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1.
J Phys Condens Matter ; 36(39)2024 Jul 04.
Article in English | MEDLINE | ID: mdl-38917836

ABSTRACT

In this manuscript, we undertake an examination of a classical plasma deployed on two finite co-planar surfaces: a circular regionΩininto an annular regionΩoutwith a gap in between. It is studied both from the point of view of statistical mechanics and the electrostatics of continua media. We employ a dual perspective: the first one is by using molecular dynamics (MD) simulations to find the system's positional correlation functions and velocity distributions. That by modeling the system as a classical two-dimensional Coulomb plasma of point-like charged particlesq1andq2on the layersΩinandΩoutrespectively with no background density. The second one corresponds to a finite Surface Electrode (SE) composed of planar metallic layers displayed on the regionsΩin,Ωoutat constant voltagesVin,Voutconsidering axial symmetry. The surface charge density is calculated by the Method of Moments (MoM) under the electrostatic approximation. Point-like and differential charges elements interact via a1/r-electric potential in both cases. The thermodynamic averages of the number density, and electric potential due to the plasma depend on the coupling and the charge ratioξ=q1/q2once the geometry of the layers is fixed. On the other hand, the fields due to the SE depend on the layer's geometry and their voltage. In the document, is defined a protocol to properly compare the systems. We show that there are values of the coupling parameter, where the thermodynamic averages computed via MD agree with the results of MoM for attractiveξ=-1and repulsive layersξ = 1.

2.
Appl Neuropsychol Adult ; : 1-10, 2024 Mar 05.
Article in English | MEDLINE | ID: mdl-38442327

ABSTRACT

OBJECTIVE: Persons with Parkinson's disease (PwPD) experience motor and non-motor symptoms that may elicit stigmatization. We investigated whether online assessment would replicate in-person findings of younger age and depression as predictors of stigma perception. We further assessed the predictive value of anxiety, and compared predictors across four stigma measures. METHODS: The online study (n = 347), like the earlier in-person study (n = 362), used the Parkinson's Disease Questionnaire stigma subscale (PDQ-39stigma). It also assessed anxiety and added the Stigma Scale for Chronic Illness (SSCI), Stigmatization Scale, and Mental Health Consumers' Experience of Stigma Scale. We correlated stigma perception scores with demographic/clinical characteristics and conducted hierarchical regression and mediation analyses. RESULTS: Online and in-person predictors of stigma perception with the PDQ-39stigma included younger age (men) and depression (men, women). Depression mediated the relation between stigma perception and motor experiences of daily living (EDLs). In the online sample, when anxiety was added, it predicted stigma perception (PDQ-39stigma, SSCI) and mediated the relation between stigma and both motor and non-motor EDLs (PDQ-39stigma). For all four stigma-perception scales, younger age predicted scores. Multiple additional predictors of PDQ-39stigma and SSCI scores suggest their utility relative to the other two scales. Conclusions: Younger age and depression predicted self-perceived stigma in online and in-person samples, indicating the cross-modal utility of the measure, PDQ-39stigma. In the online sample, anxiety also predicted stigma perception per the PDQ-39stigma and SSCI. We recommend both measures and note that treating depression and anxiety may be important especially in younger PwPD to reduce self-perceived stigma.

3.
Mov Disord Clin Pract ; 11(4): 391-397, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38269854

ABSTRACT

BACKGROUND: Self-report of motor and non-motor symptoms is integral to understanding daily challenges of persons with Parkinson's disease (PwPD). Care partners are often asked to serve as informants regarding symptom severity, raising the question of concordance with PwPD self-reports, especially regarding internalized (not outwardly visible) symptoms. OBJECTIVES: Concordance between PwPD and informant ratings of motor and non-motor symptoms was evaluated across multiple domains. METHODS: In 60 PwPD-informant pairs, we compared ratings on 11 online self-report measures comprising 33 total scores, 2/3 of which represented purely internalized symptoms. For discordant scores, multiple regression analyses were used to examine demographic/clinical predictors. RESULTS: Though concordant on 85% of measures, PwPD endorsed more non-motor symptoms, bodily discomfort, stigma, and motor symptoms than informants. For PwPD, younger age, greater disease severity, and female gender predicted discordance. CONCLUSIONS: Discordance between PwPD and informants on measures assessing symptoms that cannot be outwardly observed may require targeted education.


Subject(s)
Parkinson Disease , Humans , Female , Parkinson Disease/complications , Self Report
4.
Arch Clin Neuropsychol ; 39(1): 92-97, 2024 Jan 19.
Article in English | MEDLINE | ID: mdl-37401380

ABSTRACT

OBJECTIVE: Identifying persons needing mental health services is hampered by stigma-related underreporting of symptoms, especially by men. Men with Parkinson's disease (PD) consistently report lower rates of depression than women in in-person studies. We predicted that online anonymity would elicit more gender-based parity in depression endorsement. METHOD: We administered the Beck Depression Inventory-II (BDI-II) online to 344 participants with PD (52% women). Depression was defined as BDI-II score >13 and/or use of antidepressant medications. RESULTS: Overall depression prevalence was consistent with in-person studies, but with no significant difference between men and women. CONCLUSIONS: Online methods may circumvent barriers to depression identification in men with PD.


Subject(s)
Parkinson Disease , Male , Humans , Female , Parkinson Disease/complications , Parkinson Disease/epidemiology , Parkinson Disease/diagnosis , Depression/epidemiology , Depression/etiology , Depression/diagnosis , Prevalence , Neuropsychological Tests
5.
Brain Sci ; 13(2)2023 Jan 24.
Article in English | MEDLINE | ID: mdl-36831742

ABSTRACT

Apathy, depression, and anxiety are common non-motor symptoms of Parkinson's disease (PD). Tracking the changes in such symptoms over time would be valuable not only to determine their natural course during the disease, but also to establish the effects of unusual historical events interacting with the natural course. Having collected data on apathy (Apathy Scale), depression (Beck Depression Inventory-II), and anxiety (Parkinson's Anxiety Scale) in a large sample of persons with PD (PwPD) before the beginning of the COVID-19 era, we followed up with these individuals to investigate the changes in their prevalence of apathy, depression, and anxiety across two timepoints (T1 and T2). Of the original 347 participants, 111 responded and provided complete data at T2. The data collection at T1, before COVID-19, occurred between 2017-2018. The data collection at T2 occurred in 2021 and included the same measures, with the addition of the Coronavirus Impact Scale to assess the effects of the pandemic on the individual participants. Over this period, there was a significant increase in apathy, but not in depression or anxiety. Anxiety and depression, but not apathy, were correlated with the impact of COVID-19.

6.
Gen Psychiatr ; 35(3): e100653, 2022.
Article in English | MEDLINE | ID: mdl-35846485

ABSTRACT

Background: Parkinson's disease (PD) is associated with perceived stigma and affects quality of life (QoL). Additional health conditions may influence these consequences of PD. Aims: This study assessed the impact of health conditions on perceived stigma and QoL in persons with PD. We hypothesised that individuals with more health conditions would report more stigma and poorer QoL. We also examined the contributions of demographic and clinical characteristics to the correlations between health conditions and perceived stigma/QoL. Methods: We identified 196 eligible participants from the Boston University Online Survey Study of Parkinson's Disease and examined their health history, performance on multiple stigma measures, and scores on the 39-item Parkinson's Disease Questionnaire assessing QoL. Results: At least one health condition was reported by 79% of the sample, with a median of 2 and a range of 0-7 health conditions. More perceived stigma and poorer QoL were associated with thyroid disease, depression, anxiety, and the total number of health conditions. These correlations were related to younger age, less education, and earlier disease onset. Other health conditions (high blood pressure, back/leg surgery, headache, cancer/tumours, and heart disease) were not significantly correlated with stigma or QoL. Conclusions: Having more health conditions, or thyroid disease, depression, or anxiety, was associated with more perceived stigma and poorer QoL, with younger age, less education, and earlier disease onset affecting the associations. It is important to consider the burden of health conditions and how they affect persons with PD with specific clinical characteristics.

7.
J Phys Condens Matter ; 34(14)2022 Feb 03.
Article in English | MEDLINE | ID: mdl-35021155

ABSTRACT

In this work, we study the gapped surface electrode (SE), a planar system composed of two-conductor flat regions at different potentials with a gapGbetween both sheets. The computation of the electric field and the surface charge density requires solving Laplace's equation subjected to Dirichlet conditions (on the electrodes) and Neumann boundary conditions over the gap. In this document, the gapless surface electrode is modeled as a two-dimensional classical Coulomb gas having punctual charges +qand -qon the inner and outer electrodes, respectively, interacting with an inverse power law 1/r-potential. The coupling parameter Γ between particles inversely depends on temperature and is proportional toq2. Precisely, the density charge arises from the equilibrium states via Monte Carlo (MC) simulations. We focus on the coupling and the gap geometry effect. Mainly on the distribution of particles in the circular and the harmonically-deformed gapped SE. MC simulations differ from electrostatics in the strong coupling regime. The electrostatic approximation and the MC simulations agree in the weak coupling regime where the system behaves as two interacting ionic fluids. That means that temperature is crucial in finite-size versions of the gapped SE where the density charge cannot be assumed fully continuous as the coupling among particles increases. Numerical comparisons are addressed against analytical descriptions based on an electric vector potential approach, finding good agreement.

8.
Mov Disord Clin Pract ; 8(1): 51-59, 2021 Jan.
Article in English | MEDLINE | ID: mdl-33426159

ABSTRACT

BACKGROUND: Deficits in basic vision are associated with visual hallucinations in Parkinson's disease. Of particular interest is contrast sensitivity loss in this disorder and its effect on object identification. OBJECTIVES: Evaluate whether increased contrast improves object perception in persons with Parkinson's disease and visual hallucinations, without dementia. METHODS: We assessed 26 individuals with mild to moderate idiopathic Parkinson's disease, half of whom reported one or more episodes of hallucinations/unusual perceptual experiences in the past month, with a letter-identification task that determined the contrast level required to achieve 80% accuracy. Contrast sensitivity was further assessed with a chart that presented stimuli at multiple spatial frequencies. The groups were closely matched for demographic and clinical characteristics except for experience of hallucinations. RESULTS: Relative to participants without visual hallucinations, those with hallucinations had poorer spatial frequency contrast sensitivity and required significantly greater contrast to correctly identify the letters on the identification task. Specifically, participants with hallucinations required a mean contrast of 52.8%, whereas participants without hallucinations required 35.0%. When given sufficient contrast, the groups with and without hallucinations were equally accurate in letter identification. CONCLUSIONS: Compared to those without hallucinations, individuals with Parkinson's disease and hallucinations without dementia showed poorer contrast sensitivity. Once contrast was individually enhanced, the groups were equally accurate at object identification. These findings suggest the potential of visual perception tests to predict, and perception-based interventions to reduce, hallucinations in Parkinson's disease.

9.
Heliyon ; 5(10): e02723, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31720467

ABSTRACT

The potential of sawmill wastes as a raw material in pyrolysis process is presented in this study. Non-isothermal thermogravimetric analysis (TGA and DTG) and isoconversional methods were employed to determine triplet kinetic (activation energy, reaction model and pre-exponential factor). Through TGA and DTG, the conversion degree is described as a function of temperature for five heating rates (10, 20, 30, 40 and 50 o C/min) and four model-free methods (Flynn-Wall-Ozawa (FWO), Kissinger-Akahira-Sunose (KAS), Friedman, and Vyazovkin) with temperatures ranging from 25 to 1000 ° C were employed. Isoconversional lines were built for every method at different isoconversional degrees α ∈ [ 0,1 ] . The activation energy E was found as a function of α in the interval χ I I = [ 0.2 , 0.7 ] where each isoconversional methods were in agreement and the estimated error was sufficiently small. Findings show the same activation energy profile independently of the isoconversional method. In particular the total variation of E in χ I I was as follows: 209.909-228.238 kJ/mol (FWO); 211.235-229.277 kJ/mol (KAS); 223.050-188.512 kJ/mol (Friedman), and 211.449 kJ/mol-229.512 kJ/mol (Vyazovkin). The reaction model of the process in χ I I matched with a two-dimensional diffusion ( D 2 ) by using a master-plot analysis. The calculated and reported parameters are fundamental information for the pyrolysis reactor design using Sawmill wastes as feedstock.

10.
Behav Neurosci ; 133(4): 350-360, 2019 Aug.
Article in English | MEDLINE | ID: mdl-31294590

ABSTRACT

Spatial judgment is impaired in Parkinson's disease (PD), with previous research suggesting that disruptions in attention and executive function are likely contributors. If judgment of center places demands on frontal systems, performance on tests of attention/executive function may correlate with extent of bias in PD, and attentional disturbance may predict inconsistency in spatial judgment. The relation of spatial judgment to attention/executive function may differ for those with left-side versus right-side motor onset (LPD, RPD), reflecting effects of attentional lateralization. We assessed 42 RPD, 37 LPD, and 67 healthy control participants with a Landmark task (LM) in which a cursor moved horizontally from the right (right-LM) or left (left-LM). The task was to judge the center of the line. Participants also performed neuropsychological tests of attention and executive function. LM group differences were found on left-LM only, with both PD subgroups biased leftward of the control group (RPD p < .05; LPD p < .01; no RPD-LPD difference). For left-LM trials, extent of bias significantly correlated with performance on the cognitive tasks for PD but not for the control group. PD showed greater variability in perceived center than the control group; this variability correlated with performance on the cognitive tasks. The correlations between performance on the test of spatial judgment and the tests of attention/executive function suggest that frontal-based attentional dysfunction affects dynamic spatial judgment, both in extent of spatial bias and in consistency of response as indexed by intertrial variability. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Subject(s)
Parkinson Disease/physiopathology , Spatial Navigation/physiology , Aged , Attention/physiology , Executive Function/physiology , Female , Functional Laterality/physiology , Humans , Male , Middle Aged , Neuropsychological Tests , Psychomotor Performance , Space Perception/physiology
11.
Parkinsonism Relat Disord ; 60: 76-80, 2019 03.
Article in English | MEDLINE | ID: mdl-30297211

ABSTRACT

OBJECTIVE: The burden of PD extends beyond physical limitations and includes significant psychosocial adjustments as individuals undergo changes to their self-perception and how others perceive them. There is limited quantitative evidence of the factors that contribute to self-perceived stigma, which we addressed in the present study. METHODS: In 362 individuals with PD (157 women, 205 men), self-perceived stigma was measured by the four-item stigma subscale of the Parkinson's Disease Questionnaire (PDQ-39). Hierarchical linear modeling was used to assess predictors of stigma including demographics (age, gender) and disease characteristics: duration, stage (Hoehn & Yahr Scale), motor severity (Unified Parkinson's Disease Rating Scale, UPDRS, Part 3), activities of daily living (UPDRS Part 2), and depression (Geriatric Depression Scale). Predictor variables were chosen based on their significant correlations with the stigma subscale. Further analyses were conducted for men and women separately. RESULTS: For the total sample, the full model accounted for 14% of the variance in stigma perception (p < .001). Younger age and higher depression scores were the only significant predictors (both p < .001). This pattern was also seen for the men in the sample. For the women, only depression was a significant predictor. Depression mediated the relation between stigma and activities of daily living. CONCLUSIONS: Younger age (men) and depression (men and women) were the primary predictors of self-perceived stigma in PD. Disease characteristics (motor and ADL) did not contribute to stigma perception. Depression is a potential treatment target for self-perceived stigma in PD.


Subject(s)
Activities of Daily Living , Depression/psychology , Parkinson Disease/psychology , Self Concept , Social Stigma , Age Factors , Aged , Female , Humans , Male , Middle Aged , Parkinson Disease/physiopathology , Sex Factors
12.
PeerJ ; 6: e5442, 2018.
Article in English | MEDLINE | ID: mdl-30155357

ABSTRACT

BACKGROUND: Prior studies of oculomotor function in Parkinson's disease (PD) have either focused on saccades without considering smooth pursuit, or tested smooth pursuit while excluding saccades. The present study investigated the control of saccadic eye movements during pursuit tasksand assessed the quality of binocular coordinationas potential sensitive markers of PD. METHODS: Observers fixated on a central cross while a target moved toward it. Once the target reached the fixation cross, observers began to pursue the moving target. To further investigate binocular coordination, the moving target was presented on both eyes (binocular condition), or on one eye only (dichoptic condition). RESULTS: The PD group made more saccades than age-matched normal control adults (NC) both during fixation and pursuit. The difference between left and right gaze positions increased over time during the pursuit period for PD but not for NC. The findings were not related to age, as NC and young-adult control group (YC) performed similarly on most of the eye movement measures, and were not correlated with classical measures of PD severity (e.g., Unified Parkinson's Disease Rating Scale (UPDRS) score). DISCUSSION: Our results suggest that PD may be associated with impairment not only in saccade inhibition, but also in binocular coordination during pursuit, and these aspects of dysfunction may be useful in PD diagnosis or tracking of disease course.

13.
Neuropsychology ; 31(6): 613-623, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28414497

ABSTRACT

OBJECTIVE: Cognitive deficits are common in Parkinson's disease (PD) and exacerbate the functional limitations imposed by PD's hallmark motor symptoms, including impairments in walking. Though much research has addressed the effect of dual cognitive-locomotor tasks on walking, less is known about their effect on cognition. The purpose of this study was to investigate the relation between gait and executive function, with the hypothesis that dual tasking would exacerbate cognitive vulnerabilities in PD as well as being associated with gait disturbances. METHOD: Nineteen individuals with mild-moderate PD without dementia and 13 age- and education-matched normal control adults (NC) participated. Executive function (set-shifting) and walking were assessed singly and during dual tasking. RESULTS: Dual tasking had a significant effect on cognition (reduced set-shifting) and on walking (speed, stride length) for both PD and NC, and also on stride frequency for PD only. The impact of dual tasking on walking speed and stride frequency was significantly greater for PD than NC. Though the group by condition interaction was not significant, PD had fewer set-shifts than NC on dual task. Further, relative to NC, PD showed significantly greater variability in cognitive performance under dual tasking, whereas variability in motor performance remained unaffected by dual tasking. CONCLUSIONS: Dual tasking had a significantly greater effect in PD than in NC on cognition as well as on walking. The results suggest that assessment and treatment of PD should consider the cognitive as well as the gait components of PD-related deficits under dual-task conditions. (PsycINFO Database Record


Subject(s)
Cognitive Dysfunction/physiopathology , Executive Function/physiology , Gait Disorders, Neurologic/physiopathology , Parkinson Disease/physiopathology , Aged , Cognitive Dysfunction/etiology , Female , Gait Disorders, Neurologic/etiology , Humans , Male , Middle Aged , Parkinson Disease/complications , Walking
14.
Parkinsonism Relat Disord ; 38: 26-30, 2017 05.
Article in English | MEDLINE | ID: mdl-28256435

ABSTRACT

OBJECTIVE: Anxiety is commonly endorsed in Parkinson's disease (PD) and significantly affects quality of life. The Beck Anxiety Inventory (BAI) is often used but contains items that overlap with common PD motor symptoms (e.g., "hands trembling"). Because of these overlapping items, we hypothesized that PD motor symptoms would significantly affect BAI scores. METHODS: One hundred non-demented individuals with PD and 74 healthy control participants completed the BAI. PD motor symptoms were assessed by the Unified Parkinson's Disease Rating Scale (UPDRS). Factor analysis of the BAI assessed for a PD motor factor, and further analyses assessed how this factor affected BAI scores. RESULTS: BAI scores were significantly higher for PD than NC. A five-item PD motor factor correlated with UPDRS observer-rated motor severity and mediated the PD-control difference on BAI total scores. An interaction occurred, whereby removal of the PD motor factor resulted in a significant reduction in BAI scores for PD relative to NC. The correlation between the BAI and UPDRS significantly declined when controlling for the PD motor factor. CONCLUSIONS: The results indicate that commonly endorsed BAI items may reflect motor symptoms such as tremor instead of, or in addition to, genuine mood symptoms. These findings highlight the importance of considering motor symptoms in the assessment of anxiety in PD and point to the need for selecting anxiety measures that are less subject to contamination by the motor effects of movement disorders.


Subject(s)
Anxiety/etiology , Motor Activity/physiology , Parkinson Disease/complications , Parkinson Disease/psychology , Self Report , Aged , Analysis of Variance , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Severity of Illness Index
15.
J Geriatr Psychiatry Neurol ; 30(1): 11-25, 2017 Jan.
Article in English | MEDLINE | ID: mdl-28248557

ABSTRACT

BACKGROUND: Apathy, one of the most common neuropsychiatric symptoms in Parkinson's disease (PD), has been associated with reduced daily functioning, cognition, treatment compliance, quality of life, and increased caregiver burden and distress, among other outcomes. OBJECTIVES: The purpose of the present study was to develop and gather pilot data on the feasibility, acceptability, and efficacy of the Parkinson's Active Living (PAL) program, to our knowledge, the first behavioral treatment specifically designed to target apathy in patients with PD. The Parkinson's Active Living is a primarily telephone-based, 6-week activity scheduling and monitoring intervention that incorporates external cueing to target disease-related self-generational deficits to reduce levels of apathy in nondemented, highly apathetic patients with PD. METHODS: Participants aged 44 to 86 years (mean = 66, SD [standard deviation] = 10.7) ranging in disease duration from <1 to 23 years with elevated apathy (Apathy Evaluation Scale >35) were enrolled in a 1-arm trial and tested at 3 time points (baseline, posttest, and 1-month follow-up). RESULTS: Feasibility aspects (ie, acceptability, demand, implementation, practicality, adaptation, integration, and expansion) and efficacy of PAL program are reported. Matched pairs t tests showed a medium to large effect of treatment on patient apathy (52% showing ≥1 SD improvement), depression (33% showing ≥1 SD improvement), and quality of life at posttest, with improvements in apathy and depression maintained at follow-up. CONCLUSIONS: The program may hold promise as an effective nonpharmacological intervention for apathy in PD. Implications and future directions are discussed. Randomized controlled trials are needed.


Subject(s)
Apathy , Cognitive Behavioral Therapy/methods , Parkinson Disease/therapy , Patient Acceptance of Health Care , Program Development , Quality of Life/psychology , Telemedicine , Adult , Aged , Aged, 80 and over , Caregivers , Depression/psychology , Feasibility Studies , Female , Humans , Male , Middle Aged , Motivation , Outcome and Process Assessment, Health Care , Parkinson Disease/complications
16.
Vision Res ; 115(Pt A): 119-27, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26325394

ABSTRACT

Veering while walking is often reported in individuals with Parkinson's disease (PD), with potential mechanisms being vision-based (asymmetrical perception of the visual environment) or motoric (asymmetry in stride length between relatively affected and non-affected body side). We examined these competing hypotheses by assessing veering in 13 normal control participants (NC) and 20 non-demented individuals with PD: 9 with left-side onset of motor symptoms (LPD) and 11 with right-side onset (RPD). Participants walked in a corridor under three conditions: eyes-open, egocentric reference point (ECRP; walk toward a subjectively perceived center of a target at the end of the corridor), and vision-occluded. The visual hypothesis predicted that LPD participants would veer rightward, in line with their rightward visual-field bias, whereas those with RPD would veer leftward. The motor hypothesis predicted the opposite pattern of results, with veering toward the side with shorter stride length. Results supported the visual hypothesis. Under visual guidance, RPD participants significantly differed from NC, veering leftward despite a shorter right- than left-stride length, whereas LPD veered rightward (not significantly different from NC), despite shorter left- than right-stride length. LPD participants showed significantly reduced rightward veering and stride asymmetry when they walked in the presence of a visual landmark (ECRP) than in the eyes-open condition without a target. There were no group differences in veering in the vision-occluded condition. The findings suggest that interventions to correct walking abnormalities such as veering in PD should incorporate vision-based strategies rather than solely addressing motor asymmetries, and should be tailored to the distinctive navigational profiles of LPD and RPD.


Subject(s)
Gait Disorders, Neurologic/physiopathology , Parkinson Disease/complications , Perceptual Disorders/physiopathology , Walking/physiology , Aged , Aged, 80 and over , Analysis of Variance , Biomechanical Phenomena , Case-Control Studies , Female , Functional Laterality/physiology , Gait Disorders, Neurologic/etiology , Humans , Male , Middle Aged , Motor Activity/physiology , Neuropsychological Tests , Perceptual Disorders/etiology , Space Perception/physiology
17.
JAMA Intern Med ; 175(9): 1461-72, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26147487

ABSTRACT

IMPORTANCE: Cognitive behavioral therapy for insomnia (CBT-I) is the most prominent nonpharmacologic treatment for insomnia disorders. Although meta-analyses have examined primary insomnia, less is known about the comparative efficacy of CBT-I on comorbid insomnia. OBJECTIVE: To examine the efficacy of CBT-I for insomnia comorbid with psychiatric and/or medical conditions for (1) remission from insomnia; (2) self-reported sleep efficiency, sleep onset latency, wake after sleep onset, total sleep time, and subjective sleep quality; and (3) comorbid symptoms. DATA SOURCES: A systematic search was conducted on June 2, 2014, through PubMed, PsycINFO, the Cochrane Library, and manual searches. Search terms included (1) CBT-I or CBT or cognitive behavioral [and its variations] or behavioral therapy [and its variations] or behavioral sleep medicine or stimulus control or sleep restriction or relaxation therapy or relaxation training or progressive muscle relaxation or paradoxical intention; and (2) insomnia or sleep disturbance. STUDY SELECTION: Studies were included if they were randomized clinical trials with at least one CBT-I arm and had an adult population meeting diagnostic criteria for insomnia as well as a concomitant condition. Inclusion in final analyses (37 studies) was based on consensus between 3 authors' independent screenings. DATA EXTRACTION AND SYNTHESIS: Data were independently extracted by 2 authors and pooled using a random-effects model. Study quality was independently evaluated by 2 authors using the Cochrane risk of bias assessment tool. MAIN OUTCOMES AND MEASURES: A priori main outcomes (ie, clinical sleep and comorbid outcomes) were derived from sleep diary and other self-report measures. RESULTS: At posttreatment evaluation, 36.0% of patients who received CBT-I were in remission from insomnia compared with 16.9% of those in control or comparison conditions (pooled odds ratio, 3.28; 95% CI, 2.30-4.68; P < .001). Pretreatment and posttreatment controlled effect sizes were medium to large for most sleep parameters (sleep efficiency: Hedges g = 0.91 [95% CI, 0.74 to 1.08]; sleep onset latency: Hedges g = 0.80 [95% CI, 0.60 to 1.00]; wake after sleep onset: Hedges g = 0.68; sleep quality: Hedges g = 0.84; all P < .001), except total sleep time. Comorbid outcomes yielded a small effect size (Hedges g = 0.39 [95% CI, 0.60-0.98]; P < .001); improvements were greater in psychiatric than in medical populations (Hedges g = 0.20 [95% CI, 0.09-0.30]; χ2 test for interaction = 12.30; P < .001). CONCLUSIONS AND RELEVANCE: Cognitive behavioral therapy for insomnia is efficacious for improving insomnia symptoms and sleep parameters for patients with comorbid insomnia. A small to medium positive effect was found across comorbid outcomes, with larger effects on psychiatric conditions compared with medical conditions. Large-scale studies with more rigorous designs to reduce detection and performance bias are needed to improve the quality of the evidence.


Subject(s)
Cognitive Behavioral Therapy , Mental Disorders/complications , Sleep Initiation and Maintenance Disorders/therapy , Humans , Mental Disorders/therapy , Sleep , Sleep Initiation and Maintenance Disorders/complications , Treatment Outcome
18.
J Int Neuropsychol Soc ; 19(3): 305-13, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23298459

ABSTRACT

Cognitive performance can be impacted by many non-neurological factors, including preexisting expectations. The phenomenon of stereotype threat, or reduced cognitive performance due to preexisting beliefs, can apply to individuals following neurological injury (i.e., ''diagnosis threat''). We examined the effect of diagnosis threat on cognitive performance and symptom reporting following concussions while accounting for group identification (i.e., extent to which one's identity is tied to being concussed). We also examined gender stereotype threat (i.e., women and math ability) to understand how these two related threat effects compare. Participants with a history of concussion were randomly assigned to one of three instructional sets emphasizing concussion history or gender, or neutral instructions. Individuals without a history of concussion served as a comparison group. Results revealed an effect of diagnosis threat on cognitive performance after group identification was taken into account, but only in male participants. In contrast, an underlying gender stereotype threat was observed in females across conditions, which was counteracted in the gender stereotype condition (i.e., stereotype reactance effect) due to the type of threat cues used. Also, controls exhibited greater symptom reporting than individuals with a concussion. Our findings highlight the importance of considering non-neurological factors impacting cognitive performance.


Subject(s)
Brain Concussion/complications , Brain Concussion/psychology , Cognition Disorders , Emotions/physiology , Social Identification , Stereotyping , Adolescent , Adult , Analysis of Variance , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Cognition Disorders/psychology , Female , Humans , Male , Mathematical Concepts , Memory, Short-Term , Neuropsychological Tests , Self Concept , Severity of Illness Index , Sex Factors , Surveys and Questionnaires , Young Adult
19.
Interv Cardiol Clin ; 1(4): 429-440, 2012 Oct.
Article in English | MEDLINE | ID: mdl-28581961

ABSTRACT

ST-elevation myocardial infarction (STEMI) causes 12.6% of deaths worldwide. Treatment strategies involve early revascularization by percutaneous coronary intervention and/or fibrinolytics, with adjunctive pharmacologic therapy. While antiplatelet therapy remains the cornerstone of pharmacologic management, newer antithrombotic therapies are showing benefit in the reduction of long-term thrombotic events following acute vessel occlusion. Future directions in adjunctive STEMI management include the use of hematopoietic stem cell therapy or growth factors to induce proliferation and differentiation of cardiac myocytes.

20.
Rev. venez. cir. ortop. traumatol ; 35(2): 87-92, oct. 2003. ilus
Article in Spanish | LILACS | ID: lil-513584

ABSTRACT

Se analiza el caso de una paciente femenina de 35 años de edad, raza blanca, oficios del hogar quien consulta por presentar dolor en rodilla izquierda y dificultad para la marcha, diagnosticándose por métodos radiológicos y biopsia tumor de células gigantes de fémur izquierdo, se decide tratamiento quirúrgico consistente en resección amplia de la lesión (resección en bloque) más artroplastia de rodilla con protesis especial. Después de dos años y seis meses se evidencia fractura del componente femoral de la prótesis a nivel de su base, motivo por el cual es reintervenida, realizándose cambio del componente femoral de la misma. Estudios de bio-ingeniería determinan las causas del fracaso protésico.


Subject(s)
Humans , Adult , Female , Arthroplasty, Replacement, Knee/methods , Knee Prosthesis , Giant Cell Tumors/diagnosis , Giant Cell Tumors/therapy , Venezuela , Traumatology
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