Religiosity and spirituality in patients with epilepsy / Religiosidade e espiritualidade em pacientes com epilepsia

ABSTRACT Religiosity and spirituality (R/S) are widely regarded as important allies against illness and suffering in general. Findings in temporal lobe epilepsy (TLE) suggest the temporal lobe as the anatomical-functional basis of religious experiences. Both R/S are relevant in patients with epilepsy (PWE) since epilepsy can lead to psychosocial issues for a significant portion of patients and their families. Objective: To investigate R/S in PWE, as well as the impact of different epileptic syndromes on patients' R/S. Methods: One hundred PWE and 50 healthy volunteers matched for age, sex and educational level were submitted to an interview, as well as three previously validated questionnaires: Index of Core Spiritual Experience (INSPIRIT-R), Hospital Anxiety and Depression Scale (HADS), and the Quality of Life in Epilepsy Inventory (QOLIE-31). Results: PWE's and control's mean ages were 35.9 ± 12.4 vs. 36.3 ± 18.1 years, mean schooling was 8.9 ± 3.7 vs. 10.1 ± 4.2 years. The mean age of epilepsy onset was 14.5 ± 12.1 and monthly frequency of seizures was 5.9 ± 12.6. INSPIRIT-R's scores were not statistically significantly different between patients and controls (3.0 ± 0.8 vs. 3.0 ± 0.8); however, INSPIRIT-R's scores were significantly higher in TLE patients when compared with other epilepsy syndromes (3.2 ± 0.7 vs. 2.8 ± 0.9; p = 0.04). Conclusion: Temporal lobe epilepsy patients have higher levels of R/S.

Resumo Religiosidade e espiritualidade (R/E) são geralmente consideradas importantes aliadas no enfrentamento de doenças e sofrimento. Estudos na epilepsia do lobo temporal (ELT) sugerem que o lobo temporal é a base anatômico-funcional de experiências religiosas. Além disso, R/E têm impacto na vida de pacientes com epilepsia (PCE), uma vez que a epilepsia frequentemente está associada a distúrbios psicossociais em pacientes e seus familiares. Objetivo: Investigar R/E em PCE, bem como o impacto de diferentes síndromes epilépticas na R/E dos pacientes. Método: Cem PCE e 50 voluntários saudáveis pareados por idade, sexo e nível educacional foram submetidos a uma entrevista, bem como três questionários previamente validados: Index of Core Spiritual Experience (INSPIRIT-R), Hospital Anxiety and Depression Scale (HADS), e Quality of Life in Epilepsy Inventory (QOLIE-31). Resultados: As médias de idade de PCE e controles foram de 35,9 ± 12,4 vs. 36,3 ± 18,1 anos, com escolaridade média de 8,9 ± 3,7 vs. 10,1 ± 4,2 anos. A idade média do início da epilepsia foi de 14,5 ± 12,1 e a frequência de crises mensais foi de 5,9 ± 12,6. Os escores do INSPIRIT-R não foram estatisticamente diferentes entre os pacientes e controles (3,0 ± 0,8 vs. 3,0 ± 0,8); entretanto, os escores do INSPIRIT-R foram significativamente maiores em pacientes com ELT quando comparados com outras síndromes epilépticas (3,2 ± 0,7 vs. 2,8 ± 0,9; p = 0,04). Conclusão: Pacientes com epilepsia do lobo temporal possuem níveis mais altos de religiosidade e espiritualidade.

Is self-report sleepiness associated with cognitive performance in temporal lobe epilepsy? / A sonolência auto-relatada está associada ao desempenho cognitivo na epilepsia do lobo temporal?

ABSTRACT Sleepiness and cognitive impairment are common symptoms observed in patients with epilepsy. We investigate whether self-reported sleepiness is associated with cognitive performance in patients with refractory mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). Seventy-one consecutive patients with MTLE-HS were evaluated with the Stanford Sleepiness Scale (SSS) before neuropsychological evaluation. Their mean SSS scores were compared with controls. Each cognitive test was compared between patients with (SSS ≥ 3) or without sleepiness (SSS < 3). Imbalances were controlled by regression analysis. Patients reported a significantly higher degree of sleepiness than controls (p < 0.0001). After multiple linear regression analysis, only one test (RAVLT total) remained associated with self-reported sleepiness. Conclusion: Self-reported sleepiness was significantly higher in MTLE-HS patients than controls, but did not affect their cognitive performance. If confirmed in other populations, our results may have implications for decision making about sleepiness screening in neuropsychological settings.

RESUMO A sonolência e o comprometimento cognitivo são queixas comuns na epilepsia. Investigamos se a sonolência relatada pelo paciente está associada ao desempenho cognitivo na epilepsia do lobo temporal mesial refratária com esclerose do hipocampo (ELTM-EH). 71 pacientes com ELTM-EH foram avaliados pela Escala de Sonolência de Stanford (ESS) antes da avaliação neuropsicológica. A média na ESS foi comparada com a de controles. Cada teste foi comparado entre os pacientes com sonolência (ESS ≥ 3) ou sem sonolência (ESS <3). Diferenças foram controladas por regressão logística múltipla. Os pacientes relataram uma sonolência maior do que os controles (p <0,0001). Após a regressão, a sonolência relatada pelos pacientes mostrou-se associada a apenas um teste (RAVLT total). Os pacientes com ELTM-EH referem mais sonolência do que os controles, mas esta não foi associada com a cognição. Se confirmado em outras populações, nossos resultados implicarão na tomada de decisão sobre o impacto da sonolência no contexto neuropsicológico.

Cross-cultural adaptation of Rotter's General Locus of Control instrument / Adaptação transcultural do instrumento de Locus of Control Geral de Rotter

Abstract Objective To perform a cross-cultural adaptation of the General Locus of Control (GLoC) questionnaire, which measures where people place causation of events in their lives, i.e., if they interpret events as being the result of their own actions or external factors. Methods After translation and back-translation, a multidisciplinary committee judged and elaborated different versions of the GLoC questionnaire, with a focus on conceptual equivalence, content, comprehensibility and adjustment to the Brazilian socioeconomic context. The final version was tested on 71 healthy subjects, of whom 36 were reinterviewed and answered the GLoC questionnaire twice, after a mean of 73.06±74.15 days (range = 29-359). Results The participants' mean age was 30.82±12.83 years (range = 18-69), 62% were women, and mean years of schooling were 12.54±4.21. Test-retest reliability (Pearson's) was r = 0.828. Internal consistency resulted in a Cronbach's alpha of 0.906. The mean GLoC score obtained was 8.77±3.11 (n = 71). Conclusion The Portuguese version of the GLoC questionnaire is a faithful adaptation of Rotter's original questionnaire.

Resumo Objetivo Realizar a adaptação transcultural do questionário General Locus of Control (GLoC), que avalia a que as pessoas atribuem a causa dos seus eventos de vida, isto é, se interpretam os eventos como sendo resultado de suas próprias ações ou de fatores externos. Métodos Após as fases de tradução e retrotradução do instrumento, uma equipe multidisciplinar julgou as versões obtidas quanto à manutenção do conceito original, compreensibilidade e clareza para o contexto socioeconômico da população brasileira. A versão final foi testada em 71 indivíduos saudáveis, dos quais 36 responderam duas vezes ao questionário, com um intervalo de 73,06±74,15 (29-359) dias. Resultados A média de idade dos participantes foi de 30,82±12,83 anos (com variação de 18-69), 62% eram mulheres, e o número médio de anos de escolaridade foi 12,54±4,21. A análise de confiabilidade teste-reteste (coeficiente de correlação de Pearson) foi r = 0,828. A análise de consistência interna resultou em um valor de Crohnbach de 0,906. O escore médio entre aplicações do teste foi de 8,77±3,11 (n = 71). Conclusão A versão em português do questionário GLoC é uma adaptação fiel ao instrumento original de Rotter.

O efeito de diferentes adaptações de dificuldade em estratégias de diversão e performance em serious games para trieno de memória / The effect of different difficulty adaptation strategies on enjoyment and performance in a serious game for memory training / El efecto de diferentes adaptaciones de dificultades en estrategias de diversion y performance en seriousgames para entrenamiento de memoria

The goal of this study was to evaluate two kinds of difficulty adaptation techniques in terms of enjoyment and performance in a simple memory training game: one based on difficulty-performance matching (?task-guided?) and the other based on providing a high degree of control/choice (?user-guided?). Methods: Performance and enjoyment are both critical in making serious games effective. Therefore the adaptations were based on two different approaches that are used to sustain performance and enjoyment in serious games: 1) adapting task difficulty to match user performance by leveraging the theories of zone of proximal development and flow, thus maximizing performance that can then lead to increased enjoyment and 2) providing a high degree of control and choice by using constructs from self-determination theory, which maximizes enjoyment, that can potentially increase performance. 24 participants played a simple memory training serious game in a fully randomized, repeated measures design. The primary outcome measures were enjoyment and performance. Results: Enjoyment was significantly greater in user-guided (p < 0.05), whereas performance was significantly greater in task-guided (p < 0.05). Conclusion: The results suggest that a trade-off between maximizing performance and maximizing enjoyment could be achieved by combining the two approaches into a ?hybrid? adaptation mode that gives users a high degree of control in setting difficulty, but also advises them about optimizing performance...

Consiste em avaliar dois tipos de adaptação de dificuldades em termos de ludicidade e desempenho num jogo simples de treino de memória: um dos métodos é baseado no relacionamento entre desempenho e dificuldade (guiado a tarefas) e o outro é baseado em prover um alto grau de controle e escolha (guiado a usuário). Método: Desempenho e ludicidade são ambos críticos ao fazer jogos sérios serem eficientes. Assim sendo, a adaptação foi baseada em dois aspectos diferentes que são usados para sustentar tanto o desempenho como a ludicidade: 1) adaptar as dificuldades das tarefas para corresponder o desempenho do usuário através de nivelamento das teorias da zona proximal, maximizando o desempenho que podem levar ao acréscimo do fator lúdico e 2) prover um alto grau de controle e escolha usando construtores da teoria da autodeterminação, que maximiza o lúdico e potencializa o aumento do desempenho. Foram selecionados 24 participantes para utilizar o jogo de treino da memória de uma forma totalmente aleatória. Os primeiros resultados medidos foram ludicidade e desempenho. Resultados: A ludicidade foi significativamente maior na abordagem guiada a usuário (p<0.05), enquanto o desempenho foi significativamente maior no modelo guiado a tarefas (p<0.05). Conclusão: Os resultados sugerem que haja uma combinação entre maximização de desempenho e maximização de ludicidade, criando um modelo adaptado híbrido, capaz de dar ao usuário um alto grau de controle na escolha da dificuldade, mas também sugerindo otimizações de desempenho...

Estudio consiste en valuar dos tipos de adaptación de dificultades en respecto al lúdico y performance en un juego simple de entretenimiento para memoria: uno de los métodos es basado en el relacionamiento entre performance y dificultad (guiado a tareas) y el otro es basado en fornecer un alto grado de controle y elección (guiado a usuario). Metodos: Performance y lúdico son ambos críticos al hacer que juegos serios sean eficientes. Esto dicho, la adaptación fue basada en dos aspectos distintos que son usados para sostener tanto la performance como el lúdico: 1) adaptar las dificultades de las tareas para corresponder a la performance del usuario por el uso de las teorías de zona proximal, maximizando e la performance que pueden llevar al aumento del factor lúdico y 2) proveer un alto grado de control y elección usando constructores de la teoría de la autodeterminación, que maximiza el lúdico y potencializa el aumento de performance. Fueran seleccionados 24 participantes para utilizar el juego de manera totalmente aleatoria. Los primeros resultados medidos fueron el factor lúdico y performance. Resultados: El lúdico fue significativamente mayor en la abordaje guiada a usuario (p<0.05), mientras la performance fue significativamente mayor en el modelo guiado a tareas (p<0.05). Conclusión: Los resultados sugieren que haya una combinación entre maximización de performance y maximización del factor lúdico, creando un modelo adaptado hibrido, capaz de dar al usuario un alto grado de control en la elección de la dificultad, pero también sugiriendo optimizaciones de performance...

Population Based Cohort Study for Pediatric Infectious Diseases Research in Vietnam

A population-based cohort study on pediatric infectious diseases was established at Khanh Hoa Province, central Vietnam in 2006, to determine the etiology and risk factors for severe pediatric infectious diseases (SPID) such as acute respiratory infection (ARI), diarrhea and dengue which are the major causes of under 5 mortality. A population census survey was conducted in Nha-Trang and Ninh-Hoa to collect demographic, social-behavioral data and disease burden on SPID. The study site covered a population of 353,525 residing in 75,826 households with 24,781 children less than 5 years. Hospital databases from two hospitals covering the region were obtained. Linking the census and hospital databases, we were able to investigate on a variety of SPID such as environmental tobacco smoking exposure and increased risked of pediatric pneumonia hospitalization, population density, water supply and risk of dengue fever and animal livestock and risk of hospitalized diarrhea. To determine incidence, viral etiology and risk factors for pediatric ARI/pneumonia, we setup a population based prospective hospitalized Pediatric ARI surveillance at Khanh Hoa General Hospital, Nha-Trang in February 2007. The study has revealed RSV, rhinovirus and influenza A as major viral pathogens, role of multiple viral infection and its interaction with bacteria in the development of pneumonia. In addition, we are also conducting a birth cohort study to investigate the incidence of congenital infection and its impact on physical-neurological development, and role of host genetic polymorphism on SPID hospitalization in Vietnam. Population mobility, high cost of regular census update and low mortality are the challenges.

Population based cohort study for Pediatric Infectious Diseases research in Vietnam

A population-based cohort study on pediatric infectious diseases was established at Khanh Hoa Province, central Vietnam in 2006, to determine the etiology and risk factors for severe pediatric infectious diseases (SPID) such as acute respiratory infection (ARI), diarrhea and dengue which are the major causes of under 5 mortality. A population census survey was conducted in Nha-Trang and Ninh-Hoa to collect demographic, social-behavioral data and disease burden on SPID. The study site covered a population of 353,525 residing in 75,826 households with 24,781 children less than 5 years. Hospital databases from two hospitals covering the region were obtained. Linking the census and hospital databases, we were able to investigate on a variety of SPID such as environmental tobacco smoking exposure and increased risked of pediatric pneumonia hospitalization, population density, water supply and risk of dengue fever and animal livestock and risk of hospitalized diarrhea. To determine incidence, viral etiology and risk factors for pediatric ARI/pneumonia, we setup a population based prospective hospitalized Pediatric ARI surveillance at Khanh Hoa General Hospital, Nha-Trang in February 2007. The study has revealed RSV, rhinovirus and influenza A as major viral pathogens, role of multiple viral infection and its interaction with bacteria in the development of pneumonia. In addition, we are also conducting a birth cohort study to investigate the incidence of congenital infection and its impact on physical-neurological development, and role of host genetic polymorphism on SPID hospitalization in Vietnam. Population mobility, high cost of regular census update and low mortality are the challenges.

Estimating the Effect of Recurrent Infectious Diseases on Nutritional Status: Sampling Frequency, Sample-size, and Bias.

There is an ongoing interest in studying the effect of common recurrent infections and conditions, such as diarrhoea, respiratory infections, and fever, on the nutritional status of children at risk of malnutrition. Epidemiological studies exploring this association need to measure infections with sufficient accuracy to minimize bias in the effect estimates. A versatile model of common recurrent infections was used for exploring how many repeated measurements of disease are required to maximize the power and logistical efficiency of studies investigating the effect of infectious diseases on malnutrition without compromising the validity of the estimates. Depending on the prevalence and distribution of disease within a population, 15-30 repeat measurements per child over one year should be sufficient to provide unbiased estimates of the association between infections and nutritional status. Less-frequent measurements lead to a bias in the effect size towards zero, especially if disease is rare. In contrast, recall error can lead to exaggerated effect sizes. Recall periods of three days or shorter may be preferable compared to longer recall periods. The results showed that accurate estimation of the association between recurrent infections and nutritional status required closer follow-up of study participants than studies using recurrent infections as an outcome measure. The findings of the study provide guidance for choosing an appropriate sampling strategy to explore this association.