Clinical Neuroscience

Different work schedules of nurses in Hungary and their effects on health

FUSZ Katalin, TÓTH Ákos, VARGA Bernadett, ROZMANN Nóra, OLÁH András

MARCH 30, 2017

Clinical Neuroscience - 2017;70(03-04)

DOI: https://doi.org/10.18071/isz.70.0136

Introduction - The shift work is burdensome for nurses and may lead to health problems. Aims - The purpose of the study was to examine the nursing shift system types and to analyse the effects on nutritional status, subjective state of physical and mental health in case of different shift schedules. Method - In the first phase of the research 326 nurses working in changing shifts filled out the Bergen Shift Work Questionnaire after adaptation into Hungarian. 518 nurses participated in our second study in hospitals of the South-Danubian Region, in clinics of University of Pécs and at trainings organized by the Faculty of Health Sciences of the University of Pécs. Results - Based on the psychometric characteristics of Bergen Shift Work Questionnaire technically it is suitable for the examination of sleeping disorders associated with shift work. Sleeping quality is worse in those working in irregular work shifts compared to those working in regular and flexible work schedules (p<0.001). The irregular work schedule is worse than the regular work schedule according to 76.6% of the nurses. According to 63.8% of the respondents the following regular work schedule is the best: after one 12-hour day shift one 12-hour night shift, followed by two days of rest. The average Body Mass Index (BMI) is 26.16 kg/m2. Since the nurses work in shift work 47.7% of them reported weight gain. Among the psychosomatic symptoms the most frequent is back pain (78.4%) related elevated BMI (p=0.013). The nurses’ sense of coherence on average is 61.76 points. In case of full-time employees the sense of coherence is better than those who work in shifts (t=2.933, p=0.004). The nurses working irregular shift work asses their health worst (mean rank: 166.61; p=0.019), and their sense of coherence is lower (p=0.04). Conclusion - The irregularity of work schedules is stressful for nurses. Due to the health of nurses it would be useful to establish the least exhausting work schedules.

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Clinical Neuroscience

Procedural learning and its consolidation in autism spectrum disorder

VIRÁG Márta, JANACSEK Karolina, BALOGH-SZABÓ Virág, CHEZAN Júlia, NÉMETH Dezsõ

Children with autism spectrum disorder (ASD) show altered learning and memory. A number of recent studies have debated whether procedural learning in ASD is intact or not. Our aim was to further assess the question of whether the implicit, non-conscious form of procedural learning in ASD children is intact or not, furthermore, how shifts towards a more explicit, attention-demanding task setting can alter this performance. We administered a modified version of the Alternating Serial Reaction Time (ASRT) Task to children with ASD and IQ- and age-matched typically developing (TD) children. The task consisted of alternating blocks of cued (explicit) and uncued (implicit probe) blocks, and was repeated after a 16-hour delay. We found that ASD and TD children showed similar sequence-specific learning in cued explicit blocks, however, on the uncued probe blocks ASD children performed better compared to TD children. After the 16-hour delay both groups showed retention of the previously acquired knowledge. Finally, when we investigated the performance in different parts of the blocks, we found that ASD children did not show an effect of fatigue by the second part of the blocks. Our results suggest that children with ASD have increased implicit procedural learning skills compared to TD children. Differences in cued (explicit) and uncued (implicit) settings indicate that children with ASD are not affected by the lack of explicit instructions in probe blocks, suggesting a resistance for changes in task settings. These findings can help in a more thorough planning of cognitive therapeutic setups for ASD children.

Clinical Neuroscience

[Relationship between sport and traumatic brain injury - risks and sequelaes]

TAMÁS Viktória, KOVÁCS Noémi, BÜKI András

[Traumatic brain injury represents major public health problem worldwide. A typical form of brain injuries is the injury suffered during sports, which according to severity ranges from mild injuries to fatal damages. The significance of the sport related minor head injuries derives form the high incidence, the excessive involvement of the younger age groups, and their potential repetitive nature. The repeated mild head injuries may accumulate, leading to complex structural, neurochemical, neuroendocrine, and psychological alterations, which in long term may result in changes of the patients quality of life and in significant deterioration of participation in the everyday activity. Actually we neither have enough knowledge about the ne-gative consequences, nor the way of prevention, or protection against the harmful long term results. With this study summary we would like to draw attention to the potential hazards emerging from sport injuries, moreover we would like to emphasize the importance of study participation and follow up of articles in this field.]

Clinical Neuroscience

Surveillance and management of patients with tuberous sclerosis complex

FOGARASI András, GYORSOK Zsuzsanna, BODÓ Tímea

Tuberous sclerosis complex (TSC) is an autosomal dominant disease due to the uncontrolled differentiation, proliferation, and migration of cells in several organs. Clinical expression is highly variable, from mild skin findings and asymptomatic brain lesions to seizures, mental retardation, autism, and potentially fatal kidney, cardiac, or pulmonary disease. Aim of this paper is to summarize the diagnostic criteria, surveillance and therapeutic issues of this multisystemic disorder emphasizing the most important neurological consequences. Presenting the state-of-the-art management recommendations and comparing them with the local protocols, we hope that our review might help in the proper assessment of one of the most important single gene disorder.

Clinical Neuroscience

[A családorvosok alvási apnoéval kapcsolatos ismeretei és attitűdjei. Megvalósul-e az OSAS szűrése a járművezetők egészségi alkalmasságának vizsgálata során?]

CSATLÓS Dalma, FERENCI Tamás, KALABAY László, LÁSZLÓ Andrea, HARGITTAY Csenge, MÁRKUS Bernadett, SZAKÁCS ZOLTÁN, TORZSA Péter

[Objective - Obstructive sleep apnea syndrome (OSAS) without treatment can cause serious cardiovascular, cardiorespiratory, neurological and other complications. Family physicians have an important role in recognizing the disease. The aim of the study is to assess the knowledge and attitude of family physicians related to sleep apnea. Whether OSAS screening is realized during the general medical checkup for drivers. Methods - In the cross-sectional study we used a validated OSAKA questionnaire in mandatory continuous medical education courses, supplemented with four additional questions. Results - 116 family physicians and 103 family medicine residents filled out the questionnaire. Hungarian family physicians, especially male doctors lack the adequate knowledge of sleep apnea. The average score of female physicians was significantly higher than that of males (13.4±1.8 vs. 11.7±2.6, p=0.005). The more sprecializations the doctor has, the higher the score. Zero or one special examination holders reached 12.5±2.3 points, two special examination holders 12.7±2.2 points. three or four special examination holders reached 14.0±2.1 (p=0.05). Residents’ average score was 12.1±2.4 points, which is higher than that of family doctors (p=0.012). Female residents also had higher average points than male residents (12.6±2.0 vs. 11.3±2.7; p=0.008). The size, location and type of the practice or the doctor’s age did not show any statistically significant correlation with the number of points achieved. According to our regression analysis, corrected to variables in the model, we found correlation between gender and medical knowledge, but there was no correlation between age, number of specialities, body mass index and the theoretical knowledge of the doctors. In terms of attitude female GPs had higher average scores than male GPs (3.5±0.6 vs. 2.9±0.6, p<0.001). Despite the modification of the 13/1992 regulation only 39% of the practices carried out regularly the required OSAS screening as part of the medical examination for a driving licence. Conclusions - Despite the high prevalence and clinical importance of OSAS, GPs often do not recognize sleep apnea and they have difficulty in treating their patients for this problem.]

Clinical Neuroscience

[Multilocus genetic analysis implicates neurodevelopment and immune system in the etiology of schizophrenia]

PULAY Attila József, KOLLER Júlia, NAGY László, MOLNÁR Mária Judit, RÉTHELYI János

[Background - Schizophrenia is a severe psychiatric disorder of poorly understood etiology, characterized by high heritability, multifactorial inheritance and high heterogeneity. Multilocus associaton methods may reduce the genetic heterogeneity and improve the probability of replication between analyses. Objectives - The aims of our study were twofold: 1. To analyse genetic risk factors of schizophrenia by using multilocus genetic tests. 2. To assess the replication probability attributable to the various multilocus tests. Subjects - Discovery set: case-parent trios of unaffected parents and affected probands with a DSM-IV schizophrenia diagnosis (n=16); replication set: schizophrenia cases and unaffected controls (n=5337). Methods - Associations of single nucleotide and indel markers were transferred to gene- and geneset-based associations, furthermore to geneset-enrichment tests and functional annotation cluster analyses in a two-staged designs. Associations with p<0.1 from the discovery set were tested in the replication sample. Familywise p-value correction for multiple comparisons were performed during the replication step. Results - After correction for multiplicity, no significant association or enrichment were detected for gene-based nor canonical pathway analyses, but significant association of the 14q31 cytoband and enrichments of the 5q31 and Xq13 cytobands were found (p_corr: 0.002, 0.006 and 0.048, respectively). Functional annotation clustering yielded statistically significant enrichment scores for clusters of splicing/alternative splicing, neurodevelopment and embryonic development. Improvements in replication probabilty were found with increased test complexity (P_rep: 0, 0.015, 0.21). Conclusions - Our results corroborate the involvement of neurodevelopment, synaptic plasticity and immune mechanisms in the etiology of schizophrenia. Also, our findings indicated improvement of replication probability by using multilocus genetic analyses. ]

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Effect of maternal migraine on children’s quality of sleep

GÜNGEN Dogan Belma, YILDIRIM Ahmet, ARAS Guzey Yesim, ARAS Atılgan Bilgehan, TEKESIN Aysel, AYAZ Burcu Ayse

Backround and aim - Sleep disorders are common problems associated with migraine. These sleep disorders are known to have a debilitating impact on daily lives of migraine patients. The purpose of this study is to assess the effects of sleep disorders experienced by individuals suffering from migraine on their children as well as the presence of sleep disorders in their children. Materials and methods - This study included 96 mothers diagnosed with migraine and their 96 healthy children, and a control group formed of 74 healthy mothers and their children. Exclusion criteria were chronic systemic disease or central nervous system disease or a history of smoking/alcohol use for mothers, and chronic disease or regularly occurring headaches or recurrent abdominal pain for children. For maternal evaluation, the Visual Analogue Scale (VAS), Migraine Disability Assessment Scale (MIDAS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Index (BDI) and Beck Anxiety Index (BAI) were used and for the assessment of the children’s quality of sleep, the Children’s Sleep Habits Questionnaire (CSHQ) was used. The SPSS 21.0 program was employed for statistical analysis, with statistical significance set at p<0.05. Findings - The mean age of the group with migraine was 36.6±7.1 years, while that of the control group was 38.01±4.7. Mood and sleep disorders were more frequently observed in the participants with migraine (p<0.05). Sleep disorders were significantly low in children with migraineur mothers (p=0.02); and child sleep anxiety is significantly high in control group (p=0.048). Maternal BAI scores had a significant influence on their children’s quality of sleep. Discussion and conclusion - In our study, the presence of migraine-type headache in mothers was observed to have a positive effect on reducing sleep disorders in the children. Recurrent headaches of the migraineur mothers with or without sleep disorders and psychiatric comorbidities did not influence the quality of sleep in their children directly, but the sleep anxiety of the children may have had an impact on it.

Hypertension and nephrology

[Sleep disorders and quality of life in patients after kidney transplantation]

TURÁNYI Csilla Zita, ZALAI Dóra, MOLNÁR Miklós Zsolt, NOVÁK Márta, MUCSI István

[Kidney transplantation provides the best outcomes, concerning morbidity, mortality and health related quality of life for patients with end stage renal disease. Health related quality of life is increasingly recognized as an important outcome measure in patients with different chronic medical conditions, including chronic kidney disease. Sleep disorders, such as insomnia, sleep apnea syndrome and restless legs syndrome are common in patients with chronic kidney disease. The prevalence of insomnia and restless legs syndrome is similar in kidney transplanted patients to the prevalence observed in the general population. On the other hand, the prevalence of sleep apnea is considerably higher, about 30%. The association between sleep disorders and impaired health related quality of life has been relatively well documented in dialysis patients but only scarce information has been published about the kidney transplanted population. In this paper we summarize published data about sleep disorders and also about their association with health related quality of life in the kidney transplanted population.]

Hypertension and nephrology

[Association between sleep disorders and inflammation among kidney transplant recipients]

FORNÁDI Katalin, LINDNER Anett, CZIRA Mária Eszter, SZENTKIRÁLYI András, LÁZÁR S. Alpár, ZOLLER Rezső, TURÁNYI Csilla, VÉBER Orsolya, NOVÁK Márta, MUCSI István, MOLNÁR Miklós Zsolt

[In patients on dialysis, the results of studies examining the association of sleep disorders and inflammation are controversial. We assessed the association between inflammatory markers and different sleep disorders in a large sample of kidney transplant recipients. In the cross-sectional study 100 randomly selected kidney transplanted patients underwent one-night polysomnography [“SLeep disorders Evaluation in Patients after kidney Transplantation (SLEPT) Study”] to diagnose obstructive sleep apnea (OSA) and periodic limb movement is sleep (PLMS). Athens Insomnia Scale (AIS) was used to assess the prevalence of insomnia. Socio-demographic information, data on medication, comorbidity and laboratory parameters were collected. Inflammatory markers such as Creactive protein (CRP), serum albumin, white blood cell count, interleukine-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were measured. The mean age was 51±13 years (43% female) and the prevalence of diabetes 19%. We found no significant difference in the levels of inflammatory markers between patients with OSA and PLMS versus (vs) patients without such disorders. Apnea-hypopnea index showed a significant association with white blood cell count (rho=0.23), and weak, non significant correlations with the other inflammatory markers (rho<|0.15|). PLM index showed weak, non significant correlations with all markers of inflammation (rho<|0.15|). The serum IL-6 level was significantly higher in patients with insomnia (AIS≥10) than in non-insomniacs [median (IQR): 3.2 (2.6-5.1) vs. 1.7 (1.2- 2.9) ng/l; p=0.009]. The levels of other inflammatory markers were similar between insomniacs and non-insomniacs. We did not find any association between the presence of objectively assessed sleep disorders and inflammatory markers in kidney transplant patients.]

Hypertension and nephrology

[Restless legs syndrome in patients with chronic kidney disease]

LINDNER Anett, FORNÁDI Katalin, MOLNÁR Miklós Zsolt

[The aging of the population, the high prevalence of chronic diseases and the consequent rapid increase of healthcare expenditures present a difficult challenge for the medical care system and for the society in the developed countries. Sleep disorders are increasingly recognized as very frequent chronic diseases with significant pathophysiological and psychosocial consequences. In the last 20 years an increasing number of studies reported high prevalence of sleep disorders, such as restless legs syndrome in patients with kidney disease. Chronic renal failure is the most common condition presenting with secondary restless legs syndrome. It is associated with insomnia, depressive symptoms and anxiety, impaired quality of life, as well as elevated cardiovascular risk. Compliance of the patients with restless legs syndrome is decreased, and it is more likely that they discontinue dialysis treatment. This may be related to higher mortality in kidney disease patients with restless legs syndrome.]

Clinical Neuroscience

[Actigraphy: A valuable diagnostic tool or a luxury investigation? (Neuropsychiatric aspects)]

RAJNA Péter, SZOMSZÉD Anita

[Aim - Despite of the continuing interest in actigraphy it has a relatively low impact on the everyday medical routine. Accordingly, we set out to review the current state and to recommend relevant further indications for its application, especially in neuropsychiatry. Method - We surveyed the areas of its use and then reviewed the literature, with special regard to its advantages and methodological limitations. Adding to the results we enlarged the results with our own personal experience. Results - The limitations of the method may be decreased by methodological manipulations (a simple rational data reduction is recommended). Actigraphy appears to be a useful tool in the diagnosis of illnesses, syndromes or disorders influencing the vigilance level, the motor performance or the energetic balance of the organism. We constructed a list of the most relevant fields of indication of actigraphy in diagnostics, illustrated by anecdotal actigraphic case records. Conclusion - Further methodological considerations are needed for the successful evaluation of accelerometry. Targeted basic epidemiological studies in the healthy population and in patient groups should solve various open questions in order to make full use of the advantages of actigraphy in the everyday clinical routine.]