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A combination of cognitive and behavioral strategies, ideally delivered in person by a therapist, maximizes the benefits of cognitive behavioral therapy for insomnia (CBT-I), according to new research. CBT-I is a form of talk therapy, which can be delivered in person or through self-help guides. By analyzing 241 studies, involving over 30,000 adults, researchers identified the most beneficial components of CBT-I. These included: cognitive restructuring, third-wave components, sleep restriction, stimulus control and in-person delivery. Self-help with human encouragement could also be beneficial, while waiting for active treatment and enforcing relaxation procedures appeared to be potentially harmful. Understanding which components of CBT-I can offer the most benefit will hopefully help practitioners help their patients get a better night’s sleep.
It’s time for bed but your mind is racing. Maybe you get up several times a night or wake up early in the morning feeling hardly rested at all. It’s estimated that up to a third of adults experience insomnia at some point, and anywhere from 4% to 22% chronically. Chronic insomnia can impact daily life, making it difficult to function when awake or causing distress. More serious cases may require support and treatment, and one medication-free option is cognitive behavioral therapy for insomnia.
CBT-I is a form of therapy that uses educational, cognitive or behavioral strategies to help patients improve their quality of sleep. It may be delivered in person or online, through an app or a guidebook, with the support of a therapist or independently. Previous studies have shown that CBT-I can be a beneficial and low-risk option for patients with chronic insomnia. However, as it encompasses a broad range of strategies which can be delivered in different ways, it has been difficult to determine which are most successful and if all are necessary for a patient to experience an improvement.
A team led by researchers at the University of Tokyo Hospital analyzed 241 studies of chronic insomnia from 1980-2023, to try and connect the different threads of CBT-I with their outcomes. The studies included 31,452 adult participants, mainly from North America and Europe, with an average age of 45.4 years. “We expected to find some behavioral components (such as sleep restriction and stimulus control) beneficial, but it was surprising to find that some cognitive components (such as cognitive restructuring and third-wave components) were also effective,” explained Yuki Furukawa, lead author and a medical doctor at the university hospital.
Using a statistical method called component network meta-analysis, the team ranked the effects of different interventions. According to their results, although following a self-help guide with encouragement from other people was helpful, in-person interaction with a therapist was more beneficial. Other critical components included: cognitive restructuring (skills to identify, challenge and change unhelpful beliefs about sleep), sleep restriction (limiting time in bed), stimulus control (re-associating bed with sleep) and third-wave components (mindfulness, acceptance and commitment therapy).
On the other hand, sleep hygiene education (explaining the biology of sleep and providing recommendations about lifestyle and environment) did not appear to be essential. Trying to follow relaxation procedures (such as structured physical or cognitive exercises) could be counterproductive, while knowingly having to wait for treatment to begin appeared to have a harmful effect.
“Overall, our findings identified several essential components of CBT-I which can lead to an intervention that maximizes treatment efficacy, minimizes treatment burden and increases scalability, that is, makes it easier to offer this treatment to more patients. Further large-scale trials are needed to confirm these contributions,” said Furukawa. “We hope that our research encourages practitioners who are interested in CBT-I to learn streamlined CBT-I, so that in turn more people who experience insomnia can be offered this relatively simple, noninvasive yet potentially powerful psychotherapy.”

“It is really hard,” a colleague said, “to identify anyone who has had a larger impact on nursing than Claire.”Claire M. Fagin, a leading expert on, advocate for and change agent in the profession of nursing, and one of the first women to lead an Ivy League university, the University of Pennsylvania, died on Tuesday at her home in Manhattan. She was 97. Her death was confirmed by her son and only immediate survivor, Charles.Among other achievements, Dr. Fagin was widely credited with overturning the common practice of strictly limiting parental visits to hospitalized children. She was inspired (and infuriated) by what happened in the early 1960s when she and her husband were visiting their young son Joshua, hospitalized for hernia surgery: They were ordered out of the hospital.So when she earned her doctorate in nursing from New York University in 1964, she made the practice of limiting visits the subject of her dissertation research. Her findings that the practice was harmful drew wide attention — she was interviewed on television about it — and they ignited a transformation in medical care.“She was the one who cracked that,” said Linda H. Aiken, a professor at the University of Pennsylvania School of Nursing, where Dr. Fagin was named dean in 1977.Dr. Fagin transformed the school — tripling its enrollment, establishing a doctoral program in nursing and building Penn into a widely acknowledged world leader in nursing research and education. In 2006, Penn renamed its Nursing Education Building the Claire M. Fagin Nursing Sciences Building.“It is really hard to identify anyone who has had a larger impact on nursing than Claire,” Dr. Aiken said.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? 

Research shows prices in the United States are nearly double those in other well-off countries.Florida’s plan to save money by importing medications from Canada, authorized this month by the Food and Drug Administration, has renewed attention on the cost of prescription drugs in the United States.Research has consistently found that drug prices in America are significantly higher than those in other wealthy countries. In 2018, they were nearly double those in France and Britain, even when accounting for the discounts that can substantially reduce how much American health plans and employers pay.“The U.S. market is the bank for pharmaceutical companies,” said Ameet Sarpatwari, an expert in pharmaceutical policy at Harvard Medical School. “There’s a keen sense that the best place to try to extract profits is the U.S. because of its existing system and its dysfunction.”Here are six reasons drugs in the United States cost so much:1. There is no central negotiator willing to walk away.Other wealthy countries rely on a single negotiating body — usually the government — to decide whether to accept the price a pharmaceutical company wants to charge. In the United States, negotiations with drug makers are split among tens of thousands of health plans, resulting in far less bargaining muscle for the buyers.Other nations also conduct careful analyses of how much additional benefit a new drug presents over drugs already on the market — and at what cost. If the cost is too high and the benefit too small, those countries are more willing to say no to a new drug.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? 

Published24 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, PA MediaBy Jim ReedHealth reporterThe publication of a final report into the infected blood scandal has been delayed until May.The chairman of the public inquiry, Sir Brian Langstaff, said more time was needed to prepare “a report of this gravity”. Victims and their families were initially told they would learn the findings in autumn last year.That date was pushed back until March, and the inquiry has now confirmed the further delay to 20 May 2024.”I am sorry to tell you that the report will be published later than March. That is not what I had intended,” added Sir Brian. “When I reviewed the plans for publication, I nonetheless had to accept that a limited amount of further time is needed to publish a report of this gravity and do justice to what has happened.”It is thought about 30,000 people were infected with HIV and hepatitis C through contaminated blood products in the 1970s and 1980s.More than 3,000 have died in what has been described by MPs as the worst treatment disaster in NHS history.What is the contaminated blood inquiry?Blood scandal: 1 in 3 infected with HIV was a childHunt says compensation bill may be very largeIn April 2023, Sir Brian published his final recommendations for a full compensation scheme for those directly affected by the scandal and their relatives. The government has said it accepts the “moral case” for compensation, and interim payouts of £100,000 each have already been made to about 4,000 victims and some bereaved partners.But ministers have said they are not in a position to make a final decision on further payouts, which could total billions of pounds, until they have seen the inquiry’s findings in full. Campaigners say that one person affected by the scandal dies every four days, making the speed of compensation key.Rachel Halford, chief executive of the Hepatitis C Trust, said the latest delay would be “extremely disappointing” for a community that has “already been forced to wait half a century for justice”.”We now expect the government to immediately establish a full compensation scheme, and extend compensation to everyone affected,” she added. “The clock is ticking and the government has nowhere left to hide.”Political pressureIn December 2023, the government lost a key vote in the Commons that could force it to make final compensation payments more quickly.Opposition MPs and some Conservative rebels passed an amendment to a separate law – the Victims and Prisoners Bill – which is still making its way through the House of Lords.If the amendment becomes law, it would force ministers to set up a scheme to administer the payouts within three months of the bill receiving royal ascent. In a statement, Sir Brian said that he still wanted to see the a final compensation scheme set up “with urgency”. “No-one should be in any doubt about the serious nature of the failings over more than six decades that have led to catastrophic loss of life and compounded suffering,” he added.More on this storyInfected blood payments still not availablePublished18 December 2023PM faces ‘wrong side of history’ on blood scandalPublished5 December 2023Hunt says blood compensation bill may be very largePublished28 July 2023

Published29 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Daylesford OrganicBy Michelle RobertsDigital health editorSome organic crispbreads and biscuits are being recalled in the UK because they may be contaminated with moth larvae – caterpillar-like pests.Daylesford Organic says its rye, spelt and raisin crispbreads (120g) and savoury biscuit selection (360g and 960g) are affected. It comes a month after Tesco recalled a batch of Christmas stuffing mix because of moths. Consumers who have the products should throw them away. Full refundsThey are unsafe to eat, the Food Standards Agency says, and are being removed from sale.Daylesford Organic says stores will provide full refunds. Moths sometimes settle on grain used to make foods. Any eggs laid can then hatch days or weeks later. Food Standards Agency’s Head of Incidents, Rajwinder Ubhi said: “Daylesford Organic Rye, Spelt & Raisin Crispbreads and Savoury Biscuit Selection have been recalled by the business because the Crispbreads have been contaminated by moth larvae, making the products unsafe to eat. “Consumers should follow the advice in the published recall notice and contact Daylesford Organic directly if they have purchased the product.”More on this storyTesco recalls stuffing mix as it may contain mothsPublished14 December 2023Related Internet LinksFood Standards AgencyThe BBC is not responsible for the content of external sites.

The newsCancer deaths in the United States are falling, with four million deaths prevented since 1991, according to the American Cancer Society’s annual report.At the same time, the society reported that the number of new cancer cases had ticked up to more than two million in 2023, from 1.9 million in 2022. Cancer remains the second leading cause of death in the United States, after heart disease. Doctors believe that it is urgent to understand changes in the death rate, as well as changes in cancer diagnoses.Breast cancer mortality is one area where treatment has had a significant impact. Miguel Roberts/The Brownsville Herald, via Associated PressBackground: Treatment improvements help reduce cancer deaths.The cancer society highlighted three chief factors in reduced cancer deaths: declines in smoking, early detection and greatly improved treatments.Breast cancer mortality is one area where treatment had a significant impact.In the 1980s and 1990s, metastatic breast cancer “was regarded as a death sentence,” said Donald Berry, a statistician at the University of Texas MD Anderson Cancer Center and an author of a new paper on breast cancer with Sylvia K. Plevritis of Stanford University and other researchers (several authors of the paper reported receiving payments from companies involved in cancer therapies).The paper, published Tuesday in JAMA, found that the death rate from breast cancer had fallen to 27 per 100,000 women in 2019 from 48 per 100,000 in 1975. That includes metastatic cancer, which counted for nearly 30 percent of the reduction in the breast cancer death rate.Breast cancer treatment has improved so much that it has become a bigger factor than screening in saving lives, said Ruth Etzioni, a biostatistician at the Fred Hutchinson Cancer Center.Death rates have even declined among women in their 40s, who generally did not have regular mammograms, said Dr. Mette Kalager, a professor of medicine at the University of Oslo and Oslo University Hospital, “indicating a substantial effect of treatment,” she said.“The biggest untold story in breast cancer is how much treatment has improved,” said Dr. H. Gilbert Welch, a cancer epidemiologist at Brigham and Women’s Hospital. “This is unambiguous good news.”What We Don’t Know: The cause of new cancer cases.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? 

Published1 hour agocommentsCommentsShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Imran Rahman-JonesBBC NewsPeople who play video games are at risk of damaging their hearing due to potentially unsafe sound levels, a study has found. The new review suggests that gamers play for long periods of time with the volume turned up, beyond safe limits.It says this could contribute to irreversible hearing loss or tinnitus, a constant ringing in the ears.The paper, published in BMJ Public Health, reviewed 14 studies which in total involved more than 50,000 people.The researchers urge more public health efforts to raise awareness of the issues for gamers, in the same way that has been done for live music and headphones. Of course, gamers could turn down the volume while playing to minimise the risk, but the study suggests that part of the problem is the length of time people spend being exposed to high volumes.For example, the World Health Organization (WHO) says adults can safely be exposed to 80 decibels (dB) for 40 hours a week, which is about the noise level of a doorbell.Above that level, however, the safe amount of exposure to noise drops rapidly. Adults should only listen to 85dB for four hours a week, and 90dB for one hour and 15 minutes a week, according to the WHO guidance. For children, the thresholds are even lower.First Prince of Persia game in 14 years voiced in FarsiGame to stop selling pre-owned titlesOne of the studies evaluated by researchers found average headphone noise levels in four shooting games to be between 88.5 and 91.2dB.Another study found that impulse sounds – short loud bursts such as shooting noises – reached 119dB.The paper also found that in three separate studies, boys were recorded as playing videos games more often than girls for longer stints and at higher volumes.Some studies found correlations between gaming and hearing loss while other linked the activity with tinnitus. These used a combination of self-reported data and hearing tests to evaluate hearing.The authors acknowledge that more research should be done to establish a stronger link between gaming and hearing loss.They add that the impact of e-sports, geographic region, sex and age should be looked into more closely.Some of the studies they looked at went back to the 1990s, when the gaming world was very different to now. Only two papers published in the last 10 years objectively measured sound levels from video games or gaming centres, which are like video game arcades and popular in Asia.But the authors conclude that “the limited available evidence suggests that gaming may be a common source of unsafe listening”.They say: “The findings suggest that there may be a need to prioritise interventions, such as initiatives focused on education and awareness of the potential risks of gaming, that can help promote safe listening among gamers.”Gaming industry body Ukie said it continues to encourage people to use headphones within safe levels but would not comment further on the new study.More on this storyFirst Prince of Persia game in 14 years voiced in FarsiPublished2 days agoGame to stop selling pre-owned titlesPublished20 hours ago

Published2 hours agoShareclose panelShare pageCopy linkAbout sharingImage source, Sandrine HeutzBy Michelle RobertsDigital health editorSome children with cancer are receiving a new type of drug treatment far less toxic than chemotherapy. Arthur, 11, is one of the first to try it, at London’s Great Ormond Street Hospital, for his blood cancer.His family call the therapy “a little bit of sunshine”, since it worked without making Arthur feel much sicker. And because it could be given on the go, rather than just in hospital, he spent more time at home with his family, enjoying more of what he loves. He carried it with him in a rucksack – his “blina backpack”. For Arthur, blinatumomab or blina was his only real option after his chemo had failed to clear all of his cancer and had left him very weak.Image source, Sandrine HeutzBlina is already licensed to treat adults with cancer – and experts hope to show it can safely help children too. Some 20 centres around the UK are using it off-label for children with B-cell acute lymphoblastic leukaemia (B-ALL). The drug is an immunotherapy that seeks out cancer cells so the body’s own immune system can recognise and destroy them. And this death hunt is precisely targeted – healthy cells are untouched, unlike with chemo. Image source, Sandrine HeutzBlina comes in a bag of liquid administered through a thin plastic tube that remains running into a vein in the patient’s arm for many months.A battery-operated pump controls how quickly the drug trickles into the bloodstream – a bag can last days.All of the kit can be carried in a backpack smaller than an A4 textbook, making it fully portable.For Arthur, that meant he could do other things – like play on the swings in his local park – while the treatment was happening.And unlike his intensive chemotherapy, which had stopped working anyway, it did not make him too weak to enjoy his days.’Constant challenge’Like other patients on blina, Arthur was given medication to cut the chance of serious reactions or side effects before his infusion started.At first, he had some bouts of fever and needed to stay in hospital for checks. But shortly after, he was able to go home. The backpack stayed with Arthur continuously, including in bed – and even though the pump makes a noise, he was able to have a decent night’s sleep.Chemo had been rough for Arthur and moving on to blina was a relief, his mother, Sandrine, said.”It was completely out of his control – we were living in a constant challenge as his body was getting hit by the drugs,” she said.”We were curing him by making him feel worse – it’s a very difficult thing to process.”‘Big step’Arthur had to return to hospital every four days so doctors could top up the blina kit but was able to manage the treatment at home the rest of the time. “He enjoyed the fact that he was able to hold it and be responsible – he embraced all of it,” Sandrine said. And at the end of April 2023, Arthur had the final operation to remove the tubing from his arm. “It was a big step – he was free,” Sandrine said.Doctors say blina can replace big chunks of chemo – perhaps up to 80% of it. About 450 children a year in the UK are diagnosed with Arthur’s type of cancer. Image source, Sandrine HeutzChief investigator and consultant paediatric haematologist Prof Ajay Vora said: “Chemotherapies are poisons that kill the leukaemic cells but also kill and damage normal cells – and that is what causes their side effects. “Blinatumomab is a gentler, kinder treatment.”Another targeted immunotherapy drug, chimeric antigen receptor T-cell therapy (CAR-T), has also recently become available.But it is more expensive than blina and the patient’s own cells must be taken and then altered in the lab before being given back as the medicine, which takes time. Thanks to all the treatment, Arthur’s cancer has now gone. Sandrine said: “New Year was when we found out that the blina had worked and there was no residual cancer – and so that was just amazing and so we had double celebrations.”Additional reporting by Nicki Stiasni and Neil PatonMore on this storyGirl receives UK’s first rejection-free kidneyPublished22 September 2023Revolutionary therapy clears girl’s incurable cancerPublished11 December 2022Related Internet LinksBlinatumomab – Great Ormond Street HospitalThe BBC is not responsible for the content of external sites.

Many cancers, including some types of breast cancer, are driven by alterations in the activity of cellular enzymes called kinases. Therapies that directly inhibit these cancer-promoting activities have proven to be effective for patients in which individual driving kinases can be diagnosed.
One major challenge to this therapeutic approach is to accurately quantify tumor kinases in human biopsy samples. Many kinases are not abundantly present and are therefore more difficult to measure accurately. Although currently there are methods to quantify small amounts of kinases, measuring multiple kinases concurrently is cumbersome and impractical in a clinical setting where rapid data return is critical. It is crucial to develop methodologies to enrich kinases present in clinical samples, an important step toward effective personalized medicine.
In a study published in Clinical Proteomics, researchers at Baylor College of Medicine and collaborating institutions report the development of a kinase inhibitor pulldown assay (KiP) that can optimally enrich and quantify the small amounts of kinases present in biopsy samples in combination with mass-spectrometry techniques.
The researchers established the coverage and quantitative fidelity of the assay for kinases in a single-shot approach, optimized a 100-kinase targeted panel and determined the effectiveness of KiP in subtyping breast cancer patient-derived animal models and two breast cancer patient sample cohorts.
“Our study represents a convergence of advanced technologies, redefining basic medical research and paving the way for future clinical applications,” said first author Dr. Alexander Saltzman, senior bioinformatics analyst at the Mass Spectrometry Proteomics Core at Baylor.
“This paper emphasizes that new methods in protein mass spectrometry hold great promise for better definition of the individual druggable landscape present in each cancer and should be more widely used for research and, ultimately, clinical care,” said co-corresponding author Dr. Matthew Ellis, faculty at Baylor’s Lester and Sue Smith Breast Center.
“This methodology’s approach to identifying key kinases in cancer may even extend beyond these enzymes and into other low-abundance and biologically relevant targets,” said co-corresponding author Dr. Beom-Jun Kim, currently an associate director at AstraZeneca and an assistant professor at Baylor at the time of research.
Doug W. Chan, Matthew V. Holt, Junkai Wang, Eric J. Jaehnig, Meenakshi Anurag, Purba Singh and Anna Malovannayaalso contributed to this work. The authors are affiliated with Baylor College of Medicine, the Lester and Sue Smith Breast Center and/or the Dan L Duncan Comprehensive Cancer Center.
This work was supported by CPTAC PTRC grant National Cancer Institute’s Specialized Programs of Research Excellence (SPORE) (U01 CA214125) and a CPTAC PGDAC Award (U24 CA210954). Ellis received support from a CPRIT Established Investigator Award (RR140033) and from Ralph and Lisa Eads. Ellis also is a McNair Medical Institute Scholar. The BCM Mass Spectrometry Proteomics Core is supported in part by a Dan L Duncan Comprehensive Cancer Center Award (P30 CA125123), CPRIT Core Facility Awards (RP170005 and RP210227) and an NIH High-End Instrumentation Award (S10 OD026804).

Australian scientists have pinpointed likely ‘cells-of-origin’, the source cells that can grow into breast cancer, in women carrying a faulty BRCA2 gene who are at high risk of developing the disease.
The WEHI-led study also showed these cells have potential to be targeted with an existing cancer drug to delay tumour growth, in findings that may lead to future preventive treatments for the disease.
Abnormal cells
Women who inherit and carry a faulty BRCA2 gene have a substantially increased risk of developing breast cancer — approximately 70% of carriers will develop the disease over their lifetime.
These cancers often occur at a young age and can be clinically aggressive. Early screening is encouraged and some women undertake preventive breast surgery (mastectomy) to reduce their breast cancer risk.
In a milestone finding published in Nature Cell Biology, researchers have discovered the likely ‘cells-of-origin’ of cancer in BRCA2 carriers. By comparing cancer-free tissue samples from both carriers and non-carriers, they identified an aberrant population of cells that divide more quickly.
Study joint first author Dr Rachel Joyce said this perturbed cell population was found in the majority of tissue samples from women with a faulty BRCA2 gene.

“Given they were found in most of the BRCA2 tissue samples from healthy females, we believe these may be the cells-of-origin that lead to future breast cancers in women that carry the BRCA2 mutation,” Dr Joyce said.
Treatment targets
The aberrant cells in BRCA2 tissue, a subset of breast ductal cells called luminal progenitor cells, stood out to the scientific team because they displayed altered protein production, which is critical for the correct growth and functioning of tissues in our bodies.
“These changes may also make the cells more vulnerable to certain therapies aimed at preventing or delaying breast cancer development,” said study joint first author Dr Rosa Pascual.
Lead author Professor Jane Visvader said the team developed a pre-clinical BRCA2 model that showed similar alterations in the ductal cells, and targeted them with the existing cancer drug everolimus, which is approved to treat patients with relapsed breast cancer.
“Through pinpointing this vulnerability in protein production, we were able to show that pre-treatment with this drug delayed the formation of tumours in the pre-clinical model,” said Prof Visvader, joint head of the ACRF Cancer Biology and Stem Cells Division and the Breast Cancer Laboratory at WEHI.

“This raises the possibility that targeting specific aspects of protein production in this way could represent a new breast cancer prevention strategy for women with a faulty BRCA2 gene.”
Towards prevention
The findings are an important first step towards the goal of preventative treatments for breast cancer in BRCA2-mutation carriers.
Study author and cancer clinician, Professor Geoff Lindeman said that while the findings were exciting, more work was needed before they could be applied in the clinic.
“While everolimus did delay tumour development in the lab, this drug can have side-effects, which might limit its capacity to be used as a preventative treatment,” said Prof Lindeman, joint head of the ACRF Cancer Biology and Stem Cells Division at WEHI, and a medical oncologist at the Royal Melbourne Hospital and Peter MacCallum Cancer Centre.
“Our team want to further explore which specific parts of protein processing are dysregulated, and use this information to develop more selective and tolerable preventative treatments.
“There’s still a way to go, but we’re a big step closer.
“A few years ago, we identified the likely cells-of-origin for breast cancer in females carrying a fault in the BRCA1 gene, which is also associated with a high risk of developing breast cancer. That research has since led to an international breast cancer prevention study (BRCA-P).
“We hope that our new findings will now inform future treatment and prevention for women with a faulty BRCA2 gene.”
The study, ‘Identification of aberrant luminal progenitors and mTORC1 as a potential breast cancer prevention target in BRCA2 mutation carriers’, is published in Nature Cell Biology (DOI: 10.1038/s41556-023-01315-5).
The research was carried out on breast tissue samples kindly donated by women undergoing breast surgery, with assistance from the Victorian Cancer Biobank (funded by the Victorian Government) and the Kathleen Cuningham Foundation Consortium for research into Familial Breast cancer. The research was supported by the National Health and Medical Research Council, Breast Cancer Research Foundation, the National Breast Cancer Foundation, The Medical Research Future Fund, the Two Sisters Foundation and the Heine Family.