Placebo effects in primary insomnia

Placebo effects are commonly observed in insomnia clinical trials. With the advent of longer-term trials, such effects appear to be remarkably robust and durable. In this paper we review the classic factors that are believed to contribute to placebo effects and how these factors operate in insomnia randomized clinical trials. Beyond this we suggest that the episodic nature of insomnia may interact with patient preferences for intermittent dosing in such a way as to sustain placebo effects in the long term. An appreciation of the latter phenomenon may provide increased power to detect therapeutic outcomes and may be used to potentiate clinical gains.     

Microbiological and clinical effects of chlorhexidine enclosed in fixtures of 3I-Titamed implants

This double-blind study used a split-mouth design to investigate the microbiological and clinical effects of 0.2% chlorhexidine enclosed in fixtures. Twelve patients had 46 fixtures implanted. At second-stage surgery, a microbiological sample (baseline sample) of the inner parts of the fixtures was taken. Then, a 0.2% chlorhexidine solution was applied into the inner space of 23 fixtures (test group), and in 23 fixtures saline was applied (control group). Abutments were installed and gingival index, plaque index and crevicular fluid flow were monitored weekly. After 6 weeks, a second microbiological sample of the inner part of the fixtures was taken. At baseline, viable bacteria were detected within 46% of the fixtures. After weeks, bacteria were found in 87% of the fixtures. The numbers of bacteria in the control group were significantly higher than those in the test group. The results indicate that, after first-stage surgery, contamination of the inner spaces of the fixtures is commonplace. Application of a 0.2% chlorhexidine solution at second-stage surgery inhibits growth or acquisition of bacteria in the fixtures. In both test and control groups, the crevicular fluid flow as well as the gingival index decreased during the experimental period. At 4, 5, and 6 weeks after chlorhexidine application, these values in the test group appeared lower, but did not attain statistical significance.     

The role of imaging in the staging and treatment planning of primary malignant bone tumors in children

The accurate staging of primary bone tumors in children is critical for treatment planning. Limb salvage operations can now be performed with excellent outcomes in suitable patients. The purpose of this article is to review the current state of imaging techniques and their roles in enabling accurate staging and treatment planning to be performed in pediatric patients with primary bone tumors.     

The language of spirituality: an emerging taxonomy

BACKGROUND: This paper explores the relationships that exist between the language used to describe spirituality within nursing and the appropriateness of constructing a universal definition acceptable to all individuals. 'Spirituality' is a term that is increasingly used in nursing but there may be problems about exactly what the term means and how it is interpreted and understood by both nurses and patients. AIM: The aim of the paper is to explore some of the commonly cited definitions to establish if the concept of spirituality could be termed 'universal'. METHOD: This paper presents a discussion, based upon a literature review, of the nursing and health care databases, combined with manual searches. The review demonstrates how the term spirituality is being constructed within nursing suggesting that there are numerous definitions each with several layers of meaning. FINDINGS: From the review the authors have developed 'a spiritual taxonomy' that may explain and accommodate the different layers of meaning found within nursing and health care definitions. At the extreme left there is a spirituality based on religious and theist ideals, while at the extreme right there is a spirituality based upon secular, humanistic, existential elements. A middle way is explained containing elements from both the left and right but not as fundamental or radical. CONCLUSION: The authors argue that because there are so many definitions with different layers of meanings, spirituality can imply different things depending upon an individual's personal interpretation or worldview. The results of the review suggest nursing is constructing a 'blanket' definition of spirituality, which has a broad, almost inexhaustible set of defining characteristics. If this approach continues then there is a danger that the word may become so broad in meaning that it loses any real significance.     

Improvement of BMI,body composition,and body fat distribution with lifestyle modification in Japanese Americans with impaired glucose tolerance

OBJECTIVE: To determine whether diet and endurance exercise improved adiposity-related measurements in Japanese Americans with impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS: This study compared the effects of an American Heart Association (AHA) step 2 diet (<30% of total calories as fat, <7% saturated fat, 55% carbohydrate, and < 200 mg cholesterol daily) plus endurance exercise for 1 h three times a week (treatment group) with an AHA step 1 diet (30% of total calories as fat, 10% saturated fat, 50% carbohydrate, and <300 mg cholesterol) plus stretching exercise three times a week (control group) on BMI, body composition (% fat), and body fat distribution at 6 and 24 months of follow-up in 64 Japanese American men and women with IGT, 58 of whom completed the study. RESULTS: At 6 months, the treatment group showed significantly greater reduction in percent, body fat (-1.4 +/- 0.4 vs. -0.3 +/- 0.3%); BMI (-1.1 +/- 0.2 vs. -0.4 +/- 0.1 kg/m(2)); subcutaneous fat by computed tomography at the abdomen (-29.3 +/- 4.2 vs. -5.7 +/- 5.9 cm(2)), thigh (-13.2 +/- 3.6 vs. -3.6 +/- 3.0 cm(2)), and thorax (-19.6 +/- 3.6 vs. -8.9 +/- 2.6 cm(2)); and skinfold thickness at the bicep (-2.0 +/- 0.6 vs. 1.1 +/- 0.6 mm) and tricep (-3.7 +/- 0.8 vs. -0.9 +/- 0.6 mm), which continued despite moving to home-based exercise for the last 18 months. CONCLUSIONS: Diet and endurance exercise improved BMI, body composition, and body fat distribution and, thus, may delay or prevent type 2 diabetes in Japanese Americans with IGT.     

Insulin and amylin release are both diminished in first-degree relatives of subjects with type 2 diabetes

OBJECTIVE: To determine whether first-degree relatives of individuals with type 2 diabetes, who are at high risk of subsequently developing hyperglycemia, manifest alterations in beta-cell function including an alteration in the co-release of insulin and amylin. RESEARCH DESIGN AND METHODS: In 30 first-degree relatives and 24 matched subjects with no family history of diabetes, beta-cell function was measured as the intravenous glucose-induced acute insulin response (AIR(g)) and acute amylin response (AAR(g)). The insulin sensitivity index (S(I)) was quantified and used to account for the role of insulin sensitivity to modulate beta-cell function (S(I) x beta-cell function). RESULTS: Fasting plasma glucose (5.3 +/- 0.1 vs. 5.1 +/- 0.1 mmol/l; means +/- SEM), immunoreactive insulin (IRI) (68 +/- 7 vs. 57 +/- 6 pmol/l) and amylin-like immunoreactivity (ALI) (5.5 +/- 0.6 vs. 4.7 +/- 0.7 pmol/l) were similar in relatives and control subjects, respectively. Relatives were insulin resistant compared with control subjects (S(I): 4.86 +/- 0.63 vs. 7.20 +/- 0.78 x 10(-5) min(-1). pmol(-1). l(-1), P = 0.01), but their AIR(g) (392 +/- 59 vs. 386 +/- 50 pmol/l) and AAR(g) (5.9 +/- 0.9 vs. 6.1 +/- 0.8 pmol/l) did not differ. When beta-cell function was determined relative to insulin sensitivity, in the first-degree relatives, both AIR(g) (S(I) x AIR(g): 1.60 +/- 0.23 vs. 2.44 +/- 0.31 x 10(-2) min(-1), P < 0.05) and AAR(g) (S(I) x AAR(g): 2.39 +/- 0.35 vs. 4.06 +/- 0.56 x 10(-4) min(-1), P < 0.05) were reduced. The molar proportion of ALI to IRI was not altered in high-risk subjects (1.75 +/- 0.16 vs. 1.71 +/- 0.15%). CONCLUSIONS: First-degree relatives of subjects with type 2 diabetes have diminished beta-cell function at a time when they are not hyperglycemic, and this reduction affects insulin and amylin responses proportionally. Thus, an altered amylin-to-insulin ratio is not likely to identify individuals at high risk of developing type 2 diabetes.