Home relaxation practice in hypertension treatment: Objective assessment and compliance induction.

50 Ss (mean age 51.1 yrs) with essential hypertension were randomly assigned to 1 of 4 conditions: individualized relaxation, group relaxation (GR), GR plus contingency contracting (CC) for home practice, or a waiting list. Treated Ss were given tape players and relaxation tapes and were instructed to practice daily for 10 wks. Unknown to the Ss, the tape players had a concealed capacity to electronically monitor the amount of relaxation practice. All relaxation conditions showed significantly greater reductions in both systolic and diastolic blood pressure than waiting-list controls but did not differ from each other. Monitored relaxation predicted systolic but not diastolic changes. Self-reports exceeded monitored practice by 91%, and only 32% of the Ss averaged 1 practice/day. GR plus CC Ss showed the lowest rate of practice across most weeks. Rated self-efficacy, age, and pretreatment expectations of benefit were positively correlated with relaxation compliance. Data support the use of relaxation for hypertension but suggest that noncompliance is common in both individual and group relaxation training. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influenza virus vaccination of patients with multiple sclerosis

Our previous data showed that at least five PKC isoforms (alpha, delta, zeta, lambda and tau) were present in the decidualization. In this study, we then localized the PKC alpha and zeta by immunohistochemistry in the decidualized uterine tissues. The decidualized uterine tissues were induced by trauma-stimulation and fixed in formalin. The immunofluorescence were photographed by confocal microscope. The data revealed that the fluorescence of PKC alpha was present in the deciduomata and myometrium. In the deciduomata, PKC alpha was mainly located in the surrounding nuclear. This phenomenon of localization was especially performed on day 2 and 3 of the decidualization, just on the time of higher frequence of cell mitosis. Since the myometrium with hypertrophy did not display the phenomenon of perinuclear localization, these suggested that the expression and localization of PKC alpha may be associated with the cell proliferation. On the other hand, the PKC zeta was also present and distributed broadly in the deciduomata and myometrium. This expression was increased and similar to the previous Western blot studies. Thus, the data confirmed that the various expression and localization of PKC isoforms may be correlated with the development of deciduomata.     

Relaxation and sleep compression for late-life insomnia: A placebo-controlled trial.

Older adults with insomnia were recruited from the community and randomized to treatments: relaxation, sleep compression, and placebo desensitization. Questionnaire data collected at baseline, posttreatment, and 1-year follow-up and polysomnography data collected at baseline and follow-up yielded the following conclusions: All treatments improved self-reported sleep, but objective sleep was unchanged. Clinical significance analyses yielded the strongest findings supporting the active treatments and suggested that sleep compression was most effective. Results partially supported the conclusion that individuals with high daytime impairment (i.e., fatigue) respond best to treatments that extend sleep, as in relaxation, and individuals with low daytime impairment respond best to treatments that consolidate sleep, as in sleep compression. Strong methodological features including a placebo condition and a treatment implementation scheme elevate the confidence due these findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of the efficacy of stimulus control for medicated and nonmedicated insomniacs

A sample of 21 medicated and 20 nonmedicated insomniacs participated in a sleep medication withdrawal program that provided education about sleep medication and a gradual medication withdrawal schedule. Ten medicated participants received stimulus control treatment and the withdrawal program, and 11 medicated participants served as a control group that received only the withdrawal program. Half of the nonmedicated participants received stimulus control, and the remaining nonmedicated participants served as a wait-list control condition. Medicated participants significantly reduced sleep medication use without significant deterioration on sleep, anxiety, or depression measures from baseline to 8-week follow-up. Stimulus control participants, unlike control group participants, showed significant improvement at follow-up for total sleep time, sleep efficiency, and sleep quality. Stimulus control participants also reported less daytime sleepiness than control participants after treatment. Nonmedicated participants exhibited a more positive response to stimulus control than medicated participants.     

Primary versus secondary insomnia in older adults: Subjective sleep and daytime functioning.

Most psychological research on insomnia has centered on primary insomnia (PI). Secondary insomnia (SI), though more common than PI, has received little attention because of its presumed unresponsiveness to treatment. The present study recruited older adults with PI, SI, and a comparison group of older adults with no insomnia (NI). Self-report assessments of sleep revealed no significant difference between the 2 insomnia groups. Daytime functioning measures found significant differences in impairment between the 3 groups with SI having the worst daytime functioning, followed by PI, which was worse than NI. Further analyses found substantial independence between sleep and daytime functioning. Implications of these findings for the clinical management of SI are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Socioeconomic Status and Insomnia.

This investigation compared the likelihood of insomnia and insomnia-related health consequences among individuals of different socioeconomic status. A random-digit dialing procedure was used to recruit at least 50 men and 50 women in each age decade from 20 to 80 + years old. Participants completed 2 weeks of sleep diaries as well as questionnaires related to fatigue, sleepiness, and psychological distress. Socioeconomic status was measured by education status assessed at 3 different levels: individual, household, and community. Results indicated that individuals of lower individual and household education were significantly more likely to experience insomnia even after researchers accounted for ethnicity, gender, and age. Additionally, individuals with fewer years of education, particularly those who had dropped out of high school, experienced greater subjective impairment because of their insomnia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance on the internal medicine second-year residency in-training examination predicts the outcome of the ABIM certifying examination

For 223 residents from eight teaching hospitals, the results of the second-year in-training examination and the first-sitting certifying examination of the American Board of Internal Medicine were highly correlated. The results of the in-training examination can serve residents as an important measure of their preparedness for certification and can be useful in identifying the need for more intensive self-study strategies during the subsequent one and a half years.     

Objective sleep measures and subjective sleep satisfaction: How do older adults with insomnia define a good night's sleep?

The relationship between objective sleep measures and subjective sleep satisfaction was explored in a sample of 47 older adults (59 years and older; 35 women, 12 men) with primary insomnia. Participants submitted to all-night sleep evaluations (polysomnography) for 2 nights. After each night, participants provided subjective sleep-satisfaction ratings. Depth of sleep (decreased Stage 1 sleep and increased Stages 3 and 4 sleep) and sleep latency were the best predictors of subjective sleep satisfaction. For other sleep variables such as sleep efficiency and wake time after sleep onset, no value predicted satisfaction on a particular night. However, for these sleep variables, relative improvement from Night 1 to Night 2 predicted greater subjective satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occult sleep apnea in a recruited sample of older adults with insomnia.

Although costly polysomnography (PSG) is not routinely performed with people with insomnia, it may be more necessary with recruited older adults with insomnia because this population may pose a greater risk of veiled sleep disorders compared with younger age groups and with referred samples. The present PSG screening of a recruited sample of older adults with insomnia found a 29%–43% rate of undiagnosed sleep apnea (SA), depending on whether an apnea–hypopnea index of 15 or 5 was used, after interviews had already screened out obvious cases of SA. Also, PSGs revealed a 4% rate of occult periodic limb movements. A discriminant analysis identified overweight men reporting dry mouth at highest risk for occult SA, with an apnea-versus-insomnia classification success rate of 78%. Using PSG evaluations in research on insomnia in recruited older adults is requisite to preclude substantial representation of occult SA. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sleep compression and sleep education for older insomniacs: Self-help versus therapist guidance.

A treatment package consisting of a bed-time restriction strategy and education was administered to 50 insomniacs and 50 noninsomniacs 60 years or older. Half of the insomniacs and noninsomniacs received treatment through a self-help video only, whereas the remaining treated participants received therapist guidance to supplement the video. A waiting-list control group of 25 senior insomniacs was also included. Sleep knowledge was equivalent for senior insomniacs and noninsomniacs. The self-help insomniac group exhibited improvement on multiple sleep variables, but the addition of therapist guidance appeared to enhance treatment outcome for sleep latency wake time after sleep onset, and sleep satisfaction. Control participants also improved across time but were generally outperformed by treated insomniacs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)