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Alan G Wade,1 Mildred Farmer,2 Gil Harari,3 Naama Fund,3 Moshe Laudon,4 Tali Nir,4 Anat Frydman-Marom,4 Nava Zisapel4,51CPS Research, Glasgow, UK; 2Meridien Research Inc., St Petersburg, FL, USA; 3Medistat, Ltd, 4Neurim Pharmaceuticals Ltd, Tel Aviv, Israel; 5Department of Neurobiology, Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel Purpose: A link between poor sleep quality and Alzheimer’s disease (AD) has recently been suggested. Since endogenous melatonin levels are already reduced at preclinical AD stages, it is important to ask whether replenishing the missing hormone would be beneficial in AD and whether any such effects would be related to the presence of sleep disorder in patients.Patients and methods: The effects of add-on prolonged-release melatonin (PRM) (2 mg) to standard therapy on cognitive functioning and sleep were investigated in 80 patients (men [50.7%], women [49.3%], average age 75.3 years [range, 52–85 years]) diagnosed with mild to moderate AD, with and without insomnia comorbidity, and receiving standard therapy (acetylcholinesterase inhibitors with or without memantine). In this randomized, double-blind, parallel-group study, patients were treated for 2 weeks with placebo and then randomized (1:1) to receive 2 mg of PRM or placebo nightly for 24 weeks, followed by 2 weeks placebo. The AD Assessment Scale–Cognition (ADAS-Cog), Instrumental Activities of Daily Living (IADL), Mini–Mental State Examination (MMSE), sleep, as assessed by the Pittsburgh Sleep Quality Index (PSQI) and a daily sleep diary, and safety parameters were measured. Results: Patients treated with PRM (24 weeks) had significantly better cognitive performance than those treated with placebo, as measured by the IADL (P=0.004) and MMSE (P=0.044). Mean ADAS-Cog did not differ between the groups. Sleep efficiency, as measured by the PSQI, component 4, was also better with PRM (P=0.017). In the comorbid insomnia (PSQI ≥6) subgroup, PRM treatment resulted in significant and clinically meaningful effects versus the placebo, in mean IADL (P=0.032), MMSE score (+1.5 versus -3 points) (P=0.0177), and sleep efficiency (P=0.04). Median ADAS-Cog values (–3.5 versus +3 points) (P=0.045) were significantly better with PRM. Differences were more significant at longer treatment duration. PRM was well tolerated, with an adverse event profile similar to that of placebo.Conclusion: Add-on PRM has positive effects on cognitive functioning and sleep maintenance in AD patients compared with placebo, particularly in those with insomnia comorbidity. The results suggest a possible causal link between poor sleep and cognitive decline. Keywords: acetylcholinesterase inhibitors, memantine, insomnia

Paul T King,1,2 Stephen R Holdsworth,2 Michael Farmer,1 Nicholas J Freezer,1 Peter W Holmes11Department of Respiratory and Sleep Medicine, 2Monash University Department of Medicine, Monash Medical Centre, Melbourne, Victoria, AustraliaBackground: Bronchiectasis is a common disease and a major cause of respiratory morbidity. Chest pain has been described as occurring in the context of bronchiectasis but has not been well characterized. This study was performed to describe the characteristics of chest pain in adult bronchiectasis and to define the relationship of this pain to exacerbations.Subjects and methods: We performed a prospective study of 178 patients who were followed-up for 8 years. Subjects were reviewed on a yearly basis and assessed for the presence of chest pain. Subjects who had chest pain at the time of clinical review by the investigators were included in this study. Forty-four patients (25%) described respiratory chest pain at the time of assessment; in the majority of cases 39/44 (89%), this occurred with an exacerbation and two distinct types of chest pain could be described: pleuritic (n = 4) and non-pleuritic (n = 37), with two subjects describing both forms. The non-pleuritic chest pain occurred most commonly over both lower lobes and was mild to moderate in severity. The pain subsided as patients recovered. Conclusion: Non-pleuritic chest pain occurs in subjects with bronchiectasis generally in association with exacerbations.Keywords: sputum, collapse, bronchitis, airway obstruction

Early childhood education (ECE) provision is becoming a growing priority. During the past twenty years, Latin America has shown a growing recognition in the provision of educational programs for young children, birth to age eight, is essential. Urban and rural populations intimated in 2009, that many countries utilizing equitable access to quality early childhood programs is often seen by policy makers as a means of achieving economic and political goals (United Nations, 2012). Unfortunately, a pre-occupation with economic and political goals may conflict with the provision of quality programming for young children. In a number of Latin American countries provisions for educating young children exist as intent to provide quality services. The continuing challenge is to finance, organize and regulate those well-meaning intentions. The objective of this article is two-fold. First, to describe national policy efforts that regulate the education of young children consistently. And, second, to reflect the status of early childhood education programming; and to examine the possibilities for the improvement of the quality and accessibility of an education for all young children. Five Latin American nations have been chosen for examination, including: Belize, Brazil, El Salvador, Mexico, and Peru. (Contains 4 tables.)

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