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Background: Obstructive sleep apnoea (OSA) is a common chronic respiratory disease associated with a high burden of disabilities related to sleepiness and reduced quality of life. Despite first-line treatment with continuous positive airway pressure (CPAP) therapy, many patients experience residual excessive daytime sleepiness (EDS). The aim of this study is to compare the relative efficacy and safety of medications authorised for this indication in Europe and/or the United States (modafinil/armodafinil, solriamfetol, and pitolisant) for OSA., Methods: In this systematic review and network meta-analysis, randomised controlled trials (RCTs) that compared the efficacy and safety of authorised medications for adult patients with OSA were identified by literature searches of PubMed, Embase and ClinicalTrials.gov databases (up to 12 June 2024). The primary efficacy endpoint was combined Epworth Sleepiness Scale (ESS) and Oxford Sleep Resistance (OSLER)/Maintenance of Wakefulness Test (MWT) Z-scores. Quality of life (QoL), overall and specific cardiovascular safety, and benefit-risk ratios were calculated. The study was registered with PROSPERO: CRD42023434640., Findings: Of 4017 studies identified, a total of 20 RCTs involving 4015 patients were included. Analysis of combined subjective (ESS) and objective (OSLER/MWT) efficacy outcome Z-scores showed that solriamfetol (150 mg; effect size [ES] = 0.66 [95% CI: 0.36, 0.96]), pitolisant (20 mg; ES = 0.66 [95% CI: 0.44, 0.88]), and modafinil (200 mg; ES = 0.54: [95% CI: 0.33, 0.74]); 400 mg; ES = 0.54 [95% CI: 0.42, 0.65]) had a clinically meaningful improvement in efficacy. P-scores ranked placebo, then pitolisant, modafinil 200 mg, modafinil 400 mg and solriamfetol for overall safety; and pitolisant, then solriamfetol, modafinil 400 mg and modafinil 200 mg for benefit-risk ratio., Interpretation: Pitolisant, solriamfetol and modafinil had comparable efficacy for maintaining wakefulness in patients with OSA. Pitolisant had a better safety profile and benefit-risk ratio compared with solriamfetol and modafinil. The overall and cardiovascular safety risk ratios suggest that pitolisant might be the best candidate for patients with OSA with multiple cardiovascular comorbidities., Funding: Bioprojet., Competing Interests: This analysis has been sponsored by Bioprojet Pharma. Jean-Louis Pépin has received grants or contracts from the National Research Agency, and lecture fees and travel grants from RESMED, SEFAM and Bioprojet. Jerryll Asin received support from Bioprojet for attending meetings and/or travel; received grants or contracts (paid to his institute) from Philips, Somnomed and Zoll Respicardia; consulting fees (paid to his institute) from Zoll Respicardia; participation on a Data Safety Monitoring Board or Advisory Board (paid to his institute) from Zoll Respicardia; member of the Dutch Association of Sleep Medicine (no payment). Ferran Barbé received support from Bioprojet for attending meetings and/or travel; received grants or contracts for sleep research from Instituto de Salud Carlos III. Maria Bonsignore received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Bioprojet and Takeda; support for attending meetings and/or travel from Bioprojet; participation on a Data Safety Monitoring Board or Advisory Board for Bioprojet. Winfried Randerath received study funding from Bioprojet; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Heinen & Löwenstein, Habel Medizintechnik, Jazz Pharmaceuticals, Inspire, Philips Respironics and Bioprojet; support for attending meetings and/or travel from Heinen & Löwenstein, Habel Medizintechnik, Jazz Pharmaceuticals, Philips Respironics and Bioprojet; personal fees for participation on a Data Safety Monitoring Board or Advisory Board for Bioprojet, Jazz Pharmaceuticals and Procter & Gamble; unpaid roles with the European Respiratory Society Head Assembly 4, Sleep Disordered Breathing (until September 2023), Guidelines Director elect 2024 and the German Respiratory Society, Secretary General (until March 2024), authorised member since March 2024. Johan Verbraecken received study funding from Bioprojet; support for teaching courses (paid to his institute) from Air Liquide, Bioprojet, Inspire Medical Systems, Löwenstein Medical, Medidis, Mediq Tefa, Micromed OSG, Philips, ProSomnus, ResMed, Sefam, SomnoMed, SOS Oxygène, Tilman, Total Care, Vivisol, and Zoll Itamar outside the submitted work; royalties or licenses (paid to his institute) from Epilog; consulting fees (paid to his institute) from Desitin and Epilog; payment of honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events (paid to his institute) from Atos Medical, Idorsia, Inspire Medical Systems; support for attending meetings and/or travel from Bioprojet; past-President (since 2020) of the Belgian Association for Sleep Research and Sleep Medicine. Yves Dauvilliers received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educationa events from Jass Pharmaceuticals, Bioprojet, Takeda, UCB, Orexia, Idorsia and Avadel; support for attending meetings and/or travel from Jazz Pharmaceuticals, Bioprojet and Avadel; participation on a Data Safety Monitoring Board or Advisory Board for Idorsia. Raoua Ben Messaoud, Marie Joyeux-Faure and Sonya Craig have no declaration of interest., (© 2024 The Authors.)

Psychological capital (PsyCap) is a multidimensional concept entailing hope, self-efficacy, optimism, and resilience. This paper argues that it can be considered a form of "capital" explaining social inequality. We test whether PsyCap can be integrated into the Bourdieusian capital framework by assessing its relationship with social, economic, and cultural capital. We also identify different types of social positions based on the volume and composition of psychological, economic, cultural, and social capital. We use cross-sectional data from the European Social Survey of 2012 (N = 35,313 respondents; 29 countries). To test the associations with the Bourdieusian capital types, we calculated multilevel spearman rank correlations and performed confirmatory factor analyses (CFA). Latent Class Analysis identified different types of social positions. We found positive weak correlations between PsyCap and the indicators of cultural capital (r ≤ .14) and positive moderate correlations with the indicators of economic and social capital (r ≤ .24). The results of the CFA showed that the fit of the 4-capital model was superior to that of the 3-capital model. We identified six types of social positions: two deprived types (with overall low capital levels); two well-off types (with overall high capital levels) and two types with high psychological and social capital in combination with varying levels of cultural and economic capital. Including PsyCap in the Bourdieusian capital framework acknowledges the power of positive psychological states regarding processes of social mobility and social inequality on the one hand and calls for understanding PsyCap as a social and group-level phenomenon on the other hand. As such, integrating PsyCap into the Bourdieusian framework can help to address the longstanding issue of understanding the relationship between social and individual differences in the study of social inequalities., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 De Moortel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The literature on lottery gambling shows that players do not select numbers randomly, a phenomenon which is called conscious selection. Mainly, players prefer "small" numbers (less than thirty), either because of the existence of small lucky numbers or because they are victims of the so-called birthday-number effect. Because lotto games are parimutuel, such preferences result in poor ticket choices in terms of achieving below average returns. Using data from Belgium, where approximately 10% of the population plays lotto games every week, this paper extends prior literature by documenting the existence of a gender gap in the birthday-number effect, with women displaying a stronger birthday-number effect than men, as well as the non-persistence of the birthday-number effect (and consecutively of the gender gap) when participants are asked to fill in a second lotto ticket immediately after their first one. The disappearance of the birthday-number effect in sequential choices appears to be driven by response speed, with participants being twice as fast to fill in the second ticket compared to the first one. Moreover, we find that participants who bet on their birthday numbers take significantly more time to complete their ticket. Contrary to prior research, we find that the strength of the birthday-number effect is positively related to deliberative number choices, not intuitive and automatic number choices. Our results are robust to controlling for potential confounding effects including those related to participants' age, education, self-esteem, and superstitious beliefs., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: In people with OSA, excessive daytime sleepiness is a prominent symptom and can persist despite adherence to CPAP, the first-line therapy for OSA. Pitolisant was effective in reducing daytime sleepiness in two 12-week randomized controlled trials (RCTs), one in patients adherent to CPAP (BF2.649 in Patients With OSA and Treated by CPAP But Still Complaining of EDS [HAROSA 1]) and the other in patients refusing or not tolerating CPAP (BF2.649 in Patients With OSA, Still Complaining of EDS and Refusing to be Treated by CPAP [HAROSA 2])., Research Question: Does the efficacy and safety of pitolisant persist when these patients take it long-term?, Study Design and Methods: All adults included in the HAROSA 1 and HAROSA 2 RCTs (both pitolisant and placebo arms) were offered pitolisant (up to 20 mg/d) after completion of the short-term double-anonymized phase (ie, from week 13) in an open-label cohort study. The primary efficacy outcome was the change in Epworth Sleepiness Scale score between baseline and week 52. Safety outcomes were treatment-emergent adverse event(s) (TEAE[s]), serious TEAEs, and special interest TEAEs., Results: Out of 512 adults included in the two RCTs, 376 completed the 1-year follow-up. The pooled mean difference in Epworth Sleepiness Scale score from baseline to 1 year for the intention-to-treat sample was -8.0 (95% CI, -8.3 to -7.5). The overall proportions of TEAEs, serious TEAEs, and TEAEs of special interest were 35.1%, 2.0%, and 11.1%, respectively, without any significant difference between patients in the initial pitolisant and placebo arms. No cardiovascular safety issues were reported., Interpretation: Pitolisant is effective in reducing daytime sleepiness over 1 year in adults with OSA, with or without CPAP treatment. Taken for 1 year, it has a good safety profile (including cardiovascular)., Trial Registration: ClinicalTrials.gov; Nos.: NCT01071876 and NCT01072968; URL: www., Clinicaltrials: gov., Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: J.-L. P. reports administrative support and APC from Bioprojet during the conduct of the study; research grants from Agiradom, Air Liquide Foundation, Astra Zeneca, Bioprojet, Jazz Pharmaceuticals, Philips, Resmed, Sefam, and Vitalaire, outside the reported work; and honoraria or consultation fees from Agiradom, Somnomed, Bioprojet, ITAMAR, Jazz Pharmaceuticals, Philips, Resmed, and SEFAM, outside the reported work. C. C. is an employee of Bioprojet. Outside the reported work, J. V. has received institutional fees and educational grants from AirLiquide, AstraZen, Bekaert Deslee Academy, Bioprojet, Desitin, Ectosense, Epilog, Fisher & Paykel, Heinen & Löwenstein, Idorsia, Inspire, Jazz Pharmaceutics, Medidis, Mediq Tefa, OSG, Philips, ResMed, Sefam, SomnoMed, Total Care, UCB Pharma, Vivisol, and Westfalen Medical. Outside the reported work, R. T. reports research grants paid to his institution (Resmed, Inspire, BioProjet); personal lecture fees from Périmetres, Philips, Resmed, Jazz Pharmaceutical, and Bioprojet; and participation in advisory boards of Narval (Resmed), Bioprojet, and Idorsia. I. L. is an employee and shareholder of Bioprojet. Y. D. reports grants from Bioprojet, during the conduct of the study; and grants and/or consulting fees from UCB, JAZZ, Takeda, Theranexus, Harmony bioscience, Avadel, Paladin, and Idorsia, outside the submitted work. P. Lehert was a consultant statistician for Bioprojet during the conduct of the study; and is a consultant statistician for Merck, Sanofi, and Aguettant Pharma, outside the submitted work. None declared (V. A., J. H., and P. Lévy)., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Conscious selection is the mental process by which lottery players select numbers nonrandomly. In this paper, we show that the number 19, which has been heard, read, seen, and googled countless times since March 2020, has become significantly less popular among Belgian lottery players after the World Health Organization named the disease caused by the coronavirus SARS-CoV-2 "COVID-19". We argue that the reduced popularity of the number 19 is due to its negative association with the COVID-19 pandemic. Our study triangulates evidence from field data from the Belgian National Lottery and survey data from a nationally representative sample of 500 Belgian individuals. The field data indicate that the number 19 has been played significantly less frequently since March 2020. However, a potential limitation of the field data is that an unknown proportion of players selects numbers randomly through the "Quick Pick" computer system. The survey data do not suffer from this limitation and reinforce our previous findings by showing that priming an increase in the salience of COVID-19 prior to the players' selection of lottery numbers reduces their preference for the number 19. The effect of priming is concentrated amongst those with high superstitious beliefs, further supporting our explanation for the reduced popularity of the number 19 during the COVID-19 pandemic., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The COVID lockdowns were characterised by new forms of governmentality as lives were disrupted and controlled through the vertical transmission of biopolitics by the state. The paper considers how this was experienced by academics in 11 different countries through analysis of diaries written during the first lockdown. The paper asks if communities can offer an alternative to governmentality by looking at three levels: the national, the neighbourhood and the personal. Whilst at a national level the idea of community was instrumentalised to encourage compliance to extraordinary measures, at the local level community compassion through helping neighbours encouraged horizontal connections that could offer a "space" within the dominant logic of governmentality. At the level of personal communities, the digitalisation of social relationships helped to create supportive networks over widely dispersed areas but these were narrowly rather than widely focused, avoiding critical discussion., (© The Author(s) 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: Narcolepsy is a life-long disorder characterised by excessive daytime sleepiness and cataplexy, often arising in childhood or adolescence. Pitolisant, a selective histamine H3 receptor inverse agonist, has been approved in Europe and USA for adults with narcolepsy with or without cataplexy, with a favourable safety profile. This phase 3 study aimed to assess the safety and efficacy of pitolisant in children with narcolepsy with or without cataplexy., Methods: For this double-blind, randomised, placebo-controlled, multisite study, we recruited patients aged 6-17 years with narcolepsy with or without cataplexy in 11 sleep centres in five countries (Italy, France, Netherlands, Russia, and Finland). Participants were required to have a Pediatric Daytime Sleepiness Scale score of 15 or greater and to have not received psychostimulants for at least 14 days before enrolment; participants who needed anticataplectics (including sodium oxybate) were required to have been on a stable dose for at least 1 month. Participants were randomly assigned to treatment with pitolisant or placebo in a 2:1 ratio at the end of screening. Randomisation was stratified by study centre and treatment was allocated using an interactive web response system. After a 4-week screening period including a 2-week baseline period, patients entered in a 4-week individual up-titration scheme from 5 mg a day to a maximum of 40 mg a day of pitolisant or placebo; treatment was administered at a stable dose for 4 weeks, followed by a 1-week placebo period. For the primary analysis, we assessed pitolisant versus placebo using change in the Ullanlinna Narcolepsy Scale (UNS) total score from baseline to the end of double-blind period in the full analysis set, defined as all randomly allocated patients who received at least one dose of treatment and who had at least one baseline UNS value. A decrease in the UNS total score reflects a reduction in both excessive daytime sleepiness and cataplexy. All adverse events were assessed in the safety population, defined as all participants who took at least one dose of study medication. An open-label follow-up is ongoing. This study is registered at ClinicalTrials.gov, NCT02611687., Findings: Between June 6, 2016, and April 3, 2021, we screened 115 participants and 110 were randomly assigned (mean age 12·9 [SD 3·0] years, 61 [55%] male, and 90 [82%] with cataplexy; 72 assigned to pitolisant and 38 to placebo); 107 (70 receiving pitolisant and 37 receiving placebo) completed the double-blind period. The mean adjusted difference in UNS total score from baseline to the end of the double-blind period was -6·3 (SE 1·1) in the pitolisant group and -2·6 (1·4) in the placebo group (least squares mean difference -3·7; 95% CI -6·4 to -1·0, p=0·007). Treatment-emergent adverse events were reported in 22 (31%) of 72 patients in the pitolisant group and 13 (34%) of 38 patients in the placebo group. The most frequently reported adverse events (affecting ≥5% of patients) in either group were headache (14 [19%] in the pitolisant group and three [8%] in the placebo group) and insomnia (five [7%] in the pitolisant group and one [3%] in the placebo group)., Interpretation: Pitolisant treatment resulted in an improvement in narcolepsy symptoms in children, although the UNS was not validated for use in children with narcolepsy when our study began. The safety profile was similar to that reported in adults but further studies are needed to confirm long-term safety., Funding: Bioprojet., Competing Interests: Declaration of interests YD reports grant and consultancy fees from Bioprojet, Idorsia, Avadel, Harmony Biosciences, Takeda, and Jazz Pharmaceuticals, during the conduct of the trials. GP reports grant and consultancy fees from Bioprojet, Idorsia, Takeda, Orexia, Fidia, and Jazz Pharmaceuticals. PF reports grant and consultancy fees from Bioprojet and Jazz Pharmaceuticals. ML reports consultancy fees from Bioprojet, and Jazz Pharmaceuticals. GJL reports grant and consultancy fees from Bioprojet and Jazz Pharmaceuticals. IJ, CC, JML, and JCS are employees of Bioprojet. MP and PL declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Sunlight exposure is an essential source of vitamin D for many humans. However, hypovitaminosis D is a global public health problem. This study aimed to develop and validate a sun exposure score (SES) and correlate it with serum 25-hydroxyvitamin D levels in women of childbearing age. One hundred and sixty women aged 18 to 45 years residing in Meknes, Morocco, were included. A questionnaire estimating the sun exposure score and blood analysis of serum 25-OHD concentration were performed. The questionnaire's reliability and construct validity were evaluated using Cronbach's alpha and factor analysis. Spearman's test was used to assess the correlation between SES and 25-OHD levels. The score's reliability and construct validity were good, with Cronbach's alpha values >0.70 and factorial saturation ranging from 0.696 to 0.948. Serum 25-OHD levels were significantly associated with the total sun exposure score, and all SES domains (Rho was 0.615 ( p < 0.0001), 0.307 ( p < 0.0001), 0.605 ( p < 0.0001), and 0.424 ( p < 0.0001) for total SES, indoor exposure domain, outdoor exposure domain, and sun protection practice domain, respectively). In addition, median 25-OHD levels increased significantly when sun exposure was changed from insufficient to sufficient ( p < 0.0001). The results suggest that the sun exposure score could be used as a clinical tool to assess vitamin D levels in women of childbearing age.

Unprecedented uncertainty during the Covid-19 pandemic stimulated anxiety among individuals, while the associated health restrictions contributed to a feeling of loss of control. Prior research suggests that, in times of crisis, some individuals rely on superstitious beliefs as a coping mechanism, but it remains unclear whether superstition is positively or negatively associated with fear of Covid-19 during the pandemic, and the role that individuals' locus of control plays in this regard. In two studies conducted among individuals in Belgium and the U.S., we therefore examined the relationship between superstitious beliefs, locus of control, and feeling at risk of Covid-19. Across both countries, we found that superstition is positively, and internal locus of control negatively, related with feeling at risk of Covid-19. Moreover, in Belgium, the effect of superstition was less pronounced for individuals with a higher level of internal locus of control. The absence of an interaction effect between superstition and locus of control in the U.S. could be explained by this country's higher level of superstitious beliefs and lower level of internal locus of control combined with a stronger feeling of being at risk of Covid-19 or cultural differences such as Belgium's higher uncertainty avoidance compared to the U.S., Competing Interests: None., (© 2022 Elsevier Ltd. All rights reserved.)

Background and Objective: Excessive daytime sleepiness (EDS) and fatigue are major complaints in patients with obstructive sleep apnoea (OSA) syndrome. Pitolisant is an orally active selective histamine H3 receptor (H3R) antagonist/inverse agonist, which enhances histaminergic transmissions in the brain and thereby elicits strong wake-promoting effects. This article assesses the efficacy and safety of pitolisant 20 mg in patients with OSA, based on existing randomised controlled studies., Methods: An individual patient data (IPD) meta-analytical two-level (study-patient) hierarchical model was used assuming a random treatment effect. The Epworth Sleepiness Scale (ESS) and Oxford Sleep Resistance (OSleR) tests were co-primary endpoints., Results: A total of 512 patients, including 384 treated with pitolisant and 128 with placebo, were included in the analysis. Compared with placebo, pitolisant reduced mean ESS by - 3.1 (95% CI [- 4.1; - 2.1]; p < 0.001) and improved OSleR by 1.18 (1.02; 1.35, p = 0.022); 30% more patients had reduced fatigue (risk ratio [RR] = 1.3, [1.11; 1.53]), p = 0.001) and 46% more patients had improved Clinical Global Impression (CGI) (RR = 1.46 [1.12; 1.89], p = 0.005). No significant differences in safety endpoints were found. These results proved homogeneous across studies and subgroups of the population., Conclusion: The results provide evidence of a significant benefit of pitolisant in improving EDS and fatigue, irrespective of baseline conditions., (© 2021. The Author(s).)

In Morocco, due to the lack of education and the presence of a counterfeit market, pesticides constitute a major problem to be addressed by occupational and environmental health agencies. This paper aims to introduce the PaPOE (Parental Pesticides and Offspring Epigenome) prospective study and its goals, to motivate the study rationale and design, and to examine comprehensively whether multi-residue exposure to commonly used pesticides could induce epigenetic alterations through the oxidative stress pathway. The PaPOE project includes a cross-sectional study assessing the occupational exposure among 300 farmworkers in Meknes, and initiates a birth cohort of 1000 pregnant women. Data and biological samples are collected among farmworkers, and throughout pregnancy, and at birth. Oxidative stress biomarkers include Glutathione, Malondialdehyde, and 8-OHdG. Global and gene-specific DNA methylation is assessed. The study began enrollment in 2019 and is ongoing. As of 30 June 2021, 300 farmworkers and 125 pregnant women have enrolled. The results are expected to showcase the importance of biomonitoring for understanding individual risks, and to identify a number of regions where DNA methylation status is altered in the pesticides-exposed population, paving the way for an integrated biomonitoring system in Morocco and Africa to assess environmental exposures and their long-term health consequences.