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Exploring nightmares, associated factors and their relationship with externalising behaviours in complex psychiatric populations: A systematic review and clinical case review
No full textIntroduction: Dreaming allows for emotional processing. However, for those with psychiatric disorders, dream disturbances - namely nightmares- are prevalent. Nightmares disrupt this emotional processing, and their distress has demonstrated links to worsening clinical symptoms and increased suicide risk. Despite this, nightmares receive limited clinical attention in complex psychiatric populations. This is surprising when considering how these populations exhibit increased risk factors, such as trauma and distress, which may contribute to unique experiences of nightmares and increased association with externalising behaviours. Few studies focus on the link of nightmares to self-injurious behaviour (SIB). Systematic reviews on psychiatric populations have also failed to capture a broad understanding of nightmares in psychiatric inpatients alone. Forensic psychiatric sampling for nightmare research is particularly scarce, warranting investigation.
Materials and methods: A systematic review using Reflexive Thematic Analysis explored the nature, underlying mechanisms and correlating factors of nightmares in psychiatric inpatient populations. Titles were screened from eleven databases. Data extraction, quality assessment and inter-rater reliability were performed adhering to PRISMA guidelines. This systematic review identified variables for a review of collateral clinical information of detained forensic patients, utilising a structured clinical assessment tool, the Self-injurious behaviour Management and Behavioural Assessment (SIMBA). The SIMBA gathers clinical information based on staff reporting on mental illness, externalising behaviours and importantly, sleep challenges, including whether nightmares have presented. Mixed methods using Reflexive Thematic Analysis and regression explored what was reported about nightmares in these patients and associations with incidents of externalising behaviour.
Results: In relation to the systematic review, of the 9,534 titles screened, a total of 35 papers were included for review. Themes described the chronic and replicative nature of nightmares in psychiatric inpatients, including their violent, trauma-related and disturbing content. Underlying mechanisms of inpatient nightmares centred on trauma and emotional dysregulation, often with early onset. Inpatient nightmares demonstrated bidirectional links with exacerbating clinical symptoms, negative cognitions, distress and other sleep disturbances. The impact of nightmares on risk of suicidality was apparent. Patients in the case study papers were reported as keen to explore their nightmares, while other studies highlighted the unexplored therapeutic potential of nightmares. The methodologies and quality of the included papers varied. In the SIMBA study, nightmares were reported in 23% of the 78 patients reviewed. Themes highlighted how nightmares present as part of wider sleep disturbance, centre around trauma, and have multifaceted impacts. Patients appeared to discuss their sleep problems, yet limitations presented in staff reporting of nightmares. Nightmares qualitatively showed relationships with SIB but did not statistically predict externalising behaviours.
Conclusions: Both reviews overlapped in findings and provide initial understanding of the distressing nature of nightmares in complex psychiatric populations, their underlying mechanisms, interaction with psychiatric symptoms and limitations around assessment. Building on these results, a large study plans to explore nightmares from the perspective of male forensic inpatients and test the feasibility of a brief nightmare intervention. It is hoped that by addressing nightmares, sleep disturbances in high-risk populations can be addressed and patient wellbeing improved
Barriers to exercise participation in individuals with Fibromyalgia: Insights from a workplace survey
No full textBackground and Objectives: Regular exercise improves pain, fatigue, and overall function in individuals with fibromyalgia (FM), yet adherence remains low, especially among employed adults. This study examined symptom and workplace-related factors associated with exercise participation among employees with FM. Materials and Methods: A cross-sectional workplace survey was conducted across nine large employers (>100 employees) representing diverse occupational roles. Participants (n = 1044) reported FM diagnosis, exercise participation (≥3 sessions/week), perceived exercise barriers, sleep duration, and job-related stress. Comparisons were conducted between employees with and without FM, and within-group analyses explored exercise-related patterns among those with FM. Results: Forty-two participants (4.0%) reported a formal FM diagnosis. Compared with employees without FM, those with FM were older and reported significantly greater pain, fatigue, emotional stress and poorer sleep (all p < 0.01). Despite this increased symptom burden, rates of regular exercise did not differ between FM and non-FM employees (40.5% vs. 36.8%, p = 0.38). Within the FM group, exercisers and non-exercisers showed minimal observable differences in symptom severity. However, employees with FM reported shorter exercise session durations and identified sleep disruption, fatigue, and work-related demands as prominent barriers. Conclusions: Among employed adults with FM, symptom severity alone did not appear to distinguish those who engaged in regular exercise from those who did not. Instead, modifiable workplace and environmental barriers were indicated as key factors influencing exercise participation, emphasizing the need for occupationally informed strategies to support sustained physical activity in this population
Diagnostic utility of bowel ultrasonography in adults with inflammatory bowel disease: An updated systematic review and meta‐analysis
No full textBackground
Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), necessitates frequent disease monitoring to guide management. While colonoscopy remains the gold standard for assessing disease activity, its invasive nature limits its feasibility. Bowel ultrasonography (BUS) has emerged as a noninvasive alternative.
Objective
This systematic review and meta‐analysis evaluate the diagnostic accuracy of BUS in detecting IBD activity compared to colonoscopy.
Methods
A comprehensive literature search of PubMed, CINAHL and Embase was conducted, including 37 studies evaluating BUS modalities such as colour Doppler, small intestine contrast ultrasonography (SICUS) and contrast‐enhanced ultrasound (CEUS). Pooled sensitivity, specificity, diagnostic odds ratios (DOR) and likelihood ratios were calculated. Subgroup analyses were performed based on diagnostic modality and IBD subtype.
Results
The overall pooled sensitivity and specificity of BUS in IBD were 90.0% and 83.5%, respectively. SICUS had the highest sensitivity (95.0%), while BUS with colour Doppler had the highest specificity (85.1%). CEUS demonstrated the highest DOR (75.52). BUS performed best in detecting postoperative CD recurrence (sensitivity 91.9%, DOR 61.9). Meta‐regression identified surgical anastomosis type as a significant predictor of diagnostic performance.
Conclusion
BUS is a highly effective noninvasive imaging modality for diagnosing and monitoring IBD. Its accuracy varies by modality, with SICUS optimal for screening and colour Doppler BUS for confirmation. Future studies should standardize BUS protocols and evaluate its role alongside MRI and CT enterography
HEART RATE VARIABILITY (HRV) IN SOCCER PLAYERS DURING MILD ACUTE RESPIRATORY ILLNESS
No full textINTRODUCTION:
Heart rate variability (HRV) measures the variation in time between consecutive R-R intervals and is widely recognized as an indicator of autonomic nervous system function. Reduced HRV has been associated with illness or disease, reflecting the body’s diminished capacity to adapt to stressors. Monitoring HRV can therefore provide valuable insights into health status, early signs of sickness and the progression of medical conditions, making it a useful tool in both clinical and athletic settings.
METHODS:
Eleven professional soccer players (age 17.64 ± 1.03 years, weight 72.73 ± 6.05 kg, height 177.27 ± 5.83 cm) from the same team volunteered to participate in the study. Morning HRV measurements were collected at the end of the season using photoplethysmography via the HRV4 training smartphone application. Players also provided self-reported data, including fatigue levels, sleep quality and morning mental energy. For this study, HRV were compared between sick and healthy days, which served as a secondary purpose of the research.
RESULTS:
Linear mixed-effects modelling revealed a marked suppression of HRV during illness. On sick days, players exhibited an estimated 41% lower rMSSD compared with healthy days (p<0.01). After adjusting for self-reported sleep quality and fatigue, this effect remained the same, with rMSSD averaging 38% lower on sick days (95% CI: 23% to -54%, p<0.01). Similarly, LnRMSSD (log-transformed rMSSD), confirmed a substantial reduction in recovery status during illness. Sleep quality and fatigue did not significantly contribute to rMSSD variation. Approximately 18% of the variance in HRV was attributable to stable differences between players, while the majority (82%) reflected day-to-day within-player fluctuations. Other HRV indices showed consistent, though somewhat weaker patterns, with SDNN decreasing and resting heart rate increasing on sick days.
CONCLUSIONS:
These findings demonstrate a suppression of cardiac sympathetic activity during mild acute respiratory illness or flu episodes in professional soccer players. HRV appears sensitive to acute illnesses and may serve as a practical tool for monitoring recovery and health status in athletes, independent of sleep quality and perceived fatigue
Experimental Investigation on the Effect of Coatings on the Combustion Characteristics of Swedish Pine
No full textIn recent years, there has been a dramatic increase in façade fires, which brought an urgent demand for relevant research to reduce façade flame spread. Wooden components, e.g., balconies and decking, are widely used as part of buildings and their façades and its preservation by chemical treatment is essential for their protection. Nevertheless, the use of wood preservatives can influence their fire properties. In this work, the effect of wood preservatives on wooden decking is experimentally investigated. Heat release rate and ignition times are recorded for Swedish pine samples coated with three different water-based preservatives and compared with non-coated samples and ones treated with fire retardants in the cone calorimeter test. thermal gravimetric analysis is conducted to determine reaction rate peaks and their reference temperature. A simplified kinetic model is derived from the experimental results, which may contribute to later computational work
Characterising Challenging Behaviour Following Stroke: A Retrospective Chart Review of Presentation, Management, and Outcomes
No full textBackground/Objectives: Challenging behaviour post-stroke can complicate care and disrupt rehabilitation, yet its presentation and management are underreported. This study explored how such behaviours were documented in clinical records and managed in stroke settings, and how care delivery and discharge outcomes were documented in this context. Methods: A retrospective chart review was conducted across two NHS stroke units, covering all admissions between March and April 2022. Patient records were reviewed to capture demographic, clinical, and behavioural information, together with details relating to management and discharge. Challenging behaviour was identified retrospectively from clinical documentation during routine care. Descriptive statistics were used to summarise the data. Results: Forty-eight stroke admissions were examined, with challenging behaviour documented in thirteen patients (27%). Eleven had ischaemic stroke, with moderate severity common (n = 6), while inattention/neglect (n = 5) and infection (n = 4) were also documented. Behaviours were commonly recorded as confusion or agitation, and predominantly by nursing staff. Challenges to care delivery were documented in six of these patients, and additional professional input was provided for seven. Discharge delays were documented in patients with challenging behaviour, and the median length of stay was notably longer for this group (19 days compared with 7). Documentation of cognitive or delirium screening was uncommon. Conclusions: Challenging behaviour was documented in over a quarter of acute stroke admissions and was documented alongside greater care complexity and longer hospital stays. These preliminary descriptive findings from a small sample indicate a need for further exploration to better characterise challenging behaviour following stroke and its implications for care
Correction: A complete benchmark for polyp detection, segmentation and classification in colonoscopy images
No full textSynergistic Antioxidant and Anti-Inflammatory Effects of Baicalin-Loaded Essential Oil-Based Nano-Phytogel
No full textBaicalin (BA) is a potent flavonoid with antioxidant and anti-inflammatory properties; however, its clinical application is limited due to poor solubility and permeability. The present study aimed to develop an innovative baicalin-loaded essential oil-based lipid nanoparticle hydrogel (BA-NP-G) utilising rosemary oil (RO) as both an excipient and a therapeutic synergist for potential use in skin inflammatory disorders. BA-loaded lipid nanoparticles (BA-NPs) were formulated using a low-energy precipitation method. Following experimental optimisation for particle characteristics and encapsulation efficiency, nanoparticles were further embedded into a Carbopol-xanthan gum hydrogel. Characteristic results of BA-NPs, including size (174 ± 2.1 nm), PDI (0.25), ζ-potential (− 30.01 mV), and high entrapment efficiency (up to 69.6 ± 1.1%), were confirmed. Antioxidant efficacy was assessed in vitro in RAW264.7 cells, while ex vivo skin permeation determined Cskinmax and AUC. Stability was monitored for 90 days under multiple storage conditions, with the aim of predicting extended shelf life. Optimised BA-NP-G maintained chemical stability and > 90% drug content for up to one year at 4 °C. Ex vivo skin permeation studies revealed a ~ 3-fold increase in epidermal drug deposition and ~ 2.5-fold increase in total skin AUC in drug delivery for BA-NP-G when compared against BA solution, with notably higher Cskinmax and AUC values. Cellular response studies and antioxidant assays demonstrated superior free-radical scavenging activity when BA was encapsulated in NPs using RO as the liquid lipid, confirming a robust synergistic effect that markedly exceeded the activity of individual components. The BA-NP-G developed here combines the properties of both BA and RO, forming a synergistic blend within a nano-phytogel matrix to achieve significantly improved physical stability, enhanced skin bioavailability, and increased biological efficacy
Immediate effect of contactual hand-orientating response facilitation on wrist muscle activity in individuals with chronic stroke and severe motor deficits
No full textPurpose: Contactual hand-orientating response (CHOR) is a fundamental component of the Bobath concept which has been reported to promote hand function. This study aimed to assess activity and co-activation during CHOR facilitation of extensor digitorum (ED) which represented wrist extensors, and flexor digitorum superficialis (FDS) which represented wrist flexors. Method: CHOR facilitation of the paretic hand in 18 patients with chronic stroke with severe upper limb motor deficits, active contraction in the non-paretic hand and 18 healthy individuals wrist extensor and flexor muscles were compared using surface electromyography. Results: The co-contraction index of wrist extensors and flexors in the paretic hand in patients with chronic stroke was significantly greater during CHOR facilitation than in the healthy individuals (mean (SD)=51.88 (6.02) and 46.75 (5.50), respectively), p=0.012). Significantly greater wrist flexor and extensor muscle activity was seen in the paretic hand during CHOR facilitation compared with resting (median=0.803 vs 0.133; median=0.856 vs 0.225, respectively) (p<0.001). Conclusion: CHOR facilitation appears to selectively enhance wrist extensor and wrist flexor activity in patients with stroke despite showing a greater co-activation. These findings support the immediate effect of movement facilitation to enhance muscle activity in patients with severe motor deficits post stroke
It’s time to tell: early naming of HIV to children can break the cycle of intergenerational stigma and reduce self-stigma.
No full textChildren living with HIV are not routinely informed of their HIV diagnosis: open communication is not yet standard global practice (Warburton et al., 2022). This article presents data from a qualitative study aimed at establishing an evidence-based approach to telling children they are HIV positive. An arts-based narrative inquiry methodology was used. Sixteen young people and ten parents were recruited via voluntary sector organizations in the United Kingdom and shared their experiences through focus group participation. Participants used arts resources to create something of their choice as a vehicle to share their untold stories. Creative pieces made by participants included masks and boxes illustrating the experiences of stigma and self-stigma and highlighting the need felt by participants to hide HIV. Stigma prevents HIV-related conversations and creates self-stigmatization. Secrecy in family homes exacerbates self-stigma and a cycle of intergenerational stigma, as a new concept, was identified in the narratives. The burden of hiding a health diagnosis is an overwhelmingly negative experience for children and their families. Early naming of HIV and open communication will reduce the weight of self-stigma and intergenerational stigma experienced by children and families. It is time to break the cycle of stigma