Background Persistent postural-perceptual dizziness (PPPD) is a common vestibular disorder. This study was conducted to assess whether the addition of cognitive behavior therapy (CBT) could significantly improve the efficacy and acceptability of sertraline in treating PPPD. Methods PPPD patients were recruited and randomly assigned to control and experiment groups. Patients in both groups received sertraline 50–200 mg/day, and only patients in the experiment group received CBT (twice a week, one hour per time). The treatment was continued for eight weeks. At baseline, week 2, week 4, and week 8, the 25-item Dizziness Handicap Inventory (DHI), Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS) were used to assess the self-perceived handicapping effects caused by PPPD, anxiety, and depressive symptoms, respectively. The dose of sertraline used and the adverse events in both groups were recorded and analyzed. Results In total, 91 PPPD patients were randomly assigned to the control group (n = 45) and experiment group (n = 46). After eight weeks of treatment, the average DHI scores, HDRS scores, and HARS scores were significantly decreased in both groups. But compared to the control group, the experiment group had significantly lower average DHI score, HDRS score, and HARS score at weeks 4 and 8. Moreover, the dose of sertraline used in the experiment group was significantly lower than that in the control group, and adverse events occurred more frequently in the control group than in the experiment group (48.9% versus 26.1%, p = 0.025). Conclusion These results demonstrated that the addition of CBT could significantly improve the efficacy and acceptability of sertraline in treating PPPD and reduce the dose of sertraline used.

Colorectal cancer (CRC) is a major contributor to cancer death globally. Several studies showed some protections by certain individual dietary antioxidants against CRC development. Epidemiologic data on the composite dietary antioxidant index (CDAI) in relation to CRC risk are sparse. Using the Singapore Chinese Health Study, an ongoing prospective cohort consisting of 61 321 cancer‐free participants aged 45 to 74 years at baseline, a food‐based CDAI was calculated according to a previously established and validated method that included six food‐sourced antioxidants including vitamins A, C and E, manganese, selenium and zinc. Cox proportional hazard regression method was used to estimate the hazard ratios (HRs) and their 95% confidence intervals (CIs) for CRC associated with various levels of CDAI with adjustment for multiple potential confounders. After an average of 17.5 years of follow‐up, 2140 participants developed CRC. HRs (95% CIs) of CRC for quartiles 2, 3 and 4 of CDAI were 0.94 (0.83‐1.07), 0.86 (0.75‐1.00) and 0.80 (0.66‐0.98), respectively, compared to the lowest quartile (Ptrend = .02). This inverse association between CDAI and CRC risk was more apparent in women or those without a history of diabetes, without family history of CRC, never smokers or overweight/obese individuals. However, none of the heterogeneity tests for the CDAI‐CRC risk association reached statistical significance. Our findings suggest that food‐based antioxidants may be beneficial for reducing the risk of CRC in the general population.

ObjectivesHigher 24-hour blood pressure (BP) and blunted BP dipping during sleep and night-time hours are associated with adverse health outcomes. Night shift work may affect 24-hour BP and dipping patterns, but empirical data in emergency medical services (EMS) clinician shift workers are sparse. We implemented ambulatory blood pressure monitoring (ABPM) in EMS workers to characterise BP during night shift work versus a non-workday, and sleep versus wake.MethodsParticipants worked night shifts. Hourly ABPM and wrist actigraphy (to measure sleep) were collected during two 24-hour periods, one scheduled night shift and one non-workday. Blunted BP dipping was defined as a BP decrease of <10%.ResultsOf 56 participants, 53 (53.6% female, mean age 26.5 (SD 7.5) years) completed the study. During daytime sleep on a workday, 49.1% of participants had blunted systolic BP (SBP) or diastolic BP (DBP) dipping. During night-time sleep on a non-workday, 25% had blunted SBP dipping and 3.9% blunted DBP dipping. Blunted SBP or DBP dipping occurred among all participants who did not nap during the night shift or who napped <60 min. Blunted SBP dipping occurred in only 14.3% of participants who napped 60–120 min.ConclusionsDuring night shift work, the BP dipping of EMS shift workers is blunted; however, most who nap for 60 min or longer experience a healthy dip in BP. The potential health consequences of these observations in EMS clinicians warrant further study.

Four-season surveys of macroalgal assemblage structure on a coral reef in southern Taiwan were performed by transect investigation from October 1999 through August 2000. Species richness increased over time, and percentage cover and biomass peaked in April. Non-metric multidimensional scaling ordination analysis of species similarities between stations showed three distinct clusters corresponding to the upper reef flat, the lower reef flat and the reef slope. The macroalgal assemblage on the lower reef flat was further grouped into two clusters corresponding to the warmer months (October 1999 and August 2000) and the cooler months (January and April 2000), suggesting the macroalgal assemblage is structured primarily by zone and secondarily by season. Species richness, percentage cover, biomass, species diversity (H') and evenness (J') were highest on the lower reef flat, reflecting greater complexity in the macroalgal assemblage in this zone. However, species diversity and evenness on the lower reef flat and the reef slope did not show seasonal variations. Species diversity in the upper reef flat decreased in the warmer months due to the dominance of an unknown red alga in October 1999 and Enteromorpha linza in August 2000. The results of ANO-SIM tests showed that species structure was different not only between zones but also between seasons, and the SIMPER analyses showed that, in the warmer months, Gracilaria coronopifolia, Enteromorpha linza, Laurencia spp. and Hypnea charoides were the species that separated the lower reef flat assemblage from other assemblages. In the same way, the unknown red alga (for Present address: Kaohsiung Municipal Ming-spp., Mastrophora rosea and Portieria hornemannii were the species responsible for differences in structure between the upper reef flat and the reef slope.In the cooler months, the species responsible for differences in structures between the upper reef flat and the other two zones were Sargassum spp., Gracilaria coronopifolia, Enteromorpha linza and Padina australis, and those responsible for differences between the upper reef flat and the reef slope were Hypnea charoides, Halimeda spp., Mastophora rosea, Enteromorpha linza and Portieria hornemannii. The present investigation suggests that macroalgal abundance and structure on a coral reef in Nanwan Bay in southern Taiwan have marked spatial zonation and seasonal variations, and Sargassum on the lower reef flat has become the most abundant alga, as compared to 12 years ago.