IMPORTANCE Digital cognitive behavioral therapy (dCBT) is a scalable and effective intervention for treating insomnia. Most people with insomnia, however, seek help because of the daytime consequences of poor sleep, which adversely affects quality of life. OBJECTIVES To investigate the effect of dCBT for insomnia on functional health, psychological well-being, and sleep-related quality of life and to determine whether a reduction in insomnia symptoms was a mediating factor. DESIGN, SETTING, AND PARTICIPANTS This online, 2-arm, parallel-group randomized trial comparing dCBT for insomnia with sleep hygiene education (SHE) evaluated 1711 participants with self-reported symptoms of insomnia. Participants were recruited between December 1, 2015, and December 1, 2016, and dCBT was delivered using web and/or mobile channels plus treatment as usual; SHE comprised a website and a downloadable booklet plus treatment as usual. Online assessments took place at 0 (baseline), 4 (midtreatment), 8 (posttreatment), and 24 (follow-up) weeks. Programs were completed within 12 weeks after inclusion. MAIN OUTCOMES AND MEASURES Primary outcomes were scores on self-reported measures of functional health (Patient-Reported Outcomes Measurement Information System: Global Health Scale; range, 10-50; higher scores indicate better health); psychological well-being (Warwick-Edinburgh Mental Well-being Scale; range, 14-70; higher scores indicate greater well-being); and sleep-related quality of life (Glasgow Sleep Impact Index; range, 1-100; higher scores indicate greater impairment). Secondary outcomes comprised mood, fatigue, sleepiness, cognitive failures, work productivity, and relationship satisfaction. Insomnia was assessed with the Sleep Condition Indicator (range: 0-32; higher scores indicate better sleep). RESULTS Of the 1711 participants included in the intention-to-treat analysis, 1329 (77.7%) were female, mean (SD) age was 48.0 (13.8) years, and 1558 (91.1%) were white. Use of dCBT was associated with a small improvement in functional health compared with SHE (adjusted difference [95% CI] at week 4, 0.90 [0.40-1.40]; week 8, 1.76 [1.24-2.28]; week 24, 1.76 [1.22-2.30]) and psychological well-being (adjusted difference [95% CI] at week 4, 1.04 [0.28-1.80]; week 8, 2.68 [1.89-3.47]; week 24, 2.95 [2.13-3.76]), and with a large improvement in sleep-related quality of life (at week 4, −8.76 [−11.83 to −5.69]; week 8,-17.60 [−20.81 to −14.39]; week 24, −18.72 [−22.04 to −15.41]) (all P < .01). A large improvement in insomnia mediated these outcomes (range mediated, 45.5%-84.0%). CONCLUSIONS AND RELEVANCE Use of dCBT is effective in improving functional health, psychological well-being, and sleep-related quality of life in people reporting insomnia symptoms. A reduction in insomnia symptoms mediates these improvements. These results confirm that dCBT improves both daytime and nighttime aspects of insomnia, strengthening existing recommendations of CBT as the treatment of choice for insomnia.

Background: Maintaining adequately high organ donation rates proves essential to offering patients all appropriate and available treatment options. However, the act of donation is in itself an individual decision that requires a depth of understanding that interacts with the social setting and the institutional framework into which an individual is embedded. This study contributes to understanding factors driving organ donation rates by examining how country regulation, individuals' awareness of regulatory setting, social interactions and socio-demographic determinants influence individuals' willingness to donate their own organs or those of a relative.

"Pharmaceutical parallel trade in the European Union is a large and growing phenomenon, and hope has been expressed that it has the potential to reduce prices paid by health insurance and consumers and substantially to raise overall welfare. In this paper we examine the phenomenon empirically, using data on prices and volumes of individual imported products. We have found that the gains from parallel trade accrue mostly to the distribution chain rather than to health insurance and consumers. This is because in destination countries parallel traded drugs are priced just below originally sourced drugs. We also test to see whether parallel trade has a competition impact on prices in destination countries and find that it does not. Such competition effects as there are in pharmaceuticals come mainly from the presence of generics. Accordingly, instead of a convergence to the bottom in EU pharmaceutical prices, the evidence points at 'convergence to the top'. This is explained by the fact that drug prices are subjected to regulation in individual countries, and by the limited incentives of purchasers to respond to price differentials." Copyright � CEPR, CES, MSH, 2005.

The greater visibility of societal ageing and higher share of individuals with disabilities have created new challenges for housing and urban policies. Housing needs can influence individual choice of living environment and the willingness to undertake housing improvements. This is especially relevant in southern European countries where the family is still the main provider of care for the elderly. This study makes an empirical analysis of the underlying preferences for housing and perceptions of housing suitability in the event of dependency in old age, drawing upon a new representative database of the Spanish population. It explores whether preferences are stable for different age-groups and different levels of individual affluence, calculated in terms of income and housing assets. The study found preferences for `ageing in place', which became stronger as individuals grew older. The effect of affluence, or the `wealth effect', was considerable. Acting independently and exhibiting higher health needs, it restrained individuals from choosing institutional care options. Those respondents who preferred to `age in place' were relatively less affluent. Those with relatively less formal education, preferred living with their relatives.