Cognitive Behavioral Therapy for Insomnia Improves Sleep Outcomes in Individuals With Concussion: A Preliminary Randomized Wait-List Control Study.

OBJECTIVE: Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard treatment for insomnia, but there is limited evidence on the treatment effect of CBT-I in individuals after a concussion. Therefore, the main purpose of this study was to evaluate the treatment effect of CBT-I on sleep outcomes and postconcussion symptoms. SETTING: This study was conducted at an academic institution. The CBT-I sessions were conducted using a teleconferencing system (Zoom). PARTICIPANTS: Participants were eligible to participate if they were at least 4 weeks post- concussion, aged 18 to 64 years, and scored 10 or more on the Insomnia Severity Index. A total of 40 people were enrolled; 32 participants were included in analyses. DESIGN: This was a randomized controlled wait-list study. Participants were randomized into starting the CBT-I intervention immediately after the baseline assessment or into the wait-list group for 6 weeks before starting CBT-I. Assessments were performed at baseline, 6, 12, and 18 weeks. MAIN MEASURES: The primary outcome was the Insomnia Severity Index. Secondary measures included the Pittsburg Sleep Quality Index, Post-Concussion Symptom Scale, and Beck Depression and Anxiety Inventories. Statistical analyses included a repeated-measures analysis of variance, t tests, and mixed linear regression modeling. RESULTS: There was a group-by-time interaction for the sleep outcomes but not for the concussion or mood outcomes. Differences were seen between groups on sleep outcomes, symptom severity, and depression. The treatment effect was maintained following CBT-I for all outcomes. Improvement in sleep outcomes was predictive of improvement in postconcussion symptom severity and number of symptoms. CONCLUSIONS: CBT-I reduces insomnia in individuals with concussions, and improved sleep was associated with lower postconcussion and mood symptoms. These effects were maintained 6 to 12 weeks following the intervention.

Rural breast cancer survivors are able to maintain diet quality improvements during a weight loss maintenance intervention.

PURPOSE: Obesity and poor diet quality (DQ) are associated with increased risk of morbidity/mortality among breast cancer survivors. This study explored DQ changes during a weight loss maintenance intervention in a cohort of rural female breast cancer survivors (n = 131) who lost ≥ 5% body weight in a weight loss intervention. Previous analyses demonstrated significant DQ improvements during weight loss. METHODS: DQ was calculated using the alternate Healthy Eating Index (aHEI)-2010. Differences in scores across time for the cohort and between those that maintained weight loss within 5% (low regainers) and those that regained > 5% (high regainers) were analyzed by linear mixed models. RESULTS: Significant improvements in aHEI total score were observed from baseline (M = 52.3 ± 11) to 6 months (M = 60.7 ± 8; p < 0.001); these improvements were sustained from 6 to 18 months (M = 58.4 ± 11; p = 0.16). Total aHEI-2010 score at 18 months was higher in low regainers, compared with high regainers (60.7 vs. 56.0, p = 0.03), with healthier component scores for red meat (p = 0.01) and fruit (p = 0.04), and a trend for a healthier score for sugar-sweetened beverages (p = 0.08). CONCLUSIONS: Overall DQ improvements made during a weight loss intervention for rural breast cancer survivors were sustained during a weight loss maintenance intervention; this intervention was effective in helping low regainers maintain healthier scores in fruit, red meat, and sugar-sweetened beverage components. IMPLICATIONS FOR CANCER SURVIVORS: Maintaining higher DQ may help breast cancer survivors maintain weight loss, thereby reducing risk of breast cancer recurrence and premature death from comorbidities.

What makes us tick: Implications of personality differences among otolaryngology residents and faculty.

OBJECTIVE: The rapid personal and professional growth experienced during medical training and practice is impacted by personality. The surgeon's personality is renowned in both medical lore and literature. However, it is now known that the personality characteristics of today's millennial trainees differ from older faculty. This study investigates the variability of different personality attributes among otolaryngology residents and faculty, as well as the practical implications of these findings. METHODS: The opportunity to complete a series of web-based, commercially available, self-administered five factor-based personality assessments was given to otolaryngology residents and faculty at nine academic training programs. The psychometrically validated assessments evaluate innate personality 1) strengths, 2) challenges, and 3) motivators/values. Differences between groups in the assessed metrics were evaluated using two-tailed t tests. RESULTS: Seventy-eight otolaryngology faculty and 104 residents completed all three assessments. Of the assessed metrics, there were several significant differences between residents and faculty (all P < 0.05). Residents scored higher than faculty in the domains of interpersonal sensitivity, sociability, and inquisitiveness. With respect to potential challenges, faculty displayed higher levels of skepticism and reservation. In contrast, residents scored higher in the categories of mischievous and dutiful. As for motivators/values, although both groups were highly motivated by altruism, faculty valued tradition more than residents, whereas residents valued hedonism and affiliation more than faculty. CONCLUSION: There are notable differences between residents and faculty in multiple domains, with implications for communication, education, and professional development. LEVEL OF EVIDENCE: 3 Laryngoscope, 129:2286-2290, 2019.