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"Chasiotis, Athanasios"
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Fundamental questions in cross-cultural psychology
\"Cross-cultural psychology has come of age as a scientific discipline, but how has it developed? The field has moved from exploratory studies, in which researchers were mainly interested in finding differences in psychological functioning without any clear expectation, to detailed hypothesis tests of theories of cross-cultural differences. This book takes stock of the large number of empirical studies conducted over the last decades to evaluate the current state of the field. Specialists from various domains provide an overview of their area, linking it to the fundamental questions of cross-cultural psychology such as how individuals and their cultures are linked, how the link evolves during development, and what the methodological challenges of the field are. This book will appeal to academic researchers and postgraduates interested in cross-cultural research\"-- Provided by publisher.
Book
Tibial nerve stimulation in the management of primary sexual dysfunction in patients with multiple sclerosis: a pilot randomized control trial
Introduction
Sexual dysfunction (SD) is a common symptom that affects 40–90% of patients with multiple sclerosis (MS). Previous studies have highlighted the negative impact of sexual dysfunction in the mental health status and overall quality of life in patients with MS.
Methods
The aim of this study was to examine the effects of transcutaneous tibial nerve stimulation (TTNS) in the primary SD symptoms in patients with MS. A total of 40 participants were randomized (1:1 ratio) to either TTNS or Sham group and received three 20 min sessions over the course of two months. Pre and post intervention SD was evaluated using the Multiple Sclerosis Intimacy Questionnaire (MISQ-15).
Results
Statistically significant improvements in the aspects of primary sexual dysfunction were observed in the TTNS group pre-post intervention (specifically erectile function (for males)/vaginal lubrication (for females) (
p
< .001), orgasm quality and satisfaction for both male and female patients (
p
< .001), sexual desire (
p
< .05) and bladder related symptomatology (
p
< .005). In the sham group pre-post intervention, the only observed improvement was in the sexual desire aspect (
p
< .05). Post intervention the groups significantly differed erectile function/vaginal lubrication and orgasm quality and satisfaction (
p
< .05).
Conclusions
Our findings underline the efficacy of TTNS in improving primary SD symptoms as well as bladder problems in both male and female patients with MS. TTNS demonstrated significant improvement in the following domains: erectile function, vaginal lubrication, orgasm quality, satisfaction, bladder-related symptoms, and sexual desire.
Journal Article
Clinical, Cognitive and Demographic Determinants of Work Participation in Multiple Sclerosis: A Multicenter Cross-Sectional Study
Background and Objectives: Employment is a major determinant of quality of life in people with multiple sclerosis (pwMS). This multicenter cross-sectional study aimed to identify which commonly studied demographic, disease-related, clinical, cognitive, and psychological variables, alongside the presence of lower urinary tract symptoms (LUTS), predict employment status in pwMS. Materials and Methods: Seventy-eight pwMS were classified as either full-time employed (n = 41) or non-employed (n = 37). Participants underwent clinical and neuropsychological assessment including disability status (Expanded Disability Status Scale; EDSS), fatigue (Modified Fatigue Impact Scale; MFIS), information processing speed (Symbol Digit Modalities Test; SDMT), depressive symptoms (Hospital Anxiety and Depression Scale-Depression; HADS-D), and LUTS status (presence/absence), alongside demographic and disease-related variables (sex, age, education level, relationship status, and disease duration). Results: Hierarchical binary logistic regression indicated that higher information processing speed was associated with higher odds of employment (OR = 1.11, p = 0.008), whereas the presence of LUTS was associated with lower odds of employment (OR = 0.13, p = 0.026). Disability severity, fatigue, depressive symptoms, demographic characteristics, and disease duration did not contribute in the final model (p > 0.05). Conclusions: Information processing speed and urinary dysfunction were associated with employment status in pwMS. Within the present sample, the multivariable model including these variables showed good discrimination between employed and non-employed participants. The findings should be interpreted as exploratory, and they require further confirmation in independent cohorts before any potential application is considered.
Journal Article
High-Frequency Transcutaneous Electrical Nerve Stimulation in the Management of Pyramidal Tract-Related Spasticity: A Systematic Review
It is known that the pyramidal tract is the main pathway that carries signals for voluntary movements. In upper motor neuron lesions, lesions to the pyramidal tract can lead to devastating consequences, one of which is spasticity. Among other rehabilitation techniques, the use of high-frequency transcutaneous electrical nerve stimulation (HF-TENS) could be beneficial in spasticity management. The goal of this systematic review was to summarize previously published information on the use of HF-TENS in the management of pyramidal tract-related spasticity (PTrS). A thorough research of the PubMed, MEDLINE, and Scopus databases was performed. The search identified 340 records. After screening, nine records met the inclusion-exclusion criteria and were assessed. The included studies investigated the effectiveness of HF-TENS on pyramidal tract-related lower limb spasticity. Spasticity was measured through the Modified Ashworth Scale (MAS), Composite Spasticity Scale (CSS), and spinal inhibition reflexes through the H-reflex. Seven records used a 30-minute HF-TENS in stroke human patients with lower limb spasticity. Results showed post-TENS reduction in spasticity and enhancement in balance ability without any significant alteration in Hoffmann's reflex (H-reflex) (p < .05). The last two records performed HF-TENS in multiple sclerosis and spinal cord injury patients with lower limb spasticity. The findings showed that 60-minute HF-TENS alleviated spasticity levels and pain levels as well as decreased resistance to full range of motion (ROM) and ankle clonus (p < .05). HF-TENS seems to be a promising therapeutic tool in managing PTrS. However, there is a need for homogenization of application parameters in order to be applied in rehabilitation centers.
Journal Article
Waist Circumference and Body Mass Index as Predictors of Disability Progression in Multiple Sclerosis: A Systematic Review and Meta-Analysis
Background: While obesity has been shown to elevate the risk of developing multiple sclerosis (MS), there is a lack of strong evidence regarding its role in the disability progression and status of MS patients. Methods: This systematic review and meta-analysis aimed to provide comparative estimates of WC and BMI in patients with MS (PwMS) and to investigate potential associations between the waist circumference (WC) and body mass index (BMI) and demographic and specific MS characteristics. Adhering to PRISMA guidelines, a detailed search of the MEDLINE PubMed, Cochrane Library, and Scopus databases was conducted. Results: A total of 16 studies were included. The pooled mean WC and BMI among PwMS was estimated to be 87.27 cm (95%CI [84.07; 90.47]) and 25.73 (95%CI [25.15; 26.31]), respectively. Meta-regression models established a significant bidirectional relationship between WC and the Expanded Disability Scale (EDSS) (p < 0.001) but not between BMI and EDSS (p = 0.45). Sensitivity analyses showed no association between WC and age (p = 0.48) and a tendency between WC and disease duration (p = 0.08). Conclusions: Although WC measurements classify PwMS as normal weight, BMI measurements classify them as overweight. Therefore, WC should complement BMI evaluations in clinical practice. Additionally, our findings highlight the significant association between abdominal fat, as indicated by WC, and disease progression. Considering the heightened risk of cardiovascular comorbidity and mortality among PwMS, we recommend integrating both WC and BMI as standard anthropometric measurements in routine clinical examinations and targeted prevention strategies for PwMS.
Journal Article
Evaluating Vaporized Cannabinoid Therapy in Multiple Sclerosis: Findings from a Prospective Single-Center Clinical Study
Introduction: Multiple Sclerosis (MS) is associated with a wide range of debilitating symptoms, and conventional therapies often fail to adequately address the disease’s multifaceted challenges. Cannabidiol (CBD) 13.0% + Delta9-tetrahydrocannabinol (THC) 9.0% (CBD13/THC9), a vaporized cannabis-based medicinal product, presents a novel therapeutic option for managing MS symptoms. Methods: This single-center longitudinal study followed 69 MS patients over a six-month period. Participants were assessed at treatment initiation and at three- and six-month intervals. Key measures included muscle spasticity, urine bladder dysfunction, and the evaluation of disability progression rate. The evaluation included the Modified Ashworth Scale (MAS), the Post Void Residual (PVR) volume, and the Expanded Disability Status Scale (EDSS). Results: Significant improvement was observed across all outcome assessments. The EDSS score was decreased over time (p = 0.009), indicating a slight reduction in disability progression rate, while MAS scores showed substantial improvement in muscle spasticity (p < 0.001). Urine bladder function improved significantly, with PVR volume showing notable improvement between baseline and the six-month assessment (p < 0.001). Correlation analyses revealed that a gradual increase in vaporized CBD13/THC9 dose was correlated with slightly lower EDSS scores, while the adverse effects were negatively associated with the frequency of cannabinoid use. Finally, patients who were smokers used CBD13/THC9 more frequently. Conclusions: The vaporized CBD13/THC9 formulation demonstrated notable efficacy in slightly improving disability progression rate via reduction in muscle spasticity and urine bladder dysfunction in MS patients. This highlights its addon therapeutic value during rehabilitation in MS patients with debilitating disability symptoms.
Journal Article
Real-Time Ultrasound Elastography in Multiple Sclerosis Spasticity: Comparison with Clinical and Neurophysiological Measures
Background: Spasticity is a common and disabling symptom of multiple sclerosis (MS), yet its assessment remains challenging. Clinical scales such as the Ashworth Scale (AS) evaluate resistance to passive movement, whereas neurophysiological measures (e.g., H-reflex, F-wave) provide objective indices of α-motoneuron excitability but correlate inconsistently with clinical severity. Real-time ultrasound elastography (RTE) enables semi-quantitative, in vivo assessment of muscle stiffness, while the recently introduced Muscle Elastography Multiple Sclerosis Score (MEMSs) aims to classify muscle spasticity in MS. Objective: To evaluate the utility of RTE using MEMSs for the objective assessment of muscle status in MS patients with spasticity, and to compare elastographic findings with clinical and neurophysiological measures. Methods: In this single-center study, 26 MS patients (diagnosed according to the 2017 McDonald criteria) and age- and sex-matched healthy controls (n = 27) were enrolled. Spasticity was graded using the AS. All participants underwent bilateral RTE of the gastrocnemius muscle, with images independently scored by two blinded neurologists using the 5-point MEMSs scale. Neurophysiological assessment included the soleus H-reflex, with calculation of H/M ratios. Correlations were analyzed using Pearson’s coefficient, and inter-observer reliability was assessed. Results: No consistent or statistically robust associations were found between clinical spasticity severity (AS scores) and either neurophysiological or elastographic parameters. Several MEMSs did not correlate reliably with AS grades, and neurophysiological measures showed limited discriminatory ability between MS patients and healthy controls. Correlations between neurophysiological and elastography parameters were weak to moderate (ρ ranging from −0.49 to 0.45). Inter-observer reliability of MEMSs scoring ranged from poor to moderate across the examined muscle groups, with Cohen’s κ values ranging from −0.02 to 0.54. Conclusions: RTE using MEMSs did not demonstrate sufficient validity or reproducibility for assessing muscle spasticity in MS, showing poor agreement with both clinical and neurophysiological measures.
Journal Article
The Effect of Neuromuscular Electrical Nerve Stimulation in the Management of Post-stroke Spasticity: A Scoping Review
Stroke is a cerebrovascular disorder characterized by the sudden onset of symptoms and clinical signs caused by either vascular infraction or hemorrhage. One of the main symptoms in the majority of post-stroke patients is spasticity. The main therapeutic options of spasticity in post-stroke patients include pharmacological interventions, rehabilitation techniques, and surgery. This review aims to explore the effectiveness of Neuromuscular Electrical Stimulation (NMES) for post-stroke spastic hemiparetic limb (upper and lower). Thorough research of the PubMed Medline database was performed. Records were limited to clinical studies published between 01/01/2010 and 01/01/2022. The results were screened by the authors in pairs. The search identified 26 records. After screening, nine records met the inclusion-exclusion criteria and were assessed. There were seven studies for spastic upper limbs and two for spastic lower limbs. The approaches investigated the effectiveness of electrical stimulation on post-stroke spastic upper or lower limb. Spasticity was measured through the modified Ashworth scale (MAS) and electromyographic recordings (EMG). In most cases, spasticity was decreased for at least two weeks post-intervention. In conclusion, NMES can be used either solo or in combination with different physical therapy modalities in order to produce optimal results, taking into consideration the specific needs and limitations of each individual patient. Based on the existing literature, as well as the limitations of the included studies, the authors believe that future studies on the subject of NMES in the management of post-stroke spasticity should focus on carefully examining each electrical parameter.
Journal Article
Neuropathic Pain in Neuromyelitis Optica Spectrum Disorders: Prevalence and Management Strategies—A Systematic Review and Meta-Analysis
Introduction: Neuropathic pain (NP) in neuromyelitis optica spectrum disorder (NMOSD) represents a significant and often under-recognized complication arising from central nervous system (CNS) lesions. Unlike other demyelinating disorders, NMOSD involves a distinct immunopathogenesis primarily driven by aquaporin-4 antibodies (AQP4-IgG), leading to severe inflammatory damage. NP is typically the consequence of inflammatory damage to the spinothalamic tract or dorsal columns, resulting in both acute and chronic pain syndromes. Methods: A systematic review and meta-analysis were conducted following a comprehensive search of Medline and Scopus, identifying nine eligible studies reporting on NP in NMOSD. Results: Pooled prevalence was estimated using a random-effects metaprop meta-analysis with Freeman–Tukey transformation and REML-based heterogeneity estimation. The pooled prevalence of NP among patients with NMOSD was 56.2% (95% CI: 41.7–70.1%; I2 = 95.3%, p < 0.001). Sensitivity analysis including only AQP4-IgG+ cohorts revealed a prevalence of 63.2% (95% CI: 23.4–94.7%; I2 = 98.1%, p < 0.001). No significant difference was found between mixed and AQP4-IgG+-only populations (53.05% vs. 63.27%, p = 0.63). Meta-regression showed no significant associations between NP prevalence and age (β = 0.01, p = 0.33) or disability (β = 0.08, p = 0.18). Qualitative synthesis demonstrated an association between thoracic spinal cord lesions and NP, and also indicated that NP was often resistant and refractory to standard pharmacologic therapies. Conclusions: NP affects one in two NMOSD patients, and is associated with thoracic spinal cord lesions. In comparison with multiple sclerosis, NP in NMOSD is primarily structural and immunopathological in origin. Treatment strategies remain inadequate, emphasizing the need for early recognition and a disease-specific therapeutic approach.
Journal Article
Osteoarthritis in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis
Background: Arthritis, particularly osteoarthritis (OA), is a common synovial condition observed in individuals with multiple sclerosis (MS). Despite its high prevalence and significant impact on the quality of life of MS individuals, there is a gap in the current literature regarding the prevalence of OA in this population and its relation to MS pathology. This systematic review and meta-analysis aimed to estimate the prevalence of OA in the MS population and explore potential associations with demographic and MS-specific characteristics. Methods: Adhering to PRISMA guidelines, a systematic search of the MEDLINE PubMed, Scopus and Google Scholar databases was conducted. Results: Fifteen studies were included in the systematic review and meta-analysis. The aggregated prevalence of OA in the MS population was 27% (95% CI: 15–40%), with substantial heterogeneity (I2 = 99.9%). Sensitivity analysis, excluding one study, showed a prevalence of 21% (95% CI: 16–28%). The risk ratio of OA in MS versus controls was 1.07 (95% CI: 0.84–1.37), indicating no significant difference. Meta-regression revealed no associations between OA prevalence and age or disease duration in MS patients. Conclusions: This study reports a 21–27% prevalence of OA in people with MS. Understanding the implications of OA in pain and mobility domains, as well as the challenges in distinguishing OA symptoms from MS manifestations, underscores the need for further research to elucidate the pathophysiological mechanisms and interactions between these conditions. Additional studies are warranted to enhance clinical management and improve outcomes for individuals with MS and co-existing OA.
Journal Article