Anxiety mediates the relationship between multidimensional perfectionism and insomnia disorder

Individuals with insomnia often report aspects of perfectionism alongside symptoms of anxiety and depression. However, there has been limited examination of these factors together. The current study investigated whether individuals with insomnia report increased perfectionism compared to normal-sleepers. Further, the mediating role of anxiety and depression was examined. Participants were 39 individuals with DSM-5 defined Insomnia Disorder, and 39 normal-sleepers, who completed two measures of multidimensional perfectionism and the Hospital Anxiety and Depression Scale. Results demonstrated that, compared to normal-sleepers, individuals with insomnia display increased perfectionistic traits of: concern over mistakes, doubts about action, and parental criticism. In addition, these differences were partiality mediated by symptoms of anxiety, but not depression. Our findings highlight the significance of treating symptoms of anxiety with the prospect of alleviating negative thoughts concerning one's mistakes, doubts about action, and perception of parental criticism, which may contribute to insomnia

Improving services for people with learning disabilities and dementia: Findings from a service evaluation exploring the perspectives of health and social care professionals

Accessible summary Dementia is an illness caused by damage to a person's brain. People with learning disabilities, especially people with Down's Syndrome, are more likely to get dementia, and when they are younger. We talked to people working in community learning disability teams to find out what they thought about services and support for people with learning disabilities and dementia and carers. Screening and assessments mean that people get diagnosis and support more quickly and other problems are picked up. More appropriate housing and support is needed so people can stay at home for longer. Research needs to look at the best ways to support people with learning disabilities and dementia. It is important to find ways to involve people with learning disabilities and dementia and carers in meetings about their support and future research. Background Dementia prevalence rates are higher amongst people with learning disabilities than the general population. People with Down's syndrome are at even greater risk of developing dementia and of developing dementia at an earlier age. This study, conducted as part of a wider service evaluation, explored community learning disability team perspectives on screening, pathways, training, information and supports developed to improve services for people with learning disabilities and dementia. Methods A focus group was held with health and social care professionals working in community learning disability services. Thematic analysis was used to analyse the data. Results The dementia screening, pathways and processes had become embedded in practice, leading to a common framework, an efficient, multidisciplinary, proactive approach, earlier detection and diagnosis of dementia and identification of other health needs and issues. This avoided crisis situations supporting people to remain at home longer. Training and information were felt to improve care quality and reduce caregiver anxiety. People with learning disabilities and caregivers were involved to varying extents. External influences impacting on support included the availability, appropriateness, cost and effectiveness of different models of service provision. Conclusions Service developments have been made as a result of the findings which suggest that dementia pathways and supports improve service provision and outcomes for people with learning disabilities. It is important to develop the evidence base on the effectiveness of different service models for people with learning disabilities and dementia. Future studies need to gather views of people with learning disabilities and carers

Modelling the effect of beliefs about asthma medication and treatment intrusiveness on adherence and preference for once-daily vs. twice-daily medication

We thank the study participants whose data were used in this analysis. Medical writing support in the form of development of a draft outline and manuscript drafts in consultation with the authors, assembling tables and figures, collating author comments, copyediting, referencing and graphic services was provided by Jennifer Lawton, PhD, of Gardiner-Caldwell Communications, Macclesfield, UK, and was funded by GlaxoSmithKline. Study GHO-10-4705 is sponsored by GSK. These analyses were funded by GlaxoSmithKline (study GHO-10-4705) and supported by Spoonful of Sugar Ltd (A UCL Business spin out company). Sarah Chapman and Peter Dale were Employed by UCL School of Pharmacy at the time of involvement in this study. Gillian Stynes was employed by GSK at the time of involvement in this study. Previous presentations: These data were presented by S.C. in a poster at the European Respiratory Society 2016 Congress, and the abstract has been published: Chapman et al. Eur Respir J. 2016; 48 (Suppl 60): PA5018.Peer reviewedPublisher PD

HIV-1 subtype C mosaic Gag expressed by BCG and MVA elicits persistent effector t cell responses in a prime-boost regimen in mice

Over 90% of HIV/AIDS positive individuals in sub-Saharan Africa are infected with highly heterogeneous HIV-1 subtype C (HIV-1C) viruses. One of the best ways to reduce the burden of this disease is the development of an affordable and effective prophylactic vaccine. Mosaic immunogens are computationally designed to overcome the hurdle of HIV diversity by maximizing the expression of potential T cell epitopes. Mycobacterium bovis BCG Δ panCD auxotroph and modified vaccinia Ankara (MVA) vaccines expressing HIV-1C mosaic Gag (Gag M ) were tested in a prime-boost regimen to demonstrate immunogenicity in a mouse study. The BCG-Gag M vaccine was stable and persisted 11.5 weeks post vaccination in BALB/c mice. Priming with BCG-Gag M and boosting with MVA-Gag M elicited higher Gag-specific IFN-γ ELISPOT responses than the BCG-Gag M only and MVA-Gag M only homologous vaccination regimens. The heterologous vaccination also generated a more balanced and persistent CD4 + and CD8 + T cell Gag-specific IFN-γ ELISPOT response with a predominant effector memory phenotype. A Th1 bias was induced by the vaccines as determined by the predominant secretion of IFN-γ, TNF-α, and IL-2. This study shows that a low dose of MVA (10 4 pfu) can effectively boost a BCG prime expressing the same mosaic immunogen, generating strong, cellular immune responses against Gag in mice. Our data warrants further evaluation in non-human primates. A low dose vaccine would be an advantage in the resource limited countries of sub-Saharan Africa and India (where the predominating virus is HIV-1 subtype C)

Sleep-related attentional bias for tired faces in insomnia: evidence from a dot-probe paradigm

People with insomnia often display an attentional bias for sleep-specific stimuli. However, prior studies have mostly utilized sleep-related words and images, and research is yet to examine whether people with insomnia display an attentional bias for sleep-specific (i.e. tired appearing) facial stimuli. This study aimed to examine whether individuals with insomnia present an attentional bias for sleep-specific faces depicting tiredness compared to normal-sleepers. Additionally, we aimed to determine whether the presence of an attentional bias was characterized by vigilance or disengagement. Forty-one individuals who meet the DSM-5 criteria for Insomnia Disorder and 41 normal-sleepers completed a dot-probe task comprising of neutral and sleep-specific tired faces. The results demonstrated that vigilance and disengagement scores differed significantly between the insomnia and normal-sleeper groups. Specifically, individuals with insomnia displayed difficulty in both orienting to and disengaging attention from tired faces compared to normal-sleepers. Using tired facial stimuli, the current study provides novel evidence that insomnia is characterized by a sleep-related attentional bias. These outcomes support cognitive models of insomnia by suggesting that individuals with insomnia monitor tiredness in their social environment

Defining a valid day of accelerometer monitoring in adults with mental illness

Introduction A valid day of accelerometry is commonly defined as an absolute duration of wear time. Data processing inconsistencies can arise when using absolute valid-day criteria for adults with varied waking hours. The aim was to compare the use of absolute and relative valid-day criteria in a sample of adults with mental illness. Methods Data were from 99 non-institutionalised adults with mental illness. Participants were asked to wear an ActiGraph GT3X+ accelerometer continuously for seven days, and to note sleep and non-wear times. Absolute valid-day criteria were defined as a set number of hours/day, and relative criteria as a proportion of waking hours. The mean waking duration, non-wear time, and time spent in physical activity (PA) and sedentary behaviour (SB), were derived from accelerometer data, and compared for a range of absolute and relative criteria. The potential inaccuracy of PA and SB estimates were also estimated. Results Use of absolute criteria systematically biased the sample toward those with longer waking hours, and resulted in a median of 86% (IQR = 47%-198%) more non-wear time than relative criteria. The potential inaccuracy of SB was from -2.5% to 0% with relative criteria, and from -2.2% to 10.6% for absolute criteria. Conclusions For participant samples with varied waking hours, such as adults with mental illness, a valid-day criterion should be based on the proportion of waking hours, rather than the absolute time. The specific valid-day criterion should be chosen for each study independently, and be accompanied with a measure of the non-wear time