Development and psychometric evaluation of the Motivation to Use CPAP Scale (MUC-S) using factorial structure and Rasch analysis among patients with obstructive sleep apnea before CPAP treatment is initiated.

BACKGROUND: Continuous positive airway treatment (CPAP) is first-line treatment for obstructive sleep apnea (OSA), but adherence tends to be low. A clinical tool focusing on motivation to use CPAP is missing. The purpose was to develop a brief questionnaire to assess motivation to use CPAP that is psychometrically robust and suitable for use in clinical practice. METHODS: A convenience sample including 193 treatment naive patients with OSA (67% men; mean age = 59.7 years, SD 11.5) from two CPAP clinics was used. Clinical assessments and full night polygraphy were performed. Questionnaires administered before CPAP treatment included the newly developed Motivation to Use CPAP Scale (MUC-S), Minimal Insomnia Symptoms Scale (MISS), Epworth Sleepiness Scale (ESS), and Attitude towards CPAP treatment Inventory (ACTI). The validity and reliability of the MUC-S were investigated using Rasch and exploratory factor analysis models. Measurement invariance, dimensionality and differential item functioning (i.e., across gender groups, excessive daytime sleepiness (ESS), insomnia (MISS) and attitude towards CPAP (ACTI) groups) were assessed. RESULTS: The results supported a two-factor solution (autonomous motivation, 6 items, factor loadings between 0.61 and 0.85 and controlled motivation, 3 items, factor loadings between 0.79 and 0.88) explaining 60% of the total variance. The internal consistency was good with Cronbach's alpha of 0.88 and 0.86 for the two factors. No differential item functioning was found. A latent class analysis yielded three profiles of patients with high (n = 111), moderate (n = 60) and low (n = 22) motivation. Patients with high motivation were older, had higher daytime sleepiness scores, more insomnia symptoms and a more positive attitude towards CPAP. CONCLUSIONS: The MUC-S seems to be a valid tool with robust psychometric properties suitable for use at CPAP clinics. Future studies should focus on how motivation changes over time and if MUC-S can predict objective long-term CPAP adherence.

Psychometric properties of the Ethos Brief Index (EBI) using factorial structure and Rasch Analysis among patients with obstructive sleep apnea before and after CPAP treatment is initiated.

BACKGROUND: Continuous positive airway treatment (CPAP) is the recommended treatment for patients with obstructive sleep apnea (OSA). Outcome measures often focus on clinical and/or self-rated variables related to the medical condition. However, a brief validated instrument focusing on the whole life situation (i.e., ethos) suitable for clinical practice is missing. The aim of this study was to investigate factorial structure, categorical functioning of the response scale, and differential item functioning across sub-populations of the Ethos Brief Index (EBI) among patients with obstructive sleep apnea (OSA) before and after initiation of continuous positive airway pressure (CPAP). METHODS: A prospective design, including 193 patients with OSA (68% men, 59.66 years, SD 11.51) from two CPAP clinics, was used. Clinical assessment and overnight respiratory polygraphy were used to diagnose patients. Questionnaires administered before and after 6 months of CPAP treatment included EBI, Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale, and global perceived health (initial item in SF-36). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis models. Measurement invariance, unidimensionality, and differential item functioning across gender groups, Apnea-Hypopnea Index, and ESS groups were assessed. RESULTS: The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. The results supported unidimensionality of the EBI in confirmatory factor analysis and the Rasch model. No differential item functioning was found. A latent profile analysis yielded two profiles of patients with low (n = 42) and high (n = 151) ethos. Patients in the low ethos group were younger and had higher depression scores, lower perceived health, and higher body mass index. CONCLUSIONS: The EBI is a valid tool with robust psychometric properties suitable for use among patients with OSA before and after treatment with CPAP is initiated. Future studies should focus on its predictive validity.

Promoting medication adherence among patients with bipolar disorder: a multicenter randomized controlled trial of a multifaceted intervention.

BACKGROUND: The present research aimed to investigate the efficacy of a multifaceted intervention that included motivational interviewing (MI) and psychoeducation in improving medication adherence (MA) among patients with bipolar disorder (BD). METHOD: A multicenter, cluster randomized, observer-blind, controlled, parallel-group trial was conducted in ten academic centers in Iran. Patients with BD were randomly assigned to the experimental group (EXP; n = 136) or the usual care group (UC; n = 134). The EXP group received five sessions of MI and psychoeducation together with their family members. The primary outcome measure was changes in scores on the Medication Adherence Rating Scale from baseline to 6 months post-intervention. Other outcome measures included serum levels of mood stabilizers, clinical symptoms, quality of life, as well as measures of intention, beliefs about medicine, perceived behavioral control, automaticity, action and coping planning, and adverse reactions. RESULTS: Medication adherence improved over time in both groups, but patients in the EXP group improved more (baseline score: 6.03; score at the sixth month: 9.55) than patients in the UC group (baseline score: 6.17; score at the sixth month: 6.67). In addition, patients in the EXP group showed greater improvement than patients in the UC group in almost all secondary outcomes 6 months following the intervention. CONCLUSIONS: Multifaceted interventions that include motivational-interviewing and psychoeducation can significantly improve MA and clinical and functional outcomes in patients with BD. TRIAL REGISTRATION NUMBER: The trial was registered with theClinicalTrials.gov database (NCT02241863) https://clinicaltrials.gov/ct2/show/NCT02241863.

The relationship between anxiety, depression and religious coping strategies and erectile dysfunction in Iranian patients with spinal cord injury.

This corrects the article DOI: 10.1038/sc.2016.7.

The relationship between anxiety, depression and religious coping strategies and erectile dysfunction in Iranian patients with spinal cord injury.

OBJECTIVES: To assess the role of anxiety, depressive mood and religious coping in erectile function among Iranian patients with spinal cord injury (SCI). SETTING: Brain and Spinal Cord Injury Repair Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. METHODS: A sample of N=93 men with SCI participated in this cross-sectional study. Levels of anxiety and depressive mood were assessed using the Hospital Anxiety and Depression Scale. Religious coping strategies were measured using the 14-items Brief Coping Questionnaire. Erectile function was assessed using the International Index of Erectile Function. The joint effect of anxiety, depressive mood and religious coping strategies on erectile function was assessed by performing stepwise multiple linear regression analyses. RESULTS: The mean age of the SCI patients was 37.8 years with a mean post-injury time of 4.6 years. Multivariate regression analyses indicated that age (B=-0.27, 95% CI=-0.47 to -0.07), education (B for higher education=0.63, 95% CI=0.24 to 1.02), the American Spinal Injury Association impairment scale (B for complete impairment=-3.36, 95% CI=-3.82 to -2.89), anxiety (B=-3.56, 95% CI=-5.76 to -1.42), positive religious coping (B=0.30, 95% CI=0.03 to 0.57), negative religious coping (B=-0.56, 95% CI=-0.82 to -0.29) and the duration of injury (B=-0.25, 95% CI=-0.22 to -0.29) were all independent factors influencing erectile function in SCI patients. CONCLUSION: Overall, the results indicated that SCI patients who use positive religious coping strategies had better erectile function compared with individuals who applied negative religious coping strategies. Furthermore, higher levels of anxiety, greater impairment and longer duration of injury turned out to be risk factors for erectile dysfunction.

Does religious coping and spirituality have a moderating role on depression and anxiety in patients with spinal cord injury? A study from Iran.

OBJECTIVES: We evaluate the level of anxiety and depression among patients with spinal cord injury (SCI) in relation with their religious coping and spiritual health. SETTING: Brain and Spinal Cord Injury Repair Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. METHODS: A sample of patients with SCI participated in this cross-sectional study. They completed a sociodemographic questionnaire, the Hospital Anxiety and Depression Scale, the Brief Religious Coping Questionnaire and the Spiritual Well-being Scale. Then, the association between anxiety, depression and independent variables was examined. RESULTS: In all, 213 patients with SCI were studied. Of these, 64 (30%) have had anxiety and 32 (15%) have had depression. Multiple logistic regression analyses revealed that gender (odds ratio (OR) for female=3.34, 95% confidence interval (CI)=1.31-8.51, P=0.011), employment (OR for unemployed=5.71, 95% CI=1.17-27.78, P=0.031), negative religious coping (OR=1.15, 95% CI=1.04-1.28, P=0.006) and existential spiritual well-being (OR=0.93, 95% CI=0.89-0.97, P=0.003) were significant contributing factors to anxiety (Table 3), whereas negative religious coping (OR=1.21, 95% CI=1.06-1.37, P=0.004) and existential spiritual well-being (OR=0.90, 95% CI=0.84-0.96, P=0.001) were significant contributing factors to depression. CONCLUSION: The findings indicated that depression and anxiety are two psychologically important side effects after SCI. The findings also indicated that religion and spiritual well-being have a moderating role on occurrence of depression and anxiety.

Sexual function and associated factors in Iranian patients with chronic low back pain.

STUDY DESIGN: Case-control study. OBJECTIVES: (i) To describe the prevalence of sexual dysfunction in chronic low back pain (CLBP) patients, (ii) to compare the range of sexual function outcomes between patients with CLBP and healthy controls and (iii) to investigate which factors are associated with sexual function within the cohort of individuals with CLBP. SETTING: Low back pain (LBP) clinic of Qazvin University of Medical Sciences, Qazvin, Iran. METHODS: A total of 702 patients with CLBP and 888 healthy controls participated in the study. The Female Sexual Function Index (FSFI), International Index of Erectile Function (IIEF) and Premature Ejaculation Diagnostic Tool (PEDT) were used to evaluate sexual function. In addition, quality of life, anxiety, functional status and pain intensity were assessed in patients. Univariate and multiple linear regression analyses were performed for the identification of factors associated with sexual function. RESULTS: The prevalence of sexual problems in female patients with CLBP was 71.1% (n=177) while the corresponding figure for healthy women was 36.8% (n=161). Erectile dysfunction was present in 59.5% of male patients and in 24.5% of healthy males. Higher sexual function in both male and female patients with CLBP were being younger, lower duration of back pain, lower BMI, higher education level, being unemployed, physically active shorter sick leave, lower level of pain intensity, lower disability, higher family income, lower levels of depressive and anxiety symptoms, and higher psychical functioning and mental functioning. CONCLUSIONS: CLBP patients report considerably higher prevalences of sexual problems compared with healthy controls. Sex therapy and sexual management should be added to routine care and treatment of patients with CLBP.

Female sexual dysfunction in patients with spinal cord injury: a study from Iran.

OBJECTIVES: We assess the prevalence of sexual dysfunction in patients with spinal cord injury (SCI), compare sexual function and sexual distress between female patients with SCI and gender-matched healthy controls, and address risk factors associated with sexual dysfunction among Iranian female patients with SCI. SETTING: Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. METHODS: Eligible Iranian female patients with SCI were included in this cross-sectional study. They were asked to provide sociodemographic information, and complete the Female Sexual Function Index, Hospital Anxiety and Depression Scale and Female Sexual Distress Scale-Revised questionnaire. RESULTS: Of the 105 patients participated in this study, the average age was 41.0 (s.d.=10.1) years. Women with SCI reported significantly higher levels of sexual dysfunction compared with normal controls. Approximately, 88% of SCI patients reported at least one type of sexual dysfunction, whereas only 37% of healthy controls reported sexual dysfunction. Lack of vaginal lubrication was reported more frequent in SCI patients compared with controls. Women with SCI reported a significantly higher level of sexual distress compared with healthy women. Sexual dysfunction was observed to be significantly higher in older patients, those with less education, patients with complete lesions, those with sexual distress and patients who were anxious and depressed. CONCLUSION: Sexual dysfunction is highly prevalent among Iranian women with SCI. Sexual dysfunction is associated with age, education, symptoms of depression and anxiety and level of injury. Sexual counseling during the rehabilitation period may help to prevent sexual dysfunction following SCI.

Why Iranian adolescents do not brush their teeth: a qualitative study.

OBJECTIVES: To explore and describe attitudes towards tooth-brushing among Iranian adolescents. METHODS: A series of focus-group sessions were held with 37 Iranian adolescents in schools. The groups comprised five to eight adolescents. All focus-group discussions were tape-recorded and then transcribed verbatim. All transcripts, codes and categories were read several times to extract a theme. Data were analysed using a qualitative content analysis approach. RESULTS: Four major categories emerged from the analysis: brushing teeth is a necessary evil, parental influence on not brushing teeth, brushing teeth is insignificant, and brushing teeth is a health hazard. The theme identified in the latent content described that tooth-brushing is not part of the adolescents' activities of daily living. CONCLUSIONS: Health educators should stress on the engagement of parents, awareness of the adolescents on brushing techniques and causes of toothache, and address any misconceptions regarding tooth-brushing.

Prevalence, incidence, evolution and associated factors of sleep paralysis in a longitudinal study of the US general population.

BACKGROUND AND OBJECTIVE: Sleep paralysis is a common phenomenon which causes and consequences are seldomly studied. The aim of this study was to investigate the incidence and prevalence of sleep paralysis (SP) in the American adult population and its evolution on a 3-year period. METHODS: This longitudinal study was conducted between 2002 and 2015 and included a representative sample of the US general population. A total of 12,218 subjects were initially interviewed (W1) and 10,931 were re-interviewed three years later (W2). The subjects participated in telephone interviews using the Sleep-EVAL expert system. Each interview lasted for about 1 h. SP episodes were assessed according to their frequency and duration. RESULTS: At W1, 9.7% (95%CI: 9.1%-10.3%) reported having ≥1 episode of SP in the previous year. At W2, 15.1% (95%CI: 14.4%-15.8%) reported SP. A total of 29.9% of subjects with SP at W1 still reported episodes at W2. The 1-year incidence was 2.7% (95%CI: 2.4-3.0%). After adjusting for age and sex, prevalent SP (i.e., present at W2) was predicted by age and race and the following factors present at W1: major depressive disorder, pain, hypersomnolence, cataplexy, hypnagogic and hypnopompic hallucinations, posttraumatic stress disorder, a reduction in sleep duration of ≥60 min, and the use of analgesic/antipyretic medication. Incident SP (i.e. new cases at W2) had similar predictive factors. DISCUSSION: Episodes of SP are frequent in the general population. Its persistence is predicted by several factors associated with narcolepsy like hypersomnolence and cataplexy but also by other factors like posttraumatic stress disorder or pain.

Psychometric Properties of the Norwegian Version of the Fear of COVID-19 Scale.

To examine the psychometric properties of the Norwegian version of the Fear of COVID-19 Scale (FCV-19S), randomly selected individuals from a larger registry study were invited. We assessed the reliability and validity of the instrument in a sample of 1089 adults in Norway (response rate 73%). Internal consistency measured by Cronbach's alpha (0.88) was acceptable. Omega alphaHierarchical (ωt = 0.69) was lower indicating that the general factor is less reliable, explaining 69% of the total variance. Confirmatory factor analysis indicated that the FCV-19S is not strictly unidimensional. Exploratory graph analysis and confirmatory factor analysis supported a two-factor model (cognitive and somatic fear), which were highly correlated (r = 0.84). The Norwegian version of the FCV-19S showed an underlying two-factor structure. However, the high correlation means the two latent factors (cognitive and somatic fear) act as indicators for a second-order general factor and support use of the FCV-19S sum score. The FCV-19S appears to be a valid instrument to assess fear of COVID-19 with good psychometric properties. Supplementary Information: The online version contains supplementary material available at 10.1007/s11469-020-00454-2.

Is there an association between Health Related Quality of Life, socio-demographic status and Fatigue in Patients with Chronic Hepatitis B?

BACKGROUND: Chronic hepatitis B (CHB) is a serious and prevalent disease which may negatively influence health related quality of life (HRQOL) and fatigue. The aim of the present study was to examine the relationship between demographic variables, HRQOL, and fatigue. METHODS: A cross-sectional study was conducted involving 418 Iranian patients with CHB (average age 44.1 years, majority males). Participants completed a multidimensional fatigue inventory, chronic liver disease questionnaire, Euro quality of life-five dimensions questionnaire, and demographic information. Bivariate analyses were conducted using the Spearman correlation and Mann-Whitney U test. Hierarchical logistic regression modeling identified independent predictors of fatigue. RESULTS: The most prevalent problems related to HRQOL were anxiety/depression and pain/discomfort. Except for reduced motivation other dimensions of fatigue were significantly higher among those with CHB compared to healthy controls (p<0.05). Age, sex, education, employment, disease stage and all HRQOL subscales were significantly related to fatigue level. The Nagelkerke R Square for the logistic regression model was 0.542. CONCLUSIONS: Poor HRQOL and fatigue are widespread among patients with CHB. Given these associations between demographic, psychological, and other HRQOL dimensions and fatigue, interventions that address these factors may help to reduce fatigue in patients with CHB.