Basic needs of the first batch of medical staff in the fever clinic of Peking union medical college hospital during Coronavirus disease 2019 outbreak: A qualitative study.

Objective The objective of this study was to investigate the basic needs of medical staff during the coronavirus disease 2019 pandemic in a fever clinic, so as to provide a reference for the global epidemic medical teams. Methods A semi-structured qualitative interview outline was designed, including: (1) work level: Working hours, working intensity, and safety guarantee in a fever clinic;(2)life level: Diet, sleep, and physical comfort;(3)psychological level: Emotion, pressure, coping style, and interpersonal resources. The basic needs of the first batch of the fever clinic in Peking Union Medical College Hospital was studied by open telephone interviews. Results A total of 37 medical staff were interviewed, including 8 males (21.6%) and 29 females (78.4%). Among them, there were 16 doctors (43.2%), 19 nurses (51.4%), and 2 medical technicians (5.4%). In terms of work settings, the ideal continuous working time was 4-6 hours per shift. There should be pro re nata positions during extremely high workload, and sufficient personal protective equipment was the key to safety. In terms of living conditions, providing meals according to different shifts was important for dietary needs, and sleeping pills were temporarily needed for sleep. In terms of psychological reactions, nervousness and worrying were relatively common. Family and colleagues were important resources of support. Sport could help relieve physical and psychological stress, and psychological support from psychologists was helpful in reducing their negative emotions. Conclusions The basic needs of medical staff should be respected so as to keep the efficacy of their work. We suggest that medical staff can rest after each 4-6 h working shift. Personal protective equipment should be sufficient. Psychological support should be noted in all of them and provided when necessary.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

The Health Hexagon Model: Postulating a holistic lifestyle approach to mental health for times and places of uncertainty

Professional-driven mental health services are often predicated on westernized beliefs of mental health and distress. This presumptuous view results in treatment solutions that are not suitable to (many) non-western contexts because they are neither culturally valid nor practically sufficient. Instead of promoting imported ideas of mental health, we encourage communities, including Hong Kong, from and for where the authors primarily theorize the current thesis, to turn to and strengthen the resources they employed before the medicalization of distress and suffering. Basic foundational elements in one's everyday life, which we present here as the Health Hexagon Model, should be promoted, especially healthy sleep, healthy diet, regular physical activity, closeness with nature, supportive kinships and friendships, and a sense of purpose, meaning, or sacredness. These elements are not novel;the importance of these basic elements has been recognized, distilled, and transmitted generation after generation. We advocate for communities to identify the missing or hampered fundamental elements in their lives and focus on finding methods that would help them adopt a lifestyle conducive to individual and collective health. This call-to-action is particularly timely as the global community fights for its survival against the coronavirus and ponders ways to cope with the seismic changes in lifestyle it has brought.Copyright © 2022 The Authors

Examination of prospective sleep across the menstrual cycle

Introduction: Women are twice as likely to develop insomnia across their lifetime compared with men. This may be explained, in part, by changes in hormones and menstrual cycle phase in reproductive-aged women. Intra- and inter-variability of menstrual cycle timing can make it difficult to accurately measure sleep quality and quantity in sleep research studies. This study aimed to examine the role of menstrual cycle phase in daily self-report and actigraphy-assessed sleep across two consecutive menstrual cycles. Materials and Methods: Fifty-one women (43% Caucasian) between the ages of 18 and 35 (m age = 23.67, SD = 4.68) completed continuous sleep monitoring via actigraphy and daily sleep diaries over two menstrual cycles (m days = 51.29). Cycles were identified via first date of menstrual bleeding and midcycle urinary ovulation testing and were coded into four phases: perimenstrual, mid-follicular, periovulatory, and mid-luteal. The perimenstrual phase was defined as the 3 days prior to and the first 3 days of menstrual bleeding. Within- and between-person relationships between menstrual phase and sleep parameters were estimated using multistep hierarchical linear modeling. Subjective and objective measures yielded the following sleep variables: Total Wake Time (TWTsub and TWTobj), Sleep Efficiency (SEsub and SEobj), and subjective sleepiness. Pandemic-related stress and daily US and region-specific COVID-19 case counts were included as covariates in adjusted models. Results: The sample had a mean a cycle length of 28.61 days (SD = 2.69). Regarding actigraphy data, menstrual phase predicted TWTobj and SEobj. Women spent 4-7 fewer minutes awake during the mid-follicular (m = 61.54, SE = 3.37) and mid-luteal phases (m = 63.11, SE = 3.29), compared to the perimenstrual phase (m = 67.54, SE = 3.37;p <.001). Sleep efficiency was higher in the mid-luteal phase (m = 82.50, SE = 0.79) compared to the perimenstrual phase (m = 80.71, SE = 0.82, p =.006). Subjective ratings indicated that during the perimenstrual phase women spent 8-16 minutes longer awake (m = 52.23, SE = 5.01, p <.001) and experienced reduced sleep efficiency of between 1-3 percentage points (m = 89.70, SE = 0.10, p <.001) compared to all other phases. Women also reported increased morning sleepiness in the perimenstrual (m = 4.71, SE = 0.21) compared to the periovulatory phase (m = 4.34, SE = 0.22, p =.02). Random coefficients models for objective and subjective sleep variables were nonsignificant, indicating that these relationships did not vary significantly between participants. Conclusions: To our knowledge, this is one of the first studies to examine subjective and objective sleep prospectively across two consecutive menstrual cycles. Disturbed sleep was highest in the perimenstrual phase. Future studies should measure menstrual cycle phase when investigating sleep in reproductive age women.

Digital Cognitive Behavioural Therapy for Insomnia (dCBT-I) and emotion regulation as early intervention for employees in the workplace

Insomnia is a serious public health concern and has been linked to impaired work productivity. Studies show a link between poor sleep and aspects of occupational functioning such as absenteeism, reduced productivity and low work satisfaction. One in every three workers in the UK are affected by sleep problems costing the economy around £36 billion/year due to loss of productivity in the workplace. This results in around 200,000 working days lost every year, and it is estimated that the cost to industry will rise steadily to £44 billion by 2030 if nothing is done about it. Few studies have evaluated the effectiveness of CBT-I in workplaces, and have found improvements in severity of insomnia and quality of sleep, and slight improvements in productivity and presenteeism, but not in absenteeism. While most interventions for insomnia are focused on the treatment of those above clinical thresholds, there is crucial need for early intervention/prevention of insomnia. This has been further exacerbated during the Covid-19 pandemic due to isolation, financial insecurities, loss of loved ones and fear of infection, causing extensive sleep problems as well as stress, anxiety and depressive symptoms. This study will examine the efficacy of a new hybrid dCBT-I for mild to severe insomnia and symptoms of depression and anxiety delivered to employees in the workplace. This trial tests the efficacy of implementing a hybrid dCBT-I + emotion regulation (ER) in the workplace in a mixed methods evaluation with a two-arm randomised waitlist control (WLC) design. The dCBT-I+ER intervention is 8-weeks long and delivered via self-guided online platform and four videoconferencing therapy sessions. Primary outcomes are the Insomnia Severity Index, the Patient Health Questionnaire and the Generalised Anxiety Disorder. Secondary outcomes are job productivity, job satisfaction, well-being, quality of life, self-reported (sleep diary data) and objective (actigraphy) sleep parameters. We recruited 163 workers with sleep and emotion regulation problems ranging from subclinical to clinical levels not engaged in treatment at the time of the trial. Due to the study design, analyses for the primary hypotheses will be done when the last enrolled participant provides post-intervention follow-up (1-month) outcome measures. We hypothesise that participants randomly allocated to dCBT-I+ER will demonstrate significantly greater improvements on the primary outcomes compared to WLCs post-intervention. They will also demonstrate significantly greater improvements on objective (actigraphy) and self-reported (sleep diary) sleep parameters. Exploratory analyses will also indicate the impact of the dCBT-I+ER on work productivity, job satisfaction, wellbeing, and quality of life. Evaluation of an early intervention for workers with mild to severe symptoms of insomnia and emotion regulation difficulties will contribute to the understanding of benefits of early interventions in the workplace, and its impact on mental health and productivity. The mixed methods evaluation will provide insight into the application of intervention and help us understand people’s experiences of the intervention and what helped or hindered its use. This pilot study forms the basis of what could become a larger nationwide service delivery programme of mental health interventions for insomnia in the workplace.

Moderator effect of physical activity on stress and sleep relationship in daily life: an observational study using wearable devices

Introduction: Daily sleep may be affected by several conditions, including stress. Stress has been shown to impact our physical and mental health. Perceived stress can affect sleep quantity, quality, and architecture, with a detrimental effect on emotional responses to daily stressors. Moreover, poor quantity/quality sleep can increase the risk of severe medical and mental disorders that in turn can have a negative effect on sleep. However, some beneficial sleep/stress management interventions seem to have a mediator impact on a stress-sleep relationship. Physical activity (PA) is reported to prevent the negative effects of perceived stress on sleep, in stress conditions, as COVID-19 pandemic lockdown. The study aimed to conduct a preliminary analysis on the relationship between PA, perceived daily stress (pdStress), and sleep parameters from data collected through Garmin and Apple wearable devices by LUCA app, a psychophysiological well-being application, helping to recognize and manage stress. Materials and methods: Data from Australian users have been collected for 14 consecutive days. No inclusion and exclusion criteria were applied. PA and sleep parameters were selected if present on both Garmin and Apple devices. We assessed: PA by daily calories consumption during active daily periods, and total steps;sleep as time spent asleep;pdStress as the total score obtained from four specific daily, day-framed questions investigating the ability to relax, the presence of somatic, and emotional/cognitive symptoms [total score range: 0-12;the higher is the score the higher is the pdStress.] Statistical analysis included linear mixed models, with pdStress total score as independent variable and sleep duration as dependent variable. PA parameters were added separately as moderators of pdStress and sleep relationship, with age, sex, and the brand of the wearable devices as covariates. Results: Sample: 46 Australian users (19 from Garmin and 27 Apple wearable devices), including 27 females (58.7%);age between 20 and 60 years (years;m=40.8, sd=±9.1). On average, the sample was characterized by: low to moderate levels of PA;mild levels of pdStress;and sleep duration as WHO’s recommendations. The analyses showed a statistically significant inverse association between level of pdStress and sleep duration (p < 0.001). This relationship was moderated by PA measured by active calories consumptions (p = 0.015) and total steps (p = 0.038), with higher activity levels resulting in a reduction of the strength of the inverse association between pdStress and sleep. Discussion: Our results confirm the detrimental relationship between pdStress and nighttime sleep duration, as reported by the literature. Moreover, our data show that high levels of PA can reduce the negative effect of pdStress on sleep duration. Despite the limitations concerning the limited number of subjects, device-related recording errors, indirect sleep parameters, and non-sophisticated PA measures, our results underline the importance of PA programs when daily stress conditions and sleep alterations occur. Acknowledgment: Data collection was sponsored by Mebidio LTD. We thank all participants involved in the study.

Impairment of sleep in children with cri-duchat syndrome and autism spectrum disorder during the covid-19 pandemic

Introduction: Sleep complaints are common in individuals with neurodevelopmental disorders. However, little is known about sleep alterations in children with cri du chat syndrome (CDC) and autism spectrum disorder (ASD) due to the social isolation resulting from the COVID-19 pandemic. Objective: To assess alterations in sleep quality and its associated parameters before and after quarantine resulting from COVID-19, comparing the results between CDC, ASD or neurotypical children. Methods: Sleep was investigated in 53 children with CDC and 106 with ASD using an adaptation of the Brief Infant Sleep Questionnaire (BISQ), assessing sleep patterns both before and during the COVID-19 pandemic. Data were evaluated in comparison to 160 neurotypical (NT) children. Results: Children with CDC and ASD already had higher chances of needing parental assistance to fall asleep, taking more than 30min to fall asleep and having a wake after sleep onset time (WASO) >30min when comparing to neurotypical children in the moment preceding quarantine. Having CDC significantly increased the odds of having awakenings during the night. During quarantine, the proportion of children sleeping in their own bedrooms had decreased and the odds of awakening during the night had increased in all groups. Children with CDC and ASD had significantly higher odds of taking more than 30min to fall asleep. The chance of having a WASO >30min increased in children with ASD but decreased in CDC ones. The quarantine period statistically increased the odds ratio of children having a sleep latency of >30min by nearly 5-fold for all groups. Conclusion: The CDC group presented worse sleep parameters overall, even before quarantine. In both the CDC and ASD group worse sleep indicators were found during the COVID-19 pandemic.

Quality of life and psychological assessment in patients with Fibromyalgia Syndrome during COVID-19 pandemic in Italy: Prospective observational study

Introduction: Chronic pain patients who undergo to stressful events may experience worsening in pain, sleep, and quality of life (QoL). The primary objective of this observational study was to compare QoL and sleep parameters before and after the COVID-19 lockdown in patients with Fibromyalgia Syndrome (FMS). The psychological impact of lockdown was also assessed, as well as the emotional impact of the pandemic and its correlations with patient socio-demographics. Methods: Patients aged ≥18 years with FMS diagnosed according to ACR (American College of Rheumatology) 2016 Criteria with at least one pre-pandemic QoL and sleep evaluation were included. QoL and sleep disturbances were analyzed by comparing scores on the Fibromyalgia Impact Questionnaire-Revised (FIQ-R), the 12-item Short Form Survey (SF-12), and the Pittsburgh Sleep Quality Index (PSQI) before and after the first lockdown in Italy (March to May 2020). Psychological impact was investigated via a 52-item survey of daily life changes in FMS management during the lockdown and emotional impact with the Impact Event Scale-Revised (IES-R) tool during the onset period after the lockdown. Questionnaire responses were correlated with patients’ sociodemographics. Results: Questionnaires were submitted via email to 54 patients; 37/54 patients (63.7%) returned them. QoL and sleep disturbances showed no statistically significant worsening. However, the psychological impact survey revealed that 3 out of 5 patients feared very much for their family members’ lives during lockdown. The emotional impact survey disclosed 72.7% of patients with psychological distress. Conclusions: While questionnaire responses showed no significant changes in QoL and sleep after the COVID-19 lockdown in this sample of FMS patients, the emotional investigation revealed moderate/severe psychological distress not detected by commonly used QoL tests in FMS.