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    Impact of Cognitive and Behavioral Disturbances on Insomnia Symptom Frequency Among Medical Students
    (2020) Roane, Brandy; Momin, Shahana
    Background:About 30% of medical students report insomnia. Insomnia increases risk of depression, anxiety, and mental health disturbances. Both behavioral (e.g., clock watching) and cognitive factors (e.g., worry) contribute to insomnia. We hypothesized that experiencing cognitive and behavioral disturbances would predict more frequent insomnia symptoms among medical students. Methods:Participants were 128 1st and 2nd year medical students. Mean age was 24.2 years (SD=3.5) with 61% female, 6% Hispanic, 51% Caucasian, 37% Asian American, and 2% Black American. Data were collected during Fall/Spring semesters from 2016-2017. Students gave informed consent prior to reporting on sleep disorder symptoms including insomnia, daytime sleepiness, and sleep habits. Students reporting sleep apnea symptoms were excluded from analyses. Univariate regression analyses determined significant predictors of insomnia symptom frequency. Results:Clock watching (p< 0.001), strong emotions 1-hr before bed (p< 0.001), going to bed upset (p< 0.001) and worrying about school in bed (p=0.037) were significant predictors of more frequent insomnia symptoms. Results also showed trends for napping after 6pm; calm/relaxing activity or being very active 1-hr before bed; stomachache when going to bed; and falling asleep in bright light predicted insomnia symptom frequency. Conclusion:Cognitive disturbances were more likely to predict insomnia symptom frequency among medical students. Behavioral and cognitive disturbances increase physiological arousal, which contributes to insomnia; however, cognitive disturbances are more often associated with a negative interpretation (e.g., worrying about school versus being very active). Findings suggest that sleep hygiene, which targets mainly behavioral factors, is likely not a sufficient intervention for this population.
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    Psychological Adjustment in Parents of Children Born with Atypical Genitalia 24-months After their Child Undergoes Genitoplasty
    (2020) Palmer, Blake; Wolfe-Christensen, Cortney; Reyes, Kristy; Biben, Emily
    Purpose: Disorders of sexual development (DSD) are congenital conditions in which patients are born with ambiguous genitalia, discordant gonadal sex, or chromosomal atypia. Parents of patients with DSD have the decision to proceed with surgical genitoplasty as an option to align the phenotype with sex of rearing. These parents become at risk for developing psychological distress. We examined parental psychological adjustment up to 24 months after their child underwent genitoplasty. Methods: As part of a larger, multi-site study, parents of children who: 1) were born with a DSD involving ambiguous genitalia, 2) were under two years old at enrollment, and 3) had no history of previous genital surgery were recruited by the Urology Department at Cook Children's Medical Center. Questionnaires completed by the parent participants assessing levels of anxiety, depression, posttraumatic stress symptoms (PTSS), uncertainty, and decisional regret were collected longitudinally: before genitoplasty and 6, 12, and 24 months post-genitoplasty. Results: Ten parents of 5 children were included in the analyses. Results revealed that over the course of the study, parents showed significant improvements in levels of PTSS, anxiety, and uncertainty. Although symptoms improved, mothers continued reporting higher levels of anxious and depressive symptoms than fathers, while fathers reported higher levels of lack of clarity about the child's diagnosis and decisional regret. Conclusions: Twenty-four months after the child's genitoplasty, parents reported coping better overall. However, patterns of adjustment differed between parents, suggesting that mothers and fathers may require unique interventions to help cope with their child's diagnosis.