Fluctuations of prolonged grief disorder reactions in the daily life of bereaved people:An experience sampling study

IntroductionLoss-adaptation has been described as being characterized by ‘waves of grief’, whichmay result in a Prolonged Grief Disorder (PGD). Although this assumption about thefluctuating nature of grief is supported by theoretical work, it is not (yet) supported byempirical work. We are the first to explore to what extent PGD reactions fluctuate ineveryday life and whether fluctuations in PGD reactions are related to overall PGDlevels using experience sampling methodology (ESM).MethodsData from 38 bereaved individuals (74% women, on average 6 years post-loss, 47%lost a parent) were analyzed. For two weeks, five times per day, participants reportedon the severity of 11 PGD reactions in the past three hours (ESM-PGD). At baseline,overall PGD severity (B-PGD) in the past two weeks was assessed with telephone interviews using the Traumatic Grief Inventory–Clinician Administered. Root MeanSquare of Successive Differences (RMSSD) were calculated to reflect fluctuations inESM-PGD. Spearman correlations between RMSSD values of the 11 ESM-PGDreactions and B-PGD scores were computed.ResultsMean B-PGD scores were below the clinical cut-off. Some fluctuations in ESM-PGDreactions were found, as indicated by varying RMSSD values, but also floor effectswere detected. B-PGD levels were related to RMSSD values for ESM-PGD (ρ between.37 and .68, all p < .05; and between .36 and .63 after removal of floor effects).DiscussionWe found that (some) ESM-PGD reactions fluctuated in everyday life. This may offernew theoretical insights into loss-adaptation, which may result in optimizing PGDtreatment

Individual differences in the temporal relationship between sleep and agitation:a single-subject study in nursing home residents with dementia experiencing sleep disturbance and agitation

OBJECTIVES: Previous studies on the interrelationship between sleep and agitation relied on group-aggregates and so results may not be applicable to individuals. This proof-of-concept study presents the single-subject study design with time series analysis as a method to evaluate the association between sleep and agitation in individual nursing home residents using actigraphy. METHOD: To record activity, three women and two men (aged 78-89 years) wore the MotionWatch 8© (MW8) for 9 consecutive weeks. Total sleep time and agitation were derived from the MW8 data. We performed time series analysis for each individual separately. To gain insight into the experiences with the actigraphy measurements, care staff filled out an investigator-developed questionnaire on their and participants' MW8 experiences. RESULTS: A statistically significant temporal association between sleep and agitation was present in three out of five participants. More agitation was followed by more sleep for participant 1, and by less sleep for participant 4. As for participants 3 and 4, more sleep was followed by more agitation. Two-thirds of the care staff members (16/24) were positive about the use of the MW8. Acceptability of the MW8 was mixed: two residents refused to wear the MW8 thus did not participate, one participant initially experienced the MW8 as somewhat unpleasant, while four participants seemed to experience no substantial problems. CONCLUSION: A single-subject approach with time series analysis can be a valuable tool to gain insight into the temporal relationship between sleep and agitation in individual nursing home residents with dementia experiencing sleep disturbance and agitation

Molybdate toxicity in Chinese cabbage is not the direct consequence of changes in sulphur metabolism

In polluted areas, plants may be exposed to supra-optimal levels of the micronutrient molybdenum. The physiological basis of molybdenum phytotoxicity is poorly understood. Plants take up molybdenum as molybdate, which is a structural analogue of sulphate. Therefore, it is presumed that elevated molybdate concentrations may hamper the uptake and subsequent metabolism of sulphate, which may induce sulphur deficiency. In the current research, Chinese cabbage (Brassica pekinensis) seedlings were exposed to 50, 100, 150 and 200 lM Na2MoO4 for 9 days. Leaf chlorosis and a decreased plant growth occurred at concentrations ≥100 lM. Root growth was more affected than shoot growth. At ≥100 lM Na2MoO4, the sulphate uptake rate and capacity were increased, although only when expressed on a root fresh weight basis. When expressed on a whole plant fresh weight basis, which corrects for the impact of molybdate on the shoot-to-root ratio, the sulphate uptake rate and capacity remained unaffected. Molybdate concentrations ≥100 lM altered the mineral nutrient composition of plant tissues, although the levels of sulphur metabolites (sulphate, water-soluble non-protein thiols and total sulphur) were not altered. Moreover, the levels of nitrogen metabolites (nitrate, amino acids, proteins and total nitrogen), which are generally strongly affected by sulphate deprivation, were not affected. The root water-soluble non-protein thiol content was increased, and the tissue nitrate levels decreased, only at 200 lM Na2MoO4. Evidently, molybdenum toxicity in Chinese cabbage was not due to the direct interference of molybdate with the uptake and subsequent metabolism of sulphate

Prognostic association of cardiac anxiety with new cardiac events and mortality following myocardial infarction

BACKGROUND: General anxiety and depressive symptoms following a myocardial infarction are associated with a worse cardiac prognosis. However, the contribution of specific aspects of anxiety within this context remains unclear. AIMS: To evaluate the independent prognostic association of cardiac anxiety with cardiac outcome after myocardial infarction. METHOD: We administered the Cardiac Anxiety Questionnaire (CAQ) during hospital admission (baseline, n = 193) and 4 months (n = 147/193) after discharge. CAQ subscale scores reflect fear, attention, avoidance and safety-seeking behaviour. Study end-point was a major adverse cardiac event (MACE): readmission for ischemic cardiac disease or all-cause mortality. In Cox regression analysis, we adjusted for age, cardiac disease severity and depressive symptoms. RESULTS: The CAQ sum score at baseline and at 4 months significantly predicted a MACE (HRbaseline = 1.59, 95% CI 1.04-2.43; HR4-months = 1.77, 95% CI 1.04-3.02) with a mean follow-up of 4.2 (s.d. = 2.0) years and 4.3 (s.d. = 1.7) years respectively. Analyses of subscale scores revealed that this effect was particularly driven by avoidance (HRbaseline = 1.23, 95% CI 0.99-1.53; HR4-months = 1.77, 95% CI 1.04-1.83). CONCLUSIONS: Cardiac anxiety, particularly anxiety-related avoidance of exercise, is an important prognostic factor for a MACE in patients after myocardial infarction, independent of cardiac disease severity and depressive symptoms

An increase in depressive symptoms after myocardial infarction predicts new cardiac events irrespective of depressive symptoms before myocardial infarction

Background. Depression after myocardial infarction (MI) is associated with poor cardiovascular prognosis. There is some evidence that specifically depressive episodes that develop after the acute event are associated with poor cardiovascular prognosis. The aim of the present study was to evaluate whether an increase in the number of depressive symptoms after MI is associated with new cardiac events.Method. In 442 depressed and 325 non-depressed MI patients the Composite International Diagnostic Interview interview to assess post-MI depression was extended to evaluate the presence of the ICD-10 depressive symptoms just before and after the MI. The effect of an increase in number of depressive symptoms during the year following MI on new cardiac events up to 2.5 years post-MI was assessed with Cox regression analyses.Results. Each additional increase of one symptom was significantly associated with a 15% increased risk of new cardiac events, and this was stronger for non-depressed than for depressed patients. This association was independent of baseline cardiac disease severity. There was no interaction with the number of depressive symptoms pre-MI.Conclusions. Our findings suggest that an increase in depressive symptoms after MI irrespective of the state of depression pre-MI explains why post-MI depression is associated with poor cardiovascular prognosis. Also increases in depressive symptoms after MI resulting in subthreshold depression should be evaluated as a prognostic marker. Whether potential mechanisms such as cardiac disease severity or inflammation underlie the association remains to be clarified.</p