Anonymous online cognitive behavioral therapy for sleep disorders in shift workers-a study protocol for a randomized controlled trial

Background

Many shift workers suffer from sleep issues, which negatively affect quality of life and performance. Scientifically evaluated, structured programs for prevention and treatment are scarce. We developed an anonymous online cognitive behavioral therapy for insomnia (CBT-I) program. After successful completion of a feasibility study, we now start this prospective, randomized, controlled superiority trial to compare outcomes of two parallel groups, namely an intervention group and a waiting-list control-group. Additionally, we will compare these outcomes to those of a face-to-face CBT-I outpatient sample.

Methods

Collaborating companies will offer our anonymous online intervention to their shift-working employees. Company physicians and counseling services will screen those interested for inclusion and exclusion criteria. Participants will receive access to our online service, where they will complete psychometric assessment and receive random assignment to either the intervention group or the waiting-list control group. Participants and providers will be aware of the group assignment. We aim to allocate at least N = 60 participants to the trial. The intervention consists of psychoeducation, sleep restriction, stimulus control, relaxation techniques, and individual feedback delivered via four e-mail contacts. During the intervention, as well as during the waiting period, participants will fill out weekly sleep diaries. Immediately after completion of the program, the post-intervention assessment takes place. Participants in the control group will be able to participate in the program after all study assessments. To recruit an additional sample, collaborating outpatient sleep clinics will provide six sessions of standard face-to-face CBT-I to an ad hoc sample of shift working patients. We expect both the online and the face-to-face CBT-I interventions to have beneficial effects compared to the control group on the following primary outcomes: self-reported symptoms of depression and insomnia, sleep quality, and daytime sleepiness.

Conclusions

The online intervention allows shift workers to follow a CBT-I program independently of their working schedule and location. Forthcoming results might contribute to further improvement of prevention and therapy of sleep issues in shift workers.

Trial registration

German Clinical Trials Register DRKS DRKS00017777. Registered on 14 January 2020—retrospectively registered.

[Systematic qualitative histology of enossal implants with anodically oxidised surfaces]

Histological analysis of dental implants is often quantified by calculating the bone-implant contact rate (bone volume/total volume), whereas qualitative aspects like osteoconduction are underrepresented. The aim of this study was to focus on the micro-architectural properties of the bone-implant contact under physiologic loading using a systematic analysis of these characteristics. In 16 Beagle dogs we inserted 6 different types of dental implants in the hard bone of the mandible and the soft bone of the maxilla. After a healing period of two months the implants were loaded for three months and then histologically analysed. For the metric evaluation of qualitative histological aspects 12 examiners answered pivotal questions: 1. Is the implant functional sufficient? 2. Do you see close contact to bone, were bone is present? 3. Is the amount of bone at the implant at least similar to the peripheral bone? 4. Is the bone to implant contact homogenous? 5. Does the bone show a functional architecture? 6. Do you find osseoconductive bone apposition at the crestal and apical border? A superiority of anodic oxidized surfaces can be seen in questions 1, 2 and 3 mainly for the comparison of identical macrodesigns (MkIII). The potential for osseoconductivity (questions 4 and 5) shows a tendency for significant differences for the ZL Ticer implant. Homogenous bone to implant contact is rarely found, in contrast to rather positive implant function ratings. This suggests the existence of an optimum in the bone to implant contact rate. Bone to implant contact rate as an isolated quantitative parameter should in future be completed by a systematic, standardised and blinded analysis of qualitative properties.

Medication management of stimulants in pediatric practice settings: a national perspective

Using a nationally representative sample of office-based physicians, the management practices of pediatricians, psychiatrists, and family practice physicians were investigated. The major aims were to determine (1) what types of services these physicians were providing to children who received stimulants, (2) what factors predicted receipt of stimulants, and (3) whether these practices were concordant or discordant with professional consensus on diagnosis and treatment of attention-deficit hyperactivity disorders (ADHD). Prescribing and management practice data from the 1995 National Ambulatory Medical Care Survey (NAMCS) were analyzed for children ages 0 to 17 years who were seen for psychiatric problems and received stimulant medication. Results indicated that 2 million visits by children were made in 1995 to psychiatrists, pediatricians, or family practitioners in which psychotropic medications were prescribed. In pediatric visits where stimulant medication was prescribed, mental health counseling was provided 47.3% of the time and psychotherapy 21.6%. Follow-up arrangements were made in 79.1% of the visits. Psychiatrists were significantly more likely to provide psychotherapy and to specify follow-up visits than were pediatricians, but less likely to provide other health counseling. Controlling for demographic and physician effects, the factors with the most significant effect on the probability of receiving stimulants were geographic region (living in the South), race (being white), receiving mental health counseling, not receiving psychotherapy, and having health insurance. Less than 50% of pediatric visits for psychiatric reasons involving stimulant medications included any form of psychosocial intervention. In 21% of these visits, no recommendations were made for follow-up care. These practices diverge from National Institutes of Health (NIH) consensus panel recommendations and association-issued practice parameters.

Treatment services for children with ADHD: a national perspective

OBJECTIVE

To summarize knowledge on treatment services for children and adolescents with attention-deficit hyperactivity disorder (ADHD), trends in services from 1989 to 1996, types of services provided, service mix, and barriers to care.

METHOD

A review of the literature and analyses from 2 national surveys of physician practices are presented.

RESULTS

Major shifts have occurred in stimulant prescriptions since 1989, with prescriptions now comprising three fourths of all visits to physicians by children with ADHD. Between 1989 and 1996, related services, such as health counseling, for children with ADHD increased 10-fold, and diagnostic services increased 3-fold. Provision of psychotherapy, however, decreased from 40% of pediatric visits to only 25% in the same time frame. Follow-up care also decreased from more than 90% of visits to only 75%. Family practitioners were more likely than either pediatricians or psychiatrists to prescribe stimulants and less likely to use diagnostic services, provide mental health counseling, or recommend follow-up care. About 50% of children with identified ADHD seen in real-world practice settings receive care that corresponds to guidelines of the American Academy of Child and Adolescent Psychiatry. Physicians reported significant barriers to service provision for these children, including lack of pediatric specialists, insurance obstacles, and lengthy waiting lists.

CONCLUSIONS

The trends in treatment services and physician variations in service delivery point to major gaps between the research base and clinical practice. Clinical variations may reflect training differences, unevenness in the availability of specialists and location of services, and changes in health care incentives.

Psychoactive medication prescribing practices for U.S. children: gaps between research and clinical practice

OBJECTIVE

To determine national pediatric prescribing practices for psychotropic agents and to examine these practices in view of the available evidence concerning their safety and efficacy in this age group.

METHOD

Prescribing data from 2 national databases based on surveys of office-based medical practices were determined and reviewed vis-à-vis available safety and efficacy evidence.

RESULTS

Data indicate that levels of psychotropic prescribing in children and adolescents are greatest for stimulants, resulting in nearly 2 million office visits and 6 million drug "mentions" in 1995. Selective serotonin reuptake inhibitors were the second most prescribed psychotropic agents, while anticonvulsant mood stabilizers (prescribed for a psychiatric reason), tricyclic antidepressants, central adrenergic agonists, antipsychotics, benzodiazepines, and lithium were also prescribed for a substantial number of office visits. Comparison of prescribing frequencies with available safety and efficacy data indicates significant gaps in knowledge for commonly used agents.

CONCLUSIONS

Most psychotropic agents require further sustained study to ensure appropriate health care expenditures and vouchsafe children's safety. Recommendations for researchers, parents, federal agencies, and industry are offered as a means to accelerate the pace of research progress.

Blood component therapy during the neonatal period: a national survey of red cell transfusion practice, 1985

A questionnaire to determine patterns of neonatal red cell transfusion practice during 1985 was mailed to 2200 blood banks of American Association of Blood Banks (AABB) institutional members and children's hospitals. There were 915 responses (41.6%); 785 responses (86%) contained sufficient data for analysis. The majority (70.6%) of 785 responding hospitals were community/urban institutions. However, more highly specialized, pediatric hospitals were also represented by 92 university/tertiary-care hospitals (11.7% of respondents) and 29 children's hospitals (3.7% of respondents). Two-thirds of hospitals performed a major antiglobulin crossmatch (rather than an abbreviated one) before all neonatal red cell transfusions. The red cell preparation most frequently selected for small-volume transfusions was ABO and Rh group-specific red cell concentrates. When performing only large-volume exchange transfusions, 19.2 percent of hospitals used whole blood; all others prepared reconstituted units of red cells plus fresh-frozen plasma, a practice that frequently causes exposure to two donors per unit. Another practice likely leading to multiple donor exposure is the use of fresh-frozen plasma to adjust the hematocrit of red cell preparations to a predetermined value prior to a small-volume transfusion. Over one-half of hospitals adjusting hematocrits used plasma, presumably from one donor, to dilute packed red cells from another donor, a practice that has no apparent medical benefit. Most hospitals (63.4%) provided red cells with a reduced risk of transmitting cytomegalovirus; blood from seronegative donors was selected by 65 percent of hospitals. The majority of hospitals, including most of the community/urban hospitals, did not irradiate blood products before transfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Soft tissue sarcoma and military service in Vietnam: a case-control study

A case-control study was conducted in men who were of draftable age during the Vietnam conflict to examine the association of soft tissue sarcomas (STSs) with military service in Vietnam as well as other host and environmental risk factors. A total of 217 STS cases selected from the Armed Forces Institute of Pathology were compared to 599 controls for Vietnam service, occupational and nonoccupational exposure to various chemicals, occupational history, medical history, and life-style (smoking, alcohol, coffee, etc.). Military service information was verified by a review of the patient's military personnel records. Other information was ascertained from a telephone interview with either subjects or their next of kin. Cases and controls were stratified on the basis of the hospital type (civilian, Veterans Administration, and military); the Mantel-Haenszel estimate of the odds ratio (OR), adjusted for the effects of the stratification variable, was calculated. Vietnam veterans in general did not have an increased risk of STS when compared to those men who had never been in Vietnam (OR, 0.85; 95% confidence interval, 0.54-1.36). Subgroups of Vietnam veterans who had higher estimated opportunities for Agent Orange exposure seemed to be at greater risk of STSs when their counterparts in Vietnam were taken as a reference group. However, this risk was not statistically significant.

The disparity of indirect and direct zirconyl-gel assays for carcinoembryonic antigen

Experience with the zirconyl phosphate gel (Z-gel) radioimmunoassays for plasma CEA levels below 20 ng/ml (the indirect method) and for levels greater than 20 ng/ml (the direct method) has shown that a disparity of values exists, caused by shifting from one assay to the other. This disparity is at least partially due to PCA-labile proteins reacting in the direct assay. It may be constant for individual patients but varies among patients. The magnitude of this disparity is independent of the CEA level (above 15 ng/ml).