Arterial Spin Labeled Cerebral Blood Flow to Diagnose Normal-Pressure Hydrocephalus: A Pilot Study
Román GC, Fung SH, Corrigan MP, Jackson RE, Vega EA and Hoang AN
Arterial Spin Labeled Cerebral Blood Flow to Diagnose Normal-Pressure Hydrocephalus: A Pilot Study
Román GC, Fung SH, Corrigan MP, Jackson RE, Vega EA and Hoang AN
The diagnosis of normal-pressure hydrocephalus (NPH) is often complicated due to deficiencies of the objective measures currently used after test drainage of CSF. We used Arterial Spin Labeled Magnetic Resonance Imaging (ASL-MRI)-a novel, simplified, completely non-invasive, radiation-free method-to measure global cerebral blood flow (CBF) before and after performing a large-volume lumbar puncture (LVLP) in patients suspected of NPH.
Language-Related Safety Disparities Following a Health Literacy-Informed Rounds Intervention
Yin HS, Khan A, Glick AF, Graham DA, Alvarado-Little W, Baird JD, Cray S, Mallick N, Sectish TC, Spector ND, Dreyer BP and Landrigan CP
Language-Related Safety Disparities Following a Health Literacy-Informed Rounds Intervention
Yin HS, Khan A, Glick AF, Graham DA, Alvarado-Little W, Baird JD, Cray S, Mallick N, Sectish TC, Spector ND, Dreyer BP and Landrigan CP
To examine whether disparities in preventable adverse events (AEs) and family experience for hospitalized children of parents with and without limited comfort with English (LCE) changed following implementation of a health literacy-informed, structured family-centered rounds intervention, Patient and Family Centered I-PASS.
A Systematic Review and Meta-Analysis of Biological Sex Differences in Sleep Spindles and Slow Wave Activity in Adults With and Without Insomnia
Walsh NA, Phillips EM, Páez A, Cross NE, Dang-Vu TT and Perrault AA
A Systematic Review and Meta-Analysis of Biological Sex Differences in Sleep Spindles and Slow Wave Activity in Adults With and Without Insomnia
Walsh NA, Phillips EM, Páez A, Cross NE, Dang-Vu TT and Perrault AA
Mounting evidence shows sex-based differences in sleep experiences and outcomes, including the prevalence of insomnia disorder. However, the impact of biological sex on brain oscillations during sleep remains poorly understood, especially in the context of insomnia disorder. This is a notable gap, given that neurophysiological aspects of sleep are associated with brain health and overall sleep quality. We systematically reviewed and meta-analysed data from studies reporting spindle and slow wave activity in adults with and without insomnia disorder. We conducted systematic searches in PubMed, Embase, Scopus, and PsycInfo. Risk of bias was evaluated using the Newcastle Ottawa and the PEDro scales. Forty-three studies met our inclusion criteria, with thirteen studies of normal sleepers (N = 668) reporting sufficient data for random-effects meta-analyses. Compared with males, female normal sleepers had higher spindle density, sigma and delta power. Most studies recruited individuals with primary insomnia, and data pooling for insomnia and mixed groups was not possible due to insufficient statistical reporting. Moreover, group-by-sex interactions were limited, inconsistent, and varied across studies and sample characteristics. Further research is needed to explore sex-specific differences in sleep microarchitecture and their role in normal sleep and the manifestation of insomnia disorder.
Clinical Diagnosis and Treatment of Anxiety in Dementia With Lewy Bodies
Wadood A, Camp ME and Kelley BJ
Clinical Diagnosis and Treatment of Anxiety in Dementia With Lewy Bodies
Wadood A, Camp ME and Kelley BJ
Dementia with Lewy bodies (DLB) is one of the most common neurodegenerative causes of Major Neurocognitive Disorder and associated with a high comorbidity of mood and behavioral disturbances. There is overlap between the defining characteristics of this disorder and the DSM-5-TR criteria for generalized anxiety disorder.
Associations between fat distribution and obstructive sleep apnea severity among individuals with type 2 diabetes: an MRI-based study
Ahtola K, Ulander M, Agholme J, Amiri F, Henriksson P, Leinhard OD, Lundberg P, Dahlström N, Carlhäll CJ, Kechagias S, Nasr P, Forsgren M, Ekstedt M and Iredahl F
Associations between fat distribution and obstructive sleep apnea severity among individuals with type 2 diabetes: an MRI-based study
Ahtola K, Ulander M, Agholme J, Amiri F, Henriksson P, Leinhard OD, Lundberg P, Dahlström N, Carlhäll CJ, Kechagias S, Nasr P, Forsgren M, Ekstedt M and Iredahl F
Obstructive Sleep Apnea (OSA) affects 1 billion people globally, with a male-to-female ratio of 2:1. While obesity is a major risk factor, sex differences in fat distribution may influence OSA risk. This study examined the relationship between visceral (VAT), subcutaneous (ASAT), and total abdominal fat (TAAT) and OSA severity in patients with type 2 diabetes (T2DM). We enrolled 164 T2DM patients (97 males, 67 females) from the EPSONIP-Sleep study; 151 had complete MRI and polygraphy data. OSA severity was evaluated by home respiratory polygraphy. Linear regression assessed AHI, logistic regression assessed moderate-to-severe OSA, and the Kruskal-Wallis test compared AHI across VAT-z/ASAT-z strata. In males, VAT, ASAT, and TAAT were associated with AHI in unadjusted analyses (β = 1.3, p = 0.009; β = 1.5, p = 0.010; β = 0.85, p = 0.009, respectively). ASAT (OR = 1.23/L, 95% CI 1.01-1.49, p = 0.049) and TAAT (OR = 1.10/L, 95% CI 1.00-1.22, p = 0.02), but not VAT, were associated with moderate-to-severe OSA. No statistically significant associations were detected in females. Associations were attenuated after BMI adjustment. AHI did not differ across VAT-z/ASAT-z strata (p = 0.430). Sex differences influenced the relationship between fat and OSA severity. In males, abdominal fat volumes were associated with higher OSA severity in unadjusted analyses, but not after BMI adjustment. No statistically significant associations were detected in females. These findings should be interpreted cautiously given the modest sample size.
Effects of incremental mandibular advancement on upper airways morphology and anatomical structures: a preliminary CT scan study on body donors
Lodolo E, Evangelisti E, Gorini T, Vara G, Forni L, Lodi S, Leto S, Incerti Parenti S, Alessandri Bonetti G, Manzoli L, Ruggeri A and Ratti S
Effects of incremental mandibular advancement on upper airways morphology and anatomical structures: a preliminary CT scan study on body donors
Lodolo E, Evangelisti E, Gorini T, Vara G, Forni L, Lodi S, Leto S, Incerti Parenti S, Alessandri Bonetti G, Manzoli L, Ruggeri A and Ratti S
Obstructive Sleep Apnoea (OSA) is a sleep-related chronic disorder affecting over one billion people worldwide. Mild to moderate OSA can be treated with a Mandibular Advancement Device (MAD), but its effects on airway anatomy remain unclear. The present study aims to standardize upper airway and soft tissue CT measurements and to evaluate three-dimensional changes following progressive mandibular protrusion. Eight body donors underwent CT acquisitions at baseline and at 2 mm mandibular advancement steps up to 12 mm using a MAD-like device. Upper Airway Space (AS), Tongue (T) and Floor of the Oral Cavity (CF) measurements were obtained using a standardized protocol. Inter- and intra-observer reliability were assessed using ICC. Superior Airway Space (SPAS) increased significantly starting from 4 mm, while Inferior Airway Space at Gonion (G-IAS) changed from 6 mm. Inferior portions of T and CF increased from 2 mm, whereas differences in the superior CF occurred only at 12 mm. SPAS and G-IAS appear the most responsive airway regions, while early soft tissue changes are detected in their inferior anatomical sections. High intra- and inter-observer reliability has been observed. Although limited by the model, the proposed protocol provides a reproducible and reliable framework for analysing structural effects of mandibular advancement and may support treatment optimization.
Nightmare disorder shows reduced slow oscillation-dominant spindle coupling in NREM sleep
Papp I, Cvetkovic Z, Biabani N, Rosenzweig J, Speicher C, Delogu A, Nesbitt AD, Drakatos P, Violante IR, Vilic D, Ballard C, O'Regan D, Goadsby PJ and Rosenzweig I
Nightmare disorder shows reduced slow oscillation-dominant spindle coupling in NREM sleep
Papp I, Cvetkovic Z, Biabani N, Rosenzweig J, Speicher C, Delogu A, Nesbitt AD, Drakatos P, Violante IR, Vilic D, Ballard C, O'Regan D, Goadsby PJ and Rosenzweig I
Nightmare disorder is historically conceptualised as a rapid eye movement (REM) sleep parasomnia, but evidence also points to altered non-rapid eye movement (NREM) sleep physiology. Here, in a retrospective case-control study, we analysed overnight polysomnography from 26 adults with nightmare disorder and 32 controls using a harmonised event-based EEG pipeline. Nightmare disorder showed reduced frontal slow-oscillation-spindle coupling, whereas delta-spindle coupling was preserved, yielding lower coupling dominance than in controls (0.137 ± 0.083 versus 0.238 ± 0.096; p = 6.8 × 10). Stage-adjusted K-complex density across the first 6 h from sleep onset was also lower in nightmare disorder (0.463 ± 0.345 versus 0.723 ± 0.475 events per minute of available N2/N3 sleep; p = 0.019), whereas peak-timing differences were not robust. These findings suggest altered NREM sleep microarchitecture in nightmare disorder rather than a phenotype confined to REM sleep, and warrant prospective confirmation in harmonised, clinically phenotyped cohorts.
Factors associated with cancer-related fatigue in advanced hepatocellular carcinoma patients during the peri-intervention period: a path analysis model
Lin S, Gu S, Li L, Liang Z, Li J and Yuan Y
Factors associated with cancer-related fatigue in advanced hepatocellular carcinoma patients during the peri-intervention period: a path analysis model
Lin S, Gu S, Li L, Liang Z, Li J and Yuan Y
Cancer-related fatigue (CRF) is a significant concern in oncology, yet limited research has focused on its associated factors and pathways in hepatocellular carcinoma (HCC). This study aimed to identify the factors associated with CRF in advanced HCC patients and to explore the interrelationships among these factors using pathway analysis. This cross-sectional study enrolled participants from a tertiary cancer hospital. Data were collected through self-administered questionnaires assessing demographics, disease characteristics, positive emotions, physical activity (PA), and CRF. Multiple linear regression analyses and pathway modeling were employed to examine the associations among these variables. A total of 220 out of 275 eligible participants were included in the study. The mean Cancer Fatigue Scale (CFS) score was 31.30 (SD = 6.160, 95% CI: 30.20-32.40), with a clinical fatigue prevalence of 94.5%. Multiple linear regression analysis revealed that several factors were significantly associated with CRF, including the Herth Hope Index (HHI) (β=-0.281, 95% CI: 0.75-1.34, P < 0.01), insomnia (β = 0.22, 95% CI: 0.84-1.19, P < 0.01), economic burden (β=-0.20, 95% CI: 0.94-1.06, P < 0.01), Child-Pugh score (β = 0.19, 95% CI: 0.86-1.06, P < 0.01), General Self-Efficacy Scale (GSES) (β=-0.18, 95% CI: 0.81-1.24, P < 0.01), body mass index (BMI) (β=-0.13, 95% CI: 0.83-1.20, P < 0.01), marital status (β=-0.12, 95% CI: 0.95-1.06, P < 0.01), and Prognostic Nutritional Index (PNI) (β = 0.12, 95% CI: 0.92-1.09, P < 0.01). The pathway model showed HHI had the greatest correlation with CRF followed by GSES, Child-Pugh, and ISI. PA-Index indirectly related CRF mainly through HHI and GSES. This study highlights the high prevalence and severity of CRF in advanced HCC patients. Interventions aimed at improving physical activity, managing liver function, fostering positive emotions, enhancing sleep quality, and optimizing nutritional status may effectively reduce the risk of CRF in this population.
Effort-reward imbalance and self-rated health with the mediating role of sleep quality and physical activity among healthcare workers
Taherahmadi H, Motamedi Rad A, Mohammadi N, Mirhashemi SM, Hawawu H, Mahram M, Ghafelehbashi SH, Mirhashemi SM and Hosseinkhani Z
Effort-reward imbalance and self-rated health with the mediating role of sleep quality and physical activity among healthcare workers
Taherahmadi H, Motamedi Rad A, Mohammadi N, Mirhashemi SM, Hawawu H, Mahram M, Ghafelehbashi SH, Mirhashemi SM and Hosseinkhani Z
Beyond its personal importance, the health of healthcare workers (HCWs) is a critical factor influencing healthcare system performance and patient care quality due to their direct involvement in patient outcomes and the operational efficiency of healthcare services. This study investigates the association between effort-reward imbalance (ERI) and self-rated health (SRH) among HCWs, exploring the potential mediating roles of sleep quality and physical activity. This cross-sectional study used baseline data from a convenience sample of the Qazvin Employee Health Cohort Study (2021-2022, northwestern, Iran). SRH was assessed using a single-item instrument. In the cohort study, trained interviewers administered the validated Persian versions of the 22-item ERI questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the International Physical Activity Questionnaire (IPAQ). We used structural equation modeling as our main analytical approach. Analysis of 1250 medical university employees revealed that 43.39% reported suboptimal SRH. Those with suboptimal SRH were older, more likely to be female, and had a significantly higher prevalence of ERI (66.5% vs. 56.1%), poor sleep quality (63.5% vs. 37.8%), and low physical activity (33.3% vs. 26.6%) compared to those with optimal SRH (all p < 0.01). In correlation analysis, SRH was negatively associated with effort, the effort-reward ratio, and poor sleep, and positively associated with reward, and physical activity. Structural equation modeling demonstrated that ERI had a significant direct negative association with SRH (β = -0.07, p = 0.017) and a significant indirect negative association via worsened sleep quality (β = -0.08, p < 0.001) and slightly better physical activity (β = 0.01, p = 0.015). Although more than half of the participants reported optimal SRH and physical activity levels, ERI and poor sleep quality were still prevalent among HCWs. Among HCWs, the SRH of those perceiving their work effort exceeded their rewards was affected by poor sleep quality. Policymakers and health system managers must account for the complex relationship between health and behavioral constructs in occupational settings.
Combined healthy lifestyles and osteoarthritis among middle-aged and older adults: A cross-sectional study in US adults
Shi P and Zhao J
Combined healthy lifestyles and osteoarthritis among middle-aged and older adults: A cross-sectional study in US adults
Shi P and Zhao J
ObjectiveThis cross-sectional study aimed to examine the association between combined healthy lifestyle factors and the prevalence of osteoarthritis (OA) among middle-aged and older U.S. adults using nationally representative data from the National Health and Nutrition Examination Survey (NHANES).MethodsData were collected from 15,617 adults participating in NHANES (2005-2020). A healthy lifestyle score (range 0-6) was constructed based on six modifiable factors: smoking status, alcohol consumption, physical activity, diet quality, waist circumference, and sleep duration. Weighted multivariable logistic regression models were utilized to analyze the relationships between healthy lifestyle scores and the prevalence of OA, controlling for demographic, socioeconomic, and health-related variables. Robustness was assessed through stratified, interaction, and sensitivity analyses, including propensity score adjustment, E-value analysis, and restricted cubic spline modeling.ResultsAmong 15,617 participants, OA was present in 2,275 individuals. In the crude model, the association between the healthy lifestyle score and OA was not statistically significant for the per-factor trend. After adjustment for covariates, a higher healthy lifestyle score was significantly associated with lower odds of OA. Participants with 5-6 healthy lifestyle factors had 31% lower odds of OA, and each additional factor was associated with 7% lower odds of OA. Key factors associated with lower odds of OA included non-smoking, optimal waist circumference, and adequate sleep. The association was more pronounced in adults under 60 years. Sensitivity analyses confirmed a consistent inverse association between the lifestyle score and OA odds.ConclusionsOur findings suggest that adherence to a greater number of healthy lifestyle factors may be associated with lower odds of OA, particularly among younger adults. Notably, smoking avoidance, maintaining optimal waist circumference, and adequate sleep duration demonstrated particularly robust inverse associations. These results highlight the potential of integrated lifestyle modifications for OA-related public health strategies at both individual and population levels.
