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Article ; Online: Evaluating the Effectiveness of the SleepTracker App for Detecting Anxiety- and Depression-Related Sleep Disturbances.

Alamoudi, Doaa / Nabney, Ian / Crawley, Esther

2024 Volume 24, Issue 3

Abstract: This study emphasises the critical role of quality sleep in physical and mental well-being, exploring its impact on bodily recovery and cognitive function. Investigating poor sleep quality in approximately 40% of individuals with insomnia symptoms, the ... ...

Abstract	This study emphasises the critical role of quality sleep in physical and mental well-being, exploring its impact on bodily recovery and cognitive function. Investigating poor sleep quality in approximately 40% of individuals with insomnia symptoms, the research delves into its potential diagnostic relevance for depression and anxiety, with a focus on intervention in mental health by understanding sleep patterns, especially in young individuals. This study includes an exploration of phone usage habits among young adults during PPI sessions, providing insights for developing the SleepTracker app. This pivotal tool utilises phone usage and movement data from mobile device sensors to identify indicators of anxiety or depression, with participant information organised comprehensively in a table categorising condition related to phone usage and movement data. The analysis compares this data with survey results, incorporating scores from the Sleep Condition Indicator (SCI), Patient Health Questionnaire-9 (PHQ-9), and Generalised Anxiety Disorder-7 (GAD-7). Generated confusion matrices offer a detailed overview of the relationship between sleep metrics, phone usage, and movement data. In summary, this study reveals the accurate detection of negative sleep disruption instances by the classifier. However, improvements are needed in identifying positive instances, reflected in the F1-score of 0.5 and a precision result of 0.33. While early intervention potential is significant, this study emphasises the need for a larger participant pool to enhance the model's performance.
MeSH term(s)	Young Adult ; Humans ; Mobile Applications ; Depression/diagnosis ; Anxiety/diagnosis ; Sleep ; Sleep Initiation and Maintenance Disorders/diagnosis ; Anxiety Disorders
Language	English
Publishing date	2024-01-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2052857-7
ISSN	1424-8220 ; 1424-8220
ISSN (online)	1424-8220
ISSN	1424-8220
DOI	10.3390/s24030722
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Article ; Online: Pediatric chronic fatigue syndrome: current perspectives.

Crawley, Esther

Pediatric health, medicine and therapeutics

2018 Volume 9, Page(s) 27–33

Abstract: Pediatric chronic fatigue syndrome is an important illness as it is relatively common and also very disabling with a wide range of impacts on the child, the family, and health care systems. It is a complicated illness but the majority of children get ... ...

Abstract	Pediatric chronic fatigue syndrome is an important illness as it is relatively common and also very disabling with a wide range of impacts on the child, the family, and health care systems. It is a complicated illness but the majority of children get better with specialist treatment. This literature review provides an update on the epidemiology of chronic fatigue syndrome / myalgic encephalomyelitis, including factors associated with it, and discusses the current evidence for treatment.
Language	English
Publishing date	2018-03-29
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2616891-1
ISSN	1179-9927 ; 1179-9927
ISSN (online)	1179-9927
ISSN	1179-9927
DOI	10.2147/PHMT.S126253
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Article ; Online: The Feasibility of Using Smartphone Sensors to Track Insomnia, Depression, and Anxiety in Adults and Young Adults: Narrative Review.

Alamoudi, Doaa / Breeze, Emma / Crawley, Esther / Nabney, Ian

JMIR mHealth and uHealth

2023 Volume 11, Page(s) e44123

Abstract: Background: Since the era of smartphones started in early 2007, they have steadily turned into an accepted part of our lives. Poor sleep is a health problem that needs to be closely monitored before it causes severe mental health problems, such as ... ...

Abstract	Background: Since the era of smartphones started in early 2007, they have steadily turned into an accepted part of our lives. Poor sleep is a health problem that needs to be closely monitored before it causes severe mental health problems, such as anxiety or depression. Sleep disorders (eg, acute insomnia) can also develop to chronic insomnia if not treated early. More specifically, mental health problems have been recognized to have casual links to anxiety, depression, heart disease, obesity, dementia, diabetes, and cancer. Several researchers have used mobile sensors to monitor sleep and to study changes in individual mood that may cause depression and anxiety. Objective: Extreme sleepiness and insomnia not only influence physical health, they also have a significant impact on mental health, such as by causing depression, which has a prevalence of 18% to 21% among young adults aged 16 to 24 in the United Kingdom. The main body of this narrative review explores how passive data collection through smartphone sensors can be used in predicting anxiety and depression. Methods: A narrative review of the English language literature was performed. We investigated the use of smartphone sensors as a method of collecting data from individuals, regardless of whether the data source was active or passive. Articles were found from a search of Google Scholar records (from 2013 to 2020) with keywords including "mobile phone," "mobile applications," "health apps," "insomnia," "mental health," "sleep monitoring," "depression," "anxiety," "sleep disorder," "lack of sleep," "digital phenotyping," "mobile sensing," "smartphone sensors," and "sleep detector." Results: The 12 articles presented in this paper explain the current practices of using smartphone sensors for tracking sleep patterns and detecting changes in mental health, especially depression and anxiety over a period of time. Several researchers have been exploring technological methods to detect sleep using smartphone sensors. Researchers have also investigated changes in smartphone sensors and linked them with mental health and well-being. Conclusions: The conducted review provides an overview of the possibilities of using smartphone sensors unobtrusively to collect data related to sleeping pattern, depression, and anxiety. This provides a unique research opportunity to use smartphone sensors to detect insomnia and provide early detection or intervention for mental health problems such as depression and anxiety if insomnia is detected.
MeSH term(s)	Humans ; Young Adult ; Smartphone ; Sleep Initiation and Maintenance Disorders/diagnosis ; Depression/diagnosis ; Depression/psychology ; Feasibility Studies ; Anxiety/diagnosis
Language	English
Publishing date	2023-02-17
Publishing country	Canada
Document type	Journal Article ; Review
ZDB-ID	2719220-9
ISSN	2291-5222 ; 2291-5222
ISSN (online)	2291-5222
ISSN	2291-5222
DOI	10.2196/44123
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Article ; Online: Correction to: Anxiety in children with CFS/ME.

Crawley, Esther / Hunt, Linda / Stallard, Paul

European child & adolescent psychiatry

2023 Volume 33, Issue 5, Page(s) 1615

Language	English
Publishing date	2023-05-25
Publishing country	Germany
Document type	Published Erratum
ZDB-ID	1118299-4
ISSN	1435-165X ; 1018-8827 ; 1433-5719
ISSN (online)	1435-165X
ISSN	1018-8827 ; 1433-5719
DOI	10.1007/s00787-023-02224-6
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Article ; Online: Investigating the factors associated with meaningful improvement on the SF-36-PFS and exploring the appropriateness of this measure for young people with ME/CFS accessing an NHS specialist service: a prospective cohort study.

Gaunt, Daisy / Brigden, Amberly / Metcalfe, Chris / Loades, Maria / Crawley, Esther

BMJ open

2023 Volume 13, Issue 8, Page(s) e069110

Abstract: Objectives: Paediatric myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is relatively common and disabling, but little is known about the factors associated with outcome. We aimed to describe the number and characteristics of young people ... ...

Abstract	Objectives: Paediatric myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is relatively common and disabling, but little is known about the factors associated with outcome. We aimed to describe the number and characteristics of young people reaching the 10-point minimal clinically important difference (MCID) of SF-36-Physical Function Subscale (SF-36-PFS) and to investigate factors associated with reaching the MCID. Design: Prospective observational cohort study. Setting: A specialist UK National Health Service ME/CFS service, Southwest England; recruitment between March 2014 and August 2015. Participants: 193 eligible patients with ME/CFS aged 8-17 years reported baseline data. 124 (65%) and 121 (63%) with outcome data at 6 and 12 months, respectively. Outcome measures: SF-36-PFS (primary outcome). Chalder Fatigue Questionnaire, school attendance, visual analogue pain scale, Hospital Anxiety and Depression Scale, Spence Young People Anxiety Scale, Clinical Global Impression scale and EQ-5D-Y (secondary). Results: At 6 months 48/120 (40%) had reached the MCID for SF-36-PFS. This had increased to 63/117 (54%) at 12 months. On the Clinical Global Impressions, 77% and 79% reported feeling either a little better, much better or very much better. Those with worse SF-36-PFS at baseline assessment were more likely to achieve the MCID for SF-36-PFS at 6 months (odds ratio 0.97, 95% confidence interval 0.96 to 0.99, p value 0.003), but there was weaker evidence of effect at 12 months (OR 0.98, 95% CI 0.97 to 1.00, p value 0.038). No other factors at baseline were associated with the odds of reaching the MCID at 6 months. However, at 12 months, there was strong evidence of an effect of pain on MCID (OR 0.97, 95% CI 0.95 to 0.99, p value 0.001) and SF-36-PFS on MCID (OR 0.96, 95% CI 0.94 to 0.98, p value 0.001). Conclusions: 40% and 54% of young people reached the MCID at 6 and 12 months, respectively. No factors at assessment (other than SF-36-PFS at 6 months, and pain and SF-36-PFS at 12 months) are associated with MCID of SF-36-PFS at either 6 or 12 months. Further work is needed to explore the most appropriate outcome measure for capturing clinical meaningful improvement for young people with ME/CFS.
MeSH term(s)	Humans ; Child ; Adolescent ; Fatigue Syndrome, Chronic ; Prospective Studies ; State Medicine ; Emotions ; Pain
Language	English
Publishing date	2023-08-24
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-069110
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Article ; Online: Who should we ask about mental health symptoms in adolescents with CFS/ME? Parent-child agreement on the revised children's anxiety and depression scale.

Serafimova, Teona / Loades, Maria / Gaunt, Daisy / Crawley, Esther

Clinical child psychology and psychiatry

2021 Volume 26, Issue 2, Page(s) 367–380

Abstract: Background: One in three adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) have mental health problems. Multi-informant perspectives are key to psychological assessment. Understanding parent-child agreement is crucial to ... ...

Abstract	Background: One in three adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) have mental health problems. Multi-informant perspectives are key to psychological assessment. Understanding parent-child agreement is crucial to accurate diagnosis, particularly where severe fatigue limits self-report. Methods: Agreement on the revised children's anxiety and depression scale (RCADs) was assessed between parents and children with CFS/ME ( Results: Diagnostic thresholds were met more frequently based on child-report. Parent- and child-report had similar sensitivity and specificity on RCADS compared to gold-standard diagnostic interviews. Regression analysis found similar accuracy between both reports. For anxiety diagnoses, odds ratio (OR) for child-report was 1.10 (CI = 1.06-1.14), and 1.10 (CI = 1.05-1.14) for parent-report. For depression, OR for child report was 1.26 (CI = 1.11-1.43), while for parent-report is was 1.25 (CI = 1.10-1.41). For total score, OR for child-report was 1.10 (CI = 1.05-1.13) while OR for parent-report was 1.09 (CI = 1.05-1.13). Conclusions: Reasonable agreement was observed between parent- and child-report of mental health symptoms in paediatric CFS/ME. While parent-report can facilitate psychological evaluation in CFS/ME, this is not a substitute for a child's own report.
MeSH term(s)	Adolescent ; Anxiety/diagnosis ; Child ; Depression/diagnosis ; Fatigue Syndrome, Chronic/diagnosis ; Humans ; Mental Health ; Parent-Child Relations
Language	English
Publishing date	2021-02-15
Publishing country	England
Document type	Journal Article
ZDB-ID	1324235-0
ISSN	1461-7021 ; 1359-1045
ISSN (online)	1461-7021
ISSN	1359-1045
DOI	10.1177/1359104521994880
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Article ; Online: Experiences of pain in paediatric chronic fatigue syndrome/myalgic encephalomyelitis: a single-centre qualitative study.

Serafimova, Teona / Ascough, Caitlin / Parslow, Roxanne Morin / Crawley, Esther

BMJ paediatrics open

2022 Volume 6, Issue 1

Abstract: Background: Moderate to severe pain affects up to two-thirds of children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and is associated with worse fatigue and physical functioning. This research aims to gain a greater insight into ... ...

Abstract	Background: Moderate to severe pain affects up to two-thirds of children with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and is associated with worse fatigue and physical functioning. This research aims to gain a greater insight into pain experienced by these children. Methods: Thematic analysis of qualitative data from semistructured interviews with 13 children with CFS/ME (mean age=15.3 years, 67% female) was completed. Results: Thematic analysis enabled construction of three themes: children's wide-ranging experiences of pain, negative impact of pain and lack of effective treatment for pain and nine subthemes. The first theme demonstrated highly varied pain experiences, ranging from 'like [being]… on fire', like 'being stabbed' to 'like…lead'. Children experienced pain in multiple sites and with wide-ranging frequency and severity. The second theme highlighted the profound negative impact of pain on multiple aspects of children's lives. Physical activity was severely impaired; some children 'couldn't leave bed' or 'couldn't…brush [their] own hair'. Abdominal pain meant some would 'go…days without eating'. Pain substantially impacted on mental health, leaving children feeling 'agitated', experiencing 'really bad panic attacks' or making them '[want to] breakdown'. Children felt they 'can't do the things that everyone else can do', had 'missed out' and are 'behind everyone'. Some avoided socialising as they 'don't want to stop everyone else'. The final theme demonstrates the absence of adequate treatment for pain, with participants reporting 'nothing has ever really got rid of it' and only 'slightly [takes] the edge off' and other experiencing side effects. Conclusions: Pain in paediatric CFS/ME is highly variable, common and often results in severe physical limitation and poor mental health. Effective treatments for pain represent an unmet need.
MeSH term(s)	Abdominal Pain ; Adolescent ; Anxiety ; Child ; Fatigue Syndrome, Chronic/psychology ; Female ; Humans ; Male ; Qualitative Research ; Treatment Outcome
Language	English
Publishing date	2022-02-15
Publishing country	England
Document type	Journal Article
ISSN	2399-9772
ISSN (online)	2399-9772
DOI	10.1136/bmjpo-2021-001201
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Article ; Online: "it's a medical condition … you need to support as much as possible": a qualitative analysis of teachers' experiences of chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME).

Brigden, Amberly / Shaw, Alison / Crawley, Esther

BMC pediatrics

2021 Volume 21, Issue 1, Page(s) 6

Abstract: Background: An increasing number of children with complex health needs are being educated in mainstream classes. CFS/ME is a complex and disabling condition, and there is little guidance on how primary school teachers can support younger children with ... ...

Abstract	Background: An increasing number of children with complex health needs are being educated in mainstream classes. CFS/ME is a complex and disabling condition, and there is little guidance on how primary school teachers can support younger children with this condition. To improve care, it is important to understand what these children need in the school setting, and the barriers and facilitators to teachers providing this support. The aims for this qualitative study were to explore teachers' views about CFS/ME, their experiences of supporting a pupil with CFS/ME and their perspectives on the barriers and facilitators to providing support. Methods: We recruited families from an NHS specialist paediatric CFS/ME service and families were eligible if the child was aged between 5 and 11 years and had a diagnosis of CFS/ME. We gained written consent/assent from families to invite the child's teacher to participate in a qualitative interview. We contacted these teachers, gained written consent and then carried out semi-structured qualitative interviews. Interviews were audio-recorded, transcribed, anonymised and analysed thematically. Interviews took place between July 2018 and December 2018. Results: We interviewed 11 teachers; their pupil's age ranged from 5 to 11 years and school attendance ranged from 0 to 80%. Theme 1: Most teachers provided rich descriptions of their pupil's CFS/ME; they consistently described cognitive dysfunction and significant fatigue, but beyond this the symptoms varied from one account to the next (from mobility problems, to aches and pains, digestive problems, headaches, nausea and hypersensitivity). These teachers noted the ripple effects on their pupil's social, emotional and academic functioning. Two of the eleven teachers said that they did not observe symptoms of CFS/ME, expressing a degree of scepticism about the diagnosis. Theme 2: Teachers described a close relationship with their pupil. They said they understood the individual needs of the child and portrayed positive and proactive attitudes towards providing support. The type of support provided included facilitating rest breaks and limiting strenuous activities; using practical strategies to address cognitive, physical, social and emotional difficulties; maintaining a connection with the child during their absences from school; and encouraging the child to talk about their health and wellbeing. Teachers noted that receiving formal confirmation of the child's diagnosis enabled them to put this support in place. Theme 3: The adaptations they described were often intuitive, rather than being based on a knowledge of CFS/ME. Teachers wanted more resources to increase their understanding of the condition and its management. Conclusions: Primary school teachers want to provide effective support for children with CFS/ME. Clinical services should consider working in collaboration with teachers to equip them with evidence-based strategies for CFS/ME management in the primary school setting.
MeSH term(s)	Child ; Child, Preschool ; Delivery of Health Care ; Family ; Fatigue Syndrome, Chronic/diagnosis ; Humans ; Qualitative Research ; Specialization
Language	English
Publishing date	2021-01-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041342-7
ISSN	1471-2431 ; 1471-2431
ISSN (online)	1471-2431
ISSN	1471-2431
DOI	10.1186/s12887-020-02461-7
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Article ; Online: The epidemiology of chronic fatigue syndrome/myalgic encephalitis in children.

Crawley, Esther

Archives of disease in childhood

2013 Volume 99, Issue 2, Page(s) 171–174

Abstract: Most paediatricians regularly see children with chronic fatigue syndrome or myalgic encephalitis (CFS/ME) in their clinics and yet we know little about how common it is, who is affected, whether there are risk factors and how likely a child is to recover ...

Abstract	Most paediatricians regularly see children with chronic fatigue syndrome or myalgic encephalitis (CFS/ME) in their clinics and yet we know little about how common it is, who is affected, whether there are risk factors and how likely a child is to recover (or what might predict recovery). Recent research suggests that this illness is more complicated than previously thought and that rather than being an illness found in middle class families, it is more common in those who are socially deprived. This article reviews what is currently known about this important but little understood condition.
MeSH term(s)	Adolescent ; Child ; Fatigue Syndrome, Chronic/diagnosis ; Fatigue Syndrome, Chronic/epidemiology ; Fatigue Syndrome, Chronic/etiology ; Humans ; Incidence ; Practice Guidelines as Topic ; Risk Factors ; Socioeconomic Factors
Language	English
Publishing date	2013-10-21
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	524-1
ISSN	1468-2044 ; 0003-9888 ; 1359-2998
ISSN (online)	1468-2044
ISSN	0003-9888 ; 1359-2998
DOI	10.1136/archdischild-2012-302156
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Article ; Online: Response to Derek Enlander.

Crawley, Esther

QJM : monthly journal of the Association of Physicians

2013 Volume 107, Issue 3, Page(s) 247

MeSH term(s)	Fatigue Syndrome, Chronic/therapy ; Female ; Humans ; Male
Language	English
Publishing date	2013-08-22
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	1199985-8
ISSN	1460-2393 ; 0033-5622 ; 1460-2725
ISSN (online)	1460-2393
ISSN	0033-5622 ; 1460-2725
DOI	10.1093/qjmed/hct171
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