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1.
Sleep Med Clin ; 16(1): 155-202, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33485527

RESUMO

This article discusses information extracted from 53 studies that have measured adherence to cognitive behavior therapy for insomnia. There has been an increase in more complex and less biased methods for assessing adherence that move beyond simply asking the patients whether they have adhered to the intervention or not. There is a need for a consensus around how to measure adherence, if clinicians want to arrive at an estimate of optimal adherence. Heterogeneity of studies, particularly in the way adherence is operationalized, prohibited conclusions about the relationship between adherence and outcome, as well as about predictors of adherence.

2.
PLoS One ; 16(1): e0244873, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33400700

RESUMO

BACKGROUND: Multiple studies have highlighted the negative impact of COVID-19 and its particular effects on vulnerable sub-populations. Complementing this work, here, we report on the social patterning of self-reported positive changes experienced during COVID-19 national lockdown in Scotland. METHODS: The CATALYST study collected data from 3342 adults in Scotland during weeks 9-12 of a national lockdown. Using a cross-sectional design, participants completed an online questionnaire providing data on key sociodemographic and health variables, and completed a measure of positive change. The positive change measure spanned diverse domains (e.g., more quality time with family, developing new hobbies, more physical activity, and better quality of sleep). We used univariate analysis and stepwise regression to examine the contribution of a range of sociodemographic factors (e.g., age, gender, ethnicity, educational attainment, and employment status) in explaining positive change. RESULTS: There were clear sociodemographic differences across positive change scores. Those reporting higher levels of positive change were female, from younger age groups, married or living with their partner, employed, and in better health. CONCLUSION: Overall our results highlight the social patterning of positive changes during lockdown in Scotland. These findings begin to illuminate the complexity of the unanticipated effects of national lockdown and will be used to support future intervention development work sharing lessons learned from lockdown to increase positive health change amongst those who may benefit.


Assuntos
/psicologia , Quarentena/psicologia , Isolamento Social/psicologia , Adulto , Ansiedade/epidemiologia , Ansiedade/prevenção & controle , /prevenção & controle , Controle de Doenças Transmissíveis/métodos , Estudos Transversais , Exercício Físico/psicologia , Família/psicologia , Feminino , Humanos , Masculino , Escócia/epidemiologia , Sono/fisiologia , Higiene do Sono , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologia , Inquéritos e Questionários
3.
Artigo em Inglês | MEDLINE | ID: mdl-33327556

RESUMO

We examine the impact of the COVID-19 outbreak and concomitant restrictions (i.e., lockdown) on 24-hour movement behaviors (i.e., physical activity, sitting, sleep) in a purposive sample of people (n = 3230) reporting change recruited online. Participants' self-reported time spent in moderate-to-vigorous physical activity (MVPA), walking, sitting and sleep prior to lockdown (T1), during the first national lockdown (T2) and as restrictions initially started to ease (T3). For each 24-hour movement behavior, category-shifts are reported (positive, negative or did not change), as well as the percentage of participants recording positive/negative changes across clusters of behaviors and the percentage of participants recording improvement or maintenance of change across time. From T1 to T2 walking decreased, whereas MVPA, sitting and sleep increased, from T2 to T3 levels returned to pre-lockdown for all but MVPA. Participants who changed one behavior positively were more likely to report a positive change in another and 50% of those who reported positive changes from T1 to T2 maintained or improved further when restrictions started to ease. The current study showed that a large proportion of the sample reported positive changes, most notably those displaying initially poor levels of each behavior. These findings will inform salutogenic intervention development.


Assuntos
Exercício Físico , Pandemias , Comportamento Sedentário , Sono , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escócia , Postura Sentada , Adulto Jovem
4.
Br J Health Psychol ; : e12446, 2020 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-32558129

RESUMO

OBJECTIVES: To conduct a qualitative exploration of the lived experience of insomnia disorder and its management amongst a sample of mixed-diagnoses cancer survivors. METHODS: Twenty-seven cancer survivors with persistent insomnia were recruited to this qualitative study following completion of treatment for breast (12), prostate (7), colorectal (7), and gynaecological (1) cancers. Eleven males and 16 females (mean age 62 years), who met DSM-5 criteria for insomnia disorder, contributed to one of four focus group discussions, designed to explore the lived experience of persistent insomnia and its management within cancer care services. RESULTS: Poor sleep was a persistently troubling complaint for participants, long after the completion of active cancer treatment. The impact of insomnia was significant for all participants, with six key domains emerging as those most affected: temperament, sociability, physical well-being, cognitive functioning, relationships, and psychological well-being. In terms of insomnia management, participants frequently resorted to unfruitful self-management strategies, due to the lack of professional insomnia expertise within cancer care settings. Three main themes emerged in relation to insomnia management: self-management, seeking professional intervention, and a lack of focus on sleep. A lack of clinician understanding of the importance of sleep health and the poor availability of evidence-based insomnia interventions, such as cognitive behavioural therapy for insomnia (CBT-i), were highlighted as important gaps in cancer care. CONCLUSIONS: Insomnia was found to have a detrimental and pervasive impact on cancer survivors' quality of life, which persisted long into survivorship. There is an absence of professional attention to sleep throughout the cancer care trajectory, contributing to its prevalence, persistence, and impact. In order to break this cycle, sleep health should be integrated as a key aspect of cancer treatment and rehabilitation, much like maintaining a healthy diet and appropriate levels of physical activity.

5.
Clin J Pain ; 35(3): 261-271, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30531400

RESUMO

OBJECTIVES: Numerous psychological factors have been found to be associated with acute and chronic pain following breast cancer surgery. However, individual studies tend to be limited to a small number of predictors and many fail to employ prospective designs. This study aimed to identify a broader range of psychological predictors of acute and chronic pain following breast cancer surgery through a systematic review of relevant prospective studies. METHODS: Web of Science, psychINFO, PubMed, and MEDLINE databases were searched to identify relevant prospective cohort studies. Studies were included if women were to undergo mastectomy or wide local excision, if psychological factors were assessed before surgery, and pain assessed after surgery. RESULTS: Twelve studies (representing 11 independent cohorts) met the inclusion criteria and described 10 psychological predictors. Anxiety and depression were the most frequently assessed psychological factors, and were measured in 9 of the 12 studies. Anxiety and psychological robustness emerged as significant predictors of acute pain. Distress was the strongest predictor of chronic pain. The relationship between depression and chronic postsurgical pain was, at best, mixed. DISCUSSION: This review has identified a range of psychological predictors of acute and chronic pain following breast cancer surgery; however, the evidence was conflicting and limited. Future studies should demonstrate adequate power and take account of known confounders.


Assuntos
Dor Aguda/psicologia , Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Dor Crônica/psicologia , Dor Pós-Operatória/psicologia , Dor Aguda/diagnóstico , Neoplasias da Mama/diagnóstico , Dor Crônica/diagnóstico , Feminino , Humanos , Dor Pós-Operatória/diagnóstico
6.
Sleep ; 42(3)2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30521041

RESUMO

STUDY OBJECTIVES: Insomnia in cancer patients is prevalent, persistent, and confers risk for physical and psychological disorder. We must better understand how insomnia develops in cancer patients and explore the main contributors to its chronicity so that insomnia management protocols can be integrated more effectively within cancer care. This study monitors the etiology of insomnia in breast cancer patients and identifies risk factors for its persistence. METHODS: One hundred seventy-three females with newly diagnosed, non-metastatic breast cancer were tracked from diagnosis for 12 months. Participants completed monthly sleep assessments using the Insomnia Severity Index (ISI) and 3 monthly health-related quality-of-life assessments using the European Organisation for Research and Treatment of Cancer - Breast (EORTC QLQ-C30-BR23) scale. Clinical data on disease status and treatment regimens were also assessed. RESULTS: Prior to diagnosis, 25% of participants reported sleep disturbance, including 8% with insomnia syndrome (IS). Prevalence increased at cancer diagnosis to 46% (18% IS) and remained stable thereafter at around 50% (21% IS). We also explored sleep status transitions. The most common pattern was to remain a good sleeper (34%-49%) or to persist with insomnia (23%-46%). Seventy-seven percent of good sleepers developed insomnia during the 12-month period and 54% went into insomnia remission. Chemotherapy (odds ratio = 0.08, 95% confidence interval [CI] 0.02-0.29, p < .001) and pre-diagnosis ISI scores (odds ratio = 1.13/unit increase in pre-diagnosis sleep score, 95% CI 1.05-1.21, p = .001) were identified as the main risk factors for persistent insomnia. CONCLUSIONS: These data advance our understanding of insomnia etiology in cancer patients and help identify those who should be prioritized for insomnia management protocols.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/psicologia , Qualidade de Vida/psicologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Adulto , Neoplasias da Mama/diagnóstico , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Sono/fisiologia , Distúrbios do Início e da Manutenção do Sono/diagnóstico
7.
Future Oncol ; 14(21): 2115-2129, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29595064

RESUMO

Venetoclax is a highly selective, potent BCL-2 inhibitor that is approved for some patients previously treated for chronic lymphocytic leukemia, and has shown promising activity in adult studies across several hematologic malignancies. Preclinical studies have demonstrated venetoclax activity in pediatric patient-derived xenograft models and cell lines; however, clinical studies in pediatric patients have yet to be conducted. The prognosis is poor for children with most relapsed/refractory malignancies, and limited treatment options result in unmet clinical need. Herein, we describe the rationale and design of the first study of venetoclax in pediatric patients with relapsed/refractory malignancies: a Phase I trial investigating the safety and pharmacokinetics of venetoclax monotherapy followed by the addition of chemotherapy (Trial registration: EudraCT 2017-000439-14; NCT03236857).


Assuntos
Antineoplásicos/uso terapêutico , Compostos Bicíclicos Heterocíclicos com Pontes/uso terapêutico , Protocolos Clínicos , Desenvolvimento de Medicamentos , Neoplasias/tratamento farmacológico , Sulfonamidas/uso terapêutico , Fatores Etários , Antineoplásicos/farmacologia , Biomarcadores , Compostos Bicíclicos Heterocíclicos com Pontes/farmacologia , Pré-Escolar , Resistencia a Medicamentos Antineoplásicos , Humanos , Recidiva , Projetos de Pesquisa , Sulfonamidas/farmacologia , Resultado do Tratamento
8.
Lancet Psychiatry ; 4(10): 749-758, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28888927

RESUMO

BACKGROUND: Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations. METHODS: We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251. FINDINGS: Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohen's d=1·11; p<0·0001), paranoia (-2·22, -2·98 to -1·45, Cohen's d=0·19; p<0·0001), and hallucinations (-1·58, -1·98 to -1·18, Cohen's d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported. INTERPRETATION: To our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision. FUNDING: Wellcome Trust.


Assuntos
Alucinações/prevenção & controle , Transtornos Paranoides/prevenção & controle , Distúrbios do Início e da Manutenção do Sono/terapia , Sono/fisiologia , Adolescente , Adulto , Terapia Cognitivo-Comportamental/métodos , Feminino , Humanos , Masculino , Saúde Mental/normas , Estudantes/psicologia , Resultado do Tratamento , Reino Unido/epidemiologia , Adulto Jovem
9.
J Crit Care ; 35: 180-4, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27481756

RESUMO

OBJECTIVE: The objective of this exploratory evaluation was to understand the impact of critical care survivorship on caregivers. DESIGN: Family members who attended a quality improvement initiative within our critical care unit were asked to complete 4 questionnaires. SETTING: The setting for this study was a 20-bedded mixed critical care unit in a large teaching hospital in Scotland. Data were collected as a part of an evaluation of a quality improvement initiative. PARTICIPANTS: Thirty-six carers completed the questionnaire set. MEASUREMENTS AND MAIN RESULTS: A total of 53% of caregivers suffered significant strain. Poor quality of life in the patient was significantly associated with higher caregiver strain (P= .006). Anxiety was present in 69% of caregivers. Depression was present in 56% of caregivers, with a significant association between carer strain and depression (P< .001). Those caregivers who were defined as being strained also had significantly higher Insomnia Severity Index scores than those without carers strain (P= .007). CONCLUSION: This evaluation has demonstrated that there is a significant burden for caregivers of critical care survivors. Furthermore, they reported high levels of posttraumatic stress disorder, anxiety, depression, and insomnia. Future work on rehabilitation from critical care should focus on the inclusion of caregivers.


Assuntos
Ansiedade/epidemiologia , Cuidadores/psicologia , Cuidados Críticos/estatística & dados numéricos , Depressão/epidemiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Estresse Psicológico/complicações , Adulto , Idoso , Ansiedade/etiologia , Depressão/etiologia , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Melhoria de Qualidade , Qualidade de Vida , Escócia/epidemiologia , Distúrbios do Início e da Manutenção do Sono/etiologia , Inquéritos e Questionários
10.
Sleep Med ; 15(8): 913-7, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24791643

RESUMO

OBJECTIVES: Insomnia patients complain that mental events keep them awake. This study investigates how cognitive behavioural therapy (CBT) affects such events and considers how attributional, cognitive and psychopathological symptoms may mediate sleep improvement. METHOD: A pragmatic, parallel-group randomized controlled trial of 164 adults (120 F: (mean 49 years (18-78 years)) meeting Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for insomnia disorder, assigned to CBT (n=55; 40 F), imagery relief therapy (IRT placebo; n=55; 42 F), or treatment as usual (TAU; n=54; 38 F), was conducted. CBT/IRT comprised six online sessions delivered by an animated therapist, with automated web/e-mail support. CBT users had access to a moderated community. TAU comprised 'usual care'. Participants completed the Sleep Disturbance Questionnaire (SDQ), Glasgow Content of Thoughts Inventory (GCTI), Depression Anxiety and Stress Scales (DASS) and Sleep Condition Indicator (SCI) at baseline, post treatment and 8-week follow-up. RESULTS: The sample was characterised by mental arousal, notably 'trying too hard' to sleep (SDQ), and by 'sleep and sleeplessness' and 'rehearsal and planning' thoughts (GCTI). Treatment effects were observed for all SDQ domains (e.g., CBT vs. IRT: d=0.76 for 'trying too hard'). CBT was also superior to IRT on the GCTI (e.g., 'rehearsal and planning', d=0.62; 'sleep and sleeplessness', d=0.74). CBT vs. TAU comparisons yielded larger effects, whereas placebo effects (IRT vs. TAU) were small to moderate. Hierarchical regression demonstrated partial mediation of SCI improvement by attributional and cognitive factors (R2 = 21-27%) following CBT. Improvement in sleep efficiency appears to be independent of such factors. CONCLUSION: Online CBT modifies sleep-related attributions, night-time thought content and psychopathology. This process partly mediates improvement in DSM-5-defined insomnia.


Assuntos
Terapia Cognitivo-Comportamental , Distúrbios do Início e da Manutenção do Sono/terapia , Adolescente , Adulto , Idoso , Cognição , Terapia Cognitivo-Comportamental/métodos , Humanos , Pessoa de Meia-Idade , Sistemas On-Line , Escalas de Graduação Psiquiátrica , Testes Psicológicos , Psicopatologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
11.
BMJ Open ; 4(3): e004183, 2014 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-24643168

RESUMO

OBJECTIVE: Describe the development and psychometric validation of a brief scale (the Sleep Condition Indicator (SCI)) to evaluate insomnia disorder in everyday clinical practice. DESIGN: The SCI was evaluated across five study samples. Content validity, internal consistency and concurrent validity were investigated. PARTICIPANTS: 30 941 individuals (71% female) completed the SCI along with other descriptive demographic and clinical information. SETTING: Data acquired on dedicated websites. RESULTS: The eight-item SCI (concerns about getting to sleep, remaining asleep, sleep quality, daytime personal functioning, daytime performance, duration of sleep problem, nights per week having a sleep problem and extent troubled by poor sleep) had robust internal consistency (α≥0.86) and showed convergent validity with the Pittsburgh Sleep Quality Index and Insomnia Severity Index. A two-item short-form (SCI-02: nights per week having a sleep problem, extent troubled by poor sleep), derived using linear regression modelling, correlated strongly with the SCI total score (r=0.90). CONCLUSIONS: The SCI has potential as a clinical screening tool for appraising insomnia symptoms against Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria.


Assuntos
Distúrbios do Início e da Manutenção do Sono/diagnóstico , Sono , Inquéritos e Questionários/normas , Adulto , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Psicometria/métodos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Transtornos do Sono-Vigília , Adulto Jovem
12.
Psychooncology ; 23(6): 679-84, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24458543

RESUMO

OBJECTIVES: This secondary analysis of data from a randomised controlled trial explores associations between common symptom clusters and evaluates pre-treatment to post-treatment changes in clinical levels of these symptoms following cognitive behaviour therapy for insomnia (CBT-I). METHODS: Baseline data from 113 participants with insomnia were explored to establish rates of and associations between clinical levels of fatigue, anxiety and depression across the sample. Effects of CBT-I on this symptom cluster were also explored by examining changes in pre-treatment to post-treatment levels of fatigue, anxiety and depression. RESULTS: At baseline, the most common symptom presentation was insomnia + fatigue, and 30% of the sample reported at least three co-morbid symptoms. Post-CBT, the number of those experiencing clinical insomnia and clinical fatigue decreased. There were no changes in anxiety rates from baseline to post-treatment in the CBT group and modest reductions in rates of those with clinical depression. Seven individuals (9.6%) from the CBT group were completely symptom free at post-treatment compared with 0% from the treatment as usual condition. Chi-square analysis revealed a significant relationship between group allocation and changes in symptoms of insomnia and fatigue. No such relationship was found between group allocation and mood variables. CONCLUSIONS: These findings confirm the high rate of symptom co-morbidities among cancer patients and highlight strong associations between sleep and fatigue. CBT-I appears to offer generalised benefit to the symptom cluster as a whole and, specifically, is effective in reducing fatigue, which exceeded clinical cut-offs prior to implementation of the intervention. This has implications for the diagnosis/management of common symptoms in cancer patients.


Assuntos
Ansiedade/psicologia , Terapia Cognitivo-Comportamental/métodos , Depressão/psicologia , Fadiga/psicologia , Neoplasias/psicologia , Distúrbios do Início e da Manutenção do Sono/terapia , Idoso , Ansiedade/complicações , Depressão/complicações , Fadiga/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Distúrbios do Início e da Manutenção do Sono/complicações , Distúrbios do Início e da Manutenção do Sono/psicologia , Resultado do Tratamento
13.
Psychooncology ; 21(9): 1003-9, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21726015

RESUMO

BACKGROUND: Although it is increasingly recognized that cancer patients often have sleep problems, we lack data on their prevalence and associations in representative clinical populations. We aimed to determine (i) the prevalence of sleep problems amongst outpatients of a cancer centre and (ii) the association with medical variables, emotional distress and pain. METHODS: Secondary analysis of self-report and medical data on 2862 cancer centre outpatients. Sleep problems were identified using the sleep item from the Patient Health Questionnaire-9: 'Over the last two weeks, how often have you been bothered by trouble falling or staying asleep or sleeping too much?' scored on a four-point frequency scale. Emotional distress was measured using the Hospital Anxiety and Depression Scale and pain using the subscale of the European Organisation for Research and Treatment of Cancer Quality of Life Core 30 questionnaire. Medical data were obtained from the cancer centre clinical database. RESULTS: Sleep problems (bothered more than half the days during the previous 2 weeks) were reported by 30.2% (865/2862, 95% CI = 28.5 to 31.9) of the patients. They were common in both patients with active cancer (34.5%) and in cancer survivors (28.0%). There was only a modest association with cancer site and treatment status, but there was a strong association with pain (odds ratio = 2.7, 95% CI = 2.2 to 3.4) and emotional distress (odds ratio = 4.5, 95% CI = 3.7 to 5.6). CONCLUSIONS: Sleep problems are common in cancer outpatients and are strongly associated with pain and emotional distress. A combined approach to the management of sleep, pain and emotional distress is indicated. Copyright © 2011 John Wiley & Sons, Ltd.


Assuntos
Neoplasias/epidemiologia , Neoplasias/psicologia , Dor/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Razão de Chances , Pacientes Ambulatoriais/psicologia , Pacientes Ambulatoriais/estatística & dados numéricos , Dor/complicações , Prevalência , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Escócia/epidemiologia , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/psicologia , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto Jovem
14.
Nucleic Acids Res ; 39(Database issue): D596-600, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20929876

RESUMO

Pseudomonas is a metabolically-diverse genus of bacteria known for its flexibility and leading free living to pathogenic lifestyles in a wide range of hosts. The Pseudomonas Genome Database (http://www.pseudomonas.com) integrates completely-sequenced Pseudomonas genome sequences and their annotations with genome-scale, high-precision computational predictions and manually curated annotation updates. The latest release implements an ability to view sequence polymorphisms in P. aeruginosa PAO1 versus other reference strains, incomplete genomes and single gene sequences. This aids analysis of phenotypic variation between closely related isolates and strains, as well as wider population genomics and evolutionary studies. The wide range of tools for comparing Pseudomonas annotations and sequences now includes a strain-specific access point for viewing high precision computational predictions including updated, more accurate, protein subcellular localization and genomic island predictions. Views link to genome-scale experimental data as well as comparative genomics analyses that incorporate robust genera-geared methods for predicting and clustering orthologs. These analyses can be exploited for identifying putative essential and core Pseudomonas genes or identifying large-scale evolutionary events. The Pseudomonas Genome Database aims to provide a continually updated, high quality source of genome annotations, specifically tailored for Pseudomonas researchers, but using an approach that may be implemented for other genera-level research communities.


Assuntos
Bases de Dados Genéticas , Genoma Bacteriano , Pseudomonas/genética , Proteínas de Bactérias/análise , Ilhas Genômicas , Genômica , Polimorfismo Genético
15.
Psychooncology ; 19(9): 991-6, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20014075

RESUMO

OBJECTIVES: To conduct the first qualitative analysis of the development and impact of insomnia on a cohort of cancer survivors. METHODS: Twenty-one cancer survivors with a history of chronic insomnia contributed to four focus groups held at the University of Glasgow Sleep Research Centre. Participants' perceptions of the onset, evolution and effects of insomnia were elicited and qualitatively explored using content analysis. RESULTS: Most participants reported insomnia onset following cancer diagnosis. Participants who had a pre-existing insomnia reported that cancer diagnosis significantly aggravated their sleep complaint. Active cancer treatment was a major contributor to poor sleep quality due to the disruption of normal daily routines. This poor sleep pattern became persistent once active treatment had ceased and participants reported becoming particularly concerned about their sleep when they were discharged into follow-up cancer care. The impact of insomnia was significant for all participants in the study and six major areas emerged as being particularly affected; mood, physical health, relationships, sleep quality, sleep-related behaviour and cognition. CONCLUSIONS: The majority of cancer survivors in this study developed disturbed sleep as a result of cancer diagnosis and their sleep disruption was exacerbated by active cancer treatment. Insomnia also had a significant impact upon quality of life and these effects persisted long beyond the cessation of active anti-cancer therapy. Early identification of insomnia symptoms in cancer care settings must be a priority to ensure that sleep disturbance is not overlooked or poorly managed.


Assuntos
Neoplasias/complicações , Qualidade de Vida , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/psicologia , Sobreviventes/psicologia , Afeto , Estudos de Coortes , Fadiga , Feminino , Grupos Focais , Humanos , Masculino , Neoplasias/diagnóstico , Neoplasias/psicologia , Pesquisa Qualitativa , Escócia , Perfil de Impacto da Doença , Inquéritos e Questionários , Resultado do Tratamento
16.
J Clin Oncol ; 26(28): 4651-8, 2008 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-18591549

RESUMO

PURPOSE: Persistent insomnia is a common complaint in cancer survivors, but is seldom satisfactorily addressed. The adaptation to cancer care of a validated, cost-effective intervention may offer a practicable solution. The aim of this study was to investigate the clinical effectiveness of protocol-driven cognitive behavior therapy (CBT) for insomnia, delivered by oncology nurses. PATIENTS AND METHODS: Randomized, controlled, pragmatic, two-center trial of CBT versus treatment as usual (TAU) in 150 patients (103 females; mean age, 61 years.) who had completed active therapy for breast, prostate, colorectal, or gynecological cancer. The study conformed to CONSORT guidelines. Primary outcomes were sleep diary measures at baseline, post-treatment, and 6-month follow-up. Actigraphic sleep, health-related quality of life (QOL), psychopathology, and fatigue were secondary measures. CBT comprised five, small group sessions across consecutive weeks, after a manualized protocol. TAU represented normal clinical practice; the appropriate control for a clinical effectiveness study. RESULTS: CBT was associated with mean reductions in wakefulness of 55 minutes per night compared with no change in TAU. These outcomes were sustained 6 months after treatment. Standardized relative effect sizes were large for complaints of difficulty initiating sleep, waking from sleep during the night, and for sleep efficiency (percentage of time in bed spent asleep). CBT was associated with moderate to large effect sizes for five of seven QOL outcomes, including significant reduction in daytime fatigue. There was no significant interaction effect between any of these outcomes and baseline demographic, clinical, or sleep characteristics. CONCLUSION: CBT for insomnia may be both clinically effective and feasible to deliver in real world practice.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Neoplasias/complicações , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/enfermagem , Distúrbios do Início e da Manutenção do Sono/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Psicometria , Qualidade de Vida , Resultado do Tratamento
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