Diligent and disagreeable? The influence of personality on continuous positive airway pressure (CPAP) adherence for obstructive sleep apnea.

CPAP is an effective treatment for obstructive sleep apnea (OSA), though low adherence rates limit its benefits. Previous research has linked personality to a range of health behaviours including CPAP adherence. In keeping with these findings it was hypothesised that CPAP adherence would be positively correlated with conscientiousness and negatively correlated with emotionality. The present study also tested for an interaction between conscientiousness and emotionality as well as investigating the relationship between personality facets and adherence. Participants were 110 adults, diagnosed with OSA. After approximately one month's treatment, average nightly usage for the previous week was downloaded from the CPAP device. Participants also completed the HEXACO Personality Inventory - revised. Contrary to expectation, there was no significant relationship between CPAP adherence and conscientiousness or emotionality and no significant interaction. However, the diligence facet of conscientiousness showed a significant positive correlation with CPAP adherence (r = .23, p < .05). Unanticipated negative correlations were also found between CPAP adherence and agreeableness and two of its facets: gentleness (r = -.33, p < .01) and patience (r = -.22, p < .05). The results provide support for an association between CPAP adherence and personality. It is recommended that future research focus on facet level measurement, in particular the personality facets associated with conscientiousness and agreeableness.

A Review of Palliative and Hospice Care in the Context of Islam: Dying with Faith and Family.

BACKGROUND: By starting to understand Muslim culture, we can seek common ground with Islamic culture within the American experience and bridge opportunities for better palliative and hospice care here and in Middle Eastern countries. The United States, Canada, and Europe are education hubs for Middle Eastern students, creating an opportunity for the palliative and hospice care philosophy to gain access by proxy to populations of terminally ill patients who can benefit from end-of-life care. OBJECTIVE: The aim was to assess the state of research and knowledge about palliative and hospice care within the context of Muslim culture and religion. RESULTS: Within the guide of the key search terms, we learned that at a glance, over 100 articles meet the search criteria, but after a closer inspection, only a portion actually contributed knowledge to the literature. This confirmed the need for research in this vein. More importantly, we posit that once the layers of culture, religion, norms, and nationality are removed, human beings share a kinship based on family, spirituality, death and dying, and fear of pain. This is evident when we compare the Middle Eastern end-of-life experience with the western end-of-life care. CONCLUSIONS: A true opportunity to make a lasting impact at the patient level exists for palliative and hospice care researchers if we seek to understand, gain knowledge, and respect Muslim culture and Islamic issues at the end of life.

The Effect of Biofeedback as a Psychological Intervention in Multiple Sclerosis: A Randomized Controlled Study.

BACKGROUND: Relaxation, mindfulness, social support, and education (RMSSE) have been shown to improve emotional symptoms, coping, and fatigue in multiple sclerosis (MS). Biofeedback was trialed as a psychological intervention, designed to improve self-control, in two groups of patients with MS. Both groups received RMSSE, and one group additionally received biofeedback. METHODS: Forty people with relapsing-remitting MS were recruited from three sites in Sydney, Australia. The mean disability score (Expanded Disability Status Scale; EDSS) was 2.41 ± 1.46 (95% confidence interval [CI], 1.46-3.36); the mean age in years was 45.9 ± 12.42 (95% CI, 41.92-49.87). Participants were randomly assigned to two active treatment groups (n = 20 per group). All participants received one 1-hour session per week for 3 weeks of RMSSE, while biofeedback equipment measured breathing rate and muscle tension. Members of one group used biofeedback screens to regulate physiological response. RESULTS: Whole-group pre- and post-treatment scores demonstrated a reduction of 38% for anxiety and 39% for depression scores (P = .007 and P = .009, respectively). A post-treatment comparison failed to demonstrate any significant difference between the two active treatment groups in anxiety and depression scores. The biofeedback group showed significant pre- to post-treatment improvement or trends toward improvement in anxiety, fatigue, and stress (P = .05, .02, and .03, respectively). Comparison of pre-post treatment results between groups showed improvements for the biofeedback group in breathing rate and muscle tension (P = .06 and .09). CONCLUSIONS: For relapsing-remitting MS patients receiving biofeedback in addition to RMSSE, there was a demonstrable reduction in anxiety, fatigue, and stress. There was also a trend toward significant reduction of breathing rate and muscle tension in favor of biofeedback.

Risk indicators associated with injection drug use in the Aboriginal population.

In 2009, the incidence of positive HIV tests in the Saskatoon Health Region, Canada, was 31.3 per 100,000 population when the national average was only 9.3 per 100,000 population. A majority of the positive HIV tests were of Aboriginal cultural status with a majority of those associated with injection drug use (IDU). The main objective of the study was to determine the risk indicators independently associated with higher rates of IDU in the Aboriginal population in comparison to other cultural groups. It appears that there is no another study with a similar analysis. From September 2009 to April 2010, 603 current IDUs were interviewed; which represents 76.6% of the known Saskatoon IDUs. In our study population, 88.1% of the current IDUs were of Aboriginal cultural status despite making up only 9.2% of the general population. Comparing Aboriginal IDUs to non-Aboriginal IDUs, our study found that Aboriginal injection users were more likely to be female and younger, less likely to receive paid income and were more likely to attend a Residential School or had a parent or grandparent attend a Residential School. If exposure to Residential Schools is ignored, Aboriginal IDUs were also more likely to use sex trading as a source of income and witness death or experience permanent separation from a parent during youth. Our study has identified a limited number of risk indicators independently associated with higher rates of IDU in the Aboriginal population. More specifically, Residential Schools are having a significant generational impact on current IDU, which might explain higher HIV incidence rates within the Aboriginal population.

Risk indicators of depressive symptomatology among injection drug users and increased HIV risk behaviour.

OBJECTIVES: In 2009, the annual incidence of positive human immunodeficiency virus (HIV) test reports for people in the Saskatoon Health Region (SHR) was 31.3 per 100,000, when the national average was only 9.3 per 100 000. The first objective was to determine the prevalence of depressive symptomatology among injection drug users (IDUs) in the SHR. The second objective was to determine the unadjusted and adjusted risk indicators associated with depressive symptomatology among IDUs. The third objective was to determine if depressive symptomatology was associated with HIV risk behaviours. METHODS: From September 2009 to April 2010, 603 current IDUs were surveyed with validated instruments; this sample represents 76.6% of known IDUs in the SHR. RESULTS: Among the respondents, 81.4% reported depressive symptomatology, whereas 57.7% reported more severe depressive symptomatology. After multivariate analysis, the 4 covariates that had an independent association with depressive symptomatology included sexual assault as an adult, sexual assault as a child, attending a residential school, and having an annual income of less than $10,000 Depressive symptomatology was initially associated with 7 HIV risk behaviours. After multivariate analysis, depressive symptomatology was associated with giving sex to get money, giving drugs to get sex, and with more frequently sharing injecting equipment. CONCLUSIONS: This study found that depressive symptomatology was strongly associated with injection drug use.

The impact of the 2002 Delaware smoking ordinance on heart attack and asthma.

In the United States, smoking is the leading cause of death - having a mortality rate of approximately 435,000 people in 2000-accounting for 8.1% of all US deaths recorded that year. Consequently, we analyzed the Delaware Hospital Discharge Database, and identified state and non-state residents discharged with AMI or asthma for the years 1999 to 2004. Statistical data analysis compared the incidence of AMI or asthma for each group before (1999-2002) and after (2003-2004) the amendment. As a result, we found that pre-ordinance and post-ordinance quarterly rates of AMI for Delaware residents were 451 (se = 21) and 430 (se = 21) respectively, representing a 4.7% reduction. Over the same time period, there was negligible change in the incidence of AMI for non-Delaware residents. After adjusting for population growth, the Risk Ratio (RR) for asthma in Delaware residents post-ordinance was 0.95 (95% CI, 0.90 to 0.999), which represented a significant reduction (P = 0.046). By comparison, non-Delaware residents had an increased RR for asthma post-ordinance of 1.62 (95% CI, 1.46 to 1.86; P < 0.0001).The results suggest that Delaware's comprehensive non-smoking ordinance effectively was associated with a statistically significant decrease in the incidence of AMI and asthma in Delaware residents when compared to non-Delaware residents.

The utility of clinical electrophysiology in a case of nonorganic vision loss.

BACKGROUND: Nonorganic vision loss (NOVL) usually refers to reports of acuity reduction, field constrictions, or both without any associated organic pathology. Regardless of the underlying cause, the primary concern of the eye care practitioner is to demonstrate visual potential better than suggested by the patient's subjective reports. CASE REPORT: This article presents a case report of a 43-year-old woman with NOVL. The report shows the utility of visual electrodiagnostics in providing an objective assessment of the functional integrity of retinal and afferent visual pathway integrity and highlights how careful case history, subjective testing, observation of visual behavior, and objective testing can be used to establish a diagnosis of NOVL. CONCLUSIONS: The clever use of subjective testing and the careful selection and interpretation of objective tests such as visual electrodiagnostics can be exceptionally useful in making a diagnosis of NOVL.

Smoking practices, risk perception of smoking, and environmental tobacco smoke exposure among 6th-grade students in Ciudad Juárez, Mexico.

This study assessed the smoking practices, risk perception of smoking, and environmental tobacco smoke (ETS) exposure among adolescents in Ciudad Juárez, Mexico. We used a cross-sectional method to examine the smoking practices, risk perception of smoking, and ETS exposure of 6th-grade students (N=506), aged 11-13 years, attending six randomly selected middle schools. Schools were classified by school setting (i.e., public vs. private) and socioeconomic status (SES; i.e., low, middle, or high). The results indicated that 6th-grade students attending a public, low-SES school setting in Ciudad Juárez not only exhibited significantly higher rates of ETS exposure at home and in public places (p<.01) but also were more likely to have tried smoking (p<.01) and to be current smokers (p<.01), and were less likely to support a ban on smoking in public places (p<.01), compared with students who attended a private school or a public, middle- or high-SES school setting. These results provide further evidence that public health interventions to prevent initiation of smoking and to assist in smoking cessation among adolescents and to reduce their ETS exposure at home and in public need to target all school-aged students, especially those attending school in a low-SES settings.

Cost analysis of military eye injuries in fiscal years 1988-1998.

Army, Navy, and Air Force safety center ground eye injuries were evaluated from fiscal year 1988 through fiscal year 1998. The U.S. Army Safety Center data revealed that the average Army military eye injury mishap caused a loss of 6.1 days from work, at a cost averaging 9724 dollars. The U.S. Navy Safety Center data showed that the average Navy military eye injury mishap caused a loss of 5.9 days from work, at a cost averaging 4222 dollars. The Air Force Safety Center data revealed that the average Air Force eye injury mishap caused a loss of 4.7 days from work, at a cost averaging 3196 dollars. Comparing safety center data with Defense Medical Surveillance System data exposed an underreporting of safety center data by at least 250%. To improve accurate meaningful data collection, an automated eye injury collection system should be initiated.

Follow-up study on vision health readiness in the military.

A retrospective study reviewed medical records of military personnel who had participated in a vision readiness study the previous year. The review evaluated (1) the number of personnel who returned for an eye examination (as recommended), (2) the number of dilated eye examinations, (3) the number of optical devices ordered, (4) the number of patients requiring continuing treatment, (5) the types of eye disease in personnel who were classified as nondeployable in the original study, and (6) the relationship between patient vision complaints and the need for spectacles. Analyses revealed 44% of military personnel have never had a comprehensive eye examination. Of these personnel who never had an eye examination, 15% to 26% could improve their vision with spectacles. Finally, even though having an eye examination is important, whether or not the individual has had a comprehensive eye examination should not be a significant criterion for deployment.

Visual acuity, optical, and eye health readiness in the military.

Optimum vision readiness is essential on today's technologically advanced battlefield. A vision readiness screening of 4,825 active duty personnel at 13 Department of Defense sites from September through December 1997 revealed 4,021 (83.3%) not vision ready: 500 (10.4%) had substandard visual acuity, 1,249 (25.9%) had deficient optical devices, and 3,562 (73.8%) had eye health-related deficiencies. This suggests a more effective ongoing vision readiness process should be implemented to ensure all personnel are vision ready prior to deployment.

Descriptive analysis of military eye injuries from fiscal year 1988 to 1998.

An 11-year retrospective study of ground eye injuries collected by the Army Safety Center, Navy Safety Center, and Air Force Safety Center from fiscal year 1988 through 1998 was performed. The statistics for eye injuries indicate that the average Army, Navy, and Air Force individual sustaining an eye injury is a 20- to 24-year-old man with a rank of E2 through E5. The average military individual sustaining an eye injury is not wearing eye protection when injured. In addition, Army personnel lost 1.9 more workdays, Navy personnel lost 1.5 more workdays, and Air Force personnel lost 3.4 more workdays than those individuals who were wearing eye protection at the time of the eye injury. Proactive vision conservation education at local levels needs to focus on the military personnel that are at the highest risk for an eye injury.

Vision readiness in Operation Restore Hope.

Ensuring that our forces are vision ready for their mission is essential on today's battlefield. Vision readiness considers optical readiness (appropriate correcting eyewear) and visual readiness (adequate job-required visual acuity). A study of vision readiness among deploying personnel for Operation Restore Hope in Bosnia from December 1995 to September 1997 was conducted at Fort Benning, Georgia. Of the 10,063 personnel screened, 3,554 (35.3%) were not optically ready for deployment and 406 (4.0%) were not visually ready for deployment. Analyses indicated a statistically significant difference between the active duty and reserve components in optical and visual readiness. A more effective vision readiness process should be implemented before deployment to ensure that all personnel are deployment ready. Optometry personnel, commanders, and deploying soldiers, sailors, airmen, and marines must take a more active role in ensuring that our forces have the appropriate visual acuity and optical devices to deploy.