Highly pathogenic avian influenza A (H5N1) virus outbreak in Peru in 2022-2023.

Background: An epizootic of highly pathogenic avian influenza A (H5N1) has spread worldwide since 2022. Even though this virus has been extensively studied for many decades, little is known about its evolution in South America. Methods: Here, we describe the sequencing and characterization of 13 H5N1 genomes collected from wild birds, poultry, and wild mammals in Peru during the genomic surveillance of this outbreak. Results: The samples belonged to the highly pathogenic avian influenza (H5N1) 2.3.4.4b clade. Chilean and Peruvian samples clustered in the same group and therefore share a common ancestor. An analysis of the hemagglutinin and neuraminidase genes detected new mutations, some dependent upon the host type. Conclusions: The genomic surveillance of highly pathogenic avian influenza is necessary to promote the One Health policy and to overcome the new problems entailed by climate change, which may alter the habitats of resident and migratory birds.

The natural history of insomnia: evaluating illness severity from acute to chronic insomnia; is the first the worst?

STUDY OBJECTIVES: The 3P and 4P models represent illness severity over the course of insomnia disorder. The 3P model suggests that illness severity is worst during acute onset. The 4P model suggests that illness severity crescendos with chronicity. The present analysis from an archival dataset assesses illness severity with new onset illness (i.e. from good sleep [GS] to acute insomnia [AI] to chronic insomnia [CI]). Illness severity is quantified in terms of total wake time (TWT). METHODS: GSs (N = 934) were followed up to 1 year with digital sleep diaries, and classified as GS, AI, or CI. Data for CIs were anchored to the first of 14 days with insomnia so that day-to-day TWT was represented prior to and following AI onset. A similar graphic (+/-acute onset) was constructed for number of days per week with insomnia. GS data were temporally matched to CI data. Segmented linear mixed regression models were applied to examine the change in slopes in the AI-to-CI period compared to GS-to-AI period. RESULTS: Twenty-three individuals transitioned to AI and then CI. Average TWT rose during the first 2 weeks of AI onset (b = 1.8, SE = 0.57, p = 0.001) and was then stable for 3 months (b = -0.02, SE = 0.04, p = 0.53). Average number of affected days was stable from AI to CI (b = 0.0005, SE = 0.002, p = 0.81). That is, while there was week-to-week variability in the number of days affected, no linear trend was evident. CONCLUSIONS: In our sample of CIs, primarily with middle insomnia, the average severity and number of affected days were worst with the onset of AI (worst is first) and stable thereafter.

Learning Experiences of Future Healthcare Support Workers Enrolled in a Dual Mode Vocational Training Programme.

BACKGROUND: With life expectancy increasing, there is a growing need to train healthcare support workers who provide care for dependent people in healthcare centres and at home. This qualitative study, based on Gadamer's hermeneutic philosophy, aimed to understand the learning experiences of future healthcare support workers currently enrolled in an intermediate, dual modality vocational training programme with regard to caring for dependent people. METHODS: Convenience sampling was used to recruit the participants, who were all students enrolled in an intermediate level vocational training programme in care for dependent people. Fourteen in-depth interviews and one focus group session were conducted with the students. Atlas.ti 8.0 software was used to analyse the participants' accounts. RESULTS: The students highlighted the vocational nature of their studies and the need to feel competent and useful as a healthcare support worker for dependent people. Practice-based learning and the need for training in core competences are complementary and essential elements of the training process. CONCLUSIONS: The participants' previous experiences were key in determining their academic trajectory and reflect their motivation and interest to learn. However, they feel vulnerable, unprotected, and lack training in psychosocial skills. Educational institutions should focus training programmes on the practice and development of psychosocial skills that motivate students to acquire transversal competences.

The Assessment of Post-COVID Fatigue and Its Relationship to the Severity and Duration of Acute COVID Illness.

Emerging data suggests that COVID-19 is associated with fatigue well beyond the acute illness period. The present analysis aimed to: (1) characterize the prevalence and incidence of high fatigue at baseline and follow-up; (2) examine the impact of COVID-19 diagnosis on fatigue level following acute illness; and (3) examine the impact of acute COVID-19 symptom severity and duration on fatigue at follow-up. Subjects (n = 1417; 81.0% female; 83.3% White; X¯age = 43.6 years) completed the PROMIS-Fatigue during the initial wave of the pandemic at baseline (April-June 2020) and 9-month follow-up (January-March 2021). A generalized linear model (binomial distribution) was used to examine whether COVID-19 positivity, severity, and duration were associated with higher fatigue level at follow-up. Prevalence of high fatigue at baseline was 21.88% and 22.16% at follow-up, with 8.12% new cases at follow-up. Testing positive for COVID-19 was significantly associated with higher fatigue at follow-up. COVID-19 symptom duration and severity were significantly associated with increased fatigue at follow-up. COVID-19 symptom duration and severity during acute illness may precipitate longer-term fatigue, which could have implications for treatment planning and future research. Future studies should further evaluate the relationship between symptom severity, duration, and fatigue.

A peer-based mentoring program for reducing anxiety and depression symptoms among college students: A preliminary study.

Objective: The study evaluated the feasibility and acceptability, as well as conducted an initial test of effectiveness, of a peer-based mentoring program for mental health problems among college students. Participants: Thirty-two undergraduate students from a University in the southern part of the United States who exhibited moderate depression or anxiety symptoms were assessed. The participants were primarily white and in their freshman year. Methods: Participants were randomized into two groups. Participants in the intervention group met with a trained peer mentor once a week for four weeks, while participants in the control group were placed on a waitlist. All participants completed pre- and post-treatment surveys to assess anxiety and depression symptoms. Results: The data indicated that participants in the intervention group had significantly greater post-treatment reductions in depression symptoms. Conclusion: These findings provide preliminary support for the use of peer-based mentoring programs in treating mental health problems on college campuses.

Insomnia symptoms predict longer COVID-19 symptom duration.

OBJECTIVE: /Background: The goal of the present study was to assess the prevalence and incidence of insomnia in the United States during the COVID-19 pandemic, and whether, among those that contracted COVID-19, insomnia predicted worse outcomes (e.g., symptoms of greater frequency, duration, or severity). METHODS: A nationwide sample of 2980 adults living in the United States were surveyed online at two points during the COVID-19 pandemic (T1 = April-June 2020; T2 = January-March 2021). Insomnia symptoms were assessed at both time points using the Insomnia Severity Index (ISI). The T2 survey also asked questions regarding COVID-19 testing and symptoms. RESULTS: The prevalence of insomnia (defined as ISI ≥15) was 15% at T1 and 13% at T2. The incidence rate of insomnia (i.e., new cases from T1 to T2) was 5.6%. Participants with insomnia were not more likely to contract COVID-19 relative to those participants without insomnia. Among those participants in our sample that contracted the virus during the study interval (n = 149), there were no significant group differences in COVID-19 symptom outcomes, with one exception, participants with insomnia were more likely to report a longer symptom duration (insomnia = 24.8 sick days, no insomnia = 16.1 sick days). CONCLUSIONS: The present study suggests the prevalence of insomnia in the U.S. population remained high during the COVID-19 pandemic. The data also support that insomnia may be related to experiencing more chronic COVID-19 symptoms. These findings have more general implications for the role of sleep and insomnia on immune functioning.

Sleep Continuity, Sleep Related Daytime Dysfunction, and Problem Endorsement: Do These Vary Concordantly by Age?

OBJECTIVES: Sleep continuity (i.e., ability to initiate and/or maintain sleep) worsens with age. It is unclear whether problem endorsement and/or daytime dysfunction show similar age-related trends. Accordingly, a large archival dataset was used to examine age differences in sleep continuity, problem endorsement, and sleep related daytime dysfunction. METHOD: Participants were categorized as: Young Adults (18-29 years); Adults (30-44 years); Middle Aged Adults (45-64 years); and Older Adults (65-89 years). Young Adults, Adults, and Middle Aged Adults were 1:1 matched with Older Adults (n = 233) on the basis of gender, race, ethnicity, and BMI. MANOVA, ANOVAs, and chi-square analysis were performed to assess for age-related differences. RESULTS: In a sample of 932 adults with self-reported sleep continuity disturbance (i.e., insomnia), sleep continuity was significantly worse in older age groups. This effect was limited to middle and late insomnia with middle aged and older adults waking up with greater frequency and for longer durations of time during the night and in the early morning than younger cohorts. Problem endorsement largely increased across age groups (except for sleep latency) but reports of overall sleep-related daytime dysfunction showed no difference by age. CONCLUSION: When evaluating sleep continuity disturbance, assessing whether the patient identifies their sleep continuity disturbance as a problem and whether it affects their daytime function can be informative, particularly in older adults. It may serve to reveal (case-by-case) when there are discordances between incidence/severity of illness and problem endorsement/daytime dysfunction. Such information may better inform if treatment should be initiated.

The Hierarchical Taxonomy of Psychopathology (HiTOP) Is Not an Improvement Over the DSM.

In their response to our article (both in this issue), DeYoung and colleagues did not sufficiently address three fundamental flaws with the Hierarchical Taxonomy of Psychopathology (HiTOP). First, HiTOP was created using a simple-structure factor-analytic approach, which does not adequately represent the dimensional space of the symptoms of psychopathology. Consequently, HiTOP is not the empirical structure of psychopathology. Second, factor analysis and dimensional ratings do not fix the problems inherent to descriptive (folk) classification; self-reported symptoms are still the basis on which clinical judgments about people are made. Finally, HiTOP is not ready to use in real-world clinical settings. There is currently no empirical evidence demonstrating that clinicians who use HiTOP have better clinical outcomes than those who use the Diagnostic and Statistical Manual of Mental Disorders (DSM). In sum, HiTOP is a factor-analytic variation of the DSM that does not get the field closer to a more valid and useful taxonomy.

The natural history of insomnia: high sleep reactivity interacts with greater life stress to predict the onset of acute insomnia.

STUDY OBJECTIVES: Prior research suggests that some individuals have a predisposition to experience insomnia following acute stressors (i.e. sleep reactivity). The present study was a proof of concept and specifically aimed to provide additional empirical evidence that the link between stressful life events and the onset of acute insomnia is moderated by sleep reactivity. METHODS: About 1,225 adults with a history of good sleep (Mage = 53.2 years, 68% female, 83% white) were recruited nationwide for an online study on sleep health. Participants completed surveys to assess sleep reactivity (baseline), sleep patterns (daily sleep diary), and stressful life events (weekly survey). All daily and weekly measures were completed for a one-year period. Sleep diary data were used to identify sleep initiation/maintenance difficulties, including whether they met criteria for acute insomnia at any point during the one-year interval. RESULTS: Participants with high sleep reactivity compared to low sleep reactivity were at 76% increased odds of developing acute insomnia during the one-year interval. In general, greater weekly stressful life events were associated with greater insomnia during the subsequent week. Those participants with high sleep reactivity demonstrated a stronger relationship between weekly stressful life events and insomnia, such that they reported the greatest levels of insomnia following weeks where they experienced a greater number of stressful life events. CONCLUSIONS: These results further support the sleep reactivity model of insomnia, and specifically, provide evidence that sleep reactivity predicts the incidence of acute insomnia in a sample of participants with no history of insomnia.

Folk Classification and Factor Rotations: Whales, Sharks, and the Problems With the Hierarchical Taxonomy of Psychopathology (HiTOP).

The Hierarchical Taxonomy of Psychopathology (HiTOP) uses factor analysis to group people with similar self-reported symptoms (i.e., like-goes-with-like). It is hailed as a significant improvement over other diagnostic taxonomies. However, the purported advantages and fundamental assumptions of HiTOP have received little, if any scientific scrutiny. We critically evaluated five fundamental claims about HiTOP. We conclude that HiTOP does not demonstrate a high degree of verisimilitude and has the potential to hinder progress on understanding the etiology of psychopathology. It does not lend itself to theory-building or taxonomic evolution, and it cannot account for multifinality, equifinality, or developmental and etiological processes. In its current form, HiTOP is not ready to use in clinical settings and may result in algorithmic bias against underrepresented groups. We recommend a bifurcation strategy moving forward in which the DSM is used in clinical settings while researchers focus on developing a falsifiable theory-based classification system.

We know CBT-I works, now what?

Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be efficacious and now is considered the first-line treatment for insomnia for both uncomplicated insomnia and insomnia that occurs comorbidly with other chronic disorders (comorbid insomnia). The purposes of this review are to provide a comprehensive summary of the efficacy data (for example, efficacy overall and by clinical and demographic considerations and by CBT-I formulation) and to discuss the future of CBT-I (for example, what next steps should be taken in terms of research, dissemination, implementation, and practice).

Insomnia Severity and Degree of Dysfunction: What Is to Be Learned When These Domains are Discordant?

OBJECTIVE/BACKGROUND: Illness severity and resultant dysfunction are often linearly related and tightly coupled (concordant). Some percentage of individuals, however, exhibit discordant associations (high illness severity and low dysfunction [HL] or low illness severity and high dysfunction [LH]). In the present study, a sample of subjects with insomnia complaints were evaluated to determine what percentage of subjects exhibited discordant associations. PARTICIPANTS: Archival data were drawn from a community-based sample (n = 4,680; 61.8% female; Ages 18-105). METHODS: Median splits were calculated for illness severity and daytime dysfunction and each individual was typed as High (H) or Low (L) for the concordant (HH and LL) and discordant domains (HL and LH). RESULTS: Given this typology, 61% were classified as concordant and 39% were classified as discordant. Of these, 38% were sub-typed as HH, 23% as LL, 26% as LH, and 13% as HL. CONCLUSIONS: We propose that some of the discordance may be ascribable to a mismatch between sleep need and sleep ability. Those "who need a lot, may suffer a lot, in the face of only a little (LH)", whereas those "who need a little, may suffer only a little, in the face of a lot (HL)".

Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer.

Cognitive Behavioral Therapy for Insomnia (CBT-I) is a multi-component treatment for insomnia that targets difficulties with initiating and/or maintaining sleep and is delivered over the course of six to eight sessions. The primary focus of CBT-I is to address the perpetuating factors (according to the three-factor model of insomnia) that contribute to the development of chronic insomnia. Chronic insomnia is the most prevalent sleep disorder, occurring in approximately 6-10% of the population, and is a risk factor for multiple medical and psychiatric disorders. Despite its prevalence and morbidity, the widespread dissemination of CBT-I is not commensurate with insomnia's overall public health impact. This is particularly surprising given its large evidence base and recent recommendation as the first line intervention for insomnia. The primary goal of this article is to provide a primer or brief introduction to CBT-I that is intended to be accessible to all clinicians and researchers, including non-sleep experts. Core components of CBT-I (i.e., Sleep Restriction Therapy, Stimulus Control Therapy, Sleep Hygiene, and Cognitive Therapy), relapse prevention strategies, multicultural considerations, adjuvants to traditional interventions, treatment adherence issues, efficacy, and further training options are described. A session-by-session outline is also provided.

Tiempo de aislamiento y periodo infeccioso en pacientes con covid 19 hospitalizados / Isolation time and infectious period in patients with covid 19 hospitalized

RESUMEN: Se revisan las recomendaciones actuales de aislamiento y los criterios que se deben conocer para considerar a los pacientes que cursan con COVID, como potencialmente contagiosos. Se debe continuar utilizando las tasas de transmisión y seguir las recomendaciones de control y prevención de infecciones de los CDC para entornos de atención médica. El aislamiento ayuda a prevenir la transmisión del virus al separar a las personas infectadas con el virus de las que no lo están. Es básico por lo tanto discriminar esas situaciones clínicas y tener claros los criterios laboratoriales para tomar decisiones respecto al tiempo de aislamiento de los pacientes. Considerando la exposición del personal de salud y los pacientes hospitalizados se concluye que no necesaria la cuarentena para los asintomáticos que están al día con todas las dosis recomendadas de la vacuna contra el COVID-19 o que se han recuperado de la infección por SARS-CoV-2 en los 90 días anteriores, las posibles excepciones y el grupo de pacientes que deben someterse a pruebas, se describen en el desarrollo de este artículo.

ABSTRACT: It reviews the current isolation recommendations and the criteria that must be known to consider patients who are with COVID, as potentially contagious. Transmission rates should continue to be used and CDC infection prevention and control recommendations for health care settings should be followed. Isolation helps prevent transmission of the virus by separating people infected with the virus from those who are not. It is therefore essential to discriminate these clinical situations and to be clear about the laboratory criteria to make decisions regarding the isolation time of patients. Considering the exposure of health personnel and hospitalized patients; it is concluded that quarantine is not necessary for asymptomatic patients who are up to date with all recommended doses of COVID-19 vaccine or who have recovered from SARS-CoV-2 infection in the previous 90 days, possible exceptions and the group of patients to be tested, are described in the development of this article.

Measuring the Effects of Social Isolation and Dissatisfaction on Depressive Symptoms during the COVID-19 Pandemic: The Moderating Role of Sleep and Physical Activity.

Social distancing was universally implemented to reduce the spread of the COVID-19 virus. Long-term social distancing can lead to increased feelings of social isolation or dissatisfaction with one's daily interpersonal interactions, which can subsequently result in reduced psychological health (e.g., greater depression). The present study quantified this association, and the extent to which it was moderated by measures of sleep and physical activity, by surveying 3658 adults (mean age = 46.0 years) from across the United States. Participants answered questions related to their social experiences, sleep, physical activity, and depressive symptoms during the early stages of the pandemic (March-June 2020). Results showed that social isolation and social dissatisfaction were associated with greater depressive symptoms. As predicted, self-reported sleep quality and physical activity moderated these associations, such that lower sleep quality and physical activity exacerbated their effect on depressive symptoms.

Durability of treatment response to zolpidem using a partial reinforcement regimen: does this strategy require priming?

BACKGROUND: Previous research has shown that after one month of full dose nightly treatment with zolpidem (priming), subjects with chronic insomnia (CI) switched to intermittent dosing with medication and placebos were able to maintain their treatment responses. This approach to maintenance therapy is referred to as partial reinforcement. The present study sought to assess whether priming is required for partial reinforcement or whether intermittent dosing with placebos (50% placebos and 50% active medication) can, by itself, be used for both acute and extended treatment. METHOD: 55 CI subjects underwent a baseline evaluation (Phase-1) and then were randomized to one of two conditions in Phase-2 of the study: one month of (1) nightly medication use with standard-dose zolpidem (QHS [n = 39]) or (2) intermittent dosing with standard-dose zolpidem and placebos (IDwP [n = 16]). In Phase-3 (three months), the QHS group was re-randomized to either continued QHS full dose treatment (FD/FD) or to IDwP dose treatment (FD/VD). Treatment response rates and Total Wake Time (TWT = [SL + WASO + EMA]) were assessed during each phase of the study. RESULTS: In Phase-2, 77% (QHS) and 50% (IDwP) subjects exhibited treatment responses (p = 0.09) where the average change in TWT was similar. In Phase-3, 73% (FD/FD), 57% (FD/VD), and 88% (VD/VD) of subjects exhibited continued treatment responses (p = 0.22) where the average improvement in TWT continued with FD/FD and remained stable for FD/VD and VD/VD (p < 0.01). CONCLUSION: These results suggest that intermittent dosing with placebos can maintain effects but do not allow for the additional clinical gains afforded by continuous treatment.

The natural history of insomnia: Does sleep extension differentiate between those that do and do not develop chronic insomnia?

According to the "3P model" of insomnia, the variable that mediates the transition from acute insomnia (AI) to chronic insomnia is "sleep extension" (the behavioural tendency to expand sleep opportunity to compensate for sleep loss). In the present analysis, we sought to evaluate how time in bed (TIB) varies relative to the new onset of AI and chronic insomnia. A total of 1,248 subjects were recruited as good sleepers (GS). Subjects were monitored over 1 year with sleep diaries. State transitions were defined, a priori, for AI, recovered from AI (AI-REC), and for chronic insomnia (AI-CI). Two additional groupings were added based on profiles that were unanticipated: subjects that exhibited persistent poor sleep following AI (AI-PPS [those that neither recovered or developed chronic insomnia]) and subjects that recovered from chronic insomnia (CI-REC). All the groups (GS, AI-REC, AI-CI, AI-PPS and CI-REC) were evaluated for TIB differences with longitudinal mixed effects models. Post hoc analyses for the percentage of the groups that were typed as TIB "restrictors, maintainers, and expanders" were conducted using longitudinal mixed effects models and contingency analyses. Significant differences for pre-post AI TIB were not detected for the insomnia groups. Trends were apparent for the AI-CI group, which suggested that minor increases in TIB occurred weeks before the declared onset of AI. Additionally, it was found that a significantly larger percentage of AI-CI subjects engaged in sleep extension (as compared to GS). The present data suggest that transition from AI to chronic insomnia does not appear to be initiated by sleep extension and the transition may occur before the elapse of 3 months of ≥3 nights of sleep continuity disturbance. Given these findings, it may be that the mismatch between sleep ability and sleep opportunity is perpetuated over time given the failure to "naturally" engage in sleep restriction (as opposed to sleep extension).

Early life stress sensitizes youth to the influence of stress-induced cortisol on memory for affective words.

Early life stress (ELS) is a well-established risk factor for psychopathology across the lifespan. Cognitive vulnerability to stress-induced cortisol may explain risk and resilience. The current study aimed to elucidate a psychobiological pathway linking stress to altered memory for affective words among youth with and without exposure to ELS. One hundred and fifteen youth (ages 9-16, 47% female) were randomized either to a psychosocial stressor or a control condition. Immediately following the stress or control condition, participants completed a memory task for affective words. Change in salivary cortisol from immediately before to 25 min after stress onset were used to predict memory for affective words. Exposure to the acute laboratory stressor led to activation of the HPA axis. Greater cortisol reactivity was associated with less accurate recognition of negative valence words. Among youth exposed to ELS, greater cortisol reactivity to acute stress was associated with poorer recognition of dysphoric and neutral words. Acute increases in cortisol may interfere with negatively-valenced information processing that has implications for memory. Youth exposed to high ELS may be particularly vulnerable to the effects of cortisol, which may explain one pathway through which stress leads to psychopathology among at-risk youth.

Saccadic Eye Movements Attenuate Postural Sway but Less in Sleep-Deprived Young Adults.

Sleep deprivation affects the performance of postural control and several other aspects related to attentional mechanisms that may alter sensory cue acquisition strategies. This study aimed to examine the possible effects of horizontal saccades and ocular fixation on a target in the performance of postural control in young adults with sleep deprivation. Twenty-six adults formed two groups, tested in two evaluations. In the first evaluation, participants slept normally on the night before. In the second evaluation, 13 participants were sleep deprived (SD) and 13 slept normally (control group [CG]) on the night before. In both evaluations, each participant stood upright as still as possible, in two experimental conditions: fixating the eye on a target and performing saccadic movement toward a target presented in two different locations (0.5 Hz). Each participant performed 3 trials in each condition, lasting 62 s each. Body oscillation was obtained in both anterior-posterior and medial-lateral directions. Results showed that SD participants swayed with a larger magnitude and higher velocity after sleep deprivation in the fixation condition. In the saccadic condition, body sway magnitude and velocity were reduced but were still larger/higher in the SD participants. Sleep deprivation deteriorates the performance of postural control. Saccadic eye movements improve postural control performance even in sleep-deprived participants but are still not sufficient to avoid postural control deterioration due to sleep deprivation.