Methylphenidate improves executive functions in patients with traumatic brain injuries: a feasibility trial via the idiographic approach.

BACKGROUND: Road traffic accidents are known to be the main cause of traumatic brain injury (TBI). TBI is also a leading cause of death and disability. This study, by means of the idiographic approach (single-case experimental designs using multiple-baseline designs), has examined whether methylphenidate (MPH - trade name Ritalin) had a differential effect on cognitive measures among patients with TBI with the sequel of acute and chronic post-concussion syndromes. The effect on gender was also explored. METHODS: In comparison with healthy controls, patients with TBI (acute and chronic) and accompanying mild cognitive impairment (MCI) were screened for their integrity of executive functioning. Twenty-four patients exhibiting executive dysfunction (ED) were then instituted with the pharmacological intervention methylphenidate (MPH). The methylphenidate was administered using an uncontrolled, open label design. RESULTS: The administration of methylphenidate impacted ED in the TBI group but had no effect on mood. Attenuation of ED was more apparent in the chronic phases of TBI. The effect on gender was not statistically significant with regard to the observed changes. CONCLUSIONS: To our knowledge, this is the first feasibility trial from the Arabian Gulf to report the performance of a TBI population with mild cognitive impairment according to the IQCODE Arabic version. This investigation confirms anecdotal observations of methylphenidate having the potential to attenuate cognitive impairment; particularly those functions that are critically involved in the integrity of executive functioning. The present feasibility trial should be followed by nomothetic studies such as those that adhere to the protocol of the randomized controlled trial. This evidence-based research is the foundation for intervention and future resource allocation by policy- or public health decision-makers.

Attention Deficit Hyperactivity Disorder and Parental Factors in School Children Aged Nine to Ten Years in Muscat, Oman.

OBJECTIVES: The objectives of this study were to determine the prevalence of attention deficit hyperactivity disorder (ADHD) and specific parental risk factors that may contribute to the development of ADHD in children. METHODS: The study was conducted in Oman among fourth-grade students (aged nine to 10 years). A standardized Arabic version of the National Initiative for Children's Health Quality Vanderbilt Assessment Scale (Teachers questionnaire) was used to determine the presence of ADHD. Parental factors such as socioeconomic status, education, and occupation were documented. RESULTS: The prevalence rate of ADHD was 8.8%. Poor maternal education status, low familial socioeconomic status, and paternal occupation were significantly associated with an increased risk of ADHD. CONCLUSIONS: This was the first study that examined familial and parental characteristics of children with ADHD as potential risk factors for the condition. Such psychosocial factors could be employed to further the development of more proficient preventative measures and remedial services.

Patient safety culture assessment in oman.

OBJECTIVE: To illustrate the patient safety culture in Oman as gleaned via 12 indices of patient safety culture derived from the Hospital Survey on Patient Safety Culture (HSPSC) and to compare the average positive response rates in patient safety culture between Oman and the USA, Taiwan, and Lebanon. METHODS: This was a cross-sectional research study employed to gauge the performance of HSPSC safety indices among health workers representing five secondary and tertiary care hospitals in the northern region of Oman. The participants (n=398) represented different professional designations of hospital staff. Analyses were performed using univariate statistics. RESULTS: The overall average positive response rate for the 12 patient safety culture dimensions of the HSPSC survey in Oman was 58%. The indices from HSPSC that were endorsed the highest included 'organizational learning and continuous improvement' while conversely, 'non-punitive response to errors' was ranked the least. There were no significant differences in average positive response rates between Oman and the United States (58% vs. 61%; p=0.666), Taiwan (58% vs. 64%; p=0.386), and Lebanon (58% vs. 61%; p=0.666). CONCLUSION: This study provides the first empirical study on patient safety culture in Oman which is similar to those rates reported elsewhere. It highlights the specific strengths and weaknesses which may stem from the specific milieu prevailing in Oman.

Prevalence of depressive symptoms as elicited by Patient Health Questionnaire (PHQ-9) among medical trainees in Oman.

BACKGROUND: Despite the increasing recognition that medical training tends to coincide with markedly high levels of stress and distress, there is a dearth of validated measures that are capable of gauging the prevalence of depressive symptoms among medical residents in the Arab/Islamic part of the world. OBJECTIVE: The aim of the present study is two-fold. First is to examine the diagnostic validity of the Patient Health Questionnaire (PHQ-9) using an Omani medical resident population in order to establish a cut-off point. Second is to compare gender, age, and residency level among Omani Medical residents who report current depressive symptomatology versus those who report as non-depressed according to PHQ-9 cut-off threshold. RESULTS: A total of 132 residents (42 males and 90 females) consented to participate in this study. The cut-off score of 12 on the PHQ-9 revealed a sensitivity of 80.6% and a specificity of 94.0%. The rate of depression, as elicited by PHQ-9, was 11.4%. The role of gender, age, and residency level was not significant in endorsing depression. CONCLUSION: This study indicated that PHQ-9 is a reliable measure among this cross-cultural population. More studies employing robust methodology are needed to confirm this finding.

The detection of mood and anxiety in people with epilepsy using two-phase designs: experiences from a tertiary care centre in Oman.

BACKGROUND: The detection of mood and anxiety disorders is of great clinical importance in patients with chronic disease but data on the occurrence of affective dysfunction is lacking among people with epilepsy (PWE) in non-western populations. Further compounding such situation, the validity of some of the common assessment measures has not been examined. OBJECTIVE: The study aims to investigate the application of the Hospital Anxiety and Depression Scale (HADS) by identifying patients with comorbid affective dysfunctions in an Omani population. The semi structured interview, Composite International Diagnostic Interview (CIDI) will be used to establish the psychometric property of HADS in the Omani population. METHODS: PWE (n=150) were screened with the semi-structured, (CIDI) and the HADS. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the HADS for every possible threshold score. RESULTS: The semi-structured interview revealed the prevalence rate of 27% for depressive disorder and 45% for anxiety disorder. The best compromise using, the cut-off score of 7 or 8, gave a sensitivity of 99% for depression and 83-91% for anxiety and a specificity of 87.5-100% for depression and 85-94% for anxiety. CONCLUSIONS: Findings suggest that HADS is a useful screening tool for this particular population. This finding is discussed from the socio-cultural perspective of Omani society.

Characteristics of ADHD among Omani schoolchildren using DSM-IV: descriptive study.

BACKGROUND: There is a dearth of studies describing the characteristics of ADHD among schoolchildren attending child psychiatry clinics in the Arab world. Most of the previous quests have focused on community surveys or themes that hampered international comparison. AIM: This study screened for the presence of ADHD as well as investigates the psychosocial and educational history relevant for the diagnosis of ADHD among children. METHOD: Consecutive schoolchildren attending child psychiatric consultations were screened for the presence of ADHD according to the Diagnostic and Statistical Manual for Mental disorders (DSM) criteria. RESULT: A total of 221 schoolchildren suffering from ADHD were identified according to the DSM. The year incidence was 0.16. Males constituted the majority presenting with ADHD. The contribution of consanguinity and a history of acquired brain injury were common features. The majority were attending mainstream education as pharmacotherapy is the only option available for managing ADHD. CONCLUSION: This study is one of the few from this part of the world using DSM criteria to diagnose ADHD. The implications of the present findings are discussed in the context of the available literature and the specific situation in Oman.

Effect of amantadine on the sleep-wake cycle of an inpatient with brain injury.

BACKGROUND: A previous study suggested that the routine use of drugs intended to improve attention and arousal, such as methylphenidate, tend to have a variable but not significant effect on sleep-wake cycles. As amantadine is a frequently employed drug in brain injury rehabilitation, with known effects on fatigue and motor processing speed, this study examined the effect of amantadine on the sleep-wake behaviour of patients with brain injury undergoing rehabilitation. METHOD: This was a naturalistic observation using an observationally defined sleep-wake distribution for a total of 43 subjects with brain injury. Identified patients were observed for a full 24 hours a day 2 weeks before and 2 weeks after starting amantadine. Some of these patients (n = 12) had been administered amantadine on clinical grounds and, for this paper, served as the experimental group, while the drug naive (n = 31) served as a control. Three outcome measures were operationalized: hours of sleep in 24 hours, hours of sleep during daytime and hours of sleep during night-time. RESULT: The average number of hours of sleep during a 24-hour period was not significantly different for the two cohorts. Similarly hours of sleep during daytime and hours of sleep during night-time were on average the same for the two groups. The data suggest that amantadine has no direct bearing on sleep/wake cycles using these parameters. CONCLUSION: This study fails to demonstrate that the use of amantadine on an inpatient brain injury population will affect sleep/wake quantity.

Eating attitudes and body dissatisfaction in adolescents: Cross-cultural study.

AIMS: Sociocultural factors are thought to be important in the pathogenesis of eating disorders. However, there have been few studies comparing eating behavior among various cultural populations. The aim of the present study is to compare attitudes towards bodyweight and shape, and desire for thinness in Japanese male and female subjects with those in people from other countries and of different ethnic origin. METHODS: The subjects were 411 Japanese, 130 Indian, 135 Omani, 113 Euro-American and 196 Filipino adolescents. The Eating Attitude Test-26 and the Drive for Thinness subscale of the Eating Disorder Inventory-2 were used to assess eating attitudes and fat phobia. RESULTS: Subjects from India, Oman and the Philippines demonstrated eating attitudes that were similar to or worse than subjects from Western countries and Japan, although their desire for thinness was not as strong. The relationship between body mass index and eating attitudes or fat phobia in Indian, Omani and Filipino subjects differed from that in subjects from Western countries and Japan. In addition, both males and females showed disturbed eating attitudes in the Indian, Omani, and Filipino subjects. CONCLUSION: There are differences in eating attitudes and the drive for thinness among different cultural groups.

Association between body mass index and functional independence measure in patients with deconditioning.

OBJECTIVE: To assess the association of body mass index (BMI) with functional independence measure (FIM) score in patients with deconditioning. We also examined whether the association was different for motor and cognitive subscales of the FIM instrument. DESIGN: A retrospective study of 1077 inpatients admitted to the general medicine service for deconditioning at an acute rehabilitation hospital. Patients were classified into underweight (BMI < 18.5), normal range (BMI = 18.5-24.9), overweight (BMI = 25.0-29.9), obese class I (BMI = 30.0-34.9), obese class II (BMI = 35.0-39.9), and obese class III (BMI > or = 40). RESULTS: Median gain in FIM scores from admission to discharge was highest in obese class I patients (27 points), followed by obese class II patients (26 points). The most gain in FIM scores was accounted for by the motor subscale. Adjusting for age, gender, and length of in-hospital stay, obese class I patients had a 5.8-point (95% confidence limits = 1.2, 7.0) higher gain in FIM score compared with patients with BMI in the normal range. CONCLUSIONS: In an acute rehabilitation setting, obese patients had higher gains in FIM scores as compared with normal-range-BMI patients. Most of the improvements in FIM scores were accounted for by the motor subscale, with little or no improvement on the cognitive scale.

Tendency toward deliberate food restriction, fear of fatness and somatic attribution in cross-cultural samples.

OBJECTIVE: To compare Omani and western teenagers attending schools in Muscat, Sultanate of Oman and Filipino teenagers residing in Manila, Philippines on indices of deliberate food restriction and dieting behavior. METHODS: The sample consisted of 444 students who were assessed using the cross-culturally valid measure, Eating Attitude Test-26, a subscale of Eating Disorder Inventory to gauge the presence of the drive for thinness or 'fat phobia' and the Bradford Somatic Inventory to elicit the presence of somatization. RESULT: Significant differences in attitudes to eating, body image and somatization between the western and non-western teenagers were found. CONCLUSION: This paper suggests that trajectories of eating disorder, such as body image disturbances as expressed in fat phobia and somatization, tend to vary from culture to culture and underscore the view that some of the health related behavior among adolescents need to be examined within socio-cultural contexts.

The ineffectiveness of the Hospital Anxiety and Depression Scale for diagnosis in an Omani traumatic brain injured population.

BACKGROUND: The rehabilitation of the traumatic brain injury (TBI) patient is especially challenging in non-western populations as the phenotypic indicators as well as the neurobehavioral assessments for the survivors of brain injury are limited. OBJECTIVE: The study screened for the prevalence of anxiety and depressive states among patients with TBI and examined the validity of the Hospital Anxiety and Depression Scale (HADS) to identify TBI patients with comorbid affective dysfunctions, specifically anxiety and depressive disorders, in an Omani population. METHODS: Sixty-eight survivors of TBI were screened with the semi-structured, Composite International Diagnostic Interview (CIDI) and the HADS. A receiver operating characteristics (ROC) curve was calculated to discriminate the power of the HADS for every possible threshold score. RESULTS: The semi-structured interview revealed the prevalence rate of 57.4% for depressive disorder and 50% for anxiety disorder. The sensitivity (53.8%) and specificity 75.9%, gave the best compromise using the cut-off score of 4, suggesting HADS is not a useful screening tool for this particular population. CONCLUSIONS: Phenotypic indicators as detected by CIDI revealed that prevalence of affective dysfunctionality is common among this TBI population. Although the HADS is the most widely used screening instrument in other clinical populations, it does not appear to be a reliable resource in identifying depression and anxiety in people with traumatic brain injury in Oman.

The effect of methylphenidate on the sleep-wake cycle of brain-injured patients undergoing rehabilitation.

BACKGROUND AND PURPOSE: A number of neuro-stimulants are routinely used as part of post-acute care of hospitalized brain-injured patients. To our knowledge, the effect of these stimulants on the sleep-wake cycles of brain-injured patients undergoing rehabilitation has not been addressed. We examined the effect of one of the most commonly used neuro-stimulants, methylphenidate, on the sleep-wake behavior of brain-injured patients undergoing rehabilitation at a dedicated brain injury clinic. PATIENTS AND METHOD: For this study, records of patients admitted between January and December 1999 were scrutinized retrospectively for the data on observationally defined sleep-wake distribution. A total of 30 patients diagnosed with traumatic brain injury were identified as having been observed for a full 24h a day for at least 10 days. Some of these patients (n=17) were administered methylphenidate on clinical grounds. They served as the experimental group, while the unmedicated patients (n=13) served as controls. For the present analysis, the sleep-wake cycles were arbitrarily designated as nighttime and daytime, respectively. A cumulative sleep-wake quantity in a 24-h period was also observed. RESULT: The average number of hours of sleep during a 24-h period was not significantly different for the two cohorts. Similar trends emerged for the nighttime and daytime observations. On the whole, methylphenidate appears not to have unfavorable effects on sleep-wake cycles, presently defined as nighttime, daytime and 24-h, in the traumatic brain injury population. CONCLUSION: This study sought to gain better understanding of the effect of methylphenidate on daytime sleepiness and nighttime sleep, and the data suggest that administration of methylphenidate does not appear to have an adverse effect on sleep-wake quantity.

A study of fertility patterns of ever married women in oman.

OBJECTIVE: To examine the relation between age, education, residence and fertility rate and change in fertility rate between 1994/95 and 1999/2000. METHODS: The data for the study was extracted from the Oman National Health Survey, 2000. The birth histories data was used to extract data on woman years and births in the periods 1990 to 1994 and 1995 to 2000. RESULTS: The marital fertility rate in 1999/2000 was 7.12 births. The rates for rural and urban dwellers were 8.07 and 6.75 respectively in 1999/2000. Corresponding rates in 1994/95 (8.65, 8.30 and 9.69 respectively) were significantly higher than those in 1999/2000 for all categories, indicating a reduction in rates. In both periods the higher the education level of the mother the lower her fertility. CONCLUSION: Education was a strong determinant of fertility. This study confirms that the higher the education of the woman the lower her fertility and that fertility is on the decline in Oman.

Apathy and depression in cross-cultural survivors of traumatic brain injury.

The disturbance of motivation and its relationship to depression continues to spark contradictory findings among European and North American populations. Could a cross-cultural study shed some light on the situation? This study aims to detect the prevalence of apathy and to test whether the Apathy Evaluation Scale (AES) can spot the presence or absence of depression in survivors of traumatic brain injury (TBI) in Oman. Eighty subjects who sustained a TBI were given an Arabic version of the AES and were also interviewed with the semistructured Composite International Diagnostic Interview (CIDI). The authors found that the incidence of apathy and depression among Omani people who sustained TBI is similar to that reported elsewhere. The AES has poor discriminatory power in identifying cases of depression. These findings emphasize the importance of developing assessment tools that are culturally sensitive in light of the rising incidence of TBI in developing countries such as Oman.

Trastornos de la conducta alimentaria y percepción del miedo a estar gordo en una población adolescente no occidental: una experiencia en Omán / No disponible

Existen continuos debates sobre si un trastorno de desajuste proteico como la anorexia nerviosa tiene manifestaciones similares en diferentes culturas y si la patología de la conducta alimentaria constituye un fenómeno ligado a la cultura o de reacción a la misma. Este artículo investiga la forma en que la opinión de una percepción prototípica del miedo a estar gordo, como factor esencial para la identificación de la anorexia nerviosa, se expresa en algunas poblaciones no occidentales. Omán, un país en rápido desarrollo, tiene una mezcla de poblaciones que proporciona un entorno favorable para el estudio de las diferencias transculturales en conductas de salud. El presente estudio sugiere que la actuación de los adolescentes no occidentales (de Omán o India) en las medidas de evaluación para obtener el miedo a estar gordo o “fobia a estar gordo” es significativamente distinta a la de los adolescentes europeos y norteamericanos. Sin embargo no se encontraron diferencias significativas en función de otros índices de patologías de de la conducta alimentaria como el EAT-26 ni en las variables antropomórficas. Este estudio considera la formación de un patrón cultural que protegería a los adolescentes no occidentales de desarrollar las actitudes y conductas isomórficas que conducen a la insatisfacción con la imagen corporal (AU)

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Functional outcomes following anoxic brain injury: a comparison with traumatic brain injury.

PRIMARY OBJECTIVE: To compare the functional outcomes of patients with anoxic brain injury (ABI) and patients with traumatic brain injury (TBI) following inpatient rehabilitation. RESEARCH DESIGN: Retrospective chart review. METHODS AND PROCEDURES: Data on 68 patients with brain injury (34 with ABI and 34 with TBI) were collected. MAIN OUTCOMES AND RESULTS: The ABI and TBI groups were demographically similar, except that patients with ABI were more likely to be married. Both groups significantly improved their function and were similar upon discharge. For the ABI group, there were trends toward a shorter length of stay, increased total FIM efficiency and decreased cost of stay when compared with the TBI group. The patients with ABI tended to be discharged to a sub-acute rehabilitation facility more than those in the TBI group. CONCLUSIONS: This study is important because it shows that patients with ABI benefit from inpatient rehabilitation and made significant functional gains comparable to the gains of patients with TBI.

Eye-movements and ongoing task processing.

This study tests the relation between eye-movements and thought processing. Subjects were given specific modality tasks (visual, gustatory, kinesthetic) and assessed on whether they responded with distinct eye-movements. Some subjects' eye-movements reflected ongoing thought processing. Instead of a universal pattern, as suggested by the neurolinguistic programming hypothesis, this study yielded subject-specific idiosyncratic eye-movements across all modalities. Included is a discussion of the neurolinguistic programming hypothesis regarding eye-movements and its implications for the eye-movement desensitization and reprocessing theory.

Patient's perspective on epilepsy: self-knowledge among Omanis.

Improving patients' knowledge has been suggested to improve their symptoms and prognosis. Very little is known about epileptic patient's knowledge of their illness in cross-cultural settings. This pilot study investigated what Omani patients know about their disorder. Patients attending a tertiary hospital completed a structured knowledge questionnaire to elicit information pertaining to aetiology, safety, compliance with medication regimes, legal and employment issues concerning epilepsy.Although correctly endorsing issues related to their medication, this cross-cultural sample was found to have limited knowledge about their condition. In particular, most patients were unable to give accurate indications of epilepsy, neither were they able to give correct responses to questions pertaining to safety and compliance. There is a need for improving patient's knowledge. As with other chronic disorders, people with epilepsy in Oman should receive systematic health education about how to manage the condition most effectively.

Presence and severity of anorexia and bulimia among male and female Omani and non-Omani adolescents.

OBJECTIVE: The population of Oman is a heterogeneous mix of nationalities providing a natural setting for studying the cross-cultural differences in the presence and severity of eating disorders as well as an opportunity for evaluating the performance of measurement instruments for these disorders. METHOD: Disordered eating screening instruments (the Eating Attitude Test and the Bulimic Investigatory Test) were administered to Omani teenagers, non-Omani teenagers, and Omani adults. RESULTS: On the Eating Attitude Test, 33% of Omani teenagers (29.4% females and 36.4% males) and 9% of non-Omani teenagers (7.5% of males and 10.6% females) showed a propensity for anorexic-like behavior. On the Bulimic Investigatory Test, 12.3% of Omani teenagers showed a propensity for binge eating or bulimia (13.7% females and 10.9% males). Among the non-Omani teenagers, 18.4% showed a tendency toward bulimia, with females showing a slightly greater tendency than males. In contrast, barely 2% of Omani adults showed either a presence of or a severity of disorderly behavior with food. CONCLUSION: Omani teenagers scored significantly higher than other ethnic groups and Omani adults. This finding is discussed in the light of emerging evidence from many parts of the world suggesting that cultural transition, compounded by demographic constraints, plays a significant role in abnormal eating attitudes.

Deliberate self-poisoning in Oman.

OBJECTIVE: To describe the demographics, precipitating factors, substances and methods used for deliberate self-harm in Oman. METHODS: Data were extracted from the Accident and Emergency (A & E) records of patients treated at the A & E units in Muscat from 1993 to 1998. Data were obtained form the history, and clinical findings resulting form deliberate self-harm. RESULTS: During the 5-year study period, 123 persons presented to various hospitals in the Muscat area with injuries that resulted form deliberate self-harm. Most of these cases were women, students and unemployed. There was a high incidence of family, marital and psychiatric or social problems. The methods of self-harm were most often analgesics (such as paracetamol) and non-pharmaceutical chemicals. CONCLUSIONS: The rate of self-injurious behaviour is low in Oman, compared with other countries, including other Islamic countries. The data illustrate a rising rate and a tendency to ingest toxic doses of analgesics or non-pharmaceutical chemicals.