Group cognitive behavioural treatment for insomnia in primary care: a randomized controlled trial

BACKGROUND

Insomnia disorder is common and often co-morbid with mental health conditions. Cognitive behavioural therapy (CBT) for insomnia is effective, but is rarely implemented as a discrete treatment. The aim of this study was to evaluate the effectiveness of brief CBT groups for insomnia compared to treatment as usual (TAU) for insomnia delivered by mental health practitioners in a primary-care mental health service.

METHOD

A total of 239 participants were randomized to either a five-session CBT group or to TAU. Assessments of sleep and of symptoms of depression and anxiety were carried out at baseline, post-treatment and at 20 weeks. Primary outcome was sleep efficiency post-treatment.

RESULTS

Group CBT participants had better sleep outcomes post-treatment than those receiving TAU [sleep efficiency standardized mean difference 0.63, 95% confidence interval (CI) 0.34-0.92]. The effect at 20 weeks was smaller with a wide confidence interval (0.27, 95% CI -0.03 to 0.56). There were no important differences between groups at either follow-up period in symptoms of anxiety or depression.

CONCLUSIONS

Dedicated CBT group treatment for insomnia improves sleep more than treating sleep as an adjunct to other mental health treatment.

Collagen oligomers modulate physical and biological properties of three-dimensional self-assembled matrices

Elucidation of mechanisms underlying collagen fibril assembly and matrix-induced guidance of cell fate will contribute to the design and expanded use of this biopolymer for research and clinical applications. Here, we define how Type I collagen oligomers affect in-vitro polymerization kinetics as well as fibril microstructure and mechanical properties of formed matrices. Monomers and oligomers were fractionated from acid-solubilized pig skin collagen and used to generate formulations varying in monomer/oligomer content or average polymer molecular weight (AMW). Polymerization half-times decreased with increasing collagen AMW and closely paralleled lag times, indicating that oligomers effectively served as nucleation sites. Furthermore, increasing AMW yielded matrices with increased interfibril branching and had no correlative effect on fibril density or diameter. These microstructure changes increased the stiffness of matrices as evidenced by increases in both shear storage and compressive moduli. Finally, the biological relevance of modulating collagen AMW was evidenced by the ability of cultured endothelial colony forming cells to sense associated changes in matrix physical properties and alter vacuole and capillary-like network formation. This work documents the importance of oligomers as another physiologically-relevant design parameter for development and standardization of polymerizable collagen formulations to be used for cell culture, regenerative medicine, and engineered tissue applications.

The C282Y mutation may have been positively selected as it mitigates the infertility of celiac disease

Celiac disease and C282Y homozygous hemochromatosis have a similar increasing incidence across Europe. Both have gradients of frequency which increase from Turkey to North West Europe and culminate with a high frequency in Ireland. These two gradients follow the path of the Neolithic settlers who reached the edge of Europe at Ireland. Celiac disease and C282Y hereditary hemochromatosis have opposite effects on iron absorption and probably on the absorption of some other divalent metals including copper. The C282Y mutation is estimated to be some 2000 years old. Celiac disease is likely a much older disorder. The C282Y mutation may have been positively selected for as it increases absorption of divalent metal ions in celiac disease and thus has a mitigating effect on the infertility which may be associated with celiac disease.

Learning for interprofessional and inter-agency practice in the new social work curriculum: evidence from an earlier research study

The UK Government's consultation document, A Quality Strategy for Social Care (2000) seeks consistency and excellence in care services and enhanced service partnerships. It states that this requires improved training for social workers and raises the prospect of a new social work curriculum in which learning for interprofessional and inter-agency practice will be strengthened. The document stresses the importance of evidence in decision-making in social care and this principle applies equally to training but there are few recent research findings on interprofessional and inter-agency learning in the social work curriculum. There are, however, findings from an earlier study which contributed to the mid-1990s review of the Diploma in Social Work but which have not previously been published in the mainstream media. These findings are reported and show: the kinds of organisations and professions with whom social work practitioners were in close contact in their jobs; the importance attached by social workers to defined skills in working with them; the perceived usefulness of training in developing relevant knowledge and skills; perceptions of shared training; and marked differences of learning experience reported by practitioners who had taken different training courses. Each set of findings is described and used as the basis of questions for the new social work curriculum.

Acute effects of 50 Hz, 100 microT magnetic field exposure on visual duration discrimination at two different times of the day

A two-alternative, forced-choice visual duration discrimination task was used to examine the effect of an intermittent, 50 Hz, 100 microT magnetic field on accuracy at two different times of the day. A total of 59 female and 40 male subjects with an age range of 18 to 46 years were studied under both field-exposed and sham-exposed conditions. The subject's task was to decide which of two sequentially presented light flashes had the longer duration, percentage correct being the measure of performance. The data were gathered under double-blind conditions with sham and real exposure counterbalanced. Exposure to the magnetic field produced a small improvement in accuracy but only at the most difficult level of the task, with female subjects showing a larger improvement than males. The time of day at which the study was run had no effect on performance. Despite the relatively large number of subjects used and a relaxed alpha level (P = .3), the statistical power of the test to detect the observed effect was still only 0.71.

Pediatric orthopaedic mission to Colombia: taking care of the children

This team of nurses and doctors donated a week's vacation, the cost of their airline tickets, and many hours of preparation to help more than 200 children who could not afford orthopaedic care in Colombia. During the outreach mission, Colombian health care staff worked closely with the American team to exchange knowledge of orthopaedic skills and surgical techniques. The impact that members of this team have on the care of these needy children makes the countless hours of preparation for the mission and the work in Colombia very worthwhile. The sharing of time, knowledge, and expertise has not only influenced the orthopaedic health care for children in this small area of the world, but is also a rewarding educational experience for all involved.

Orthopedic nursing practice guidelines. The NAON Standards Task Force

The NAON Standards Task Force has revised Orthopaedic Nursing: Process and Outcome Criteria for Selected Nursing Diagnoses published jointly by the American Nurses' Association (ANA) and NAON in 1986. The new document is entitled Orthopaedic Nursing Practice Guidelines. It contains guidelines for the care of orthopaedic patients with 11 selected nursing diagnoses and is an important decision-making tool for orthopaedic nurses. This article contains excerpts from the new guidelines with suggestions for its use.

Clinical aspects of contact dermatitis

The role of the primary care physician is to identify the agent that causes the contact dermatitis and to aid the patient in avoiding further contact with it or other similar materials. The physician's credo should be "suspect everything." To fulfill these goals, a physician must obtain an informed inventory of contactants in a patient's environment and develop an ability to recognize clinical morphology and distribution patterns common to contact dermatitis.

An overview of consumer ergonomics in the United Kingdom

Consumer ergonomics has emerged as one of the mainstream areas of ergonomics research and application. This paper discusses the background to this development and provides a framework for the three special issues of Applied Ergonomics devoted to this topic. The main aspects of current consumer ergonomics research, for example the fields of application, available techniques and relevant criteria, are reviewed by drawing on papers from this special series and other complementary published work. Some criticisms are made relating to the failure to achieve the systematic application of ergonomics in the design process, and a series of recommendations is made as to how the contribution of ergonomics could be made more effective. Finally, the future of consumer ergonomics in considered in the light of three major trends - the increased complexity of products, changes in social climate and forthcoming changes in consumer legislation.