Assessing the feasibility and acceptability of a cluster-randomized study of cognitive behavioral therapy for chronic insomnia in a primary care setting.

BACKGROUND: Cognitive behavioral therapy for chronic insomnia (CBT-i) is the treatment of choice for this condition but is underutilized in patients who attend primary care. The purpose of the present feasibility-pilot study was to assess the feasibility and acceptability of a cluster-randomized study of CBT-i in a primary care setting. METHODS: This study, performed at two primary health care centers in Majorca, Spain, was a mixed methods feasibility-pilot study of a parallel cluster-randomized design comparing CBT-i and usual care (UC). Patients were included if they were 18 to 65 years-old; had diagnoses of chronic insomnia according to the Insomnia Severity Index (ISI ≥ 8); had insomnia for more than 3 months. Twenty-five GPs and nurses and 32 patients were randomly allocated to two groups. The main outcome of the intervention was improvement of dimensions of sleep quality, measured using the Spanish version of the Pittsburgh Sleep Quality Index, at baseline and at 3 months after the intervention. Other primary outcomes of the study were the feasibility and applicability of the intervention, collected through nominal groups. A thematic analysis was performed to classify primary care provider (PCP) proposals. Additionally, we assessed the recruitment process, compliance with the intervention sessions, and patient retention. RESULTS: We adapted the CBT-i approach of Morin to a primary care context. After intervention training, PCPs expressed the need for more extensive training in the different aspects of the therapy and the discussion of more cases. PCPs considered the intervention as adequate but wanted fewer but longer sessions as well as to discard the cognitive restructuring component. PCPs considered it crucial to prepare each session in advance and to establish a specific agenda for the CBT-i. Regular reminders given to PCPs and patients were suggested to improve study participation. Compared to the UC group, higher proportions of patients in the intervention group had short sleep latency, slept for longer than 5 h, and had fewer sleep disruptions. CONCLUSIONS: This feasibility-pilot study identified several key issues that must be addressed before performing a CBT-i intervention in future clinical trial in a primary care setting. TRIAL REGISTRATION: NCT04565223 . (Clinical trials.gov) Registered 1 September 2020-Retrospectively registered.

Draft genome of Streptomyces tsukubaensis NRRL 18488, the producer of the clinically important immunosuppressant tacrolimus (FK506).

The macrocyclic polyketide tacrolimus (FK506) is a potent immunosuppressant that prevents T-cell proliferation produced solely by Streptomyces species. We report here the first draft genome sequence of a true FK506 producer, Streptomyces tsukubaensis NRRL 18488, the first tacrolimus-producing strain that was isolated and that contains the full tacrolimus biosynthesis gene cluster.

Lymantria dispar (L.) (Lepidoptera: Erebidae): Current Status of Biology, Ecology, and Management in Europe with Notes from North America.

The European Spongy moth, Lymantria dispar (L.) (Lepidoptera: Erebidae), is an abundant species found in oak woods in Central and Southern Europe, the Near East, and North Africa and is an important economic pest. It is a voracious eater and can completely defoliate entire trees; repeated severe defoliation can add to other stresses, such as weather extremes or human activities. Lymantria dispar is most destructive in its larval stage (caterpillars), stripping away foliage from a broad variety of trees (>500 species). Caterpillar infestation is an underestimated problem; medical literature reports that established populations of caterpillars may cause health problems to people and animals. Inflammatory reactions may occur in most individuals after exposure to setae, independent of previous exposure. Currently, chemical and mechanical methods, natural predators, and silvicultural practices are included for the control of this species. Various insecticides have been used for its control, often through aerial sprayings, which negatively affect biodiversity, frequently fail, and are inappropriate for urban/recreational areas. However, bioinsecticides based on various microorganisms (e.g., entomopathogenic viruses, bacteria, and fungi) as well as technologies such as mating disruption using sex pheromone traps have replaced insecticides for the management of L. dispar.

Characterisation of a γ-butyrolactone receptor of Streptomyces tacrolimicus: effect on sporulation and tacrolimus biosynthesis.

Streptomyces tacrolimicus (ATCC 55098) was reported to produce the immunosuppressant tacrolimus. The wild-type strain sporulates sparsely and produces very low levels of this immunosuppressant. The lack of genetic knowledge of this strain has hampered strain improvement. In this work, we have cloned the gene encoding a γ-butyrolactone receptor protein (Gbr). The gbr gene is linked to two genes encoding two subunits of the dihydroxyacetone kinase, putatively involved in the biosynthesis of the dihydroxyacetone phosphate precursor of γ-butyrolactone but is not flanked by γ-butyrolactone synthetase genes. The Gbr protein was overexpressed in Escherichia coli and purified. Electrophoretic mobility shift assays showed that Gbr binds to a specific autoregulatory element sequence located 338 bp upstream of the gbr gene, indicating that its expression is self-regulated. The deletion mutant Δgbr showed a very early and intense sporulation in two different media. A phenotype similar to that of the wild-type strain was restored by complementation of the Δgbr mutant with a wild-type gbr allele. Duplication of the gbr gene resulted in a slower sporulation. The Δgbr mutant produced much lower amount (32%) of tacrolimus quantified by high performance liquid chromatography. This analysis, using an optimised system, allowed the resolution of tacrolimus from ascomycin and other contaminant metabolites. Our results indicate that the Gbr protein regulates negatively the sporulation and positively the production of tacrolimus.

Knowledge and attitudes of primary care nurses about the management of patients with insomnia. / Conocimientos y actitudes de las enfermeras de Atención Primaria sobre el manejo del paciente con insomnio.

OBJECTIVE: To describe the knowledge, attitudes, and performance of primary care nurses in the management of patients with insomnia. METHODS: Descriptive study. An online questionnaire was sent to all primary care nurses of the Majorca Primary Care Department between June-July 2014. MEASUREMENTS: sociodemographic variables, professional characteristics, tuition, usual clinical practice in the management of patients with insomnia. RESULTS: 138 nurses answered the questionnaire (47%). Most of them were women (92.8%), 50.42 years old (DE=8.9). The majority considered insomnia an important health problem. Only 11% had received some formative activity on insomnia in the last 5 years. Nearly half declares to ask patients about consequences of insomnia in their jobs and about habits that alter their sleep quality. 79.7% considered the possible adverse effects of insomnia drugs and take into consideration the age of patient (80.4%). The usual treatments were sleep hygiene (76%), phytotherapy (44.9%) and 22.4% cognitive behavioral therapy (CBT). This therapy is considered effective and applicable by nurses (63.7%) and doctors (58%). Those nurses who attended courses in the last 5 years apply CBT more frequently. CONCLUSIONS: Nurses conduct a correct anamnesis and evaluation of patients with insomnia. However some therapies of known effectiveness, such as CBT, are still scarcely applied.

Efficient pyramidal arrangement of an ordered cosmid library: Rapid screening of genes of the tacrolimus-producer Streptomyces sp. ATCC 55098.

A gene library is a useful tool for molecular biology studies, but the classical screening of multiple plates is laborious and time-consuming. Cosmid gene libraries are particularly well suited for isolation of large gene clusters encoding the biosynthetic pathways of secondary metabolites in Streptomyces. A gene library of the immunosuppressant tacrolimus-producer strain Streptomyces sp. ATCC 55098 was constructed in the SuperCos1 vector and 1656 clones were organized in an easy pyramidal arrangement system. This clustering method allows a dual efficient screening (PCR and in situ colony hybridization) of the gene library in a two-step method by using only one 96-well plate. The dual screening combines the advantages of both techniques, the swiftness of PCR and the robustness of colony hybridization.

Conocimientos y actitudes de las enfermeras de Atención Primaria sobre el manejo del paciente con insomnio / Knowledge and attitudes of primary care nurses about the management of patients with insomnia

OBJETIVO: Describir los conocimientos, actitudes y actuación de las enfermeras en un área de Atención Primaria sobre la atención al paciente con insomnio. MÉTODOS: Estudio descriptivo. Se envió cuestionario online a todas las enfermeras de centros de salud del área sanitaria de Mallorca entre junio-julio de 2014. Variables: sociodemográficas, del profesional, formación, preferencias de manejo clínico del insomnio. RESULTADOS: Respondieron 138 enfermeras (47%). La mayoría mujeres (92,8%), media de edad 50,42 años (DE=8,9). La mayoría lo considera un problema importante de salud. Solo un 11% ha realizado alguna actividad formativa sobre trastornos del sueño en los últimos 5 años. Casi la mitad declara interrogar habitualmente sobre las repercusiones del insomnio en la vida laboral y sobre los hábitos que pueden alterar el sueño. El 79,7% valora posibles reacciones adversas de los medicamentos que toma el paciente para el insomnio y valora de forma diferente a los ancianos el 80,4%. Los tratamientos que declaran realizar habitualmente son medidas higiénicas (76%), fitoterapia (44,9%) y 22,4% terapia cognitivo-conductual. La terapia cognitivo-conductual es considerada efectiva y aplicable por las enfermeras (63,7%) y médicos (58%). Los profesionales que más se forman son los que practican de forma significativa terapia cognitivo-conductual con mayor frecuencia. CONCLUSIONES: Las enfermeras realizan una correcta anamnesis y evaluación del insomnio, sin embargo algunas terapias de demostrada efectividad son todavía escasamente utilizadas

OBJECTIVE: To describe the knowledge, attitudes, and performance of primary care nurses in the management of patients with insomnia. METHODS: Descriptive study. An online questionnaire was sent to all primary care nurses of the Majorca Primary Care Department between June-July 2014. Measurements: sociodemographic variables, professional characteristics, tuition, usual clinical practice in the management of patients with insomnia. RESULTS: 138 nurses answered the questionnaire (47%). Most of them were women (92.8%), 50.42 years old (DE=8.9). The majority considered insomnia an important health problem. Only 11% had received some formative activity on insomnia in the last 5 years. Nearly half declares to ask patients about consequences of insomnia in their jobs and about habits that alter their sleep quality.79.7% considered the possible adverse effects of insomnia drugs and take into consideration the age of patient (80.4%). The usual treatments were sleep hygiene (76%), phytotherapy (44.9%) and 22.4% cognitive behavioral therapy (CBT). This therapy is considered effective and applicable by nurses (63.7%) and doctors (58%). Those nurses who attended courses in the last 5 years apply CBT more frequently. CONCLUSIONS: Nurses conduct a correct anamnesis and evaluation of patients with insomnia. However some therapies of known effectiveness, such as CBT, are still scarcely applied

Desarrollo de un instrumento de observación en danza movimiento terapia (DMT) / No disponible

La danza movimiento terapia (DMT) se basa en el uso terapéutico del movimiento. Una de las problemáticas existentes es la escasez de herramientas para observar de manera objetiva las conductas emocionales del movimiento. Objetivo: desarrollar una pauta de observación en castellano que permita evaluar las conductas del movimiento relacionadas con la dimensión de relaciones interpersonales. Método: se hizo una revisión bibliográfica de los sistemas de codificación más empleados en DMT, la definición de las dimensiones, una construcción preliminar de la escala y por último, una evaluación piloto con un grupo de pacientes de salud mental. Resultados: se establecieron tres variables (relaciones interpersonales, utilización del espacio y la participación) con 29 ítems evaluados durante la sesión terapéutica que permiten su aplicación en grupo y con medida cualitativa y cuantitativa. Conclusiones: Este instrumento permite objetivar resultados, hacer una valoración inicial, durante y al final del tratamiento y la redacción de la memoria de cada sesión. (AU)

The dance movement therapy (DMT) is based on the therapeutic use of movement. One of the existing problems is the lack of objective evaluation tools to measure the emotional behaviors of the movement. Objective: to develop an observation tool in spanish to assess related movement behaviors evaluated in the different dimensions and items to consider in the psychotherapeutic work done with DMT. Method: a literature review of the coding systems used in DMT was done, the scale dimensions were defined, a preliminary construction of the observation tool and a preliminary evaluation with mental health patients was done. Results: three main outcomes where established: the observation of the interpersonal relationship, the space use and participation inside the therapeutic space with29 items applicable to the group and with quantitative and qualitative measures. Conclusions: this observation tool allows an objective evaluation to make an initial assessment, during and after treatment and to write memory as a guide for each session (AU)