Search

Many cellular processes are controlled by sleep. Therefore, alterations in sleep might be expected to stress biological systems that could influence malignancy risk.

ABSTRACT:Objective:To characterize 1) the relationship between laxative use and objective sleep metrics, and 2) the relationship between laxative use and self-reported insomnia symptoms in a convenience sample of middle-aged/elderly patients who completed in-laboratory polysomnography.Methods:We cross-sectionally analyzed first-night diagnostic in-laboratory polysomnography data for 2946 patients over the age of 40 (mean age 60.5 years; 48.3% male). Laxative use and medical comorbidities were obtained through self-reported questionnaires. Patient insomnia symptoms were based on self-report. Associations between laxative use and objective sleep continuity were analyzed using multivariable linear regression models. Associations between laxative use and insomnia were assessed using multivariable logistic regression models.Results:After adjusting for age, sex, body mass index, total recording time, and relevant comorbidities, laxative users had a 7.1% lower sleep efficiency (p< 0.001), 25.5-minute higher wake after sleep onset (p< 0.001), and a 29.4-minute lower total sleep time (p< 0.001) than patients not using laxatives. Laxative users were found to be at greater odds of reporting insomnia symptoms (OR = 1.7, p= 0.024) than patients not using laxatives.Conclusion:Laxative use is associated with impairments in objective sleep continuity. Patients using laxatives were also at greater odds of reporting insomnia symptoms.

AbstractRATIONALE: Narcolepsy is a chronic sleep disorder, with typical onset in childhood or adolescence. Features of narcolepsy include excessive daytime sleepiness (EDS), cataplexy, sleep paralysis, hallucinations and disturbed nocturnal sleep. The constellation of symptoms may be challenging for patients to manage. Adolescents with narcolepsy report poor quality of life and mental health concerns.OBJECTIVE: The objective of this report was to understand the experience of living with narcolepsy as an adolescent and its impact on daily functioning, relationships and mental health.METHODS: In-depth, semistructured interviews with adolescents with narcolepsy were conducted from May to August 2019 at the Hospital for Sick Children in Toronto, Canada. Interview questions focused on perceptions of 1) disease symptoms, 2) mental health, 3) daily functioning, 4) relationships and 5) coping. Interviews were digitally audio-recorded for verbatim transcription, coded by two researchers and analyzed using NVivo qualitative data computer software.RESULTS: Eighteen adolescents with narcolepsy (age range = 10-17, mean age = 14.4 ± 2.0, 72.2% male) participated. The findings suggest some of the common symptoms of narcolepsy (eg, EDS) are often experienced as unpleasant, while vivid dreaming may be pleasant. Emotional challenges such as frustration with symptoms and worries about the future are common. Participants emphasize the importance of ongoing support from others (eg, clinical team, teachers) to help with coping with chronic illness.CONCLUSION: Living with narcolepsy poses unique challenges for adolescents and impacts their psychosocial health. We recommend increased psychosocial support from mental health professionals, educational resources for schools and teachers, and peer support groups for adolescent narcolepsy patients.

Supplemental Digital Content is available in the text.

ABSTRACT:Objective:We assessed long-term incidence and prevalence trends of dementia and parkinsonism across major ethnic and immigrant groups in Ontario.Methods:Linking administrative databases, we established two cohorts (dementia 2001–2014 and parkinsonism 2001–2015) of all residents aged 20 to 100 years with incident diagnosis of dementia (N = 387,937) or parkinsonism (N = 59,617). We calculated age- and sex-standardized incidence and prevalence of dementia and parkinsonism by immigrant status and ethnic groups (Chinese, South Asian, and the General Population). We assessed incidence and prevalence trends using Poisson regression and Cochran–Armitage trend tests.Results:Across selected ethnic groups, dementia incidence and prevalence were higher in long-term residents than recent or longer-term immigrants from 2001 to 2014. During this period, age- and sex-standardized incidence of dementia in Chinese, South Asian, and the General Population increased, respectively, among longer-term immigrants (by 41%, 58%, and 42%) and long-term residents (28%, 7%, and 4%), and to a lesser degree among recent immigrants. The small number of cases precluded us from assessing parkinsonism incidence trends. For Chinese, South Asian, and the General Population, respectively, prevalence of dementia and parkinsonism modestly increased over time among recent immigrants but significantly increased among longer-term immigrants (dementia: 134%, 217%, and 117%; parkinsonism: 55%, 54%, and 43%) and long-term residents (dementia: 97%, 132%, and 71%; parkinsonism: 18%, 30%, and 29%). Adjustment for pre-existing conditions did not appear to explain incidence trends, except for stroke and coronary artery disease as potential drivers of dementia incidence.Conclusion:Recent immigrants across major ethnic groups in Ontario had considerably lower rates of dementia and parkinsonism than long-term residents, but this difference diminished with longer-term immigrants.

Abstract: A patient presented with a small-bowel obstruction associated with signs and symptoms of botulism. Fecal cultures were positive for viable Clostridium botulinum. This case emphasizes the importance of a [...]

Narcolepsy is a sleep disorder with no cure with onset typically during adolescence. Caring for an adolescent with a lifelong medical condition can negatively impact family structure, cohesion, relationships, and overall functioning. The primary objective of this study was to evaluate family functioning in a cohort of adolescents with narcolepsy using the PedsQL Family Impact Module. The secondary objective was to compare family functioning in adolescents with narcolepsy to adolescents with chronic pain based on published data.

Supplemental Digital Content is available in the text.

Existing normal polysomnography values are not truly normative as they are based on small sample sizes due to the fact that polysomnography is expensive and burdensome to obtain. There is a clear need for a large sample of truly normative data for clinical management and research. This study is a comprehensive meta-analysis of adult polysomnography parameters scored using recent criteria and establishes normative values adjusted for age and sex.

ABSTRACT:Objectives:We assessed trends in the incidence, prevalence, and post-diagnosis mortality of parkinsonism in Ontario, Canada over 18 years. We also explored the influence of a range of risk factors for brain health on the trend of incident parkinsonism. Methods:We established an open cohort by linking population-based health administrative databases from 1996 to 2014 in Ontario. The study population comprised residents aged 20–100 years with an incident diagnosis of parkinsonism ascertained using a validated algorithm. We calculated age- and sex-standardized incidence, prevalence, and mortality of parkinsonism, stratified by young onset (20–39 years) and mid/late onset (≥40 years). We assessed trends in incidence using Poisson regression, mortality using negative binomial regression, and prevalence of parkinsonism and pre-existing conditions (e.g., head injury) using the Cochran–Armitage trend test. To better understand trends in the incidence of mid/late-onset parkinsonism, we adjusted for various pre-existing conditions in the Poisson regression model. Results:From 1996 to 2014, we identified 73,129 incident cases of parkinsonism (source population of ∼10.5 million), of whom 56% were male, mean age at diagnosis was 72.6 years, and 99% had mid/late-onset parkinsonism. Over 18 years, the age- and sex-standardized incidence decreased by 13.0% for mid/late-onset parkinsonism but remained unchanged for young-onset parkinsonism. The age- and sex-standardized prevalence increased by 22.8%, while post-diagnosis mortality decreased by 5.5%. Adjustment for pre-existing conditions did not appreciably explain the declining incidence of mid/late-onset parkinsonism. Conclusion:Young-onset and mid/late-onset parkinsonism exhibited differing trends in incidence over 18 years in Ontario. Further research to identify other factors that may appreciably explain trends in incident parkinsonism is warranted.

CASE A 75-year-old man is seen by his primary care physician with complaints of increasing fatigue and lack of energy over the past few months. He denies any other symptoms [...]

Supplemental Digital Content is available in the text.

Narcolepsy, encompassing excessive daytime sleepiness (EDS), cataplexy, sleep paralysis and hypnogogic hallucinations, was previously considered rare in childhood. Recently, cases of childhood narcolepsy have increased significantly and the reasons for this may include the increasing awareness of narcolepsy as well as the H1N1 vaccination. The aim of this study was to describe the clinical characteristics of childhood narcolepsy, specifically focusing on cataplexy subtypes that may facilitate early recognition of narcolepsy.

More than ever, the stability, reputation and value of today's businesses are imbedded in the strength and controls of their software information systems. The following briefly identifies some of the [...]

Emerging evidence suggests that living near major roads might adversely affect cognition. However, little is known about its relationship with the incidence of dementia, Parkinson's disease, and multiple sclerosis. We aimed to investigate the association between residential proximity to major roadways and the incidence of these three neurological diseases in Ontario, Canada.

•Language discordance (when a patient's primary spoken language differs from the primary language of the health system) is associated with worse post-stroke functional outcomes and greater neurovascular risk compared to language concordant participants.•Language concordance is a simple, readily available marker to identify those at risk of worse outcome.•Adaptive care models, treatments and education strategies may be needed to mitigate barriers influenced by language discordance.

A 54-year-old man presented with pain in the left chest for 3 days. His medical history was remarkable for hyperlipidemia managed with diet and statin. He denied tobacco smoking and consumption of alcohol. Physical examination was unrevealing. The patient was diagnosed with an adenocarcinoma of the lung harboring an epidermal growth factor receptor (EGFR) mutation that metastasized to T2-T4 levels. He was treated with radiotherapy and dexamethasone followed by Gefitinib.

Supplemental Digital Content is available in the text.

To investigate the association between self-reported and objective measures of sleep and wind turbine noise (WTN) exposure.

To test the hypothesis that enlarged Virchow-Robin space volumes (VRS) are associated with objective measures of poor quality sleep.

Supplemental Digital Content is available in the text.

The article reflects on a conversation about who should argue the case and when. It suggests that the trial lawyer should build a convincing argument and create a more convenient environment around client and cause. It further advises the lead lawyers to be acquainted with the record and facts and to work with whoever is doing the oral argument from the beginning of the process.

Excessive daytime sleepiness (EDS) is common and a potentially devastating public health challenge. EDS has been implicated as a contributing factor to workplace injury, motor vehicle accidents, cardiovascular disease, and impaired quality of life. Subjective self-report measures have failed to sufficiently quantify EDS. The use of objective tools found in sleep laboratories is therefore fundamental in the management of patients with EDS. The purpose of this review is to provide an overview of the current methods used to quantify sleepiness, and to highlight recent advances.

In stroke patients, obstructive sleep apnea (OSA) is associated with poorer functional outcomes than in those without OSA. We hypothesized that treatment of OSA by continuous positive airway pressure (CPAP) in stroke patients would enhance motor, functional, and neurocognitive recovery.

The article discusses the role of pro bono work on a young lawyer's professional development. According to the author, pro bono work offers young lawyers the early opportunity to have a meaningful direct interaction with their clients. Pro bono work also helps young lawyers in developing their skills. It also provide young litigators the opportunity to lead in trials and appeals.

Intravenous tissue plasminogen activator for ischemic stroke is approved for eligible patients who can be treated within a 3-hour window, but treatment rates remain disappointingly low, often <5%. To improve rapid access to stroke thrombolysis in Toronto, Canada, a citywide prehospital acute stroke activation protocol was implemented by the provincial government to transport acute stroke patients directly to one of 3 regional stroke centers, bypassing local hospitals. This comprised a paramedic screening tool, ambulance destination decision rule, and formal memorandum of understanding of system stakeholders. This report describes the initial impact of the activation protocol at our regional stroke center.

The article discusses how pro bono work benefits the professional development of lawyers. The author suggests taking on pro bono matters, particularly for young litigators as an opportunity to do some good in the world while gaining valuable experience and developing skills. The benefits gained by a young litigator from pro bono work include early opportunities for direct interaction with clients, development of skills through experience, and gaining experience in a range of subjects.

Ponto-geniculo-occipital (PGO) waves are phasic pontine, lateral geniculate, and cortical field potentials occurring during and before REM sleep that are proposed to mediate a wide variety of sleep related neural processes. We sought to identify and characterize human PGO waves.

The article focuses on the elimination of class actions and its impact on arbitration in the case AT&T v. Concepcion. Topics discussed include importance of legal doctrines in invalidating class action waivers in arbitration provisions, judicial opinion of the U.S. Supreme Court in the case of Concepcion and importance of class action waiver in the consumer contracts. It further discusses the decision of the California Court of Appeal in the case Sanchez v. Valencia Holding Company LLC.

To evaluate the association between depressive symptoms, sleep patterns (duration and quality), excessive daytime sleepiness (EDS), and physical activity (PA) in adolescents with narcolepsy.