Stigma of Binge-Eating Disorder in Hong Kong Chinese Adults: Effects of Weight Status, Diagnostic Labeling, and Etiological Explanations.

OBJECTIVE: Binge-eating disorder (BED) is a strongly stigmatized condition and is often complicated by weight stigma. Research on the intersection between BED and weight stigma is scarce especially in Chinese populations. The present study examined BED stigma in Chinese, whether BED stigma was independent from weight stigma, and whether diagnostic labeling and etiological explanations influenced the degree of BED stigma. METHOD: Using a between-subject experimental vignette study, 642 participants (mean age = 29.74 years, SD = 11.34) were randomly assigned to read one of the 18 vignettes, describing a character with information on BED symptoms, weight status, diagnostic labeling, and etiological explanations, followed by measures of stigma and help-seeking intentions. RESULTS: The character with BED symptoms was ascribed more negative personality characteristics, elicited more negative affective reactions, and triggered greater desired social distance compared to the character without BED symptoms. No evidence for weight stigma was found nor for its interaction with BED stigma. The Cantonese diagnostic label of BED, kwong sik zing, was associated with lower levels of volitional stigma and greater help-seeking intentions than the diagnostic label of eating disorders, jam sik sat tiu, and the absence of labeling. The effect of etiological explanations was only significant in the univariate test, indicating that providing either a psychosocial or a biogenetic etiological explanation lessened the negative evaluations of personality characteristics. DISCUSSION: The present study provided first evidence for BED stigma in Chinese. BED stigma appeared to be attributable to the presence of disordered eating behavior rather than the BED diagnosis.

Daily Associations Between Sleep Parameters and Depressive Symptoms in Individuals with Insomnia: Investigating Emotional Reactivity and Regulation as Mediators.

OBJECTIVES: Previous research suggests that insomnia and depressive symptoms might be causally related. Emotional reactivity and regulation have been proposed to explain the potential causal relationship between insomnia and depression. However, longitudinal evaluations of their mediating effects are limited. Hence, the current study aimed to examine the mediating effects of emotional reactivity and regulation on the longitudinal associations between daily sleep parameters and depressive symptoms over 14 days in individuals with insomnia. METHODS: Participants were sixty adults aged 18-65 who had clinically significant insomnia. They filled out a survey each morning and evening and wore actigraphy watches for 14 consecutive days. The five sleep parameters were measured by sleep diary in the morning survey (subjective total sleep time, subjective sleep efficiency, and sleep quality) and actigraphy watches (objective total sleep time and objective sleep efficiency). Emotional reactivity and emotion regulation strategy use during the day were assessed in the evening survey using the International Positive and Negative Affect Schedule Short Form, Emotion Regulation Questionnaire, and Cognitive Emotion Regulation Questionnaire. Depressive symptoms of the day were evaluated in the evening survey with the Center for Epidemiologic Studies Depression Scale. RESULTS: Results showed that sleep quality and depressive symptoms, as well as actigraphy-measured sleep efficiency and depressive symptoms, predicted each other in individuals with insomnia, mediated by negative reactivity but not emotion regulation. CONCLUSIONS: The present findings support the mediating role of negative emotional reactivity in the bidirectional, daily relationship between sleep parameters and depression in individuals with insomnia.

Is Cognitive Behavioral Therapy for Insomnia Effective for Improving Sleep Duration in Individuals with Insomnia? A Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Accumulating evidence suggests that sleep duration is a critical determinant of physical and mental health. Half of the individuals with chronic insomnia report less than optimal sleep duration. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for reducing sleep difficulties in individuals with chronic insomnia. However, its effectiveness for increasing sleep duration is less well-established and a synthesis of these findings is lacking. PURPOSE: To provide a synthesis of findings from randomized controlled trials (RCTs) on the effect of CBT-I on subjective and objective total sleep time (TST). METHODS: A systematic search was performed on articles published from 2004 to 05/30/2021. A total of 43 RCTs were included in the meta-analysis. Publication biases were examined. Meta-regressions were conducted to examine if any sample or treatment characteristics moderated the effect sizes across trials. RESULTS: We found a small average effect of CBT-I on diary-assessed TST at post-treatment, equivalent to an approximately 30-min increase. Age significantly moderated the effects of CBT-I on diary-measured and polysomnography-measured TST; older ages were associated with smaller effect sizes. Contrarily, a negative, medium effect size was found for actigraphy-assessed TST, equivalent to an approximately 30-min decrease. Publication biases were found for diary data at follow-up assessments suggesting that positive findings were favored. CONCLUSIONS: CBT-I resulted in improvements in TST measured by sleep diaries and polysomnography (in adults). These improvements were not corroborated by actigraphy findings. Theoretical and clinical implications were discussed.

Chronic insomnia is a common sleep disorder and can be treated effectively with cognitive behavioral therapy for insomnia (CBT-I). Previous research has consistently shown that CBT-I can reduce sleep difficulties such as difficulty falling and maintaining sleep. The effects of CBT-I on increasing sleep duration are less consistent across studies. This meta-analysis reviewed 43 randomized controlled trials of CBT-I published between 01/01/2004 and 05/30/2021 and synthesized the findings of the effects of CBT-I on sleep duration, measured subjectively and objectively. We found that CBT-I increased sleep duration measured by sleep diaries and polysomnography by about 30 min at post-treatment. This effect is weaker in people with older ages. Contrarily, CBT-I is found to lead to a decrease in sleep duration for about 30 min when sleep duration is measured by actigraphy. The discrepant findings between different sleep measurements reinforce the notion that different measures of sleep assess different aspects of sleep, and that different sleep measurements may have different responsiveness to the treatment of insomnia. Additionally, most people do not achieve the recommended sleep duration at the end of CBT-I. Future studies are needed to evaluate interventions that can help individuals with insomnia increase and maintain optimal sleep duration.

Sleep Quality, Sleep-Related Experiences, and Dissociation in Adult Survivors of Childhood Trauma.

OBJECTIVES: Exposure to traumatic stress in childhood increases the risk of sleep disturbances. Preliminary evidence suggests that the relationship between childhood trauma and sleep may depend on trauma chronicity. Additionally, little is known about the relationship between sleep and dissociation, a common symptom in post-traumatic stress disorder. This study examined sleep quality, sleep-related experiences, and dissociation in survivors of childhood trauma with different trauma chronicity. METHOD: Nine-hundred-and-fourteen community-dwelling adults completed an online survey. They were divided into three groups: no childhood trauma, short-term childhood trauma, and chronic childhood trauma. RESULTS: We found that survivors of chronic childhood trauma had poorer sleep quality than survivors of short-term childhood trauma and individuals without a history of childhood trauma, controlling for age, number of trauma types experienced, psychological distress, and PTSD symptoms. The relationship between dissociation and sleep quality was moderated by trauma chronicity such that dissociation was associated with better sleep quality only in the chronic trauma group. Dissociation was positively associated with sleep-related experiences regardless of trauma exposure and trauma chronicity. CONCLUSION: Our findings highlighted the differential impact of acute and chronic traumatic stress on sleep, and suggested that the relationship between dissociation and sleep could depend on trauma chronicity.

Psychometric evaluation of the Hong Kong Chinese version of the Dissociative Experiences Measure, Oxford (HKC-DEMO).

The Dissociative Experiences Measure, Oxford (DEMO) is a recently developed measure that reflects the current conceptualization of dissociation. However, psychometric investigations of the DEMO are still limited. The current study examined the factor structure and psychometric properties of the Hong Kong Chinese version of the DEMO (HKC-DEMO). Online survey data on 914 community-dwelling adults in Hong Kong was extracted from a primary preregistered study on sleep and dissociation. Confirmatory factor analyses revealed that a five-factor structure, identified as "unreality," "numbness and disconnectedness," "memory blanks," "zoned out," and "vivid internal world," fit the data adequately. The five-factor structure fit significantly better than a four-factor structure, which combined "zoned out" and "vivid internal world" as a single factor of "absorption." Furthermore, the HKC-DEMO demonstrated excellent reliability, and satisfactory convergent, and divergent validity. The current study was the first to translate the DEMO to other language and showed that the HKC-DEMO is reliable and valid for use in Hong Kong Chinese adults. Further validation of the HKC-DEMO with a clinical sample and samples with a wider age range would enhance the generalizability of the HKC-DEMO.

Elevated Prevalence of Probable Insomnia among Young Men during Social Unrest in Hong Kong: A Population-Based Study.

OBJECTIVE/BACKGROUND: Hong Kong has experienced a series of major protests in 2019, leading to deteriorating population mental health. Few studies have documented the impact of social unrest on sleep health. The present study examined the prevalence of probable insomnia and its demographic correlates in a population-based random sample of Hong Kong adults. PARTICIPANTS AND METHODS: A population-based cross-sectional telephone survey on lifestyle behaviors was conducted during the period between July and September 2019. Data obtained from 1004 participants who completed the insomnia measure were analyzed. The Chinese version of the Patient-Reported Outcomes Information System (PROMIS) v1.0 Sleep Disturbance Short Form was used to measure insomnia. Logistic regressions were conducted to evaluate if prevalence estimates differed by demographic variables. RESULTS: The weighted prevalence of probable insomnia for the population was 20.7%, a nearly twofold increase compared to a prior population-based study in Hong Kong. A novel age by sex interaction was found (p = .046). Men had significantly greater odds of having probable insomnia than women in the 18-39 age group (M = 23.1 vs W = 16.5%), whereas women had greater odds of probable insomnia in the 40-59 (M = 14.8 vs W = 25.6%) and 60+ groups (M = 17.2 vs W = 25.2%). CONCLUSION: The present findings documented in a random population-based sample elevated prevalence of probable insomnia among Hong Kong adults, especially young men, during the social unrest in 2019. Easily accessible and scalable intervention is urgently needed to mitigate the potential impact of continued social unrest on deteriorating sleep health facing Hong Kong adults.

Daily Associations of Sleep Quality and Sleep Duration with Anxiety in Young Adults: The Moderating Effect of Alexithymia.

OBJECTIVES: The present study examined the daily, within-individual associations of anxiety with sleep quality and sleep duration and the moderating effects of alexithymia on these associations in community-dwelling young adults. It was hypothesized that daily anxiety and sleep parameters would be bidirectionally related and alexithymia would moderate these relationships. METHOD: Participants completed morning and evening diaries assessing daily anxiety and sleep parameters for 30 consecutive days. They also completed questionnaires assessing baseline sleep parameters, anxiety, and alexithymia. Multilevel modeling was used to evaluate the within-individual associations between daily anxiety and sleep parameters and whether between-individual differences in alexithymia moderated these associations. RESULTS: Higher anxiety relative to personal averages across the study period was associated with shorter sleep duration at night. Poorer sleep quality and shorter sleep duration relative to personal averages were associated with higher next-day anxiety. A significantly stronger association between poorer sleep quality and higher next-day anxiety was observed in individuals with higher levels of alexithymia. CONCLUSION: Daily anxiety and sleep quantity are bidirectionally associated within individuals in community-dwelling young adults. Poorer sleep quality was associated with higher next-day anxiety but not vice versa. Individuals with higher levels of alexithymia might be more vulnerable to the effects of poor sleep on next-day anxiety.

Sleep Discrepancy in a Randomized Controlled Trial of Brief Behavioral Therapy for Chronic Insomnia in Older Adults.

Background/Objective: Some older adults with insomnia experience sleep discrepancy, often characterized by greater subjective sleep difficulties and shorter subjective sleep duration than the estimates derived from objective measures. The present study examined whether a brief behavioral therapy for insomnia (BBTi) is efficacious for reducing sleep discrepancy in older adults. Methods: This study is a secondary analysis of a randomized controlled trial of BBTi for community dwelling older adults with chronic insomnia (N = 62). Thirty-two participants received BBTi, delivered in four individual face-to-face sessions. Thirty received the self-monitoring control (SMC). They all completed daily sleep diaries and wore an actigraph from baseline to posttreatment, and for 2 weeks at 3-month follow-up. Sleep discrepancy was calculated by subtracting diary from actigraphy estimates of sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Mixed modeling was used to analyze data. SOL discrepancy decreased significantly in BBTi participants compared to SMC participants. The decreases in SOL discrepancy were explained by changes in diary-assessed SOL and subjective sleep quality but not changes in actigraphy-assessed SOL. Although WASO discrepancy and TST discrepancy decreased from baseline to posttreatment and follow-up, the Time by Group interaction effects were not significant indicating that BBTi participants did not experience greater reductions in WASO discrepancy and TST discrepancy than SMC participants. In conclusion, BBTi is efficacious for reducing SOL discrepancy in older adults with chronic insomnia.

Dynamic daily associations between insomnia symptoms and alcohol use in adults with chronic pain.

Individuals with chronic pain are at risk for sleep disruption and heavy alcohol use, yet the daily associations between these behaviours are not well characterized. This study aimed to determine the extent to which alcohol use affects insomnia symptoms and vice versa in adults reporting symptoms of chronic pain. Participants were 73 individuals (93% women) reporting alcohol use in addition to symptoms of insomnia and chronic pain. They completed daily diaries assessing insomnia symptoms and alcohol use for 14 days. Multilevel modelling was used to evaluate the bidirectional associations between alcohol use and insomnia symptoms at the daily level. Consistent with laboratory-based research, alcohol use was associated with decreased sleep-onset latency the same night but increased sleep-onset latency 2 nights later. Specifically, for every alcoholic drink consumed, time to sleep onset decreased by 5.0 min in the same night but increased by 4.3 min 2 nights later. Alcohol use was not significantly associated with subsequent wake after sleep onset or total sleep time, and insomnia symptoms were not significantly associated with subsequent alcohol use. To our knowledge, these data provide the first evidence that alcohol use negatively affects insomnia symptoms up to 2 days post-consumption in patients reporting symptoms of insomnia and chronic pain. Findings suggest that one drink will have minimal impact on sleep, but heavier drinking (e.g. four-five drinks) may have a clinically significant impact (16-25-min increase in sleep-onset latency). Future studies may assess alcohol use as a point of intervention within this population.

Delay discounting and response disinhibition moderate associations between actigraphically measured sleep parameters and body mass index.

Previous research suggests that the sleep-obesity association varies significantly across individuals. This study examined the associations between actigraphically measured sleep parameters and body mass index and hypothesized that the associations would be stronger in individuals with greater delay discounting, the devaluation of future rewards and response disinhibition and the difficulty in withholding previously rewarded responses. Seventy-eight college students carried a wrist-worn actigraph and completed diaries reporting bedtime, wake time and covariates including physical activity, alcohol and caffeine consumption, daytime nap duration and perceived stress for 7 days and completed the delay discounting and go/no-go response disinhibition tasks. Their height and weight were measured. Only bedtime variability was significantly associated with body mass index in the main effect model controlling for all covariates (B = 0.03, P = 0.001). Delay discounting moderated associations of bedtime (B = 0.03, P < 0.001), sleep duration variability (B = 0.05, P = 0.002), bedtime variability (B = 0.03, P = 0.002) and wake time variability (B = 0.02, P < 0.001) with body mass index; these associations were significant only when the delay discounting rate was high. Response disinhibition moderated the association between bedtime variability and body mass index in a similar pattern (B = 0.01, P = 0.004). The findings suggest that, using actigraphy measures of sleep, circadian desynchrony rather than sleep duration is a risk factor for higher body mass index. The findings support the hypothesis that delay discounting and response disinhibition moderate the associations between sleep and body mass index. Delay discounting and response disinhibition might characterize individuals who are vulnerable to the influence of circadian desynchrony on weight.

Effects of sleep deprivation on food-related Pavlovian-instrumental transfer: a randomized crossover experiment.

Recent research suggests that insufficient sleep elevates the risk of obesity. Although the mechanisms underlying the relationship between insufficient sleep and obesity are not fully understood, preliminary evidence suggests that insufficient sleep may intensify habitual control of behavior, leading to greater cue-elicited food-seeking behavior that is insensitive to satiation. The present study tested this hypothesis using a within-individual, randomized, crossover experiment. Ninety-six adults underwent a one-night normal sleep duration (NSD) condition and a one-night total sleep deprivation (TSD) condition. They also completed the Pavlovian-instrumental transfer paradigm in which their instrumental responses for food in the presence and absence of conditioned cues were recorded. The sleep × cue × satiation interaction was significant, indicating that the enhancing effect of conditioned cues on food-seeking responses significantly differed across sleep × satiation conditions. However, this effect was observed in NSD but not TSD, and it disappeared after satiation. This finding contradicted the hypothesis but aligned with previous literature on the effect of sleep disruption on appetitive conditioning in animals-sleep disruption following learning impaired the expression of appetitive behavior. The present finding is the first evidence for the role of sleep in Pavlovian-instrumental transfer effects. Future research is needed to further disentangle how sleep influences motivational mechanisms underlying eating.

Development and evaluation of a Chinese short-form of the Sleep-related Behaviors Questionnaire in Hong Kong Chinese adults using item response theory.

Insomnia-related safety behaviors are behaviors that aim to mitigate the negative consequences of insomnia but inadvertently perpetuate insomnia. This study aimed to develop and evaluate a Chinese short-form of the sleep-related behavior questionnaire (SRBQ-SF), a self-report measure of insomnia-related safety behaviors, using item response theory. The Chinese version of the original SRBQ was completed by 536 Chinese-speaking adults with clinically significant insomnia. The automatic item selection procedure of the Mokken scaling analysis was used to develop and evaluate the SRBQ-SF. A 23-item SRBQ-SF consisting of a 14-item reduced engagement and avoidance subscale (SRBQ-REA) and a 9-item preoccupation with sleep subscale (SRBQ-PS) was derived. Classical test theory-based estimates showed that the SRBQ-REA and SRBQ-PS had good internal consistency and acceptable convergent and discriminant validities, and they were only weakly correlated with each other. We recommend the use of the SRBQ-REA and SRBQ-PS separately to assess two dimensions of safety behaviors in the study and treatment of insomnia in Chinese-speaking adults.

Assessing the Short-Term Efficacy of Digital Cognitive Behavioral Therapy for Insomnia With Different Types of Coaching: Randomized Controlled Comparative Trial.

BACKGROUND: Digital cognitive behavioral therapy for insomnia (dCBTi) is an effective intervention for treating insomnia. The findings regarding its efficacy compared to face-to-face cognitive behavioral therapy for insomnia are inconclusive but suggest that dCBTi might be inferior. The lack of human support and low treatment adherence are believed to be barriers to dCBTi achieving its optimal efficacy. However, there has yet to be a direct comparative trial of dCBTi with different types of coaching support. OBJECTIVE: This study examines whether adding chatbot-based and human coaching would improve the treatment efficacy of, and adherence to, dCBTi. METHODS: Overall, 129 participants (n=98, 76% women; age: mean 34.09, SD 12.05 y) whose scores on the Insomnia Severity Index [ISI] were greater than 9 were recruited. A randomized controlled comparative trial with 5 arms was conducted: dCBTi with chatbot-based coaching and therapist support (dCBTi-therapist), dCBTi with chatbot-based coaching and research assistant support, dCBTi with chatbot-based coaching only, dCBTi without any coaching, and digital sleep hygiene and self-monitoring control. Participants were blinded to the condition assignment and study hypotheses, and the outcomes were self-assessed using questionnaires administered on the web. The outcomes included measures of insomnia (the ISI and the Sleep Condition Indicator), mood disturbances, fatigue, daytime sleepiness, quality of life, dysfunctional beliefs about sleep, and sleep-related safety behaviors administered at baseline, after treatment, and at 4-week follow-up. Treatment adherence was measured by the completion of video sessions and sleep diaries. An intention-to-treat analysis was conducted. RESULTS: Significant condition-by-time interaction effects showed that dCBTi recipients, regardless of having any coaching, had greater improvements in insomnia measured by the Sleep Condition Indicator (P=.003; d=0.45) but not the ISI (P=.86; d=-0.28), depressive symptoms (P<.001; d=-0.62), anxiety (P=.01; d=-0.40), fatigue (P=.02; d=-0.35), dysfunctional beliefs about sleep (P<.001; d=-0.53), and safety behaviors related to sleep (P=.001; d=-0.50) than those who received digital sleep hygiene and self-monitoring control. The addition of chatbot-based coaching and human support did not improve treatment efficacy. However, adding human support promoted greater reductions in fatigue (P=.03; d=-0.33) and sleep-related safety behaviors (P=.05; d=-0.30) than dCBTi with chatbot-based coaching only at 4-week follow-up. dCBTi-therapist had the highest video and diary completion rates compared to other conditions (video: 16/25, 60% in dCBTi-therapist vs <3/21, <25% in dCBTi without any coaching), indicating greater treatment adherence. CONCLUSIONS: Our findings support the efficacy of dCBTi in treating insomnia, reducing thoughts and behaviors that perpetuate insomnia, reducing mood disturbances and fatigue, and improving quality of life. Adding chatbot-based coaching and human support did not significantly improve the efficacy of dCBTi after treatment. However, adding human support had incremental benefits on reducing fatigue and behaviors that could perpetuate insomnia, and hence may improve long-term efficacy. TRIAL REGISTRATION: ClinicalTrials.gov NCT05136638; https://www.clinicaltrials.gov/study/NCT05136638.

Pavlovian-instrumental transfer effects in individuals with binge eating.

BACKGROUND: The food addiction model of binge-eating postulates that hyperpalatable food can sensitize the reward processing system and lead to elevated cue-elicited motivational biases towards food, which eventually become habitual and compulsive. However, previous research on food reward conditioning in individuals with binge-eating is scarce. The present study examined the Pavlovian-instrumental transfer (PIT) effects in individuals with recurrent binge-eating. It was hypothesized that hyperpalatable food would elicit specific transfer effects, i.e., biased responding for the signaled food even after satiation on that food, and this effect would be stronger in individuals with binge-eating compared to healthy controls. METHODS: Fifty-one adults with recurrent binge-eating and 50 weight-matched healthy controls (mean age: 23.95 [SD = 5.62]; % female = 76.2%) completed the PIT paradigm with food rewards. Participants also completed measures of hunger, mood, impulsivity, response disinhibition, and working memory. Mixed ANOVAs were conducted to examine transfer effects and if they differed between individuals with binge-eating and those without. RESULTS: The group by cue interaction effect was not significant, suggesting that the specific transfer effect did not differ between groups. The main effect of cue was significant, indicating that the outcome-specific cue biased instrumental responding towards the signaled hyperpalatable food. However, the biased instrumental responding was attributable to suppressed responding in the presence of the cue predicting no reward, rather than enhanced responding in the presence of the specific food-predicting cues. CONCLUSIONS: The present findings did not support the hypothesis that individuals with binge-eating would be more vulnerable to specific transfer effects elicited by hyperpalatable food, as measured by the PIT paradigm.

Cues associated with food are known to increase one's motivation for food consumption. Such a tendency, if not diminished after satiation, may lead to excessive and compulsive food consumption. Hyperpalatable food, which refers to food high in fats, refined carbohydrates, sugar, and sodium, is believed to elevate food-consuming motivation and may lead to binge-eating behavior. Hence, the present study aimed to evaluate the effects of cues on people's motivation to seek signaled hyperpalatable food in those with or without recurrent binge-eating. Results showed that, although conditioned cues biased the choice of response towards the signaled food, this bias was due to suppressed responding in the presence of cues predicting no reward rather than increased responding in the presence of cues predicting the signaled reward. Notably, we did not find significant differences in this effect between people with binge-eating and those without, suggesting that the effects of cues on food-seeking motivation did not differ in people with recurrent binge-eating.

Advancing Nitinol: From heat treatment to surface functionalization for nickel-titanium (NiTi) instruments in endodontics.

Nickel-titanium (NiTi) alloy has been extensively researched in endodontics, particularly in cleaning and shaping the root canal system. Research advances have primarily focused on the design, shape, and geometry of the NiTi files as well as metallurgy and mechanical properties. So far, extensive investigations have been made surrounding surface and thermomechanical treatments, however, limited work has been done in the realm of surface functionalization to augment its performance in endodontics. This review summarizes the unique characteristics, current use, and latest developments in thermomechanically treated NiTi endodontic files. It discusses recent improvements in nano-engineering and the possibility of customizing the NiTi file surface for added functionalization. Whilst clinical translation of this technology has yet to be fully realized, future research direction will lie in the use of nanotechnology.

Efficacy and safety of ustekinumab in the treatment of moderate to severe plaque psoriasis in Singapore.

Introduction: Ustekinumab is a human monoclonal antibody that binds to the p40 subunit of both interleukin (IL)-12 and IL-23, and it is approved for the treatment of moderate to severe plaque psoriasis. In this study, we assessed the efficacy and safety of patients receiving ustekinumab for psoriasis. Methods: This retrospective study included all adults with chronic plaque psoriasis who were prescribed ustekinumab in a tertiary dermatologic centre between December 2009 and December 2015. Efficacy end points included a proportion of patients achieving at least 50% and 75% improvement from baseline psoriasis area and severity index (PASI) and body surface area (BSA) at Weeks 4 and 16. Results: A total of 99 patients were prescribed ustekinumab; 69% of these were Chinese, followed by 15% Indians and 9% Malays. 31 patients had documented PASI scores and 55 patients had documented BSA improvements. In patients with recorded PASI scores, 29 (93.5%) of 31 patients achieved PASI 50, and 21 (67.7%) of 31 achieved PASI 75 at week 16. In patients with recorded BSA, 43 (78.2%) of 55 had at least 50% BSA improvement, and 31 (56.4%) of 55 achieved 75% BSA improvement at 16 weeks. Regarding safety, no patient experienced tuberculosis reactivation. A total of 11 (11%) of 99 patients had latent tuberculosis infection and were treated with prophylactic isoniazid. No patient experienced serious adverse events. No cardiovascular events, cutaneous malignancies or deaths were reported over six years. Conclusion: Ustekinumab is safe and efficacious in the treatment of patients with moderate to severe plaque psoriasis in a multiethnic Asian population.

Daily associations between sleep and opioid use among adults with comorbid symptoms of insomnia and fibromyalgia.

STUDY OBJECTIVES: Disturbed sleep and use of opioid pain medication are common among individuals with chronic pain. Anecdotally, opioids are thought to promote sleep by relieving pain. This study aimed to determine whether opioid use is associated with daily sleep parameters (and vice versa) in adults with comorbid symptoms of insomnia and fibromyalgia. METHODS: Individuals reporting symptoms of insomnia and opioid use for fibromyalgia (n = 65, 93% women, 79% White) wore wrist actigraphy and completed daily diaries for 14 days (910 observations). Analyses examined daily associations between opioid dose (measured in lowest recommended dosage units) and three sleep parameters (actigraphy/self-reported total wake time and self-reported sleep quality). Multilevel models were used to account for the clustering of daily sleep and opioid assessments (level 1) within individuals (level 2). RESULTS: Opioid use did not have a significant daily effect on total wake time or sleep quality, and sleep parameters did not significantly impact opioid use the next day; however, participants reported worse sleep quality and greater doses of opioids on evenings that they experienced greater pain. CONCLUSIONS: Among adults reporting symptoms of insomnia and opioid use for fibromyalgia pain, opioid use is not reliably associated with wake time or sleep quality that night, and these sleep parameters are not significantly associated with opioid use the next day; however, evening pain has an adverse daily impact on both sleep quality and opioid use. Studies identifying strategies to prevent and manage fibromyalgia pain are needed, especially for individuals reporting comorbid insomnia and opioid use.

Telehealth cognitive behavioral therapy for insomnia in children with autism spectrum disorder: A pilot examining feasibility, satisfaction, and preliminary findings.

LAY ABSTRACT: Insomnia is common in children with autism. Cognitive behavioral treatment for childhood insomnia (CBT-CI) may improve sleep and functioning in children with autism and their parents, but typical delivery involving multiple office visits can make it difficult for some children to get this treatment. This pilot study tested telehealth delivery of CBT-CI using computers, which allowed children and their parents to get the treatment at home. This pilot shows therapists that parents and children were able to use telehealth CBT-CI to improve child and parent sleep, child behavior and arousal, and parent fatigue. Parents found telehealth CBT-CI helpful, age-appropriate, and autism-friendly. Telehealth CBT-CI holds promise for treating insomnia in school-aged children with autism and deserves further testing.

Corrigendum: Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol.

[This corrects the article DOI: 10.3389/fpubh.2021.625640.].