The mediating effect of sleep satisfaction on the relationship between stress and perceived health of adolescents suffering atopic disease: Secondary analysis of data from the 2013 9th Korea Youth Risk Behavior Web-based Survey

Perceived Stress, but Not Rumination, Mediates the Relationship Between Trait Mindfulness and Sleep Quality in Young Adults

Objective

Poor sleep among young adults is prevalent, yet the mediating variables are largely understudied, and there is limited relevant work utilizing objective sleep measures. The present study investigated the mediating effects of perceived stress and rumination in the relationship between trait mindfulness and subjective and objective sleep quality in young adults.

Methods

A total of 170 healthy adults (aged 18-37, M = 20.8, SD = 2.9) self-reported on trait mindfulness, perceived stress, and rumination. The primary (N = 140) and secondary (N = 30) samples both completed the Pittsburgh Sleep Quality Index (PSQI) to assess subjective sleep quality. The secondary sample (N = 30) additionally provided sleep diaries, as well as wrist-worn actigraphy data for assessing objective sleep quality. A mediation analysis was conducted to assess the effect of trait mindfulness on sleep quality with perceived stress and rumination as mediators.

Results

Trait mindfulness was positively associated with better subjective sleep quality; this was fully mediated by perceived stress, b = -0.08, 95% CI [-.12, -0.06]. Rumination was negatively associated with subjective sleep quality but did not mediate the relationship between trait mindfulness and sleep quality, b = -0.01, 95% CI [-.03, 0.02]. Only trait mindfulness was correlated with diary-based sleep ratings, and none of the measures were associated with actigraphy-based sleep quality.

Conclusion

This study indicates that perceived stress is an important mediator in the relationship between trait mindfulness and subjective sleep quality among young adults, rather than rumination. These findings have implications for mindfulness-based therapeutic approaches to address the high prevalence of sleep disorders among young adults, adding mechanistic detail to the literature.

Sleep Disturbances in Children With Atopic Dermatitis: A Scoping Review

Atopic dermatitis (AD) is associated with various quality of life concerns including poor sleep. Sleep impairments in children with AD are associated with increased risk of short stature, metabolic syndrome, mental illness and neurocognitive dysfunction. Although the association between AD and sleep disturbance is well established, the specific types of sleep disturbance in pediatric AD patients and their underlying mechanisms are not fully understood. A scoping literature review was performed to characterize and summarize the types of sleep disturbance in children (less than 18 years of age) with AD. 31 papers met inclusion criteria and extracted data were analyzed in an iterative manner. Two types of sleep disturbances were found to be more prevalent in pediatric AD patients in comparison to controls. One category was related to loss of sleep (increased frequency or duration of awakenings, increased sleep fragmentation, delayed sleep onset, decreased total sleep duration, and decreased sleep efficiency). Another category was associated with unusual behaviors during sleep (restlessness/limb movement/scratching, sleep-disordered breathing including obstructive sleep apnea and snoring, nightmares, nocturnal enuresis and nocturnal hyperhidrosis). Some mechanisms underlying these sleep disturbances include pruritus and induced scratching and increased proinflammatory markers induced by sleep loss. Sleep disturbance appears to be associated with AD. We recommend clinicians to consider interventions that may reduce sleep disturbances in children with AD. Further investigation of these sleep disturbances is needed to elucidate pathophysiology, develop additional treatments, and reduce negative impacts on the health outcomes and quality of life in pediatric AD patients.

Do lifestyle risk behaviors affect anxiety, depressive symptoms, and suicidal ideation among adolescents?

Cultivating and maintaining good mental health and a healthy lifestyle during adolescence-the period when physical and psychological development occurs-is important. Further, an unhealthy lifestyle can have long-term effects on health. Few studies have examined the multiple effects of lifestyle risk behavior on mental health, and the behaviors that interact with this relationship remain unclear. This study aimed to explore the associations between anxiety, depressive symptoms, and suicidal ideation and a cumulative unhealthy lifestyle. The study included 54,948 participants from the 2020 Korea Youth Risk Behavior Web-Based Survey. The generalized anxiety disorder-7 scale was used to define the disorder. Depressive symptoms and suicidal ideation were evaluated using a self-reported questionnaire. The relationship between mental health and lifestyle risk scores was examined using multiple logistic regression analysis. There was a significantly positive relationship of a high lifestyle risk score with the risk of generalized anxiety disorder, depressive symptoms, and suicidal ideation. There were interaction effects between sex and academic achievement. Insufficient/prolonged sleep was strongly associated with poor mental health among Korean adolescents. Our findings showed an association between poor mental health and high lifestyle risk scores. Longitudinal studies to identify potential risk behaviors and to reveal causal relationships are warranted.

Relationship between Smartphone Addiction and Sleep Satisfaction: A Cross-Sectional Study on Korean Adolescents

The purpose of this study was to analyze the relationship between smartphone addiction and sleep satisfaction in 54,948 Korean adolescents. This study utilized the Korea Youth Risk Behavior Web-Based Survey (KYRBS). The dependent variable was sleep satisfaction. Independent variables were smartphone addiction level and usage time. Gender, school grade, stress, depression, regular physical activity (PA), asthma, allergic rhinitis, and atopic dermatitis were selected as confounding variables. A chi-squared test, logistic regression, and independent t-test were performed for data analysis. As a result of the chi-squared test, sleep satisfaction showed significant relationships with all confounding variables (all p < 0.001). As a result of adjusting all confounding variables, sleep satisfaction of smartphone normal users was significantly higher (odds ratios: 1.372, p < 0.001) than that of high-risk users with smartphone addiction. Smartphone users with a daily smartphone usage time from 2 h to 8 h a day were 1.096−1.347 times (p = 0.014 to p < 0.001) more likely to be satisfied with their sleep than smartphone users with a daily smartphone usage time over 8 h, who were unsatisfied with their sleep. The group that was not satisfied with their sleep had a significantly higher average daily smartphone usage time and total score on the smartphone addiction scale than the group that was satisfied with their sleep (both p < 0.001). In conclusion, it will be necessary to manage the use of smartphones to improve the sleep satisfaction of Korean adolescents.

Analysis of patient factors associated with hospital visits for allergic rhinitis in Japanese adult patients: A cross-sectional study

OBJECTIVE

Allergic rhinitis (AR) is one of the most common diseases in Japan. However, several AR patients do not seek optimal treatments at clinics/hospitals. This may affect the patient's quality of life and labor productivity. In this study, we assessed the characteristics of the outpatients' AR and factors associated with their hospital visit, using the dataset obtained from a nation-wide survey in Japan.

METHODS

In this cross-sectional study, we used data from the nation-wide 2013 and 2016 Comprehensive Survey of Living Conditions (CSLC) in Japan. We analyzed the data of AR outpatients through logistic regression, using the outcome as the dependent variable, and age groups, sex, household size, educational status, smoking history, alcohol use, household expenditure, psychological distress, quality of sleep, asthma and atopic dermatitis outpatients as explanatory variables.

RESULTS

Among the data of 317,984 outpatients aged between 20 and 79 years in 2016 CSLC survey, the proportion of AR outpatients was significantly less among current smokers (odds ratio (OR); 0.47, 95% confidence interval (CI); 0.43-0.51, P < 0.001) and those with large household sizes (OR; 0.80, 95% CI; 0.72-0.89, P < 0.001). Conversely, the proportion of AR outpatients was significantly more among subjects with a past smoking habit (OR; 1.19, 95% CI; 1.08-1.31, P < 0.001), insufficient sleep (OR; 2.93, 95% CI; 2.52-3.42, P < 0.001), psychological distress (OR; 1.71, 95% CI; 1.62-1.80, P < 0.001), high household expenditures (OR; 1.68, 95% CI; 1.56-1.80, P < 0.001), and asthma and atopic dermatitis outpatients (OR; 8.97, 95% CI; 8.13-9.89 P < 0.001 for asthma and OR; 7.61, 95% CI; 6.76-8.58 P < 0.001 for atopic dermatitis). We observed the same trend using the dataset of 2013 CLSC survey.

CONCLUSION

This study revealed that smoking habit, psychological distress, insufficient sleep, high household expenditures and outpatients with other allergic diseases are the factors associated with AR outpatient visit.

Secondary Data Analysis in Nursing Research: A Contemporary Discussion

This editorial provides an overview of secondary data analysis in nursing science and its application in a range of contemporary research. The practice of undertaking secondary analysis of qualitative and quantitative data is also discussed, along with the benefits, risks and limitations of this analytical method.

The Pittsburg Sleep Quality Index (PSQI) and Associated Factors in Middle-school Students: A Cross-sectional Study

Purpose

The purpose of this study was to evaluate the current level of sleep quality among Korean middle-school students using the Pittsburg Sleep Quality Index (PSQI), and to analyze the factors influencing sleep quality.

Methods

The study used a descriptive cross-sectional design and a self-report questionnaire. The participants were 744 middle-school students. The questionnaire included the PSQI and health-related questions, such as the types of diseases they had been diagnosed with and the frequency of hospital admissions. The data were analyzed using the independent t-test, analysis of variance, Pearson correlation coefficients, and linear multiple regression.

Results

The global PSQI score was 4.21, which indicated good sleep quality. The major factors that were associated with the sleep quality of middle-school students were the number of diseases they had been diagnosed with (β=.54, p=.001) and atopic dermatitis (β=.32, p=.001). In addition, asthma and the frequency of hospital admissions were significant factors influencing each component of the PSQI.

Conclusion

The findings from this study suggest that sleep quality was associated with several health-related factors. Thus, nurses, school nurses, and nursing researchers may need to assess the health-related factors associated with adolescents' sleep quality as part of efforts to improve their sleep quality.

Effects of Rumination and Worry on Sleep

Recent research suggests that the stress-sleep relationship is mediated by pre-sleep arousal (PSA) and that cognitive arousal has a stronger mediating effect than somatic arousal; however, this has not been directly tested. Using multilevel moderated mediation, we compared the effects of cognitive arousal and somatic arousal within the stress-sleep relationship. We also assessed whether two forms of repetitive negative thought-rumination and worry-are similarly involved in the stress-sleep relationship. Data was collected from 178 participants across the United States via an online platform. Participants completed baseline self-report surveys examining rumination tendencies and worry tendencies. Over the course of 2 weeks, participants completed daily questionnaires assessing daily stress, PSA, and sleep quality. Results indicated that indirect effects from stress to sleep quality via PSA were statistically significant at low and high levels of rumination and worry, and people at high levels of rumination and worry had stronger relationships between stress and PSA. Across all models, cognitive arousal consistently accounted for more of the variance in the stress-sleep relationship as compared to somatic arousal. Implications for the cognitive behavioral treatment of insomnia are discussed.

Health risk behavior among chronically ill adolescents: a systematic review of assessment tools

BACKGROUND

Adolescents living with chronic illnesses engage in health risk behaviors (HRB) which pose challenges for optimizing care and management of their ill health. Frequent monitoring of HRB is recommended, however little is known about which are the most useful tools to detect HRB among chronically ill adolescents.

AIMS

This systematic review was conducted to address important knowledge gaps on the assessment of HRB among chronically ill adolescents. Its specific aims were to: identify HRB assessment tools, the geographical location of the studies, their means of administration, the psychometric properties of the tools and the commonest forms of HRB assessed among adolescents living with chronic illnesses globally.

METHODS

We searched in four bibliographic databases of PubMed, Embase, PsycINFO and Applied Social Sciences Index and Abstracts for empirical studies published until April 2017 on HRB among chronically ill adolescents aged 10-17 years.

RESULTS

This review indicates a major dearth of research on HRB among chronically ill adolescents especially in low income settings. The Youth Risk Behavior Surveillance System and Health Behavior in School-aged Children were the commonest HRB assessment tools. Only 21% of the eligible studies reported psychometric properties of the HRB tools or items. Internal consistency was good and varied from 0.73 to 0.98 whereas test-retest reliability varied from unacceptable (0.58) to good (0.85). Numerous methods of tool administration were also identified. Alcohol, tobacco and other drug use and physical inactivity are the commonest forms of HRB assessed.

CONCLUSION

Evidence on the suitability of the majority of the HRB assessment tools has so far been documented in high income settings where most of them have been developed. The utility of such tools in low resource settings is often hampered by the cultural and contextual variations across regions. The psychometric qualities were good but only reported in a minority of studies from high income settings. This result points to the need for more resources and capacity building for tool adaptation and validation, so as to enhance research on HRB among chronically ill adolescents in low resource settings.