Optimism on quality of life in Portuguese chronic patients: moderator/mediator?

OBJECTIVE: optimism is an important variable that has consistently been shown to affect adjustment to quality of life in chronic diseases. This study aims to clarify if dispositional optimism exerts a moderating or a mediating influence on the personality traits-quality of life association, in Portuguese chronic patients. METHODS: multiple regression models were used to test the moderation and mediation effects of dispositional optimism in quality of life. A sample of 729 patients was recruited in Portugal's main hospitals and completed self-reported questionnaires assessing socio-demographic and clinical variables, personality, dispositional optimism, quality of life (QoL) and subjective well-being (SWB). RESULTS: the results of the regression models showed that dispositional optimism did not moderate the relationships between personality traits and quality of life. After controlling for gender, age, education level and severity of disease perception, the effects of personality traits on QoL and in SWB were mediated by dispositional optimism (partially and completely), except for the links between neuroticism/openness to experience and physical health. CONCLUSION: dispositional optimism is more likely to play a mediating, rather than a moderating role in personality traits-quality of life pathway in Portuguese chronic patients, suggesting that "the expectation that good things will happen" contributes to a better quality of life and subjective well-being.

Optimism on quality of life in Portuguese chronic patients: moderator/mediator? / O papel do otimismo na qualidade de vida de pessoas portuguesas com doenças crônicas: moderador/mediador?

Objective: optimism is an important variable that has consistently been shown to affect adjustment to quality of life in chronic diseases. This study aims to clarify if dispositional optimism exerts a moderating or a mediating influence on the personality traits-quality of life association, in Portuguese chronic patients. Methods: multiple regression models were used to test the moderation and mediation effects of dispositional optimism in quality of life. A sample of 729 patients was recruited in Portugal's main hospitals and completed self-reported questionnaires assessing socio-demographic and clinical variables, personality, dispositional optimism, quality of life (QoL) and subjective well-being (SWB). Results: the results of the regression models showed that dispositional optimism did not moderate the relationships between personality traits and quality of life. After controlling for gender, age, education level and severity of disease perception, the effects of personality traits on QoL and in SWB were mediated by dispositional optimism (partially and completely), except for the links between neuroticism/openness to experience and physical health. Conclusion: dispositional optimism is more likely to play a mediating, rather than a moderating role in personality traits-quality of life pathway in Portuguese chronic patients, suggesting that "the expectation that good things will happen" contributes to a better quality of life and subjective well-being. .

Objetivo: o otimismo tem sido demonstrado como uma variável importante no ajustamento da qualidade de vida de pessoas com doenças crônicas. O estudo tem como objetivo verificar se o otimismo exerce um efeito moderador ou mediador entre os traços de personalidade e a qualidade de vida, em portugueses com doenças crônicas. Métodos: os modelos de regressão linear múltipla foram usados para avaliar o efeito de moderação e mediação do otimismo na qualidade de vida. A amostra, constituída por 729 doentes, recrutados nos principais hospitais de Portugal responderam a questionários de autorresposta avaliando questões sócio-demográficas e clínicas, personalidade, otimismo disposicional, qualidade de vida e bem-estar subjetivo. Resultados: os resultados encontrados mostraram que o otimismo disposicional não exerce um papel moderador entre os traços de personalidade e a qualidade de vida. Controlando por idade, sexo, nível de escolaridade e percepção da severidade da doença, o efeito dos traços de personalidade na qualidade de vida e no bem-estar subjetivo foi mediado pelo otimismo (parcial e total), expecto para as associações, neuroticismo/abertura à experiência e à saúde física. Conclusão: o otimismo disposicional exerce apenas um papel mediador entre os traços de personalidade e qualidade de vida, em pessoas com doenças crônicas, sugerindo que 'a expectativa de que coisas boas vão acontecer' contribui para uma melhor qualidade de vida e melhor bem-estar subjetivo. .

Utilidad de la caracterización genética de la narcolepsia y la hipersomnia en la definición del fenotipo: estudio en pacientes portugueses / Usefulness of genetic characterization of narcolepsy and hypersomnia on phenotype definition: a study in Portuguese patients

Introducción. La determinación del genotipo de los antígenos leucocitarios humanos (HLA) de clase II es un método muy difundido para confirmar el diagnóstico de la narcolepsia, con y sin cataplejía. El genotipado del HLA es fiable, sencillo y proporciona seguridad al médico. También es menos invasivo que otros métodos y entronca con la hipótesis autoinmunitaria sobre el origen de la narcolepsia. Objetivo. Evaluar la utilidad de los marcadores genéticos (HLA) en el diagnóstico diferencial de diferentes trastornos del sueño y su relevancia en el contexto de nuestra población. Sujetos y métodos. Se analizó una cohorte de 113 pacientes con episodios de somnolencia diurna, 38 de los cuales fueron clasificados como afectados por narcolepsia con cataplejía, 13 con narcolepsia y 62 con hipersomnia/hipersomnia idiopática. La población de control estaba integrada por 206 individuos sanos del mismo origen geográfico. Resultados. La frecuencia del alelo HLA-DQB1*06:02 era superior a la habitual en los pacientes con narcolepsia y narcolepsia con cataplejía (46% y 71%, respectivamente, frente al 16% en la población control), con un valor de p = 4, 53-13 en el caso de la narcolepsia con cataplejía. La frecuencia del alelo HLA-DQB1*02 era más elevada en la población con hipersomnia en comparación con la población control (55% frente a 34%; p = 0,004). Conclusiones. La caracterización genética tiene posibilidades de mejorar el diagnóstico diferencial entre varios fenotipos de somnolencia diurna excesiva, que corresponden a diversas entidades con diferentes mecanismos biológicos (AU)

Introduction. The determination of human leukocyte antigen (HLA) class II genotype is widely used to confirm the diagnosis of narcolepsy with or without cataplexy. The HLA genotyping is reliable, easy to perform and reassures the clinician. It is also less invasive than other methodologies and is in accordance with the autoimmune hypothesis for the origin of narcolepsy. Aim. To assess the usefulness of genetic markers (HLA) in the differential diagnosis between different sleep disorders and their relevance in the context of our population. Subjects and methods. We analyzed a cohort of 113 patients with episodes of daytime sleepiness, 38 patients were classified as narcolepsy with cataplexy, 13 as narcolepsy and 62 as hypersomnia/idiopathic hypersomnia. A control population of 206 reportedly healthy individuals from the same geographic origin was used. Results. The HLA-DQB1*06:02 allele frequency was overrepresented in patients with narcolepsy and narcolepsy with cataplexy (46% and 71% respectively vs. 16% in control population), with a value of p = 4.53-13 for narcolepsy with cataplexy. The HLA-DQB1*02 frequency was increased in the population with hypersomnia when compared with the control population (55% vs. 34%; p = 0.004). Conclusions. Genetic characterization has the potential to enhance the ability to carry out differential diagnosis among diverse excessive daytime sleepiness phenotypes, corresponding to diverse entities with different biological mechanisms (AU)

Polissonografia: aspectos técnicos e clínicos / Polysomnography: technical aspects and clinical use

O sono pode ser estudado por registro em poligrafia (registro combinado de vários sinais biológicos) geralmente chamado de polissonografia (PSG). Neste artigo comparam-se os resultados dos achados da PSG, segundo Rechtshaffen and Kales sleep scoring manual, 1968 ("R and K" rules), com American Academy of Sleep Medicine Manual for Scoring Sleep and Associated Events, 2007, mas se enfatiza o uso do segundo manual. Sumariamente, e com uso de ilustrações, resumem-se a aplicação prática da PSG; o estudo dos potenciais bioelétricos e suas bases; os sensores e transdutores usados nesta poligrafia; as características dos estágios do ciclo sono-vigília. Associadamente, apresentam-se alguns achados normais e anormais da PSG, avaliam-se parâmetros do estudo do ciclo sono-vigília.

Sleep can be studied by a polygraph registration (registration of various combined biological signals) commonly called polysomnography (PSG). In this paper we compare the results of the PSG, according to the Rechtshaffen and Kales sleep scoring manual of 1968 ("R and K" rules), to the American Academy of Sleep Medicine Manual for Scoring Sleep and Associated Events, 2007, however it is emphasized the second manual. Briefly, and with the help of illustrations, we summarize: practical application of the PSG and the study of bioelectric potential and its bases; sensors and transducers used in this polygraph; the characteristics of the stages of sleep-wake cycle. In addition, we present some PSG normal and abnormal findings, and we evaluate the parameters of the study of sleep-wake cycle.

Distrofia miotônica de Steinert e hipersonia primária: relato de caso / Myotonic dystrophy of Steinert and primary hypersomnia: case report

Este artigo apresenta o caso de uma paciente com distrofia miotônica tipo 1 (DM1) (doença de Steinert) e faz a revisão de literatura sobre sonolência excessiva diurna (SED) nestes pacientes. Paciente de 36 anos, portadora de (DM1), apresenta SED e testes múltiplos de latência com média de latências de 1 minuto e 22 segundos. DM1 e SED podem ter várias etiologias, a ressaltar as devidas à disfunção no sistema nervoso central ou à miopatia. No caso da paciente, provavelmente predomina a SED de origem central.

This article presents the case of a myotonic dystrophy type 1 - Steinert's disease (DM1) patient and reviews the literature on excessive daytime sleepiness (EDS) in these patients. Patient of 36 years of age, with DM1, presents EDS and mean multiple sleep latency test of 1 minute and 22 seconds. DM1 and EDS can have some etiologies, mainly due to central nervous system dysfunction or to the myopathy. In the present case, probably predominate the SED of central origin.

Qualidade de vida, ansiedade e depressão: um exemplo de indicadores e relações na epilepsia / Quality of life, anxiety and depression: an example of indicators and relations in Epilepsy

A identificação de preditores modificáveis da qualidade de vida (QDV) de indivíduos com epilepsia poderá ser usada para desenvolver estratégias eficazes de promoção da QDV destes mesmos indivíduos. Assim, o objectivo do presente estudo é comparar a capacidade preditiva de diferentes indicadores de ansiedade e depressão (scores vs. itens). Para o efeito, foram avaliados 99 indivíduos com clínica sugestiva de epilepsia focal, através de um Questionário Sócio-demográfico e Clínico, do SF-36 v1.0, da Escala de Função Cognitiva, da Escala de Controlo das Crises (QDV) e da Hospital Anxiety and Depression Scale (HADS; ansiedade/depressão). A capacidade preditiva (R quadrado ajustado) dos scores de ansiedade e/ou depressão da HADS oscilou entre 0,161 (Desempenho Emocional) e 0,568 (Saúde Mental), não sendo nenhum destes scores da HADS preditor do Controlo das Crises; a capacidade preditiva de subgrupos de itens da HADS oscilou entre 0,115 (Controlo das Crises) e 0,683 (Saúde Mental). Os resultados indicam que os scores tradicionais/globais de ansiedade e de depressão da HADS não são tão bons preditores da QDV da amostra como subconjuntos de itens da HADS. Estes resultados apoiam um modo diferente de explorar os dados recolhidos em contextos clínicos e de investigação.(AU)

The identification of changeable quality of life (QOL) predictors could be used to develop adequate QOL promotion strategies for epilepsy patients. Consequently, the aim of the present study is to compare the predictive power of different anxiety and depression indicators (scores vs. items). To do so, 99 individuals with clinical evidence of focal epilepsy were assessed with a Socio-demographic and Clinical Questionnaire, the SF-36 v1.0, the Cognitive Function Scale, the Seizure Control Scale (QOL), and the Hospital Anxiety and Depression Scale (HADS; anxiety/depression). The predictive power (adjusted R square) of the HADS anxiety and/or depression scores varied between .161 (Role Emotional) and .568 (Mental Health); none of these HADS scores was a predictor of Seizure Control. The predictive power (adjusted R square) of subgroups of HADS items varied between .115 (Seizure Control) and .683 (Mental Health). The results indicate that the traditional/global HADS anxiety and depression scores are not as good QOL predictors as subgroups of HADS items. This results support a different way of exploring the data collected in clinical and research settings.(AU)