Preliminary analysis of the concurrent validity of the Spanish translation of the BEARS sleep screening tool for children.

WHAT IS KNOWN ON THE SUBJECT?: Paediatric sleep problems are clinical conditions that often coexist with other mental health problems and meet criteria that warrant the implementation of screening procedures, including high prevalence, and significant clinical impact. Researchers have designed the BEARS, a user-friendly paediatric sleep screening tool that seems to increase the amount of sleep information recorded, as well as the likelihood of identifying sleep problems during routine health encounters. Nonetheless, there are no studies using the BEARS in Spanish-speaking samples. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Using a sample of children with mental health problems, this study provides support for the use of the Spanish version of the BEARS to identify the most common sleep problems seen in paediatric populations. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Considering how frequent sleep problems are, it is especially important for health professionals working with children in general, and with children with mental health problems in particular, to be aware of and be encouraged to use simple brief screening tools for paediatric sleep problems. ABSTRACT: Objective Research studies describe a high prevalence of sleep problems in children with mental health problems, up to 50%, and its role as a risk factor in the development of psychopathology. These often go unnoticed and are not evaluated in the clinical field. Our objective was to assess the concurrent validity of the BEARS, a brief paediatric sleep screening instrument, using the Children Sleep Habits Questionnaire (CSHQ) as the comparison instrument. Methods In this cross-sectional descriptive study, the BEARS was applied by a registered nurse to a sample of parents of children aged 2-16 years (n = 60, 71.7% male) who attended a mental healthcare facility (located in Murcia, Spain) for the first time to receive a group psychoeducational intervention. The association between the information collected with the BEARS and scores on the related subscales of the CSHQ was assessed by Mann-Whitney U tests. Results Children who, according to the BEARS, had a sleep problem obtained scores on the CSHQ-related subscales significantly higher than children who did not have a sleep problem (all Ps  < 0.05). Conclusion Our results support the concurrent validity of the Spanish translation of the BEARS to detect sleep problems in paediatric nursing assessments. Further studies, with bigger and more heterogeneous samples, are warranted.

Personality traits and sick leave in workers diagnosed with nonorganic neck pain

Previous research has suggested that personality can influence the perception and reporting of physical symptoms, such as pain. To assess the relationship between the course of nonorganic neck pain and the individual’s personality, we studied the association between two indicators of neck pain prognosis, such as the duration of sick leave associated with neck pain and sick leave recurrence, and 15 personality traits in a sample of 64 workers suffering from disabling neck pain without any signs of physical abnormalities in the neck area. The TEA Personality Test (TPT), a selfreport instrument designed to evaluate personality traits related to organizational behaviors, was used. Compared to the normative data, the study sample obtained high scores in the Depression, Anxiety and Emotional Instability scales, thus suggesting a personality profile primarily characterized by high neuroticism-related scores. Controlling for age, gender, and any rehabilitation undergone, we found a positive relationship between Depression and the duration of sick leave (in weeks). Moreover, lower scores on the TPT personality trait Dynamism and activeness were associated with higher likelihood of sick leave recurrence. These findings highlight the need for further research into the role played by personality at the onset and in the maintenance of nonorganic neck pain. Furthermore, they suggest that a complementary psychological approach may be useful to nonorganic neck pain management (AU)

Diversos estudios de investigación sugieren que la personalidad se relaciona con la percepción y quejas de síntomas físicos, tales como el dolor. Con el objetivo de explorar la relación entre la evolución del dolor cervical sin alteración orgánica y la personalidad del individuo, analizamos la asociación entre dos indicadores del pronóstico de dolor cervical, tales como la duración y la recurrencia de la baja laboral, y 15 rasgos de personalidad en una muestra de 64 trabajadores en situación de baja laboral con diagnóstico de dolor cervical sin alteración orgánica. Para la evaluación de los rasgos de personalidad utilizamos el cuestionario de personalidad de TEA, TPT. Este instrumento evalúa específicamente rasgos de personalidad que son relevantes en el contexto laboral. En comparación con los datos normativos referentes a población española proporcionados en el manual del cuestionario, nuestra muestra de estudio obtuvo puntuaciones significativamente más elevadas en Depresión, Ansiedad y Labilidad emocional. Estos datos sugieren un perfil de personalidad en estos trabajadores con tendencia al neuroticismo. Controlando el efecto de la edad, el género y el hecho de haber realizado rehabilitación para el problema de dolor, encontramos una relación positiva entre las puntuaciones en la escala Depresión y la duración de la baja. De otro lado, puntuaciones más bajas en la escala Dinamismo y actividad se relacionó con una mayor probabilidad de recurrencia de la baja laboral. Estos resultados preliminares enfatizan la necesidad de explorar de manera más detallada el rol que juega la personalidad del individuo en la aparición y el mantenimiento del dolor cervical sin alteración orgánica. Así mismo, nuestros datos sugieren que un abordaje psicosocial, complementario al tratamiento médico que reciben estos pacientes, podría resultar útil para el manejo del dolor cervical (AU)

Moving beyond average values: assessing the night-to-night instability of sleep and arousal in DSM-IV-TR insomnia subtypes.

STUDY OBJECTIVES: We explored differences between individuals with DSM-IV-TR diagnoses of primary insomnia (PI) and insomnia related to a mental disorder (IMD) by using serial measurements of self-reported sleep variables (sleep onset latency, SOL; wake after sleep onset, WASO; total sleep time, TST; sleep efficiency, SE), and visual analogue scale ratings of 2 forms of bedtime arousal (cognitive and emotional). Furthermore, we sought to examine the relationship between sleep and arousal within each diagnostic subgroup. DESIGN: Between-group and within-group comparisons. SETTING: Duke and Rush University Medical Centers, USA. PARTICIPANTS: One hundred eighty-seven insomnia sufferers (126 women, average age 47.15 years) diagnosed by sleep specialists at 2 sleep centers as PI patients (n=126) and IMD patients (n=61). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Multilevel models for sleep measures indicated that IMD displayed significantly more instability across nights in their TST (i.e., larger changes) than did PI patients. With respect to pre-sleep arousal, IMD patients exhibited higher mean levels of emotional arousal, as well as more instability on the nightly ratings of this measure. Within the PI group, correlational analyses revealed a moderate relationship between the 2 arousal variables and SOL (r values 0.29 and 0.26), whereas the corresponding correlations were negligible and statistically nonsignificant in the IMD group. CONCLUSIONS: We found a number of differences on nighttime variables between those diagnosed with primary insomnia and those diagnosed with insomnia related to a mental disorder. These differences imply different perpetuating mechanisms involved in their ongoing sleep difficulties. Additionally, they support the categorical distinctiveness and the concurrent validity of these insomnia subtypes.

Home is where sleep is: an ecological approach to test the validity of actigraphy for the assessment of insomnia.

STUDY OBJECTIVES: This study tested the ecological validity of actigraphy (ACT) for estimating objective sleep parameters in participants' homes. We also examined how well ACT and polysomnography (PSG) measures discriminated (1) individuals with and without insomnia; and (2) nights participants rated worse, the same as, or better than average. METHODS: Thirty-one primary insomnia sufferers and 31 normal sleepers completed up to 3 consecutive monitoring nights with wrist ACT and PSG in their homes. They also rated how each night compared to their "average night's" sleep. ACT and PSG measures of sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE) were then compared using Bland and Altman correlational procedures and repeated measures ANOVAs. Differences between groups and among nights assigned distinctive ratings were tested via mixed-model ANOVAs. RESULTS: Medium to large between- and within-subject correlations were observed for all measures in the insomnia sufferers sample and for most measures in the normal sleepers sample. Two (ACT vs. PSG) x 3 (nights) repeated measures ANOVAs showed that, in both samples, SOL derived from ACT was consistently lower than SOL derived from PSG across the 3 nights of recording. By contrast, ACT and PSG produced estimates of WASO, TST, and SE that did not differ from each other across nights. Subsequent 2 (insomnia vs. normal sleeper) x 3 (worse, same, better than average) mixed-model ANOVAs showed only ACT SOL discriminated those with and without insomnia and nights assigned distinctive ratings. Among the PSG-derived measures, only SE showed such a pattern. CONCLUSIONS: ACT provides informative data for insomnia sufferers and normal sleepers in their usual sleep environments. The ACT estimate of SOL seems sensitive to night-to-night differences in subjective sleep ratings. A possible strength of ACT lies in its assessment of nocturnal movement, a parameter different from PSG-based sleep measures.

A penny for your thoughts: patterns of sleep-related beliefs, insomnia symptoms and treatment outcome.

The aim of this study was to determine how distinctive patterns of unhelpful beliefs about sleep endorsed by insomnia patients relate to their presenting symptoms and treatment responses. A sample of 281 primary insomnia sufferers completed items comprising the Dysfunctional Beliefs About Sleep scale (DBAS-16). Their resultant scores on the four DBAS-16 subscales were then subjected to a cluster analysis, which resulted in the identification of four distinctive age-matched subgroups. Two subgroups were characterized by pathologically elevated scores on at least two of the DBAS-16 subscales, whereas the other two subgroups had subscale scores that closely resembled those of a normative sample. Subsequent comparisons showed the insomnia subgroups differed in regard to their insomnia severity, use of prescribed medication for sleep, depression and anxiety symptoms, and daytime sleepiness. Furthermore, comparisons of treatment outcomes (i.e. analysis of change scores and normative comparisons) across clusters showed that the subgroups did not benefit equally from a standardized form of Cognitive-Behavioral Therapy (CBT) for insomnia. Findings demonstrate the contribution of specific sleep-related beliefs on presenting insomnia symptoms and suggest the potential usefulness of tailoring CBT protocols to match the needs of distinctive insomnia subtypes.

The use of natural products for sleep: A common practice?

BACKGROUND: Despite a paucity of data on efficacy and safety of natural (herbal and dietary) products, their use appears to be widespread. This study aimed at examining the frequency of natural products' use for sleep and their correlates in a population-based sample. METHODS: A randomly selected sample of adults (n=997; 59.9% women) from the province of Quebec completed a postal survey on sleep, use of sleep-promoting products (natural products, prescribed medication, over-the-counter medication and alcohol), physical and mental health, lifestyle habits and demographics. RESULTS: A total of 18.5% of participants reported having used natural products as sleep aids in the past 12months, with chamomile being the most popular product. Participants who exclusively used natural products as sleep aids (10.3% of the sample) were predominantly females, younger and had a higher educational level than those using prescribed medications. Natural products users reported engaging in more health-promoting behaviors than the nonusers of sleep aids and, despite the presence of subthreshold insomnia symptoms (mean Insomnia Severity Index score=9.33), they tended to perceive themselves as healthier when compared with prescribed medication users and nonusers of sleep aids. CONCLUSIONS: The use of natural products as sleep aids is a common practice. Often associated with a general health-promoting lifestyle, it may reflect the common perception that natural products are necessarily beneficial for sleep and without risks.

Variables psicosociales y de personalidad asociadas a la cervicalgia recurrente / Psychosocial and personality variables related to recurrent cervicalgia

El objetivo del presente estudio es evaluar la relación existente entre variables de personalidad y bienestar en pacientes diagnosticados de cervicalgia. Para ello, se seleccionó una muestra de sujetos con diagnóstico y baja laboral por cervicalgia procedentes de dos mutuas de accidentes de trabajo de la ciudad de Murcia. Los resultados indican que la mitad de los sujetos de la muestra tiene una estructura de personalidad desadaptativa, con un claro perfil “neurótico”. Este perfil se caracteriza por inestabilidad emocional, escasos recursos para afrontar las situaciones de estrés y dificultades para adaptarse e implicarse activamente en el trabajo. El 61,9% de los participantes muestra una estructura de personalidad inapropiada para tener éxito laboral. Así mismo, el 49,1% perciben claramente un malestar psicológico que se focaliza en la presencia de síntomas somáticos. La presencia de sintomatología ansioso-depresiva es un indicador de mal pronóstico con relación a la duración de la baja. El perfil de personalidad “neurótica” y la presencia de cuadros depresivos se relacionan con la recurrencia de los cuadros cervicálgicos. Con respecto a la prevención, los resultados sugieren que la evaluación y el tratamiento de aspectos psicopatológicos serían importantes para reducir las bajas laborales, minimizar su duración y evitar las recurrencias

The objective of the present work is to evaluate the relationship between personality variables and wellness among patients diagnosed with cervicalgia. A sample of subjects with cervicalgia and on sick-leave was recruited from two sickness and accident insurance companies at the city of Murcia. About half of the sample showed not to have a well-adapted personality, with a clear “neurotic” profile. This profile was characterised by emotional instability, poor resources to cope with stress and difficulties to be adapted and involved into the work life. 61.9% of participants showed a personality structure non-efficient to achieve work success. In this way, 49.1% reported some psychological discomfort, which was often expressed in soma to form symptoms. Regarding the sick-leave length, the presence of anxious- depressive symptoms was an indicator of worse prognosis. The “neurotic” personality profile and the depressive symptoms were related to the neck pain recurrence. With relation to prevention, our results suggest that taking into account the evaluation and treatment of psychopathological aspects may be of help to minimize the number of sick-leaves, reduce their length and prevent their recurrence

Relación entre la calidad del sueño, el burnout y el bienestar psicológico en profesionales de la seguridad ciudadana / Relation between the quality sleep, burnout and psychological well-being in policemen

La mala calidad del sueño es un síntoma que con frecuencia aparece asociado a fatiga, disminución de las capacidades cognitivas y motoras durante el día y una mayor incidencia de accidentes de tráfico y laborales. Las consecuencias de una pobre calidad del sueño tiene una relevancia especial en diversos colectivos de trabajadores, involucrados en condiciones laborales estresantes tales como: profesionales sanitarios, de la seguridad, etc. El objetivo de este estudio se centra en evaluar la calidad del sueño, el burnout y el bienestar psicológico en una muestra de policías locales, así como la posible relación de estas medidas con variables laborales, tales como turnos de trabajo, bajas laborales, etc.La información se recogió por medio de pruebas estandarizadas, tales como la Escala de Somnolencia Diurna de Epworth (ESS; Murray, 1991), el Cuestionario de Salud General (GHQ-28; Goldberg, 1970) y la Escala de Burnout de Maslach (MBI-GS; Schaufeli, 1996), así como mediante un protocolo estructurado, que recogía las principales variables sociolaborales objeto de estudio. La muestra estuvo compuesta por 252 sujetos que contestaron el protocolo. Los resultados muestran relaciones significativas entre las tres variables principales, de forma que los sujetos con más problemas de sueño presentan menor bienestar y mayor burnout. También aparecen relaciones significativas entre burnout y bienestar psicológico, de modo que quienes tienen mayor burnout presentan un menor bienestar (AU)

[What is the attitude of doctors to the current model of primary care?]. / Cuál es la actitud de los médicos hacia el actual modelo de atención primaria?

OBJECTIVES: To determine the attitude of doctors towards the current model of primary care and to calculate its relationship with social and demographic and/or work variables. DESIGN: Multi-centre cross-sectional study. SETTING: Health centres in Area II of the Murcia region. Participants. All general practitioners, family doctors and paediatricians in the health centres mentioned (54 in all). MAIN MEASUREMENTS: The "Scale of attitudes towards the contents of primary health care" by Ballesteros et al. was used as the tool of evaluation. This scale provides both a total score and a specific score for each of its 7 dimensions. RESULTS: In general, doctors' attitudes were favourable (4.1 points average out of 5). We found a less favourable attitude in the dimension "Inclusion of second-level professionals in primary care", with family doctors most in agreement. The professionals working in centres on the periphery and those without tenure had a more positive attitude towards the current model, for the remaining variables. CONCLUSIONS: Understanding professionals' attitudes and the variables related to them may serve as a basis for designing intervention strategies aimed at improving the quality of primary care and for the positive evolution of professionals working in PC.

¿Cuál es la actitud de los médicos hacia el actual modelo de atención primaria? / What is the attitude of doctors to the current model of primary care?

Objetivo. Determinar cómo es la actitud de los médicos hacia el actual modelo de atención primaria de salud y estimar su relación con variables de tipo sociodemográfico y/o laboral. Diseño. Estudio multicéntrico, transversal. Emplazamiento. Centros de salud del Área II de la Región de Murcia. Participantes. Totalidad de médicos generales, de familia y pediatras de los centros de salud mencionados (54 en total).Mediciones principales. Como instrumento de evaluación se utiliza la 'Escala de actitudes hacia los contenidos de atención primaria de salud', de Ballesteros et al. Esta escala proporciona una puntuación total, así como una puntuación específica para cada una de las 7 dimensiones que la componen. Resultados. En general, la actitud de los médicos es favorable (4,1 puntos de media sobre 5). En la dimensión 'Inclusión de los profesionales del segundo nivel en atención primaria' es donde hemos encontrado una actitud menos favorable, siendo los médicos de familia los que se muestran más de acuerdo. En cuanto a las demás variables asociadas, los profesionales que trabajan en centros periféricos y en situación de interinidad muestran una actitud más positiva hacia el actual modelo. Conclusiones. El conocimiento de las actitudes de los profesionales, así como de las variables relacionadas, puede servir de base para diseñar posibles estrategias de intervención dirigidas a la mejora de la calidad asistencial en atención primaria y para una evolución positiva de los profesionales que prestan sus servicios (AU)