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Sanchez-Trigo H, Molina-Martínez E, Grimaldi-Puyana M, Sañudo B. Effects of lifestyle behaviours and depressed mood on sleep quality in young adults. A machine learning approach. Psychol Health 2024; 39:128-143. [PMID: 35475409 DOI: 10.1080/08870446.2022.2067331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Modern lifestyles may lead to high stress levels, frequently associated with mood disorders (e.g. depressed mood) and sleep disturbance. The objective of this study was to develop a machine learning model aimed at identifying risk factors for developing poor sleep quality in young adults. MATERIAL AND METHODS The sample consisted of 383 college-aged students (mean age ± SD: 21 ± 1 years; 61% males). Sleep quality, mood state, physical activity, number of sitting hours, and smartphone use were measured. RESULTS A decision tree algorithm distinguished participants' sleep quality with 74% accuracy using a combination of four features: depressed mood, physical activity, sitting time, and vigour. Together with depressed mood, both physical activity (>6432 metabolic equivalent tasks -METs- per week) and sedentary behaviour (sitting time greater than 7 h/day) were the primary features that could differentiate those with poor sleep quality from those with good sleep quality. CONCLUSIONS We provided a decision tree model with a sensitivity of 90.7% and a specificity of 54.3%, with an AUC of 0.725. These findings could promote improvements in prevention strategies and contribute to the development of meaningful and evidence-based intervention programs.
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Affiliation(s)
| | | | | | - Borja Sañudo
- Physical Education and Sports Department, University of Seville, Sevilla, Spain
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2
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Zhang H, Xing Y, Zhang Y, Sheng S, Zhang L, Dong Z, Gao Q, Cai W, Mou Z, Jing Q. Association between depression and quality of life in older adults with type 2 diabetes: A moderated mediation of cognitive impairment and sleep quality. J Affect Disord 2023; 340:17-24. [PMID: 37506770 DOI: 10.1016/j.jad.2023.07.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 07/15/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The acceleration of aging and the increase in life expectancy have resulted in an increasing number of older adults developing physical and mental comorbidities. We examined the association between depression and quality of life (QoL) using cognitive impairment (COI) as a mediator and sleep quality (SQ) as a moderator among older adults with type 2 diabetes. METHODS A total of 2646 participants from Weifang, Shandong, China completed the survey. Their depression, cognitive function, SQ, and QoL were assessed. PROCESS was used to investigate mediating and moderating effects. RESULTS COI mediated the association between depression and QoL (indirect effect = -0.1058, bootstrapped 95 % CI [-0.1417, -0.0725]). Moderated mediation analyses indicated that SQ moderated the first half of the pathway of depression's impact on QoL through COI (moderating effect = -0.1128, bootstrapped 95 % CI [-0.1981, -0.0348]). Depression negatively impacted cognitive function in participants with poor (vs. better) SQ. LIMITATIONS First, multiple assessment tools should be considered to increase objective assessment. Second, the cross-sectional design limited our ability to make causal inferences. Third, additional diabetes-related variables should be included to explore this relationship. Finally, the pathways of influence and mechanisms of action of COI in older adults should be explored further. CONCLUSION Depression could impair the QoL of older adults by aggravating their COI. Fortunately, improving patients' SQ may undermine this negative effect. These findings may play an integral role in promoting the psychiatric health of older adults with type 2 diabetes.
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Affiliation(s)
- Han Zhang
- School of Management, Weifang Medical University, Weifang, Shandong, China; "Health Shandong" Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, Shandong, China; China Academy of Rehabilitation and Health, Weifang Medical University, Weifang, Shandong, China
| | - Yang Xing
- Weifang People's Hospital, Weifang, Shandong, China
| | - Yefan Zhang
- School of Management, Weifang Medical University, Weifang, Shandong, China; "Health Shandong" Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, Shandong, China; China Academy of Rehabilitation and Health, Weifang Medical University, Weifang, Shandong, China
| | - Sen Sheng
- School of Management, Weifang Medical University, Weifang, Shandong, China; "Health Shandong" Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, Shandong, China
| | - Linlin Zhang
- School of Management, Weifang Medical University, Weifang, Shandong, China; "Health Shandong" Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, Shandong, China
| | - Zhiwei Dong
- School of Management, Weifang Medical University, Weifang, Shandong, China; "Health Shandong" Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, Shandong, China
| | - Qianqian Gao
- School of Management, Weifang Medical University, Weifang, Shandong, China; "Health Shandong" Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, Shandong, China; China Academy of Rehabilitation and Health, Weifang Medical University, Weifang, Shandong, China
| | - Weiqin Cai
- School of Management, Weifang Medical University, Weifang, Shandong, China; "Health Shandong" Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, Shandong, China; China Academy of Rehabilitation and Health, Weifang Medical University, Weifang, Shandong, China
| | - Zhongchen Mou
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, Shandong, China.
| | - Qi Jing
- School of Management, Weifang Medical University, Weifang, Shandong, China; "Health Shandong" Collaborative Innovation Center for Severe Social Risk Prediction and Governance, Weifang, Shandong, China; China Academy of Rehabilitation and Health, Weifang Medical University, Weifang, Shandong, China.
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Navarro-Soria I, Costa-López B, Collado-Valero JA, de Mier RJR, Lavigne-Cervan R. Anxiety, sleep habits and executive function during the COVID-19 pandemic through parents’ perception: a longitudinal study. PSICOLOGIA-REFLEXAO E CRITICA 2023; 36:8. [PMID: 36988724 PMCID: PMC10050808 DOI: 10.1186/s41155-023-00251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
AbstractThe present study therefore aims to examine trait and state anxiety, sleep habits and executive functioning during 1 year and a half of the COVID-19 pandemic in children and adolescents through the lens of parents. Assessments were conducted at three different times: April 2020 (T1), October 2020 (T2) and October 2021 (T3). The main sample included 953 children and adolescents aged 6 to 18 years, and scales were used to assess anxiety (STAIC), sleep habits (BEARS) and executive functioning (BRIEF-2). The results showed that 6 months after the outbreak of the pandemic, state and trait anxiety, sleep disturbances and executive dysfunctions increased significantly. One and a half year later, trait anxiety and sleep disturbances have been maintained, while state anxiety and executive dysfunction have decreased their scores obtaining scores similar to those of April 2020. In conclusion, there has been a further decrease in children and adolescents’ mental health since the beginning of the pandemic, and it seems to remain at the present time, such as trait anxiety as a part of the personality.
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Jordan DG, Slavish DC, Dietch J, Messman B, Ruggero C, Kelly K, Taylor DJ. Investigating sleep, stress, and mood dynamics via temporal network analysis. Sleep Med 2023; 103:1-11. [PMID: 36709723 PMCID: PMC10006381 DOI: 10.1016/j.sleep.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/17/2023]
Abstract
OBJECTIVE/BACKGROUND Prior research has emphasized the bidirectional relationships between sleep, stress, and affective states, such as depression. Given the inherent variability and fluctuations associated with sleep, assessing how sleep and affective variables function within a dynamic system may help further uncover possible causes and consequences of sleep disturbances, as well as find candidate targets for intervention. To this end, we examined dynamic relationships between self-reported stress, depressed mood, and clinically-relevant sleep parameters via temporal network analysis. METHODS Participants were 401 nurses (92% female, 78% White, Mage = 39.47 years) who completed 14 days of sleep diaries incorporating self-reported stress and depression, as well as total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset. RESULTS AND CONCLUSIONS Overall, total sleep time emerged as a highly influential variable in the context of "outstrength centrality," meaning total sleep time had numerous outward connections with other variables (e.g., stress and sleep efficiency). The high outstrength centrality of total sleep time suggests this variable is a source of activation within this dynamic system. Conversely, stress showed high "instrength centrality," suggesting this variable was highly impacted by other variables in the system, such as depressed mood and sleep efficiency. These findings emphasize the importance of assessing unfolding sleep processes within a naturalistic setting, and implicate the role of total sleep time in fueling depressed mood and stress. Discussion emphasizes implications of these results for understanding the connections between sleep, stress, and depression as well as clinical relevance of these findings.
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Kim SY, Lee KH, Lee H, Jeon JE, Kim S, Lee MH, Lee J, Jeon S, Oh SM, Kim SJ, Lee YJ. Neural activation underlying emotional interference of cognitive control in rotating shift workers: moderating effects of the prefrontal cortex response on the association between sleep disturbance and depressive symptoms. Sleep 2022; 45:6701668. [DOI: 10.1093/sleep/zsac219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/25/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study Objectives
This study investigated the altered neural function involved in emotional interference and its role in linking sleep disturbance and depressive/anxiety symptoms in rotating shift workers.
Methods
Sixty rotating shift workers and 61 controls performed the emotional Stroop task in three blocks (emotional-related, sleep-related, and neutral words) during functional magnetic resonance imaging (fMRI) assessments. Sleep disturbance and depressive/anxiety symptoms were assessed using self-report measures and sleep diaries. Actigraphy was used to assess the sleep and circadian variables. fMRI scans were performed to compare brain activation during the emotional Stroop task. The proposed moderating models were tested using the PROCESS macro in SPSS software.
Results
A significant condition effect on reaction time was detected. Regardless of the group, reaction times were longer in the negative emotional word and sleep-related conditions than in the neutral word condition. Whole-brain analysis revealed that rotating shift workers show greater neural activation in the left dorsolateral prefrontal cortex (DLPFC) compared with controls while performing the emotional Stroop task with negative emotional words. Sleep disturbance was more strongly associated with depressive symptoms when activation of the left DLPFC was higher during the emotional Stroop task with negative words.
Conclusions
The left DLPFC may play important roles in increased sensitivity to emotional information, possibly due to circadian misalignment, and has moderating effects on the association between sleep disturbance and depressive symptoms in rotating shift workers. These findings will help to identify possible brain regions where interventions can be performed to correct sleep and mood problems in rotating shift workers.
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Affiliation(s)
- Sun-Young Kim
- Department of Psychiatry, Ewha Womans University College of Medicine, Ewha Womans University Seoul Hospital , Seoul , Republic of Korea
| | - Kyung Hwa Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital , Seoul , Republic of Korea
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul National University Hospital , Seoul , Republic of Korea
| | - Hayoung Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul National University Hospital , Seoul , Republic of Korea
| | - Jeong Eun Jeon
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul National University Hospital , Seoul , Republic of Korea
| | - Soohyun Kim
- Department of Neurology, Gangneung Asan Hospital , Gangneung , Republic of Korea
| | | | - Jooyoung Lee
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center , Seoul , Republic of Korea
| | - Sehyun Jeon
- Department of Psychiatry, Korea University Anam Hospital , Seoul , Republic of Korea
| | - Seong-Min Oh
- Seoul Top Class Clinic , Seoul , Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center , Seoul , Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul National University Hospital , Seoul , Republic of Korea
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Oliveira JMDD, Butini L, Pauletto P, Lehmkuhl KM, Stefani CM, Bolan M, Guerra E, Dick B, De Luca Canto G, Massignan C. Mental health effects prevalence in children and adolescents during the COVID-19 pandemic: A systematic review. Worldviews Evid Based Nurs 2022; 19:130-137. [PMID: 35229967 PMCID: PMC9115455 DOI: 10.1111/wvn.12566] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/27/2021] [Accepted: 11/21/2021] [Indexed: 11/29/2022]
Abstract
Background The COVID‐19 pandemic health crisis has changed household and school routines leaving children and adolescents without important anchors in life. This, in turn, can influence their mental health, changing their behavioral and psychological conditions. Aims To systematically review the literature to answer the question: “What is the worldwide prevalence of mental health effects in children and adolescents during the COVID‐19 pandemic?”. Methods Embase, Epistemonikos database, LILACS, PsycINFO, PubMed, Scopus, Web of Science, and World Health Organization Global literature on coronavirus disease were searched. Grey literature was searched on Google Scholar, Grey Literature Report, and Preprint server MedRxiv. Observational studies assessing the prevalence of mental health effects in children and adolescents during the COVID‐19 pandemic were included. Four authors independently collected the information and assessed the risk of bias of the included studies. Results From a total of 11,925 identified studies, 2873 remained after the removal of the duplicated records. Nineteen studies remained after the final selection process. The proportion of emotional symptoms and behavior changes varied from 5.7% to 68.5%; anxiety 17.6% to 43.7%, depression 6.3% to 71.5%, and stress 7% to 25%. Other outcomes such as the prevalence of post‐traumatic stress disorder (85.5%) and suicidal ideation (29.7% to 31.3%) were also evaluated. Linking Evidence to Action Overall findings showed that the proportion of children and adolescents presenting mental health effects during the COVID‐19 pandemic showed a wide variation in different countries. However, there was a trend toward mental health issues. Therefore, policymakers, healthcare planners, youth mental health services, teachers, parents, and researchers need to be prepared to deal with this demand.
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Affiliation(s)
- Júlia Meller Dias de Oliveira
- Brazilian Centre for Evidence-Based Research (COBE), Florianópolis, Brazil.,Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Luciana Butini
- Brazilian Centre for Evidence-Based Research (COBE), Florianópolis, Brazil.,Division of Pediatric Dentistry, Faculdade São Leopoldo Mandic, São Paulo, Brazil
| | - Patrícia Pauletto
- Brazilian Centre for Evidence-Based Research (COBE), Florianópolis, Brazil.,Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Karyn Munyk Lehmkuhl
- Brazilian Centre for Evidence-Based Research (COBE), Florianópolis, Brazil.,University Library, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Cristine Miron Stefani
- Brazilian Centre for Evidence-Based Research (COBE), Florianópolis, Brazil.,Department of Dentistry, Health Sciences Faculty, University of Brasília (UnB), Brasília, Brazil
| | - Michele Bolan
- Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Eliete Guerra
- Department of Dentistry, Health Sciences Faculty, University of Brasília (UnB), Brasília, Brazil
| | - Bruce Dick
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Graziela De Luca Canto
- Brazilian Centre for Evidence-Based Research (COBE), Florianópolis, Brazil.,Department of Dentistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Carla Massignan
- Brazilian Centre for Evidence-Based Research (COBE), Florianópolis, Brazil.,Department of Dentistry, Health Sciences Faculty, University of Brasília (UnB), Brasília, Brazil
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7
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Jordan TL, Bartholomay KL, Lee CHY, Miller JG, Lightbody AA, Reiss AL. COVID-19 Pandemic: Mental Health in Girls With and Without Fragile X Syndrome. J Pediatr Psychol 2021; 47:25-36. [PMID: 34718672 PMCID: PMC8574337 DOI: 10.1093/jpepsy/jsab106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022] Open
Abstract
Objective Children and adolescents, who have less developed coping skills, are affected by natural disasters and other traumatic events differently than adults. Emotional and behavioral effects are particularly pronounced during a pandemic-related disaster, when support networks that typically promote healthy coping, such as friends, teachers, and family members, may be less available. Children and adolescents with fragile X syndrome (FXS), who are at increased risk for developing anxiety and depression, may be particularly vulnerable to behavioral or emotional difficulties during a pandemic. This study examined the mental health outcomes of school-aged girls with FXS during the COVID-19 pandemic and associated stay-at-home orders. Methods Participants included 47 school-aged girls with FXS and 33 age- and developmentally matched comparison girls. Associations between COVID-19 behavioral and emotional outcomes and prior academic, adaptive, behavioral, and emotional functioning as well as prior maternal mental health and characteristics of the mother–child relationship were examined. Qualitative data from the parental report of emotional and behavioral responses to the pandemic were also obtained. Results Results indicate that school-aged girls with FXS demonstrate a distinct profile of COVID-19 related associations compared to the comparison group, such that pandemic-related worries and emotional impact of pandemic restrictions were predicted by prior mental health factors for the comparison group but by prior social, behavioral, and relational factors for the FXS group. Conclusions Findings provide insight into factors that may confer risk or resilience for youth with special needs, suggesting potential therapeutic targets and informing public health initiatives in response to the pandemic.
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Affiliation(s)
- Tracy L Jordan
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Kristi L Bartholomay
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Cindy Hsin-Yu Lee
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Jonas G Miller
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Amy A Lightbody
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - Allan L Reiss
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA.,Department of Radiology, Stanford University School of Medicine, USA.,Department of Pediatrics, Stanford University School of Medicine, USA
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8
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The Impact of COVID-19 on Cognitive Development and Executive Functioning in Adolescents: A First Exploratory Investigation. Brain Sci 2021; 11:brainsci11091222. [PMID: 34573241 PMCID: PMC8472250 DOI: 10.3390/brainsci11091222] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The rapid expansion and severity of the COVID-19 contagion has had negative physical and psychological health implications for millions of people around the world, but even more so among children and adolescents. Given the severity of the situation and the small number of studies on the direct influence of viral infection on the cognitive development within adolescents, the present study aims at understanding the consequences of contracting the virus and being hospitalized in relation to cognitive functioning, in particular, for executive functioning, among adolescents. Methods: To all subjects included in the sample, divided into four groups based on the severity of the COVID-19 infection, were administered the WISC-IV in order to evaluate the global cognitive functioning, and subsequently, the subtests Courses and Tower of London (ToL), both part of the BVN 12–18, were administered for the evaluation of executive operation. Results: Our analyses showed that between subjects who did not contract the viral infection and those who contracted it in an asymptomatic form, there are no significant differences in cognitive functioning, but only in executive functioning. Furthermore, in both hospitalized and non-hospitalized subjects, we found lower scores especially for WM skills, while IQ scores are in a medium range. Conclusion: the present study shows that contracting the viral infection and, thus, being hospitalized, caused greater problems and difficulties as compared to those who were not hospitalized, impacting global cognitive (and executive) functioning, especially the WM. We believe that these results could allow an early detection of alterations in cognitive and executive functioning, a fundamental aspect of the interventions that occur in evolutionary phases such as those related to pre-adolescence, allowing, therefore, the activation of functional recovery pathways in a short time.
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Pre-pandemic sleep behavior and adolescents' stress during Covid-19: a prospective longitudinal study. Child Adolesc Psychiatry Ment Health 2021; 15:43. [PMID: 34461960 PMCID: PMC8404546 DOI: 10.1186/s13034-021-00399-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To prospectively document changes in adolescents' sleep before versus during the COVID-19 pandemic, and to examine their impact on adolescents' perceived stress. METHODS Sixty-two typically developing adolescents participated in the study before (Time 1: January 15 to March 13, 2020) and during (Time 2: May 15 to June 30, 2020) the COVID-19 pandemic in Canada. At Time 1, each participant's sleep pattern was assessed in the home environment using actigraphy and sleep logs for seven consecutive nights. Adolescents completed a battery of questionnaires in which they reported on their sleep schedule, duration, and quality, as well as their activities at bedtime, their daytime sleepiness, and their social/emotional behavior. The participants' parents provided demographic information. At Time 2, each participant completed a sleep log, the same battery of questionnaires regarding sleep, and the Perceived Stress Scale. RESULTS (1) Adolescents' reported sleep was of longer duration and on a delayed schedule during the COVID-19 pandemic compared to pre-pandemic. (2) A larger proportion of adolescents reported meeting or exceeding the recommended amount of sleep during the COVID-19 pandemic compared to pre-pandemic sleep. (3) "Social jet lag" disappeared during the COVID-19 pandemic. (4) A shorter reported sleep duration and higher level of arousal at bedtime at Time 1 were significant predictors of adolescents' perceived stress at Time 2-during the COVID-19 pandemic. (5) A higher levels of arousal at bedtime and lower reported sleep quality at Time 2 were concurrently associated with higher levels of perceived stress among adolescents, even when we controlled for the levels of pre-pandemic emotional or behavioral issues, sleep duration, or sleep quality. CONCLUSION Sleep duration and cognitive-emotional arousal, which are both modifiable behaviors, were associated with adolescents' perceived stress during the COVID-19 pandemic. These behaviors could be useful targets for preventive interventions aiming to reduce adolescents' stress in the face of stressogenic situations, such as the COVID-19 pandemic.
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Namdar P, Mojabi NA, Mojabi B. Neuropsychological and Psychosocial Consequences of the COVID-19 Pandemic. NEUROPHYSIOLOGY+ 2021; 52:446-455. [PMID: 34400849 PMCID: PMC8357964 DOI: 10.1007/s11062-021-09903-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Indexed: 12/28/2022]
Abstract
The coronavirus disease designated as COVID-19 reached the level of a pandemic, affecting countries all across the world. Widespread outbreaks of COVID-19 are associated with psychological distress and symptoms of mental disorders. This article is a narrative review of the existing scientific literature on mental health of the society and interventions relevant to the COVID-19 pandemic. A search in the existing databases using the respective keywords has been carried out. It focuses on the consequences of the pandemic with respect to people’s mental health in different clusters of society, including children, health care workers and their relatives, and pregnant women and their families. The unpredictability of the virus pandemic and its high transmission rate is an emergency of psychological problems and certain neuropsychological symptoms, such as fear and abnormal high anxiety, with respect to the spread of the disease, depression, avoidant behaviors, sleep disturbance, irritability, post-traumatic stress disorder (PTSD), pathological anger, and suicide cases.
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Affiliation(s)
- P Namdar
- Social Determinant of Health Research Center, Research Institute for Prevention of Noncommunicable Diseases, Qazvin University of Medical Science, Qazvin, Iran
| | - N A Mojabi
- Science Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - B Mojabi
- Idaho State University College of Pharmacy, Pocatello, Idaho USA
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11
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Sleep and self-control: A systematic review and meta-analysis. Sleep Med Rev 2021; 59:101514. [PMID: 34157493 DOI: 10.1016/j.smrv.2021.101514] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 01/06/2023]
Abstract
Controlling impulses and overcoming temptations (i.e., self-control) are key aspects of living a productive life. There is a growing yet disperse literature indicating that sleep is an important predictor of self-control. The goal of this meta-analysis is to empirically integrate the findings from multiple literatures, and investigate whether sleep quality, and sleep duration predict self-control. To provide a thorough understanding of the proposed relationships, this meta-analysis also investigated potential differences between the level of analysis (between-individual vs. within-individual), research design (experiment vs. correlation; and cross-sectional vs. time-lagged), and types of measure (subjective vs. objective for sleep and self-control). A systematic review was conducted through ABI/Inform (including PsycInfo), ERIC, ProQuest Dissertation & Theses, PubMed, and Psychology Database using keywords related to self-control and sleep. Sixty-one independent studies met the inclusion criteria. The results, in general, suggest that sleep quality (between-individual 0.26, CI 0.21; 0.31; and within-individual 0.35, CI 0.24; 0.45), and sleep duration (between-individual 0.14, CI 0.07; 0.21; and within-individual 0.20, CI 0.09; 0.31) are all related to self-control. Given the impact of self-control on how individuals live productive lives, a future research agenda should include a deeper investigation in the causal process (potentially via prefrontal cortex activity) linking sleep and self-control, and an examination of the moderators (individual and contextual variables) that could impact the relationship between sleep and self-control.
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12
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Effects of Covid-19 confinement on the mental health of children and adolescents in Spain. Sci Rep 2021; 11:11713. [PMID: 34083653 PMCID: PMC8175710 DOI: 10.1038/s41598-021-91299-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/24/2021] [Indexed: 01/01/2023] Open
Abstract
In Spain, in order to control COVID-19 transmission, one of the strictest confinement measures in the world for children and teenagers has been implemented. From 14 March to 26 April 2020 underage Spaniards were not allowed to leave their homes, except for reasons of force majeure. This could have consequences on their mental health in both the short and the long term. Thus, the aim of the present study was to explore the consequences of confinement on the mental health of Spanish children and teenagers, at the time when minors had been locked down in their homes between 8 and 10 days. The sample was composed of 590 confined Spanish children and teenagers between 8 and 18 years old. The scales of Depression, Self-esteem, Anxiety, Problems with Emotional Regulation, Rage Control Problems, Integration and Social Competence, Somatic Complaints, Rebellious Behaviour, as well as Awareness of the Problems of the Assessment System for Children and Adolescents (SENA) were used. The results revealed that, during confinement, children and adolescents showed emotional and behavioural alterations. This study, as far as we know, is the first one to explore the psychological consequences of lockdown in minors while it was taking place, with them being the ones directly assessed.
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Pizarro-Ruiz JP, Ordóñez-Camblor N. Effects of Covid-19 confinement on the mental health of children and adolescents in Spain. Sci Rep 2021. [PMID: 34083653 DOI: 10.1038/s41598-021-91299-9]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
In Spain, in order to control COVID-19 transmission, one of the strictest confinement measures in the world for children and teenagers has been implemented. From 14 March to 26 April 2020 underage Spaniards were not allowed to leave their homes, except for reasons of force majeure. This could have consequences on their mental health in both the short and the long term. Thus, the aim of the present study was to explore the consequences of confinement on the mental health of Spanish children and teenagers, at the time when minors had been locked down in their homes between 8 and 10 days. The sample was composed of 590 confined Spanish children and teenagers between 8 and 18 years old. The scales of Depression, Self-esteem, Anxiety, Problems with Emotional Regulation, Rage Control Problems, Integration and Social Competence, Somatic Complaints, Rebellious Behaviour, as well as Awareness of the Problems of the Assessment System for Children and Adolescents (SENA) were used. The results revealed that, during confinement, children and adolescents showed emotional and behavioural alterations. This study, as far as we know, is the first one to explore the psychological consequences of lockdown in minors while it was taking place, with them being the ones directly assessed.
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Lim JE, Kim S, Seo S, Kang W, Kim A, Kang Y, Choi KW, Tae WS, Ham BJ, Han KM. Association of Prefrontal Cortex Thinning with High Impulsivity in Healthy Adults. Psychiatry Investig 2021; 18:570-579. [PMID: 34130438 PMCID: PMC8256145 DOI: 10.30773/pi.2020.0404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/05/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Studies have been conducted to identify brain structural alterations related to high impulsivity in psychiatric populations. However, research on healthy subjects is relatively less extensive. Therefore, we aimed to investigate the correlation between the cortical thickness of whole brain regions and the impulsivity level in a healthy population. METHODS We included 100 healthy participants aged 19-65 years. Their T1-weighted magnetic resonance images and the 23-item Barratt Impulsiveness Scale (BIS) score were obtained. The patients were divided into high and low impulsivity groups according to the 75th percentile score of the BIS in the sample. The thickness of each cortical region was calculated using the FreeSurfer, and the difference in cortical thickness of the whole brain between the high and low impulsivity groups was analyzed using one-way analysis of covariance including age, sex, education level, and total intracranial cavity volume as covariates. RESULTS The high impulsivity group showed significant cortical thinning in the left pars opercularis. The cortical thickness of the left pars opercularis significantly correlated negatively with the total, attention, and motor scores of the BIS scale. CONCLUSION Our findings suggest that prefrontal cortex thinning may play an important role in the development of high impulsivity in healthy adults.
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Affiliation(s)
- Ji-Eun Lim
- Department of Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seoyeon Kim
- Department of Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Surin Seo
- Department of Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Wooyoung Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Aram Kim
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Youbin Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kwan Woo Choi
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Suk Tae
- Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung-Joo Ham
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.,Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Man Han
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.,Brain Convergence Research Center, Korea University College of Medicine, Seoul, Republic of Korea
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Terzioğlu MA, Büber A. Traumatic Effects of the COVID-19 Outbreak in Middle School Students and Caregivers. Psychiatry Investig 2021; 18:553-560. [PMID: 34218643 PMCID: PMC8256140 DOI: 10.30773/pi.2021.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/02/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To investigate the traumatic effects of the COVID-19 pandemic on middle-school students and their parents. METHODS This epidemiological cross-sectional study was conducted with middle-school students in Denizli. A questionnaire consisting of the IES-R, CRIES-13 and a sociodemographic data form was delivered online. A total of 1059 participants who fully completed the questionnaire were included for analysis. RESULTS The IES-R total and subdimension scores and the CRIES-13 scores were found to be significantly higher in families with an income level of ≤2,500 TL. The CRIES-13 scores of children were found to be significantly higher in divorced families. No statistically significant difference was determined between the IES-R total and subdimension scores of the parents who were healthcare workers and the CRIES-13 scale scores of their children. CONCLUSION A statistically significant, positive, moderate relationship was found between the IES-R scale total and subdimension scores of parents and the CRIES-13 scale scores of children. A low socioeconomic level was seen to increase the prevalence of anxiety in adults and adolescents. The children of divorced families were found to be at higher risk of PTSD. Successful management of mental health symptoms in parents will reflect positively on the mental health status of their children.
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Affiliation(s)
- Merve Aktaş Terzioğlu
- Department of Child and Adolescent Psychiatry, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ahmet Büber
- Department of Child and Adolescent Psychiatry, Pamukkale University Faculty of Medicine, Denizli, Turkey
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Lavigne-Cerván R, Costa-López B, Juárez-Ruiz de Mier R, Real-Fernández M, Sánchez-Muñoz de León M, Navarro-Soria I. Consequences of COVID-19 Confinement on Anxiety, Sleep and Executive Functions of Children and Adolescents in Spain. Front Psychol 2021; 12:565516. [PMID: 33664690 PMCID: PMC7921483 DOI: 10.3389/fpsyg.2021.565516] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
Children and adolescents are not indifferent to the dramatic impact of the COVID-19 pandemic, and the need to be forced to live in confinement. The change in life to which they have been abruptly subjected forces us to understand the state of their mental health in order to adequately address both their present and future needs. The present study was carried out with the intention of studying the consequences of confinement on anxiety, sleep routines and executive functioning of 1,028 children and adolescents, aged from 6 to 18 years, residing in Spain to; assess if there are differences regarding these consequences in terms of sex and age; how anxiety affects executive functioning in males and females; and to examine the possible correlations between the measured variables. For this purpose, an online questionnaire containing five sections was designed: the first section gathers information on sociodemographic and health data, while the following sections gather information from different standardized scales which measure anxiety, sleep and executive functions, whose items were adapted in order to be completed by parents, and/or legal guardians. The statistical analyzes carried out highlights significant differences in executive functioning between males and females. In turn, in regards to age, greater difficulties were detected in anxiety in the 9 to 12 age group and greater sleep disturbances between 13 and 18 year olds. On the other hand, significant differences were found in intra-sexual executive functioning depending on whether they presented greater or lesser anxiety, with executive functioning being more tendentiously maladjusted in males than in females, revealing a significantly relevant effect size (p = 0.001; ω2 = 0.27 BRIEF-2; ω2 = 0.19 BDEFS-CA; 95%). Positive correlations are obtained between state anxiety and sleep and executive functioning alterations. Finally, through Path Analysis, it is verified that state anxiety is the variable with the greatest weight within the model that would explain the alteration in the executive functioning of the present sample.
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Affiliation(s)
- Rocío Lavigne-Cerván
- Department of Developmental and Educational Psychology, University of Malaga, Málaga, Spain
| | - Borja Costa-López
- Department of Health Psychology, University of Alicante, Alicante, Spain
| | | | - Marta Real-Fernández
- Department of Developmental and Educational Psychology, University of Alicante, Alicante, Spain
| | | | - Ignasi Navarro-Soria
- Department of Developmental and Educational Psychology, University of Alicante, Alicante, Spain
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Maestro-Gonzalez A, Sánchez-Zaballos M, Mosteiro-Díaz MP, Zuazua-Rico D. Quality of sleep among social media users during the lockdown period due to COVID-19 in Spain. Sleep Med 2021; 80:210-215. [PMID: 33607556 PMCID: PMC9188780 DOI: 10.1016/j.sleep.2021.01.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/01/2020] [Accepted: 01/26/2021] [Indexed: 11/06/2022]
Abstract
Aims To analyse the quality of sleep of the Spanish population during the lockdown due to COVID-19. Design Cross-sectional descriptive study using a web based survey design. Methods Pittsburgh Sleep Quality Index questionnaire and sociodemographic, occupational, health and sleep quality variables were used to collect data during the first month of the lockdown period due to COVID-19 (March–April 2020). A snowball sampling was carried out, where participants were asked to disseminate and distribute the questionnaire among their own profiles in social networks. Results A representative sample of 5220 participants aged ≥18 years old took part in the study. The global PSQI score was 8.17 points (SD 4.43). A statistical association was found between the global PSQI score and several of the variables collected. Findings show that the quality of sleep was worse among women (p < 0.001), single participants (p 0.02), those working in rotating shifts (p < 0.001), on-site workers (p < 0.001), and people diagnosed with COVID-19 or who had someone in their environment diagnosed with the virus (p < 0.001). Conclusion Findings show that the Spanish population has experienced poor quality of sleep during the lockdown period. Being a woman, working in rotating shifts, having suffered from COVID-19 or having someone close suffering from COVID-19, being unemployed or being affected by a Temporary Redundancy Scheme, as well as spending long hours in bed were associated with poorer sleep quality. On the contrary, being older and sleeping longer hours were associated with a better sleep quality.
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Affiliation(s)
- Alba Maestro-Gonzalez
- Faculty of Medicine and Health Sciences, University of Oviedo, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Marta Sánchez-Zaballos
- Faculty of Medicine and Health Sciences, University of Oviedo, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | - David Zuazua-Rico
- Faculty of Medicine and Health Sciences, University of Oviedo, Hospital Universitario Central de Asturias, Oviedo, Spain
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Agarwal V, L. G, B.K. S. Impact of COVID-19 on the mental health among children in China with specific reference to emotional and behavioral disorders. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2020. [DOI: 10.1108/ijhrh-05-2020-0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose
This paper aims to investigate impact of coronavirus COVID-19 on children’s mental health specifically emotional and behavioral disorders. It aims at identifying the main disorders faced by children during epidemics and suggests recommendations to nurture resilience among children and involving them in various positive activities.
Design/methodology/approach
This study is based on review of literature focused on COVID-19. Recent articles related to coronavirus or COVID-19 and psychological distress among children were included to draw conclusion and impact of COVID-19 on mental health of children. Due to the limited availability of studies on CONID-19 impact on mental health of children, studies focused on recent pandemic were focused.
Findings
The identified literature reports a negative impact of COVID-19 on individual’s mental health. Relatives’ health, poor appetite, fear of asking questions about epidemics, agitation, clinginess, physical discomfort, nightmares and poor sleep, inattention and separation issues were among the major psychological conditions analyzed. Personal attributes such as resilience, should be nurtured so that children will be empowered to manage difficult situations such as traumas and disappointments. Several measures were suggested by pediatricians in China to family members and parents such as playing games with children to reduce feeling of loneliness, increased communication to address their concerns and fears, promoting and encouraging physical activities and involving in musical activities to reduce fear, worry and stress among children.
Originality/value
Coronavirus is new pandemic and growing rapidly. most of the research studies are focused on physical health of individuals, but mental health concept has bene overlooked. This study helps to broaden the scope of research on children's mental health by examining the impact of COVID-19.
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Jiao WY, Wang LN, Liu J, Fang SF, Jiao FY, Pettoello-Mantovani M, Somekh E. Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic. J Pediatr 2020; 221:264-266.e1. [PMID: 32248989 PMCID: PMC7127630 DOI: 10.1016/j.jpeds.2020.03.013] [Citation(s) in RCA: 608] [Impact Index Per Article: 152.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Wen Yan Jiao
- Department of Psychology, Shaanxi Provincial People's Hospital of Xi'an, Jiatong University, Jiatong, China
| | - Lin Na Wang
- Department of Clinical Medicine, Xi'an Medical University, Jiatong, China
| | - Juan Liu
- Department of Child Health Care, Shenmu City Hospital, Shemnu City, China
| | - Shuan Feng Fang
- Child Health Care Department, Zhengzhou University, Zhengzhou, Henan, China
| | - Fu Yong Jiao
- Children's Hospital, Shaanxi Provincial People's Hospital of Xi'an, Jiatong University, Jiatong, China
| | - Massimo Pettoello-Mantovani
- Department of Pediatrics, Scientific Institute "Casa Sollievo della Sofferenza," University of Foggia, Foggia, Italy; European Pediatric Association-Union of National European Pediatric Societies and Associations, Berlin, Germany
| | - Eli Somekh
- European Pediatric Association-Union of National European Pediatric Societies and Associations, Berlin, Germany; Department of Pediatrics, Mayaney Hayeshuah Medical Center, Bnei Brak and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Cai XY, Lin DQ, Xiao ZZ, Zhang DD, Lin Y, Chen HY, Xu YX, Zhou YH. Comparison of a Novel Muscle Training Device with Conventional Rehabilitation Training in Motor Dysfunction of Lower Limb Patients: A Pilot Study. Clin Interv Aging 2020; 15:2209-2218. [PMID: 33239870 PMCID: PMC7680714 DOI: 10.2147/cia.s277118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/02/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Postoperative functional training for fracture or osteoarthritis is mainly focused on functional self-exercise, which aims to recover the function of the lower limbs. PURPOSE To compare the function and life quality recovery in patients with fracture or arthritis treated with novel muscle training device (NMT) or conventional rehabilitation training (CRT) following surgery. PATIENTS AND METHODS A total of 32 fracture patients were randomly divided into the NMT or the CRT groups. The evaluation was performed on the first and 7th day after surgery. The outcome measurements included the incidence of foot drop, Deep Vein Thrombosis and pressure ulcers, Hospital for Special Surgery knee score (HSS scores), pain scores for the Visual Analogue Scale (Pain scores for VAS), Zung self-rating anxiety scale (SAS), Pittsburgh sleep quality index (PSQI) and the Barthel Index score. RESULTS The comparison of the change scores between the two groups indicated significant differences on day 7 following surgery in the Barthel Index score (P<0.01). The Pain scores for VAS between the two groups indicated a significant difference (P<0.05, U=20.0). The HSS scores between the two groups indicated a significant difference (P<0.05, U=19.0). The HSS scores exhibited a highly significant difference in the NMT group (P<0.01). The Mann-Whitney test was used to analyze the various components of the HSS scores. The comparison of the change scores on the function between the two groups indicated a significant difference (P<0.05). The Range of Motion difference between groups exhibited highly significant differences (P<0.01). CONCLUSION The novel muscle training device positively influenced the decrease in pain score, which resulted in a range increase of knee joint movement and a significant overall improvement in motion.
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Affiliation(s)
- Xin-ying Cai
- Clinical Medical Research Center, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou, Guangdong, People’s Republic of China
| | - Dong-qi Lin
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
- Dong-qi Lin Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People’s Republic of ChinaTel +86 0754-88915647 Email
| | - Zhi-zhen Xiao
- Nursing Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou, Guangdong, People’s Republic of China
| | - Dan-dan Zhang
- Nursing Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou, Guangdong, People’s Republic of China
| | - Ying Lin
- Nursing Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou, Guangdong, People’s Republic of China
| | - Han-yu Chen
- Rehabilitation Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou, Guangdong, People’s Republic of China
| | - Yan-xing Xu
- Nursing Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou, Guangdong, People’s Republic of China
| | - Yu-hua Zhou
- Nursing Department, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-Sen University, Shantou, Guangdong, People’s Republic of China
- Correspondence: Yu-hua Zhou Nursing Department, Shantou Central Hospital, Wai-ma Road 114, Shantou City, Guangdong Province, People’s Republic of ChinaTel +86 0754-88903584Fax +86 0754-88548117 Email
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