Exploring Sleep in Caregivers of Children with Autism Spectrum Disorder (ASD) and the Relationship to Health-Related Quality of Life (HRQoL) and Family Quality of Life (FQoL)

Background and Objectives: To investigate (1) the prevalence of sleep disorder symptoms in caregivers of children with autism spectrum disorder (ASD) and (2) the relationships between caregiver sleep problems and their health-related quality of life and family quality of life. Materials and Methods: Descriptive cross-sectional study of caregivers (N = 62) of children aged 6 to 11 years old diagnosed with ASD and receiving care at a regional autism research and resource center. Results: Participants completed the Sleep Habits Questionnaire (SHQ), the Medical Outcomes Study (MOS) SF-12, and the Beach Center Family Quality of Life Scale (FQoL). Caregivers with longer sleep duration reported better mental health and better family quality of life. Caregivers who reported insomnia symptoms, non-restorative sleep, and insufficient sleep were more likely to report poorer mental health than caregivers who did not report these sleep disorder symptoms. Caregivers with obstructive sleep apnea and restless legs syndrome experienced worse physical quality of life. Conclusions: The physical and mental health of the primary caregiver is essential to the support of the child with ASD and to the functioning of the family. The study findings point to the importance of future research and interventions to enhance sleep health in order to improve quality of life for caregivers of children with ASD.

Wake-up Call: Night Shifts Adversely Affect Nurse Health and Retention, Patient and Public Safety, and Costs

The purpose of this mini review is to (1) summarize the findings on the impact of night shift on nurses' health and wellness, patient and public safety, and implications on organizational costs and (2) provide strategies to promote night shift nurses' health and improve organizational costs. The night shift, compared with day shift, results in poorer physical and mental health through its adverse effects on sleep, circadian rhythms, and dietary and beverage consumption, along with impaired cognitive function that increases nurse errors. Nurse administrators and health care organizations have opportunities to improve nurse and patient safety on night shifts. Low-, moderate-, and higher-cost measures that promote night nurses' health and well-being can help mitigate these negative outcomes. The provided individual and organizational recommendations and innovations support night shift nurses' health, patient and public safety, and organizational success.

CE: Nurses Are More Exhausted Than Ever: What Should We Do About It?

ABSTRACT

For nurses, the challenges posed by demanding work environments and schedules often lead to fatigue, and this can be exacerbated during crises like the COVID-19 pandemic. In this article, the authors discuss causes and challenges of nurse fatigue and consider several evidence-based strategies and solutions for individual nurses and organizations. Barriers to implementation, including a negative workplace culture and inadequate staffing, are also described, and several resources are presented.

Disparities in Sleep Health and Potential Intervention Models: A Focused Review

Disparities in sleep health are important but underrecognized contributors to health disparities. Understanding the factors contributing to sleep heath disparities and developing effective interventions are critical to improving all aspects of heath. Sleep heath disparities are impacted by socioeconomic status, racism, discrimination, neighborhood segregation, geography, social patterns, and access to health care as well as by cultural beliefs, necessitating a cultural appropriateness component in any intervention devised for reducing sleep health disparities. Pediatric sleep disparities require innovative and urgent intervention to establish a foundation of lifelong healthy sleep. Tapping the vast potential of technology in improving sleep health access may be an underutilized tool to reduce sleep heath disparities. Identifying, implementing, replicating, and disseminating successful interventions to address sleep disparities have the potential to reduce overall disparities in health and quality of life.

0826 Gender Differences in Sleep Knowledge of Community-Dwelling Older Adults

Introduction

This work compares sleep knowledge of community-dwelling older adult men and women.

Methods

Data were derived from a community-based sleep training program that assessed pre- and post-test knowledge of obstructive sleep apnea (OSA), Insomnia, short sleep duration (SSD), restless leg syndrome (RLS), circadian rhythm disorders (CRD), and drowsy driving (DD) on a 1 (none) to 5 (great deal of knowledge) Likert-like scale. Data were analyzed with frequencies for age, sex, and sources of sleep information, and ANOVA to determine gender differences using SPSS (V24) with significance set at p<.05.

Results

Participants (N=158; 68% women) were 56 years and older residing in a retirement community. Pre-test means±standard deviations showed women versus men had greater knowledge of Insomnia (3.5±1.3 vs. 2.9±1.0, p=.004) whereas men showed more knowledge of DD (3.2±1.1 vs. 2.6±1.3, p=.01). A trend was noted for women to have greater knowledge of SSD (3.6±1.2 vs. 3.2±1.0, p=.05). Post-test ANOVA showed a further increase in Insomnia knowledge for women versus men (4.4±0.8 vs. 4.1±0.7, p=.04); however, overall pre/post-test scores for each of the sleep disorders across men and women increased significantly at the p<.001 level. Notably, more women to men reported accessing various resources for sleep information: newspapers/magazines (46:7), friends/family (29:9), the internet (25:11), TV (37:7), and physicians/nurses (45:20).

Conclusion

Findings indicate, prior to sleep training, women have greater knowledge of insomnia and short sleep duration, while men have more knowledge of drowsy driving. Women’s greater understanding of insomnia persists even after sleep training; however, pre- to post-test scores for both sexes across sleep disorders show significant learning outcomes. One possible reason for women’s greater knowledge of insomnia and short sleep could be their greater likelihood to access information on health and healthy lifestyle factors, including sleep, as well as their greater health care utilization.

Support

N/A

Hózhó: Promoting sleep health among Navajo caregivers

OBJECTIVES

This study explored the feasibility and acceptability of a sleep health education intervention for caregivers of children with developmental disabilities (DD).

DESIGN

This mixed-methods pilot study utilized repeated measures and caregiver interviews.

SETTING

The intervention occurred in the homes of caregivers who live on the Navajo Nation.

PARTICIPANTS

Fifteen caregivers of children with DD aged from birth to 3 years old participated.

INTERVENTION

The intervention consisted of three 1-hour home-based sessions. Educational modules were tailored to specific sleep issues of the caregiver and their child(ren), as well as the unique environmental and cultural features of Navajo families.

MEASUREMENTS

Quantitative measures included a sleep habits questionnaire, pre- and postmeasures of learning, and the SF-12 HRQoL. Quantitative data were analyzed with frequencies and repeated measures analyses with p .05. Qualitative comments regarding facilitators and detractors to healthy sleep were transcribed verbatim and categorized into themes.

RESULTS

Caregiver sleep duration increased by 2 hours (5.8±1.8 to 7.8±1.9, p = .005). Caregivers also reported improved physical (45.0±8.2 to 52.8+8.7 p = .001) and mental HR-QoL (41.8±8.9 to 49.3±10.9, p = .002), and enhanced knowledge of sleep disorders (13.4±4.0 to 20.7±5.6) and healthy sleep habits (15.7±4.1 to 25.4±3.4 each p = .005). Many participants reported better sleep quality in their children with earlier bedtimes and less night waking.

CONCLUSIONS

Findings suggest that this tailored sleep education program is a culturally responsive approach to promoting caregiver sleep health and HR-QoL, as well as the sleep health of their children. Caregivers credited improved sleep to the support they received during visits and text messaging.

Radiographic and arthroscopic features of third carpal bone slab fractures and their impact on racing performance following arthroscopic repair in a population of racing Thoroughbreds in the UK

BACKGROUND

Slab fractures of the third carpal bone (C3) are a common injury of Thoroughbred racehorses. Results of arthroscopically guided repair have not been reported since the initial description of the technique in 1986. Additionally, fracture details and racing outcomes in a population of Thoroughbreds racing under UK jurisdiction have not previously been described.

OBJECTIVES

To report the frequency distribution of C3 slab fractures and to determine the impact on racing performance following arthroscopically guided repair in a population of Thoroughbred racehorses.

STUDY DESIGN

Retrospective case series.

METHODS

Case records of Thoroughbred racehorses undergoing arthroscopically guided repair of C3 slab fractures at Newmarket Equine Hospital between 2006 and 2015 were retrieved. Radiographs and arthroscopic studies were reviewed. The effect of demography and fracture morphology on racing outcome was evaluated.

RESULTS

C3 slab fractures occurred most commonly through the radial facet in a frontal plane (45/71 63.4%). Comminution was identified during arthroscopy in 42/71 (59.2%) fractures and occurred most frequently at the palmar margin of the fracture. Forty-one out of 65 horses (63.1%) raced at least once post-operatively. Females were less likely to return to racing compared to males (P<0.001). Horses that had raced before injury were more likely (OR 4.4, 95% CI 1.4-13.5, P = 0.01) to race after injury compared to horses that were unraced at the time of injury. After injury horses had a small but significant reduction in racing performance.

MAIN LIMITATIONS

The series is a preselected population of Thoroughbred racehorses which referring veterinary surgeons considered potential candidates for surgical repair.

CONCLUSION

Fracture configurations can be identified radiographically but is not a reliable predictor of comminution or other intra-articular lesions. Arthroscopy not only directs repair but also identifies and facilitates management of concurrent lesions. The results reported should assist in formulating appropriate prognoses for Thoroughbred horses racing in the UK.

Impact of Sleep and Dialysis Mode on Quality of Life in a Mexican Population

BACKGROUND

Health-related quality of life (HR-QOL) is reduced with end-stage renal disease (ESRD) but little is known about the impact of sleep disorders, dialysis modality and demographic factors on HR-QOL of Mexican patients with ESRD.

METHODS

121 adults with ESRD were enrolled from 4 dialysis units in the state of Guanajuato, Mexico, stratified by unit and dialysis modality (hemodialysis [HD], continuous ambulatory peritoneal dialysis [CAPD] and automated peritoneal dialysis [APD]). Analysis included clinical information and data from the Sleep Heart Health Study Sleep Habits Questionnaire, the Medical Outcomes Study (MOS) short form (SF-36) HR-QOL measure and Epworth Sleepiness Scale.

RESULTS

Overall, sleep symptoms and disorders were common (e.g., 37.2% insomnia). SF-36 scores were worse versus US and Mexican norms. HD patients reported better, while CAPD patients poorer HR-QOL for Vitality. With multivariate modelling dialysis modality, sleep disorders as a group and lower income were significantly associated with poorer overall SF-36 and mental health HR-QOL. Overall and Mental Composite Summary models showed HR-QOL was significantly better for both APD and HD with small to moderate effect sizes. Cost-effectiveness analysis demonstrated an advantage for APD.

CONCLUSIONS

Mexican ESRD patients have reduced HR-QOL, and sleep disorders may be an important driver of this finding. APD should be the preferred mode of dialysis in Mexico.

ROLE OF SPOUSAL INVOLVEMENT IN CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) ADHERENCE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA (OSA)

INTRODUCTION

Little is known about the impact of spousal involvement on continuous positive airway pressure (CPAP) adherence. The aim of this study was to determine whether spouse involvement affects adherence with CPAP therapy, and how this association varies with gender.

METHODS

194 subjects recruited from Apnea Positive Pressure Long Term Efficacy Study (APPLES) completed the Dyadic Adjustment Scale (DAS). The majority of participants were Caucasian (83%), and males (73%), with mean age of 56 years, mean BMI of 31 kg/m². & 62% had severe OSA. The DAS is a validated 32-item self-report instrument measuring dyadic consensus, satisfaction, cohesion, and affectional expression. A high score in the DAS is indicative of a person's adjustment to the marriage. Additionally, questions related to spouse involvement with general health and CPAP use were asked. CPAP use was downloaded from the device and self-report, and compliance was defined as usage ≥ 4 h per night.

RESULTS

There were no significant differences in overall marital quality between the compliant and noncompliant subjects. However, level of spousal involvement was associated with increased CPAP adherence at 6 months (p=0.01). After stratifying for gender these results were significant only among males (p=0.03). Three years after completing APPLES, level of spousal involvement was not associated with CPAP compliance even after gender stratification.

CONCLUSION

Spousal involvement is important in determining CPAP compliance in males in the 1^st 6 months after initiation of therapy but is not predictive of longer-term adherence. Involvement of the spouse should be considered an integral part of CPAP initiation procedures.

SUPPORT

HL068060.

Symptoms of Restless Legs Syndrome in Biological Caregivers of Children with Autism Spectrum Disorders

STUDY OBJECTIVES

In this study, we investigated the prevalence of symptoms of restless legs syndrome (RLS) in biological caregivers of children with a diagnosis of autism spectrum disorder (ASD).The relationship of RLS symptoms to caregiver health-related quality of life (HRQoL) was also examined. Finally, we compared the sleep quality and daytime behaviors of children with ASD in caregivers with and without symptoms of RLS.

METHODS

Biological caregivers (n = 50) of children ages 6 to 11 y with a diagnosis of ASD completed a Sleep Habits Questionnaire (SHQ) that included RLS as determined by four questions. HRQoL was assessed using the Medical Outcomes Survey (MOS) 12-Item Short Form (SF-12). Caregivers also completed the Children's Sleep Habits Questionnaire (CSHQ) and Child Behavior Checklist (CBCL6/18).

RESULTS

Eleven caregivers (22%) fit the criteria for RLS symptomatology and caregivers with RLS reported poorer mental health. Caregivers with RLS described more night waking and greater internalized behavior problems in their children with ASD than the caregivers without RLS.

CONCLUSIONS

Biological caregivers of children with ASD demonstrated a high prevalence of RLS symptoms and poorer mental health. RLS is known as a sleep disorder that has strong heritability, and it is possible that many of the children with ASD also have symptoms of RLS. RLS as a possible disruptor of sleep should be considered in caregivers and in their children with ASD.

BeWell24: development and process evaluation of a smartphone "app" to improve sleep, sedentary, and active behaviors in US Veterans with increased metabolic risk

Lifestyle behaviors across the 24-h spectrum (i.e., sleep, sedentary, and active behaviors) drive metabolic risk. We describe the development and process evaluation of BeWell24, a multicomponent smartphone application (or "app") that targets behavior change in these interdependent behaviors. A community-embedded iterative design framework was used to develop the app. An 8-week multiphase optimization strategy design study was used to test the initial efficacy of the sleep, sedentary, and exercise components of the app. Process evaluation outcomes included objectively measured app usage statistics (e.g., minutes of usage, self-monitoring patterns), user experience interviews, and satisfaction ratings. Participants (N = 26) logged approximately 60 % of their sleep, sedentary, and exercise behaviors, which took 3-4 min/day to complete. Usage of the sleep and sedentary components peaked at week 2 and remained high throughout the intervention. Exercise component use was low. User experiences were mixed, and overall satisfaction was modest.

Conversations for providers caring for patients with rectal cancer: Comparison of long-term patient-centered outcomes for patients with low rectal cancer facing ostomy or sphincter-sparing surgery

For some patients with low rectal cancer, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients who are eligible for sphincter-sparing surgery may not be well served by the surgery, and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects after the two surgeries has not been synthesized. Therefore, this systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. The goals are: 1) to improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) to increase the patient's participation in the decision; 3) to alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, to improve patients' long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. CA Cancer J Clin 2016;66:387-397. © 2016 American Cancer Society.

Association of sleep duration with kidney function and albuminuria: NHANES 2009-2012

OBJECTIVE

The purpose of this study was to examine the association between self-reported sleep duration and markers of kidney function.

DESIGN

A cross-sectional survey from the 2009-2012 National Health and Nutrition Examination Survey.

SETTING AND PARTICIPANTS

The participants were 8690 adults (e20years) without a previous sleep disorder diagnosis, end-stage kidney failure, or other kidney or liver problems. Subsamples with pre-diabetes and pre-hypertension were examined.

MEASUREMENTS

Participants reported habitual sleep duration, coded as d5, 6, 7, 8, and e9hours per night. Biomarkers of kidney function were determined, including glomerular filtration rate (eGFR) estimated from the Chronic Kidney Disease Epidemiology Collaboration equation, urine albumin-to-creatinine ratio (ACR), microalbuminuria status, and glomerular hyperfiltration status. Weighted and adjusted general linear models assessed associations between sleep duration with eGFR and ACR. Logistic regression analyses evaluated the associations of microalbuminuria and glomerular hyperfiltration status with sleep duration.

RESULTS

Greater eGFR was related to short sleep duration in the total sample and among participants with pre-diabetes. Greater ACR was associated with short and long sleep duration. Short sleep duration (d5hours) was associated with an increased odds for glomerular hyperfiltration (OR, 1.41; 95% CI, 0.97-2.06) and microalbuminuria (OR, 1.31; 95% CI, 0.96-1.79).

CONCLUSIONS

In a US representative sample of adults, self-reported short and long sleep duration were related to higher ACR. Short sleep duration was associated with higher eGFR and microalbuminuria. Research is needed to understand whether these associations indicate increased risk for kidney damage and cardiovascular risk.

Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survivors

BACKGROUND

Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors' health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis.

METHODS

This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N = 856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high vs. low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction.

RESULTS

CRC survivors made substantial, permanent dietary, and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use.

CONCLUSIONS

CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship.

Factors affecting mobility in community-dwelling older Koreans with chronic illnesses

PURPOSE

This descriptive study aims to describe the levels of mobility in community-dwelling older Koreans with chronic illnesses, and to examine the associations of their mobility with sleep patterns, physical activity and physical symptoms including fatigue and pain.

METHODS

The participants were a total of 384 community-dwelling older adults recruited from three senior centers in Seoul, Korea. Measures included mobility assessed using 6-minute walk test (6MWT), physical activity behavior, sleep profiles, fatigue and pain. Data were collected from July to December 2012.

RESULTS

The mean 6MWT distance was 212.68 meters. Over 90% of the study participants (n = 373) were classified as having impaired mobility using 400 meters as the cutoff point diagnostic criteria of normal mobility in 6MWT. The 6MWT distance was 246.68 meters for participants in their 60s, 212.32 meters for those in their 70s, and 175.54 meters for those in their 80s. Significant predictors of mobility included younger age, taking mediation, regular physical activity, female gender, higher income, higher fatigue and better perception on sleep duration, which explained 18% of the total variance of mobility.

CONCLUSIONS

A high-risk group for mobility limitation includes low income, sedentary older men who are at risk for increased fatigue and sleep deficit. Further research should incorporate other psychological and lifestyle factors such as depression, smoking, drinking behavior, and/or obesity into the prediction model of mobility to generate specific intervention strategies for mobility enhancement recommendations for older adults.

Sleep disturbances of adult women suffering from fibromyalgia: a systematic review of observational studies

Although sleep complaints are often reported in patients with fibromyalgia syndrome (FMS), there is no conclusive evidence that these complaints represent symptomatic disorders of sleep physiology. Thus, the question of the role of sleep disturbances as an etiological or maintenance factor in FMS remains open. This study identifies the subjective and objective characteristics of sleep disturbances in adult women diagnosed with FMS. We carried out a systematic review of publications since 1990, the publication year of the American College of Rheumatology criteria of FMS. We selected empirical studies comparing sleep characteristics of adult women with FMS and healthy women or women with rheumatic diseases. We identified 42 articles. Patients with FMS were more likely to exhibit sleep complaints and also a less efficient, lighter and fragmented sleep. The evidence of a FMS signature on objective measures of sleep is inconsistent, however, as the majority of studies lacks statistical power. Current evidence cannot confirm the role played by sleep physiology in the pathogenesis or maintenance of FMS symptoms; nonetheless, it is clear that sleep disturbances are present in this syndrome.

Impact of CPAP on activity patterns and diet in patients with obstructive sleep apnea (OSA)

STUDY OBJECTIVES

Patients with severe OSA consume greater amounts of cholesterol, protein, and fat as well as have greater caloric expenditure. However, it is not known whether their activity levels or diet change after treatment with CPAP. To investigate this issue, serial assessments of activity and dietary intake were performed in the Apnea Positive Pressure Long-term Efficacy Study (APPLES); a 6-month randomized controlled study of CPAP vs. sham CPAP on neurocognitive outcomes.

METHODS

Subjects were recruited into APPLES at 5 sites through clinic encounters or public advertisement. After undergoing a diagnostic polysomnogram, subjects were randomized to CPAP or sham if their AHI was ≥ 10. Adherence was assessed using data cards from the devices. At the Tucson and Walla Walla sites, subjects were asked to complete validated activity and food frequency questionnaires at baseline and their 4-month visit.

RESULTS

Activity and diet data were available at baseline and after 4 months treatment with CPAP or sham in up to 231 subjects (117 CPAP, 114 Sham). Mean age, AHI, BMI, and Epworth Sleepiness Score (ESS) for this cohort were 55 ± 13 [SD] years, 44 ± 27 /h, 33 ± 7.8 kg/m(2), and 10 ± 4, respectively. The participants lacking activity and diet data were younger, had lower AHI and arousal index, and had better sleep efficiency (p < 0.05). The BMI was higher among women in both CPAP and Sham groups. However, compared to women, men had higher AHI only in the CPAP group (50 vs. 34). Similarly, the arousal index was higher among men in CPAP group. Level of adherence defined as hours of device usage per night at 4 months was significantly higher among men in CPAP group (4.0 ± 2.9 vs. 2.6 ± 2.6). No changes in consumption of total calories, protein, carbohydrate or fat were noted after 4 months. Except for a modest increase in recreational activity in women (268 ± 85 vs. 170 ± 47 calories, p < 0.05), there also were no changes in activity patterns.

CONCLUSION

Except for a modest increase in recreational activity in women, OSA patients treated with CPAP do not substantially change their diet or physical activity habits after treatment. .

Prevalence of sleep disorders by sex and ethnicity among older adolescents and emerging adults: relations to daytime functioning, working memory and mental health

The study determined the prevalence of sleep disorders by ethnicity and sex, and related daytime functioning, working memory, and mental health among older adolescent to emerging adult college students. Participants were U.S.A. undergraduates (N = 1684), aged 17-25, recruited from 2010 to 2011. Participants completed online questionnaires for all variables. Overall, 36.0% of the sample screened positive for sleep disorders with insomnia, restless legs syndrome, and periodic limb movement disorder being the most prevalent. Women reported more insomnia and daytime impairment. African-Americans reported more early morning awakenings and less daytime impairment. Students with insomnia symptoms or restless legs syndrome tended to have lower working memory capacities. Students with nightmares or parasomnias had greater odds for mental disorders. In an older adolescent to emerging adult college student sample, sleep disorders may be a common source of sleep disturbance and impairment. Certain sleep disorders may be associated with lower working memory capacity and poor mental health.

Reallocating time to sleep, sedentary behaviors, or active behaviors: associations with cardiovascular disease risk biomarkers, NHANES 2005-2006

Sleep and sedentary and active behaviors are linked to cardiovascular disease risk biomarkers, and across a 24-hour day, increasing time in 1 behavior requires decreasing time in another. We explored associations of reallocating time to sleep, sedentary behavior, or active behaviors with biomarkers. Data (n = 2,185 full sample; n = 923 fasting subanalyses) from the cross-sectional 2005-2006 US National Health and Nutrition Examination Survey were analyzed. The amounts of time spent in sedentary behavior, light-intensity activity, and moderate-to-vigorous physical activity (MVPA) were derived from ActiGraph accelerometry (ActiGraph LLC, Pensacola, Florida), and respondents reported their sleep duration. Isotemporal substitution modeling indicated that, independent of potential confounders and time spent in other activities, beneficial associations (P < 0.05) with cardiovascular disease risk biomarkers were associated with the reallocation of 30 minutes/day of sedentary time with equal time of either sleep (2.2% lower insulin and 2.0% lower homeostasis model assessment of β-cell function), light-intensity activity (1.9% lower triglycerides, 2.4% lower insulin, and 2.2% lower homeostasis model assessment of β-cell function), or MVPA (2.4% smaller waist circumference, 4.4% higher high-density lipoprotein cholesterol, 8.5% lower triglycerides, 1.7% lower glucose, 10.7% lower insulin, and 9.7% higher homeostasis model assessment of insulin sensitivity. These findings provide evidence that MVPA may be the most potent health-enhancing, time-dependent behavior, with additional benefit conferred from light-intensity activities and sleep duration when reallocated from sedentary time.

Dietary and behavioral adjustments to control bowel function by long-term colorectal cancer survivors

573

Background: Bowel dysfunction is a known complication of colorectal cancer (CRC) treatment, and has a detrimental impact on survivors’ health-related quality of life (HRQOL). The prevalence of dietary and behavioral modifications in CRC survivors has been described in only a small number of studies. To better understand dietary and behavioral adjustments that long-term (≥ 5 years) CRC survivors make to regulate their bowel function, we performed a mixed methods analysis, comparing survivors with a permanent ostomy and those with anastomosis. Methods: CRC survivors with or without permanent ostomies were surveyed with the modified version of the City of Hope Quality of Life for Ostomy tool (N=919).Dietary adjustments were compared by ostomy status (ostomy versus anastomosis) and higher quartile versus lower quartile HRQOL scores.Student’s t-tests were used to compare HRQOL measures between groups. Qualitative data from 13 focus groups (N=63) and interviews with 30 female ostomates were analyzed to explore specific strategies used for regulating bowel function. Results: CRC survivors make substantial andpermanent dietary adjustments following treatment. The majority of survivors reported that they took more than one month to feel comfortable with their diet, and many (10% to 18%) never became comfortable. No significant dietary adjustment differences were noted based on ostomy status. Survivors who took less time (<1 month) to feel comfortable with their diet and for their appetite to return had better HRQOL (p < 0.001) ≥ 5 years later. Adjustments to control bowel function consisted of four overall strategies: dietary adjustments, behavioral adjustments, exercise, and medications. Conclusions: CRC survivors use a multitude of adaptive strategies to control their bowel function. Many survivors struggle with unpredictable bowel function continually for the rest of their lives, and many never find any set of management strategies to achieve regularity. Understanding the myriad of adjustments made by CRC survivors will lead to evidence-based recommendations to foster positive adjustments after cancer treatment.

Sleep disordered breathing, insomnia symptoms, and sleep quality in a clinical cohort of U.S. Hispanics in south Florida

STUDY OBJECTIVES

There is a paucity of information on the epidemiology of sleep disorders among US Hispanics. This study describes the frequency of sleep disordered breathing (SDB) risk, insomnia complaints, poor sleep quality, and daytime somnolence in a clinical cohort of ethnically diverse US Hispanics living in South Florida.

METHODS

We explored the presence of sleep disorders in a cohort of Hispanics seen at primary care, pulmonary, and sleep clinics at the University of Miami and Miami Veterans Affair Medical Center. Participants completed validated questionnaires, evaluating risk of SDB, presence of insomnia symptoms, sleep quality, and daytime sleepiness. Polysomnography was completed on the majority of the sleep clinic participants.

RESULTS

Participants (N = 282; 62% male; mean age 54 ± 15 years; mean BMI 31 ± 6 kg/m(2)) included Hispanics of Cuban, Puerto Rican, Central/South American, and Caribbean heritage. Excessive daytime sleepiness was noted by 45% of participants. Poor sleep quality was reported by 49%; 76% screened high risk for SDB, and 68% had insomnia symptoms. Sleep disorders were more commonly reported in sleep clinic participants; however, 54% of non-sleep clinic participants were high risk for SDB, 35% had insomnia complaints, 28% had poor sleep quality, and 18% reported daytime sleepiness.

CONCLUSIONS

Sleep disorders (including SDB) are common in clinical samples of Hispanics in South Florida. These findings highlight the urgent need for linguistically relevant and culturally responsive screening, awareness and education programs in clinical sleep medicine among US Hispanics.

CITATION

Shafazand S; Wallace DM; Vargas SS; Del Toro Y; Dib S; Abreu AR; Ramos A; Nolan B; Baldwin CM; Fleming L. Sleep disordered breathing, insomnia symptoms, and sleep quality in a clinical cohort of US Hispanics in South Florida. J Clin Sleep Med 2012;8(5):507-514.

Irrigation practices in long-term survivors of colorectal cancer with colostomies

For some patients diagnosed with rectal cancer, surgery will involve the creation of a temporary or permanent ostomy. When the colostomy is located in the sigmoid or descending colon, regulation of fecal output can occur through irrigation, a procedure that involves instilling fluid into the bowel to flush out gas and fecal material. When successfully used, irrigation can prevent fecal output between irrigations, providing some control over colostomy output. The purpose of this article is to describe participants of a large, multisite, multi-investigator study of health-related quality of life in long-term colorectal cancer survivors who answered questions about colostomy irrigation and reported the potential advantages and disadvantages of the procedure. The article also will explore healthcare professionals' role in ensuring patients and family members are educated and well informed about their options regarding temporary or permanent ostomies.

Spanish translation and cross-language validation of a sleep habits questionnaire for use in clinical and research settings

STUDY OBJECTIVES

To translate, back-translate and cross-language validate (English/Spanish) the Sleep Heart Health Study Sleep Habits Questionnaire for use with Spanish-speakers in clinical and research settings.

METHODS

Following rigorous translation and back-translation, this cross-sectional cross-language validation study recruited bilingual participants from academic, clinic, and community-based settings (N = 50; 52% women; mean age 38.8 ± 12 years; 90% of Mexican heritage). Participants completed English and Spanish versions of the Sleep Habits Questionnaire, the Epworth Sleepiness Scale, and the Acculturation Rating Scale for Mexican Americans II one week apart in randomized order. Psychometric properties were assessed, including internal consistency, convergent validity, scale equivalence, language version intercorrelations, and exploratory factor analysis using PASW (Version18) software. Grade level readability of the sleep measure was evaluated.

RESULTS

All sleep categories (duration, snoring, apnea, insomnia symptoms, other sleep symptoms, sleep disruptors, restless legs syndrome) showed Cronbach α, Spearman-Brown coefficients and intercorrelations ≥ 0.700, suggesting robust internal consistency, correlation, and agreement between language versions. The Epworth correlated significantly with snoring, apnea, sleep symptoms, restless legs, and sleep disruptors) on both versions, supporting convergent validity. Items loaded on 4 factors accounted for 68% and 67% of the variance on the English and Spanish versions, respectively.

CONCLUSIONS

The Spanish-language Sleep Habits Questionnaire demonstrates conceptual and content equivalency. It has appropriate measurement properties and should be useful for assessing sleep health in community-based clinics and intervention studies among Spanish-speaking Mexican Americans. Both language versions showed readability at the fifth grade level. Further testing is needed with larger samples.

Gender differences in quality of life among long-term colorectal cancer survivors with ostomies

PURPOSE/OBJECTIVES

To describe how gender shapes the concerns and adaptations of long-term (i.e., more than five years) colorectal cancer survivors with ostomies.

DESIGN

Qualitative study using content analysis of focus group content.

SETTING

Oregon, southwestern Washington, and northern California.

SAMPLE

Four female and four male focus groups (N = 33) selected from 282 quantitative survey participants with health-related quality-of-life (HRQOL) scores in the highest or lowest quartile.

METHODS

Eight focus groups discussed the challenges of living with an ostomy. Content was recorded, transcribed, and analyzed using directive and summative content analysis.

MAIN RESEARCH VARIABLES

HRQOL domains of physical, psychological, social, and spiritual well-being.

FINDINGS

All groups reported avoiding foods that cause gas or rapid transit and discussed how limiting the amount of food eaten controlled the output. All groups discussed physical activities, getting support from friends and family, and the importance of being resilient. Both genders identified challenges with sexuality and intimacy. Coping and adjustment difficulties mostly were discussed by women, with men only discussing these issues to a small extent. Difficulties with sleep primarily were identified by women with low HRQOL. Problems with body image and depression were discussed only by women with low HRQOL.

CONCLUSIONS

Common issues included diet management, physical activity, social support, and sexuality. Although both genders identified challenges, women described more specific psychological and social issues than men.

IMPLICATIONS FOR NURSING

Application of these gender-based differences can inform educational interventions for colorectal cancer survivors with ostomies.

Bisphosphonates inhibit expression of p63 by oral keratinocytes

Osteonecrosis of the jaw (ONJ), a side-effect of bisphosphonate therapy, is characterized by exposed bone that fails to heal within eight weeks. Healing time of oral epithelial wounds is decreased in the presence of amino-bisphosphonates; however, the mechanism remains unknown. We examined human tissue from individuals with ONJ and non-bisphosphonate-treated control individuals to identify changes in oral epithelium and connective tissue. Oral and intravenous bisphosphonate-treated ONJ sites had reduced numbers of basal epithelial progenitor cells, as demonstrated by a 13.8±1.1% and 31.9±5.8% reduction of p63 expression, respectively. No significant differences in proliferation rates, vessel density, or macrophage number were noted. In vitro treatment of clonal and primary oral keratinocytes with zoledronic acid (ZA) inhibited p63, and expression was rescued by the addition of mevalonate pathway intermediates. In addition, both ZA treatment and p63 shRNA knock-down impaired formation of 3D Ex Vivo Produced Oral Mucosa Equivalents (EVPOME) and closure of an in vitro scratch assay. Analysis of our data suggests that bisphosphonate treatment may delay oral epithelial healing by interfering with p63-positive progenitor cells in the basal layer of the oral epithelium in a mevalonate-pathway-dependent manner. This delay in healing may increase the likelihood of osteonecrosis developing in already-compromised bone.

Overcoming challenges: life with an ostomy

BACKGROUND

Studies have demonstrated decreased health-related quality of life in patients with stomas.

METHODS

Using US Department of Veterans Affairs electronic medical records, veterans with stomas were surveyed using the City of Hope Quality of Life-Ostomy questionnaire. Focus groups were conducted segregated by type of stoma (ileostomy vs colostomy) and quality-of-life score (high vs low). Qualitative analysis was performed on the basis of the City of Hope Quality of Life for Ostomates format of health-related quality of life (physical, psychological, social, and spiritual). The findings of the colostomy focus groups are reported.

RESULTS

Two new domains emerged: colostomy specific and health care specific. The most common domains discussed were colostomy specific, psychological, and social. The most frequently discussed colostomy-specific theme was effective and ineffective solutions to colostomy care. Family and spousal relationships were the main theme from the psychological category. The predominant social issue was sexual relationships.

CONCLUSIONS

Awareness of patients' social, psychological, and medical status allows surgeons to identify those likely to have problems and devote resources to those veterans.

Effects of homeopathic medicines on polysomnographic sleep of young adults with histories of coffee-related insomnia

BACKGROUND

Homeopathy, a common form of alternative medicine worldwide, relies on subjective patient reports for diagnosis and treatment. Polysomnography offers a modern methodology for evaluating the objective effects of taking homeopathic remedies that clinicians claim exert effects on sleep quality in susceptible individuals. Animal studies have previously shown changes in non rapid eye movement sleep with certain homeopathic remedies.

METHODS

Young adults of both sexes (ages 18-31) with above-average scores on standardized personality scales for either cynical hostility or anxiety sensitivity (but not both) and a history of coffee-induced insomnia participated in the month-long study. At-home polysomnographic recordings were obtained on successive pairs of nights once per week for a total of eight recordings (nights 1, 2, 8, 9, 15, 16, 22, 23). Subjects (N=54) received placebo pellets on night 8 (single-blind) and verum pellets on night 22 (double-blind) in 30c doses of one of two homeopathic remedies, Nux Vomica or Coffea Cruda. Subjects completed daily morning sleep diaries and weekly Pittsburgh sleep quality index scales, as well as profile of mood states scales at bedtime on polysomnography nights.

RESULTS

Verum remedies significantly increased PSG total sleep time and NREM, as well as awakenings and stage changes. Changes in actigraphic and self-rated scale effects were not significant.

CONCLUSIONS

The study demonstrated the feasibility of using in-home, all-night sleep recordings to study homeopathic remedy effects. Findings are similar though not identical to those reported in animals with the same remedies. Possible mechanisms include initial disruption of the nonlinear dynamics of sleep patterns by the verum remedies.

Sleep disturbances, quality of life, and ethnicity: the Sleep Heart Health Study

STUDY OBJECTIVES

To compare health-related quality of life (HR-QOL) across subgroups defined by sleep disturbances and ethnicity.

METHODS

Men (47%) and women (53%) Sleep Heart Health Study participants age 40 and older (N = 5237) underwent overnight polysomnography and completed self-report questionnaires on symptoms of sleep disturbances. The physical and mental composite scales (PCS and MCS) of the Medical Outcomes Study 36-item short form survey assessed HR-QOL and were compared to sleep data.

RESULTS

Participants self-identified as Caucasian/White (n = 4482, 86%), African American/Black (n = 490, 9%), or Hispanic/Mexican American (n = 265, 5%). The prevalence of obstructive sleep apnea (OSA) was 17%, frequent snoring was 34%, difficulty initiating or maintaining sleep (DIMS; insomnia symptoms) was 30%, and excessive daytime sleepiness (EDS) was 25%. African American participants with frequent snoring, insomnia symptoms, or EDS had significantly poorer physical health compared to Caucasians (p < 0.001). Hispanics with frequent snoring, insomnia symptoms, or EDS had significantly poorer mental health than Caucasian participants (p <0.001). Neither PCS nor MCS scores differed significantly across ethnic subgroups for participants with moderate to severe OSA (respiratory disturbance index > 15, 4% desaturation).

CONCLUSIONS

Across ethnic/racial subgroups, sleep disturbances are associated with worse physical and better mental HR-QOL than the U.S. norm, but this relationship may be moderated by comorbid health conditions. This study replicates and extends prior research indicating differences among minority and non-minority participants and highlights the need for future studies of sleep disturbances with larger samples of minorities that control for comorbid health conditions.

Sleepiness, quality of life, and sleep maintenance in REM versus non-REM sleep-disordered breathing

RATIONALE

The impact of REM-predominant sleep-disordered breathing (SDB) on sleepiness, quality of life (QOL), and sleep maintenance is uncertain.

OBJECTIVE

To evaluate the association of SDB during REM sleep with daytime sleepiness, health-related QOL, and difficulty maintaining sleep, in comparison to their association with SDB during non-REM sleep in a community-based cohort.

METHODS

Cross-sectional analysis of 5,649 Sleep Heart Health Study participants (mean age 62.5 [SD = 10.9], 52.6% women, 22.6% ethnic minorities). SDB during REM and non-REM sleep was quantified using polysomnographically derived apnea-hypopnea index in REM (AHI(REM)) and non-REM (AHI(NREM)) sleep. Sleepiness, sleep maintenance, and QOL were respectively quantified using the Epworth Sleepiness Scale (ESS), the Sleep Heart Health Study Sleep Habit Questionnaire, and the physical and mental composites scales of the Medical Outcomes Study Short Form (SF)-36.

MEASUREMENTS AND MAIN RESULTS

AHI(REM) was not associated with the ESS scores or the physical and mental components scales scores of the SF-36 after adjusting for demographics, body mass index, and AHI(NREM) x AHI(REM) was not associated with frequent difficulty maintaining sleep or early awakening from sleep. AHI(NREM) was associated with the ESS score (beta = 0.25; 95% confidence interval [CI], 0.16 to 0.34) and the physical (beta = -0.12; 95% CI, -0.42 to -0.01) and mental (beta = -0.20; 95% CI, -0.20 to -0.01) components scores of the SF-36 adjusting for demographics, body mass index, and AHI(REM).

CONCLUSIONS

In a community-based sample of middle-aged and older adults, REM-predominant SDB is not independently associated with daytime sleepiness, impaired health-related QOL, or self-reported sleep disruption.

Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex

PURPOSE

Intestinal stomas can pose significant challenges for long-term (> or = 5 years) rectal cancer (RC) survivors. Specifying common challenges and sociodemographic or clinical differences will further the development of tailored interventions to improve health-related quality of life (HRQOL).

PATIENTS AND METHODS

This was a matched cross-sectional study of long-term RC survivors conducted in three Kaiser Permanente regions. The mailed questionnaire included the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-Ostomy) and Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2). Groups surveyed were permanent ostomates (cases) and those who did not require an ostomy (controls). RC survivors were matched on sex, age, and time since diagnosis. Comparisons between groups used regression analysis with adjustment for age, comorbidity score, history of radiation therapy, income, and work status.

RESULTS

Response rate was 54% (491 of 909). Cases and controls had similar demographic characteristics. On the basis of the mCOH-QOL-Ostomy, both male and female cases had significantly worse social well-being compared with controls, while only female cases reported significantly worse overall HRQOL and psychological well-being. For younger females (< age 75 years), ostomy had a greater impact on physical well-being compared with older females. Based on the SF-36v2, statistically significant and meaningful differences between female cases and controls were observed for seven of the eight scales and on the physical and mental component summary scores.

CONCLUSION

Men and women report a different profile of challenges, suggesting the need for targeted or sex-specific interventions to improve HRQOL in this population. This may include focus on physical HRQOL for female ostomy survivors younger than age 75.

Gender differences in sleep disruption and fatigue on quality of life among persons with ostomies

STUDY OBJECTIVES

The aim of this study is to examine differences in sleep disruption and fatigue of men and women colorectal cancer (CRC) survivors with intestinal ostomies and associated health-related quality of life (HR-QOL).

METHODS

Participants in this cross-sectional study of long-term (> 5 years) CRC survivors received care at Kaiser Permanente. Measures included the City of Hope QOL Ostomy questionnaire with narrative comments for ostomy-related "greatest challenges." The Short Form-36 Version 2 (SF-36v2) health survey provided physical (PCS) and mental composite scale (MCS) scores to examine generic HR-QOL. The "sleep disruption" and "fatigue" items from the ostomy questionnaire (scale from 0 to 10 with higher scores indicating better HR-QOL) were dependent variables, while independent variables included age, ethnicity, education, partnered status, body mass index, and time since surgery. Data were analyzed using chi-square for nominal variables, Student t-tests for continuous variables, and logistic regression with significance set at p < 0.05.

RESULTS

On the ostomy-specific measure, women (n = 118) compared to men (n = 168) reported more sleep disruption (p < 0.01), adjusted for age, and greater levels of fatigue (p < 0.01), adjusted for time since surgery. Women's PCS and MCS scores indicated poorer HR-QOL compared to men, and differences were clinically meaningful. Qualitative narrative comments suggested that sleep disruption could stem from ostomy-associated fear of or actual leakage during sleep.

CONCLUSION

Although women CRC survivors with ostomies report more sleep disruption and fatigue, which is reflected in their reduced physical and mental health scores on the SF-36v2 compared to men with ostomies, their stated reasons for disrupted sleep are similar to their male counterparts. These findings can provide a foundation for gender-relevant ostomy interventions to improve sleep and HR-QOL in this patient population.

Obstructive sleep apnea and ischemic heart disease in southwestern US veterans: implications for clinical practice

This study describes associations between obstructive sleep apnea (OSA), intake of food rich in antioxidant nutrients, and ischemic heart disease (IHD) in military veterans. Subjects were male veterans (n=211), 54 to 85 years of age, and enrolled in primary care clinics at the Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, AZ. Measures included the SAVAHCS Minority Vascular Center Questionnaire, the Sleep Heart Health Study Sleep Habits Questionnaire, the Arizona Food Frequency Questionnaire, height, weight, and blood pressure. Veterans with OSA were significantly more likely to be obese, to have elevated systolic blood pressure and physician-diagnosed IHD, more likely to undergo coronary angiography, and less likely to consume foods rich in cardioprotective antioxidants compared to veterans without OSA. After adjusting for confounding variables, the association between OSA and IHD remains significant [adjusted OR=2.99, confidence interval (CI)=1.07-8.42]. These data reinforce the importance of recognizing OSA within the veterans affairs health care system and suggest that early detection of OSA may improve veterans' health and well-being and reduce associated medical costs.

Longitudinal evaluation of sleep-disordered breathing and sleep symptoms with change in quality of life: the Sleep Heart Health Study (SHHS)

STUDY OBJECTIVES

Findings from population studies evaluating the progression and incidence of sleep disordered breathing have shown evidence of a longitudinal increase in the severity of sleep disordered breathing. The present study evaluates the association among changes in sleep disordered breathing, sleep symptoms, and quality of life over time.

DESIGN

Prospective cohort study. Data were from the Sleep Heart Health Study.

SETTING

Multicenter study.

PARTICIPANTS

Three thousand seventy-eight subjects aged 40 years and older from the baseline and follow-up examination cycles were included.

MEASUREMENTS

The primary outcomes were changes in the Physical Component Summary and Mental Component Summary scales obtained from the Medical Outcomes Study Short-Form Health Survey. The primary exposure was change in the respiratory disturbance index obtained from unattended overnight polysomnograms performed approximately 5 years apart. Other covariates included measures of excessive daytime sleepiness and difficulty initiating and maintaining sleep.

RESULTS

Mean respiratory disturbance index increased from 8.1 +/- 11 SD at baseline to 10.9 +/- 14 (P < 0.0001) at follow-up. The mean Physical Component Summary and Mental Component Summary scores were 48.5 and 54.1 at baseline and 46.3 and 54.8 at follow-up. No associations between change in respiratory disturbance index and changes in Physical Component Summary or Mental Component Summary scores were seen. However, worsening of difficulty initiating and maintaining sleep and excessive daytime sleepiness were significantly associated with lower quality of life.

CONCLUSIONS

A slight increase in severity of sleep disordered breathing was seen over 5 years; this was not associated with worsening of quality of life. However, subjective symptoms of quality of sleep and daytime sleepiness were associated with declining quality of life.

Polysomnographic and health-related quality of life correlates of restless legs syndrome in the Sleep Heart Health Study

STUDY OBJECTIVES

Sleep disturbance is the primary clinical morbidity of restless legs syndrome (RLS). To date, sleep disturbance in RLS has been measured in (1) clinical samples with polysomnography (PSG) or (2) population-based samples by self-report. The objective of this study was to analyze sleep by PSG in a population-based sample with symptoms of RLS.

DESIGN

Cross-sectional observational study.

SETTING

Community-based.

PARTICIPANTS

3433 older men and women.

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

RLS was evaluated using an 8-item self-administered questionnaire based on NIH diagnostic criteria and required symptoms occurring > or = five times per month and associated with at least moderate distress. Health-related quality of life (HRQOL) was determined using the SF-36. Unattended, in-home PSG was performed. Data were assessed using general linear models with adjustment for demographic, health-related variables, and apnea-hypopnea index (AHI). Subjects with RLS had longer adjusted mean sleep latency (39.8 vs 26.4 min, P < 0.0001) and higher arousal index (20.1 vs 18.0, P = 0.0145) than those without RLS. Sleep latency increased progressively as the frequency of RLS symptoms increased from 5-15 days per month to 6-7 days per week. No differences in sleep stage percentages were observed between participants with and without RLS. Subjects with RLS also reported poorer HRQOL in all physical domains as well as in the Mental Health and Vitality domains.

CONCLUSIONS

These novel PSG data from a nonclinical, community-based sample of individuals with RLS document sleep disturbance in the home even in individuals with intermittent symptoms.

EEG ALPHA SENSITIZATION IN INDIVIDUALIZED HOMEOPATHIC TREATMENT OF FIBROMYALGIA

Fibromyalgia (FM) patients show evidence of sensitizability in pain pathways and electroencephalographic (EEG) alterations. One proposed mechanism for the claimed effects of homeopathy, a form of complementary medicine used for FM, is time-dependent sensitization (TDS, progressive amplification) of host responses. This study examined possible sensitization-related changes in EEG relative alpha magnitude during a clinical trial of homeopathy in FM. A 4-month randomized, placebo-controlled double-blind trial of daily orally administered individualized homeopathy in physician-confirmed FM, with an additional 2-month optional crossover phase, included three laboratory sessions, at baseline, 3 and 6 months (N = 48, age 49.2 +/- 9.8 years, 94% women). Nineteen leads of EEG relative alpha magnitude at rest and during olfactory administration of treatment and control solutions were evaluated in each session. After 3 months, the active treatment group significantly increased, while the placebo group decreased, in global alpha-1 and alpha-2 during bottle sniffs over sessions. At 6 months, the subset of active patients who stayed on active continued to increase, while the active-switch subgroup reversed direction in alpha magnitude. Groups did not differ in resting alpha. Consistent with the TDS hypothesis, sniff alpha-1 and alpha-2 increases at 6 months versus baseline correlated with total amount of time on active remedy over all subjects (r = 0.45, p = .003), not with dose changes or clinical outcomes in the active group. The findings suggest initiation of TDS in relative EEG alpha magnitude by daily oral administration of active homeopathic medicines versus placebo, with laboratory elicitation by temporolimbic olfactory stimulation or sniffing.

Coping and acceptance: the greatest challenge for veterans with intestinal stomas

OBJECTIVE

Intestinal stomas (ostomies) create challenges for veterans. The goal of this qualitative analysis was to understand better patients' perspectives regarding their greatest challenge.

METHODS

Ostomates at three Veterans Affairs locations were surveyed using the modified City of Hope Quality of Life-Ostomy questionnaire that contained an open-ended request for respondents to describe their greatest challenge. The response rate was 51% (239 of 467); 68% (163 of 239) completed the open-ended item. Content analysis was performed by an experienced qualitative research team.

RESULTS

Coping and acceptance were the most commonly addressed themes. The most frequently expressed issues and advice were related to a need for positive thinking and insight regarding adjustment over time. Coping strategies included the use of humor, recognition of positive changes resulting from the stoma, and normalization of life with an ostomy.

CONCLUSIONS

Coping and acceptance are common themes described by veterans with an intestinal stoma. Health-care providers can assist veterans by utilizing ostomate self-management strategies, experience, and advice.

Influence of intestinal stoma on spiritual quality of life of U.S. veterans

PURPOSE

To examine spiritual quality of life (QOL) of veterans with intestinal ostomies.

DESIGN

Mixed-method cross-sectional.

METHODS

Male veterans with total scores in the upper (n = 59) and lower (n = 61) quartiles of the City of Hope Quality-of-Life-Ostomy survey provided spiritual QOL data. Analyses included chi-square and analysis of variance with significance set at p < .05. Content analysis was used to explicate narratives and focus groups.

RESULTS

The high spiritual QOL group was more likely to be married, older, and report more years since surgery (each p < .0001). Upper quartile participants had more favorable scores for several spiritual QOL domains (all p < .0001). Qualitative comments reflected high or low total QOL scores.

CONCLUSIONS

Spiritual QOL is influenced by an intestinal stoma. Qualitative comments lend insight into the meaning of spirituality items. Findings can assist in the provision of holistic care in this population.

The greatest challenges reported by long-term colorectal cancer survivors with stomas

This paper presents a qualitative analysis of the greatest challenges reported by long-term colorectal cancer survivors with ostomies. Surveys that included an open-ended question about challenges of living with an ostomy were administered at three Kaiser Permanente regions: Northern California, Northwest, and Hawaii. The study was coordinated at the Southern Arizona Veterans Affairs Health Care System in Tucson. The City of Hope Quality of Life Model for Ostomy Patients provided a framework for the study's design, measures, data collection, and data analysis. The study's findings may be generalized broadly to community settings across the United States. Results replicate those of previous research among veterans, California members of the United Ostomy Association, Koreans with ostomies, and colorectal cancer survivors with ostomies residing in the United Kingdom. The greatest challenges reported by 178 colorectal cancer survivors with ostomies confirmed the Institute of Medicine's findings that survivorship is a distinct, chronic phase of cancer care and that cancer's effects are broad and pervasive. The challenges reported by study participants should inform the design, testing and integration of targeted education, early interventions, and ongoing support services for colorectal cancer patients with ostomies.