Obstructive sleep apnea and psychiatric disorders: A systematic review

Study Objectives: Obstructive sleep apnea (OSA) has been associated with psychiatric pathology. Psychiatric comorbidity in OSA may affect patient quality of life and adherence to CPAP. A focused evaluation of OSA in highly selected groups of primarily psychiatric patients may provide further insights into the factors contributing to comorbidity of OSA and psychopathology. The goal of this study is to examine the prevalence and treatment of OSA in psychiatric populations. Methods: A systematic review following the PRISMA guidelines was conducted to determine the prevalence of OSA in schizophrenia and other psychotic disorders, mood disorders, and anxiety disorders, and to examine potential interventions. The PubMed, EMBASE, and PsycINFO databases were searched (last search April 26, 2014) using keywords based on the ICD-9-CM coding for OSA and the DSM-IV-TR diagnostic groups. Results: The search retrieved 48 records concerning studies of OSA in the selected disorders. The prevalence studies indicate that there may be an increased prevalence of OSA in individuals with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), despite considerable heterogeneity and a high risk of bias. There was insufficient evidence to support increased OSA in schizophrenia and psychotic disorders, bipolar and related disorders, and anxiety disorders other than PTSD. Studies of treatment of OSA indicate an improvement in both OSA and psychiatric symptoms. CPAP adherence was reduced in veterans with PTSD. Conclusions: OSA prevalence may be increased in MDD and PTSD. In individuals with OSA and psychiatric illness, treatment of both disorders should be considered for optimal treatment outcomes

Parents' and clinicians' views of an interactive booklet about respiratory tract infections in children: a qualitative process evaluation of the EQUIP randomised controlled trial

Background: ‘When should I worry?’ is an interactive booklet for parents of children presenting with respiratory tract infections (RTIs) in primary care and associated training for clinicians. A randomised controlled trial (the EQUIP study) demonstrated that this intervention reduced antibiotic prescribing and future consulting intentions. The aims of this qualitative process evaluation were to understand how acceptable the intervention was to clinicians and parents, how it was implemented, the mechanisms for any observed effects, and contextual factors that could have influenced its effects.<p></p> Methods: Semi-structured interviews were conducted with 20 parents and 13 clinicians who participated in the trial. Interviews were audio-recorded and transcribed verbatim. Data were analysed using a framework approach, which involved five stages; familiarisation, development of a thematic framework, indexing, charting, and interpretation.<p></p> Results: Most parents and clinicians reported that the ‘When should I worry’ interactive booklet (and online training for clinicians) was easy to use and valuable. Information on recognising signs of serious illness and the usual duration of illness were most valued. The interactive use of the booklet during consultations was considered to be important, but this did not always happen. Clinicians reported lack of time, lack of familiarity with using the booklet, and difficulty in modifying their treatment plan/style of consultation as barriers to use. Increased knowledge and confidence amongst clinicians and patients were seen as key components that contributed to the reductions in antibiotic prescribing and intention to consult seen in the trial. This was particularly pertinent in a context where decisions about the safe and appropriate management of childhood RTIs were viewed as complex and parents reported frequently receiving inconsistent messages. Conclusions: The ‘When should I worry’ booklet, which is effective in reducing antibiotic prescribing, has high acceptability for clinicians and parents, helps address gaps in knowledge, increases confidence, and provides a consistent message. However, it is not always implemented as intended. Plans for wider implementation of the intervention in health care settings would need to address clinician-related barriers to implementation

Living at the cutting edge: Women's experiences of protection orders. Volume 1: The women's stories

This report examines the experiences of 43 Māori, Pakeha, Pasifika and other ethnic minority women who were victims of male partner violence, the impact of the violence on them and their children, and their experiences of the justice system when they reached out for protection. The objectives of the project were to: a.identify and describe the experiences of a sample of women in obtaining protection orders, the impact of protection orders and the response to breaches of protection orders; b.identify those aspects that are working well (that is, positive experiences of protection orders); and c.identify areas for improvement including barriers that prevent women from applying for and obtaining protection orders

Post-diagnostic lived experiences of individuals with essential tremor

Purpose: This research study aimed to explore the lived experience of individuals with essential tremor. Method: This study was qualitative in nature and informed by interpretative phenomenological analysis methodology. Semi-structured interviews were conducted with a relatively homogenous sample of nine individuals with a diagnosis of essential tremor. Results: Three major themes were constructed: “But they often look at you like you’re some drug addict or smackhead”: Social attitudes to difference; “I just couldn’t do it anymore”: The restrictive nature of essential tremor; and “You’ve got to cope; you’ve got to learn to fight different ways”: Rescuing some normality amid physical deterioration. Conclusion: This study offers much needed experiential understanding and interpretation of one of the most prevalent neurological conditions with regard to the emotions associated with specific day-to-day experiences, the restrictions placed upon everyday practicalities and the coping strategies employed. This study has highlighted the need for health care professionals to provide individuals with information regarding psychological support, and a need for more public awareness campaigns centred around essential tremor

Living at the cutting edge: Women's experiences of protection orders. Volume 2: What's to be done? A critical analysis of statutory and practice approaches to domestic violence

This report examines the experiences of 43 Māori, Pakeha, Pasifika and other ethnic minority women who were victims of male partner violence, the impact of the violence on them and their children, and their experiences of the justice system when they reached out for protection. The objectives of the project were to: a.identify and describe the experiences of a sample of women in obtaining protection orders, the impact of protection orders and the response to breaches of protection orders; b.identify those aspects that are working well (that is, positive experiences of protection orders); and c.identify areas for improvement including barriers that prevent women from applying for and obtaining protection orders

Comorbidities only account for a small proportion of excess mortality after fracture: A record linkage study of individual fracture types

Background: Non-hip non-vertebral fractures (NHNV) constitute the majority of osteoporotic fractures but few studies have examined the association between these fractures, co-morbidity and mortality. Objective: To examine the relationship between individual non-hip non-vertebral fractures, co-morbidities and mortality. Methods: Prospective population-based cohort of 267,043 subjects (45 and Up Study, Australia) had baseline questionnaires linked to hospital administrative and all-cause mortality data from 2006 - 2013. Associations between fracture and mortality examined using multivariate, time dependent Cox models, adjusted for age, prior fracture, body mass index, smoking and co-morbidities (cardiovascular disease, diabetes, stroke, thrombosis and cancer) and survival function curves. Population attributable fraction calculated for each level of risk exposure. Results: During 1,490,651 person-years, women and men experienced 7,571 and 4,571 fractures and 7,064 deaths and 11,078 deaths, respectively. In addition to hip and vertebral fractures, pelvis, humerus, clavicle, rib, proximal tibia/fibula, elbow and distal forearm fractures in both sexes, and ankle fractures in men, were associated with increased multivariable adjusted mortality hazard ratios ranging from 1.3 to 3.4. Co-morbidity independently added to mortality such that a woman with a humeral fracture and one co-morbidity had a similarly reduced 5 year survival to that of a woman with a hip fracture and no co-morbidities. Population mortality attributable to any fracture without co-morbidity was 9.2% in women and 5.3% in men. Conclusion: All proximal non-hip, non-vertebral fractures in women and men were associated with increased mortality risk. Co-existent co-morbidities independently further increased mortality. Population attributable risk for mortality for fracture was similar to cardiovascular disease and diabetes, highlighting their importance and potential benefit for early intervention and treatment