeping problems, pain, and fatigue—including cognitive and emotional impairments. Meaning discrepancies were concentrated on six main themes: shifting perspectives and priorities, growing sense of autonomy, widening the limits of normality, dissociating oneself from the disease, embracing alternative health services, and feeling lucky. The women engaged in a wide range of coping techniques as efforts to change global meaning, and to develop a more positive view on the cancer experience. Common coping efforts across the six main themes were social comparison, denial, positive reappraisal, problem-focused coping, and revaluing ordinary events.Conclusion: Many cancer patients report on unmet needs for help with their meaning making, and the facilitation of meaning making processes is rarely included in the follow-up care of cancer survivors. The findings of the present study may help health care professionals provide care for women who have experienced breast cancer. The concrete knowledge of common coping efforts in the meaning making process may contribute to the development of future interventions and for gaining a deeper understanding for older survivors of breast cancer.

Daily Impacts of Missing Teeth in Adult Population in Lahore, Pakistan

OBJECTIVE: The objective of this study is to evaluate the impact of tooth loss on oral health related quality of life in adults. METHODOLOGY: The survey was conducted during March – June 2019 at Rashid Latif Dental Hospital. A sample size of 373 adults aged 18-80 years was randomly selected from the out-patient department. Number of missing teeth was the main exposure, and it was clinically assessed. OHRQoL was evaluated through “Oral Impacts on Daily performance (OIDP) questionnaire”. RESULTS: From total patients presented in OPD 44% had one or more missing teeth. Top reported impacts of missing teeth included difficulty eating and relaxing/sleeping problems. Adults with missing teeth showed 1.28 (95%CI 1.04-4.55) (P=0.01) times higher odds for reporting higher oral impacts compared to those without missing teeth. CONCLUSION: Individuals with missing teeth likely had frequent difficulties in their daily lives due to missing teeth including trouble with eating, speaking, and oral infection, which could spread to the rest of your body. KEYWORDS: OIDP, Tooth-loss, Adults, Missing teeth, Lahore HOW TO CITE: Shahzad HB, Awais F, Raza NUH, Majeed Ha, Shahbaz M, Kazmi F. Daily impacts of missing teeth in adult population in Lahore, Pakistan. J Pak Dent Assoc 2021;30(3):157-163.

Impact of Excessive Screen Time and the Mediating Effect of Physical Exercise on Sleep in Physiotherapy Students During Covid-19

Aim: The science of today is the technology of tomorrow. The 21st century has witnessed a great development in the field of technology. Whether we love it or loathe it, technology affects everything we do today and influences almost everything we plan for our tomorrow. It has advanced everywhere making people access various types of devices. Sleep is fundamental to optimal functioning including health and behavior. This paper describes the interrelations between sleep and screen use. The purpose of this study was to identify technology use hence exploring the screen time of the individual and its impact on sleep and the mediating effect of physical exercise. Method: A representative sample of 150 Physiotherapy students was surveyed using an online questionnaire to analyze their technology use and sleep patterns. Results: A total number of 150 completed forms were analyzed. 94.7% students screen time use had increased during the lockdown. 43.3% of student participants spent more than 6 hours on digital devices on a daily basis. 73.3% of the population agreed that screen time did affect their sleeping pattern in the lockdown. 64% students encountered sleeping problems. 52% people admitted that excessive screen use has affected their sleep quality. 65.3% of the students have been taking part in physical exercises regularly, out of which 65.27 % reported decreased sleeping complaints. Conclusion: This study shows that use of screen based digital devices and media use has significantly increased during COVID-19 pandemic lock down in Physiotherapy students and provides scientific evidence for its negative impact on sleep. Physical exercises were associated with a positive effect on sleep disorders.