Self-help treatment for insomnia symptoms associated with chronic conditions in older adults: a randomized controlled trial.

OBJECTIVES: To evaluate the effectiveness of a self-help cognitive behavioral intervention in improving sleep quality in older adults reporting insomnia symptoms associated with chronic disease. DESIGN: A pragmatic two-arm randomized controlled trial comparing supported self-help with treatment as usual (TAU). SETTING: Primary care. PARTICIPANTS: One hundred ninety-three self-referred individuals aged 55 to 87 with long-term conditions and chronic insomnia symptoms (as defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). INTERVENTION: Self-help participants received six consecutive booklets, at weekly intervals, providing structured advice on important components of cognitive behavioral therapy for insomnia (CBT-I, including self-monitoring, sleep restriction, stimulus control procedures, and cognitive strategies), plus access to a telephone helpline. Control group participants received a single sheet of advice detailing standard sleep hygiene measures. MEASUREMENTS: The primary outcome was sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes were the Insomnia Severity Index (ISI), the subjective sleep efficiency index, and the Fatigue Severity Scale. RESULTS: In the self-help group, sleep outcomes showed significant improvements after treatment (PSQI, P < .001; ISI, P < .001; sleep efficiency, P < .001) and at 3-month (PSQI, P = .002; ISI, P = .006; sleep efficiency, P = .001) and 6-month (PSQI, P = .003; ISI, P = .003; sleep efficiency, P = .001) follow-up. Effect sizes were moderate (range of adjusted Cohen d = 0.51-0.75). Treatment had no effect on levels of daytime fatigue. Most treated participants (73%) said they would recommend the self-help program to others. CONCLUSION: Self-help CBT-I offers a practical first-line response to individual reporting insomnia symptoms associated with chronic disease in primary care settings. In these individuals, symptoms of daytime fatigue may be more closely associated with disease processes than with sleep quality.

Improving sleep management in people with Parkinson's.

This article considers the practicality and patient benefits of transferring evidence-based sleep management skills to community health professionals. Sleep disturbances are among the most frequently reported and poorly managed non-motor symptoms in Parkinson's. But, despite their prevalence, sleep problems in Parkinson's are often under-recognized, under-diagnosed and inadequately treated. To raise awareness and improve patient care in Parkinson's, a three-day sleep management course was developed for Parkinson's disease nurse specialists (PDNSs) practising within NHS Scotland. The course aimed to transfer skills in health education as applied to sleep and insomnia; the assessment of sleep; the practice of sleep hygiene; delivering relaxation methods; the use of stimulus control and sleep restriction procedures; and cognitive approaches to insomnia management. Between June 2010 and July 2011, 38 PDNSs and practising occupational therapists undertook the course. Interviews and evaluations with patients and professionals were carried out afterwards. Patients reported a reduction in anxiety over sleep problems, feeling able to manage their sleep, and having a sense of control over their sleep. Programme outcomes suggest that the training model used is feasible and practical; the resources designed for clinical use are practical and relevant; and that the initiative as a whole represents a valid and affordable investment in patient wellbeing.

The extinction context enables extinction performance after a change in context.

One experiment with human participants determined the extent to which recovery of extinguished responding with a context switch was due to a failure to retrieve contextually controlled learning, or some other process such as participants learning that context changes signal reversals in the meaning of stimulus-outcome relationships. In a video game, participants learned to suppress mouse clicking in the presence of a stimulus that predicted an attack. Then, that stimulus underwent extinction in a different context (environment within the game). Following extinction, suppression was recovered and then extinguished again during testing in the conditioning context. In a final test, participants that were tested in the context where extinction first took place showed less of a recovery than those tested in a neutral context, but they showed a recovery of suppression nevertheless. A change in context tended to cause a change in the meaning of the stimulus, leading to recovery in both the neutral and extinction contexts. The extinction context attenuated that recovery, perhaps by enabling retrieval of the learning that took place in extinction. Recovery outside an extinction context is due to a failure of the context to enable the learning acquired during extinction, but only in part.

Conditional immune-gene suppression of honeybees parasitized by Varroa mites.

The ectoparasitic mite, Varroa destructor, is the most destructive parasite of managed honeybee colonies worldwide. Since V. destructor transfers pathogens to honeybees, it may be adaptive for bees to respond to mite infestation by upregulating their immune responses. Mites, however, may overcome the host's immune responses by suppressing them, which could facilitate the mite's ability to feed on hemolymph. A humoral immune response of bees parasitized by V. destructor may be detected by studying the expression levels of antibacterial peptides, such as abaecin and defensin, known to be immune-responsive. Expression levels for these two antibacterial peptides changed non-linearly with respect to the number of mites parasitizing honeybee pupae. Bees exposed to low or moderate number of mites had fewer immune-related transcripts than pupae that were never parasitized or pupae with high mite loads. Although many of the pupae tested indicated the presence of bacteria, no correlation with mite numbers or immune-response levels existed. All bees tested negative for acute paralysis and Kashmir bee viruses known to be vectored by V. destructor.

CONSPECIFIC SPERM PRECEDENCE IS AN EFFECTIVE BARRIER TO HYBRIDIZATION BETWEEN CLOSELY RELATED SPECIES.

Conspecific sperm precedence is widespread in animals, appears to evolve rapidly, and is thought to have the potential to prevent hybridization between closely related species. However, to date no study has tested the isolating potential of such a barrier in mixed populations of two taxa under conditions in which other potential barriers to gene flow are controlled for or are prevented from operating. We tested the isolating potential of conspecific sperm precedence in the ground crickets Allonemobius fasciatus and A. socius in population cage experiments in which the frequency of the two species was varied. Despite the observation of abundant interspecific matings, the proportions of hybrid progeny were low and differed statistically from the proportions expected in the absence of conspecific sperm precedence. The results demonstrate that conspecific sperm precedence can severely limit gene flow between closely related species, even when one species is less abundant than the other.

A POSTINSEMINATION BARRIER TO FERTILIZATION ISOLATES TWO CLOSELY RELATED GROUND CRICKETS.

Postinsemination barriers to fertilization generally have been ignored by biologists interested in the origin and nature of reproductive isolation among closely related terrestrial animals. Yet evidence presented in this paper indicates that such a barrier bears primary responsibility for the reproductive isolation between the ground crickets Allonemobius fasciatus and Allonemobius socius. Postinsemination barriers to fertilization may isolate many other terrestrial animals as well, but the design of most laboratory hybridization experiments precludes the detection of these barriers.

SURVIVAL OF HYBRIDS IN A MOSAIC HYBRID ZONE.

The ground crickets Allonemobius fasciatus and A. socius meet in a mosaic hybrid zone that stretches from New Jersey at least as far west as Illinois. Within mixed populations from the contact zone, "pure" species individuals predominate. To determine whether hybrids are less viable than pure-species individuals, and to assess whether the high proportion of pure-species individuals in mixed populations results from hybrid inviability, we performed a cohort analysis. In this study, five mixed populations from the hybrid zone were each sampled three to five times from the fall of 1986 to the spring of 1988. Individuals were assigned to one of three categories based on their genotypes: A. socius (individuals harboring only alleles unique to A. socius), hybrid (individuals with alleles unique to both species), and A. fasciatus (individuals harboring only alleles unique to A. fasciatus). This sampling and measurement scheme permitted monitoring of the proportion of hybrid individuals in a population over time. The results were fairly consistent. The relative survival of A. socius was greater than the relative survival of members of the other two groups in four of the five populations. The relative viability of A. fasciatus was greater than that of hybrids in one population, approximately equal to that of hybrids in two populations, and less than that of hybrids in two populations. These results not only shed light on an important component of fitness, viability from hatching to adulthood, but they demonstrate that loss of hybrid individuals during the course of the field season will not explain deviations from random mating expectations present in mixed populations in late summer. The deviations must be due to assortative mating or to a reproductive barrier operating prior to egg hatch.