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Internet-Based Intervention May Improve Insomnia
An online insomnia intervention based on established face-to-face cognitive behavioral therapy techniques appears to improve patients" sleep, according to a report in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
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HIV Specialty Clinics Across U.S. Closing, Changing Focus, Citing Lack Of Funding, Other Reasons
HIV Specialty Clinics Across U.S. Closing, Changing Focus, Citing Lack Of Funding, Other Reasons. The Scripps Howard/Kansas City infoZine examines how some medical clinics across the U.S. that specialize in treating patients with HIV are closing due to lack of funding and decreased demand, among other reasons.
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This Time Around, Debate Much Different
Insurance companies, "the industry that gets credit for helping to kill the Clinton administration"s health care overhaul 15 years ago," are now "striking a conciliatory tone as it faces the most serious attempt to overhaul the system since that effort collapsed," CQ Politics reports. With low favorability ratings and Democrats in control of the federal government, "insurers know they aren"t in a good bargaining position" this time around. They have already offered concessions, including providing "insurance in the individual markets to everyone, without regard to who is sick," and not "charging people who are ill higher rates and cut health care costs." But they"ve also been ""careful to structure their offers in such a way that appears significant but does not overpromise." An individual mandate for all Americans and an end to health screening for applicants could offer "a win-win outcome, one that will benefit not just patients but potentially the profits of the industry as well." But "perhaps the biggest motivation for insurers to deal now is that they fear what might happen if they don"t" - the "creation of a government-run plan that would be more attractive to the public and siphon off customers" (Adams, 6/1).
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New Internet Intervention Gives Insomnia Patients A Better Night's Sleep

The estimated one-third of adults who suffer from insomnia could soon find effective treatment without ever leaving their homes. Researchers at the University of Virginia Health System have developed a unique Internet-based intervention, based on well-established face-to-face cognitive behavioral therapy techniques, that has shown remarkable results in improving patients" sleep. In the pilot study, Lee M. Ritterband, Ph.D., associate professor of psychiatry and neurobehavioral sciences at the UVA School of Medicine, and colleagues evaluated the effectiveness of the Internet intervention among 44 adults who had a history of sleep difficulties lasting more than 10 years on average. A total of 22 participants were randomly assigned to a control group and 22 received the Internet intervention, called SHUTi. "All 44 patients were in the moderate severity range for insomnia when we began our study," Ritterband says. "After completing our study 73 percent of those who used our system reported no severity of insomnia, whereas all patients who didn"t use the system continued to have the same level of moderate severity." Furthermore, Ritterband reports that all patients with improved sleep after using the Internet intervention maintained these improvements six months after the study"s completion. The study, supported by a grant from the National Institute of Mental Health, National Institutes of Health, appears in the July 2009 issue of Archives of General Psychiatry. The highly interactive nine-week program uses text, graphics, animations, vignettes, quizzes and games to present behavioral, educational and cognitive techniques for improving sleep. For instance, patients were advised to avoid reading and watching television in the bedroom, stop daytime napping and change unhelpful beliefs and thoughts (including worries about the consequences of insomnia) that may exacerbate sleep difficulties. "Our program is unique in that it engages the user and tailors the treatment to an individual"s particular needs," says Ritterband. "These interactive components make it like no other online intervention for insomnia out there right now." Participants completed daily sleep diaries before and after the intervention and also rated their symptoms on the seven-item Insomnia Severity Index, which produces a score from zero (no symptoms) to 28 (severe insomnia). Among individuals who received the intervention, scores on the index improved from 15.73 to 6.59, whereas scores did not change for the control group. These gains were maintained at a six-month follow-up assessment. "One of the exciting pieces of Internet-based interventions is to be able to provide treatment to people who otherwise might not get treatment," says Ritterband. Cognitive behavioral therapy a psychological treatment focusing on the behaviors and dysfunctional thoughts that contribute to sleep problems is one of the most effective treatments for insomnia. "Unfortunately, availability of cognitive behavioral therapy is severely limited for many reasons, including lack of trained clinicians, poor geographical distribution of knowledgeable professionals, expense and inaccessibility to treatment and clinicians," says Ritterband. "An Internet intervention has the potential of meeting the large unmet treatment needs of the population with insomnia by providing effective treatment through the Web. An effective and inexpensive Internet intervention would expand treatment options for large numbers of adults with insomnia, especially those whose geographical location prohibits access to relevant care, and could be a substantive first-line treatment choice." University of Virginia Health System


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