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      Ultradian hydrocortisone replacement alters neuronal processing, emotional ambiguity, affect and fatigue in adrenal insufficiency: The PULSES trial.

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          Abstract

          Primary adrenal insufficiency (PAI) mortality and morbidity remain unacceptably high, possibly arising as glucocorticoid replacement does not replicate natural physiology. A pulsatile subcutaneous pump can closely replicate cortisol's circadian and ultradian rhythm.

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          Most cited references32

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          The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research

          Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
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            Development and validation of brief measures of positive and negative affect: the PANAS scales.

            In recent studies of the structure of affect, positive and negative affect have consistently emerged as two dominant and relatively independent dimensions. A number of mood scales have been created to measure these factors; however, many existing measures are inadequate, showing low reliability or poor convergent or discriminant validity. To fill the need for reliable and valid Positive Affect and Negative Affect scales that are also brief and easy to administer, we developed two 10-item mood scales that comprise the Positive and Negative Affect Schedule (PANAS). The scales are shown to be highly internally consistent, largely uncorrelated, and stable at appropriate levels over a 2-month time period. Normative data and factorial and external evidence of convergent and discriminant validity for the scales are also presented.
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              Short form 36 (SF36) health survey questionnaire: normative data for adults of working age.

              To gain population norms for the short form 36 health survey questionnaire (SF36) in a large community sample and to explore the questionnaire's internal consistency and validity. Postal survey by using a booklet containing the SF36 and several other items concerned with lifestyles and illness. The sample was drawn from computerised registers of the family health services authorities for Berkshire, Buckinghamshire, Northamptonshire, and Oxfordshire. 13,042 randomly selected subjects aged 18-64 years. Scores for the eight health dimensions of the SF36. The survey achieved a response rate of 72% (n = 9332). Internal consistency of the different dimensions of the questionnaire was high. Normative data broken down by age, sex, and social class were consistent with those from previous studies. The SF36 is a potentially valuable tool in medical research. The normative data provided here may further facilitate its validation and use.
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                Author and article information

                Journal
                J Intern Med
                Journal of internal medicine
                Wiley
                1365-2796
                0954-6820
                Jan 2024
                : 295
                : 1
                Affiliations
                [1 ] Laboratories of Integrative Neuroscience and Endocrinology, Bristol Medical School, University of Bristol, Bristol, UK.
                [2 ] University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK.
                [3 ] North Bristol NHS Trust, Bristol, UK.
                [4 ] Department of Informatics and Telecommunications, Human-Computer Interaction Laboratory, University of Ioannina, Arta, Greece.
                [5 ] Clinical Research and Imaging Centre, University of Bristol, Bristol, UK.
                [6 ] Faculty of Medicine and Dentistry (Malta Campus), Queen Mary University of London, Victoria, Malta.
                [7 ] Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.
                [8 ] Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.
                [9 ] Neurosciences and Mental Health, Liverpool Health Partners, Liverpool, UK.
                [10 ] School of Psychology, University of East Anglia, Norwich, UK.
                [11 ] School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
                [12 ] Division of Psychology and Language Sciences, UCL, London, UK.
                [13 ] Department of Psychiatry, Oxford University and Oxford Health NHS Foundation Trust, Oxford, UK.
                [14 ] MRC Integrative Epidemiology Unit, School of Psychological Science, University of Bristol, Bristol, UK.
                Article
                10.1111/joim.13721
                37857352
                f5fe52eb-ea8d-4a12-beb0-d06a4b93cbdb
                History

                fMRI,ultradian,primary adrenal insufficiency,glucocorticoid replacement therapy

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