Self-help treatment for insomnia: bibliotherapy with and without professional guidance.

Fifty-four adults with primary insomnia were randomly assigned to a self-help treatment (cognitive-behavioral bibliotherapy [BT]), BT with weekly phone consultations, or a waiting-list control (WL) group. Treated participants were mailed 6 treatment booklets at the rate of 1 booklet per week; 1/2 of them also received minimal professional guidance through a 15-min weekly phone consultation. The WL group members continued to monitor their sleep during this period. Participants in both treatment conditions improved significantly on the main outcome variables (total wake time and sleep efficiency) at posttreatment, whereas WL participants remained unchanged. The addition of weekly phone calls slightly enhanced improvements at posttreatment. However, both treatment conditions were comparable at follow-up. These results suggest that BT, with or without minimal professional guidance, is an effective approach for treating primary insomnia.     

Photoperiodic responsiveness of hamsters with lesions of the lateral geniculate nucleus is related to hippocampal damage

We tested the hypothesis that the geniculohypothalamic tract is important for hamster photoperiodism. Adult male hamsters, maintained in a long photoperiod (LD 14:10), received either large bilateral neurotoxic lesions of the lateral geniculate nucleus (LGN) or sham lesions. One week later, half of the animals from each group were transferred to a short photoperiod (LD 8:16) where they were maintained for 15 weeks. Most lesions effectively destroyed the intergeniculate leaflet (IGL) and much of the lateral geniculate complex. They also caused substantial damage to the overlying hippocampus. The lesions had no effect on long-day animals, but significantly reduced the extent of testicular regression during short photoperiod exposure. This effect, however, appeared to be the result of hippocampal, rather than geniculate, damage. Four individuals with complete IGL lesions, but minimal hippocampal damage, underwent a pattern of regression that was indistinguishable from controls. Body weight was increased by lesions in short-day, but not long-day, animals. This effect was not related to the extent of hippocampal damage. We conclude that geniculate input to the suprachiasmatic nuclei is not essential for hamster photoperiodism and that hippocampal damage may modify the effect of short daylengths on testes size.     

Distribution of eosinophils in the nose in patients with perennial rhinitis.

The traditional method of classifying perennial rhinitis into eosinophilic and non-eosinophilic is by taking a single nasal smear from one nostril. In the light of personal experience it was felt that this method of sampling may be inadequate. The present study included 20 patients with perennial rhinitis undergoing nasal surgery. Serum total IgE levels were taken and those above 40 IU/ml had allergen specific IgE measured. Nasal smears and biopsies were taken from 5 sites on each side of the nose; middle and inferior turbinates and post nasal space. The smears significantly correlated with the biopsies (rs = 0.446, P < 0.001). The distribution of eosinophils between and within nasal cavities was found to differ. Representative sampling of the nose is important for accurate eosinophil expression. The definition of an eosinophil rich and poor nose requires greater clarification as it has great clinical relevance regarding management.     

Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce

Background  

Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART), for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers. As national treatment programmes are planned, better estimates of human resource needs and improved approaches to assessing the impact of different staffing models are critically needed. However there have been few systematic assessments of staffing patterns in existing programmes or of the estimates being used in planning larger programmes.