For healthcare professionals only


Electronic insomnia, and other stories

BMJ 2013; 346 doi: (Published 26 March 2013) Cite this as: BMJ 2013;346:f1910

Minerva generally sleeps well, but according to “the great British bedtime report” the average Briton goes to bed at 11.15 pm and achieves just six hours and 35 minutes of sleep, with a third of adults getting less than six hours ( Poor “sleep hygiene” such as watching television, checking emails, and using a laptop in bed can result in electronic insomnia. All of these can create stress, and they all emit bright light, which disrupts the production of natural sleep hormones. Exercise is the most useful solution to improve sleep.

Postcards sent to patients who have taken overdoses can cut the number of repeated self poisoning attempts. An Australian randomised controlled trial of 722 patients admitted to hospital with overdose compared sending eight supportive postcards over 12 months after discharge with usual follow-up care (British Journal of Psychiatry 2013, doi:10.1192/bjp.bp.112.112664). The intervention halved self poisoning events and reduced psychiatric admissions by a third after five years. There were substantial savings in general hospital and psychiatric hospital bed days.

It’s compression quality that counts when it comes to cardiopulmonary resuscitation. A systematic review and meta-analysis concludes that deeper chest compressions and rapid rates of compression are associated with significantly improved survival from cardiac arrest (Circulation: Cardiovascular Quality and Outcomes 2013, doi:10.1161/CIRCOUTCOMES.111.000041). Survivors were significantly more likely to have received chest compression rates closer to 85-100 compressions per minute than non-survivors. No significant difference in no-flow fraction or ventilation rate was detected between those who survived and those who did not.

Neck injuries are associated with major socioeconomic consequences for patients, their partners, and society, but Danish researchers say increased costs after injury cannot be explained by the injury alone. A large matched register based study found that these patients already had lower employment rates, lower incomes, and negative social and health related status up to 11 years before their neck injury compared with controls (Spine 2013;38:449-57, doi:10.1097/BRS.0b013e3182819203). The researchers suggest that these patients have a pre-existing vulnerability.

Italian scientists have developed a polymer based optoelectronic interface for restoring light sensitivity to the retinas of blind rats (Nature Photonics 2013, doi:10.1038/nphoton.2013.34). They placed a retina with damaged rods and cones on to a glass substrate coated with indium tin oxide and P3HT, a polymer semiconductor commonly found in organic solar cells. They then showed that the polymer layer, when under direct pulsed illumination, functioned as an artificial photoreceptor causing the retinal neurones to fire.

A longitudinal study of more than 16 600 patients in the cardiovascular arm of the UK General Practice Research Database found that higher dose statins taken for at least two years are associated with significant reductions in clinically important outcomes in osteoarthritis (Journal of General Internal Medicine 2013, doi:10.1007/s11606-013-2382-8). Estimated reductions in osteoarthritis outcome were 18% after two years and 40% after four years in people taking high dose statins compared with non-statin users. Biological modification of osteoarthritis seems a plausible explanation, and abnormal lipid metabolism might be a causal factor in the pathogenesis of the disease.

Emerging evidence suggests that taking multivitamins plus folic acid in early pregnancy may significantly reduce the risk of gestational hypertension or pre-eclampsia. But what about folic acid alone? Analysis of data from a large Chinese population based cohort study of folic acid and neural tube defects found overall incidences of gestational hypertension and pre-eclampsia of 9.5% and 2.5%, respectively, which were not affected by folic acid supplementation (Hypertension 2013;61:873-9, doi:10.1161/hypertensionaha.111.00230).

Self care strategies for managing depressive symptoms in people with HIV can be taught and are effective, according to a randomised controlled trial of an HIV/AIDS symptom management manual for depressive symptoms. In an international sample of people with HIV, who were part of a larger study, 124 people were given the manual and 98 controls were given a nutrition manual (AIDS Care 2013;25:391-9, doi:10.1080/09540121.2012.712662). The best strategies were distraction techniques and prayer. However, the effects may be short term—depressive symptoms were significantly lower at one month but not after two.

The transition into parenthood brings changes in mental health and psychological distress. A longitudinal study that looked at the impact of becoming a parent compared the experience in three waves—from non-parent to parent, from first time parent to subsequent parent (a baby joining other children), and the transition to no longer having young children (Journal of Epidemiology and Community Health 2013;67:339-45, doi:10.1136/JECH-2012-201765). After adjusting for partner status, area deprivation, employment status, and household income, new first time parents reported an improvement in mental health and a reduction in psychological distress. Subsequent parents also reported less distress.


Cite this as: BMJ 2013;346:f1910


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